Background: Cytokines are involved in fetoplacental development, and have been suggested to be the placental factor capable of damaging endothelial cells and contributing to many of the pathophysiological changes associated with preeclampsia.  Uterine artery Doppler measurements show that impedance to flow in the uterine arteries decreases with gestational age in normal pregnancies. That impedance to flow is increased in established pre-eclampsia and fetal growth restriction (FGR), and this increased impedance predates the onset of the clinical syndrome of pre-eclampsia or FGR. Objective: To determine the validity of using combined biophysical (uterine artery Doppler) and biochemical (TNf- α) markers at 11-13 weeks for early screening for pre-eclampsia. Patients and methods: This study was conducted at the outpatient clinic at Sayed Galal Hospital, Al-Azhar University. This was a prospective cohort study that carried out  on three hundred pregnant women who attended to outpatient clinic for antenatal care at 11-13 weeks of pregnancy with 48 missed cases (in the form of 2 IUFDs, 3 preterm labors, 30 miscarriages, and inability to follow 13 cases up). Results: There were no statistically significant differences between women who developed pre-eclampsia and who did not develop pre-eclampsia as regard maternal age and BMI. The mean concentration of sTNF- α, was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cut off value of the serum TNF- α is ≥14 pg/ml and at this value, we have sensitivity 67.8%; specificity 98%; PPV 79.4%; NPV 96.4%. The mean PI of the right and the left uterine arteries was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cutoff value of the mean uterine arteries was 1.7 and at this value we have 100% sensitivity, 84.4% specificity, 41.7% PPV, 100% NPV. Conclusion: The combination of TNF-α and UA Doppler waveforms almost invariably predicts PET and other adverse pregnancy outcomes; therefore, when used together, biochemistry and ultrasound screening have the ability to improve the sensitivity of screening for PET.