Evaluate if Doppler ultrasound can aid in characterisation of severity of hypertensive disease when there is abnormal activation of complement in pre-eclampsia. Secondary analysis of project COPA (Complement and Pre-eclampsia in the Americas), the largest study to-date of complement (CO) biomarkers in pre-eclampsia. IRB approved, multicentre observational study. Enrolled subjects from 6 centres and 3 cities in Colombia; Nov ‘15-Jul ‘16; n=352. Subjects enrolled in blocks by GA and diagnosis. Subset of women with early-onset (<34 weeks) gestational hypertension (GHTN), pre-eclampsia (PE), or PE with severe features (PE-SF), and Doppler ultrasound (DU) data [umbilical (UA), middle cerebral (MCA), and uterine (Ut-A) arteries]. Blood, urine and DU data collected at enrolment. C5b-9 measured by enzyme linked immunosorbent assays. DU results analysed (normal/abnormal), against nomograms. Data analysed test of medians; significance at p<0.05. 47 subjects with GHTN, PE, or PE-SF <34 weeks gestation had 47 UA, 42 MCA, and 42 Ut-A DU studies. Abnormal DU in 25.5% (UA), 18.5% (MCA) 61.9% (Ut-A). Those with abnormal UA or MCA DU had lower C5b-9 in plasma and higher C5b-9 in urine, compared to those with normal UA or MCA DU (table 1). No difference in those with abnormal Ut-A DU. High levels of C5b-9 in urine and low levels in plasma are associated with abnormal UA or MCA DU in early onset disease. Our data suggest that CO activation contributes to hypertensive disease in pregnancy.