Background: Preeclampsia presents substantial dangers to the health of both mother and child, calling for accurate indicators of potential negative consequences. Using the middle cerebral to uterine artery pulsatility index ratio, t The purpose of this prospective study was to examine the relationship between foetal and neonatal outcomes and pulsatility index ratios in fifty preeclamptic patients utilising Doppler tests and other evaluations. To find out if there was a correlation between normal and abnormal ratio cases and factors like foetal weight, gestational age, intrauterine growth restriction (IUGR), preterm labour, caesarean section (CS), The results showed that in preeclampsia cases, around 40.4% had aberrant middle cerebral to umbilical artery ratios (<1.58) and about 38.3% had abnormal middle cerebral to uterine artery pulsatility index ratios (<2.3). Lower foetal weight (p < 0.05), reduced gestational age at examination and delivery (p < 0.05), higher rates of intrauterine growth restriction (IUGR) (p < 0.05), preterm birth (p < 0.05), and increased central semen (CS) (p < 0.05) were all substantially linked with abnormal ratios. Nevertheless, no discernible disparities were seen in Apgar scores below 7 at 5 minutes or in the admission to the NICU (p > 0.05). Results: Abnormal ratios of the middle cerebral artery to the umbilical artery pulsatility index were associated with lower foetal weight, earlier gestational age, increased rates of intrauterine growth restriction (IUGR), and preterm birth. These findings suggest that these indexes may be useful as predictive markers for adverse outcomes in preeclampsia.