Background: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality.Objective: To evaluate the role of middle cerebral artery and umbilical artery pulsatility index (PI) ratio in predicting neonatal outcome in pregnancies induced hypertension. Patients and methods:This study which included 100 women with severe preeclampsia admitted to Alsayed Galal University Hospital during the period between November 2018 and July 2019. Were evaluated the accuracy of middle cerebral/umbilical artery pulsatility index ratio in predicting admission to neonatal intensive care unit (NICU), acidemia and low Apgar score at 5 minutes after birth in neonates of severe preeclamptic pregnant women. Results:The best cut off value of middle cerebral artery (MCA) / umbilical artery (UA) PI ratio for prediction of NICU admission was sensitivity 62.5%, specificity 71.43%, positive predictive value (PPV) 29.41%, negative predictive value (NPV) 90.91% and the accuracy 70%. The cut off value of MCA/UA PI ratio for prediction of low Apgar score at 5 min was 50% sensitivity and 88.10% specificity. Estimated positive predictive value =44.44 and negative predictive value =90.24, and the cut off value of MCA/UA PI ratio for prediction of low UA PH were 43.75% sensitivity, 69.05% specificity, estimated positive predictive value =21.21, and negative predictive value =86.57. Conclusion:Doppler data combining both umbilical and cerebral velocimetry provides information on consequences of the placental abnormality; Hence, Doppler can be a useful tool in the management of patients with preeclampsia and can help in deciding the time of delivery so that the fetus can be saved.