Objective：To explore the predictive value of high definition flow imaging（HD-Flow）in detecting different systolic parameters of M1 segment of the fetal middle cerebral artery（MCA）for fetal distress（FD）in preeclampsia（PE）. Methods：A total of 120 PE patients who underwent HD -Flow detection in the First Hospital of Hebei Medical University from June 2019 to June 2023 were selected as the study objects. According to the occurrence of FD，the patients were divided into the non -occurrence FD（NFD） group（n=64）and the FD group（n=56）. The clinical data and systolic parameters of distal M1 segment and proximal 1/3 of M1 segment were compared between the two groups. LASSO logistic regression analysis model screened the potential factors of FD，and multivariate logistic regression analyzed the risk factors affecting the occurrence of FD. The risk prediction model of FD occurrence was constructed and verified. The predictive ability of each index to FD occurrence was analyzed. The receiver operating characteristic（ROC）curve was plotted and the area under the curve（AUC）was calculated to analyze the predictive value of different systolic parameters for the occurrence of FD. Results：LASSO regression analysis screened out 15 predictors，and logistic analysis results showed that gestational age，intrauterine infection，gestational diabetes mellitus，partial pressure of carbon dioxide（PCO₂），resistance index（RI），pulsatility index（PI），peak systolic velocity（PSV），and peak systolic velocity/end diastolic velocity（S/D）at the distal and mesial 1/3 of M1 segment were independent risk factors for FD. The AUC before and after ROC curve verification of the constructed prediction model were 0.801（95%CI：0.696-0.845）and 0.785（95%CI：0.688-0.829），respectively，indicating a good model differentiation and a high accuracy. Gestational age，intrauterine infection，gestational diabetes mellitus and PCO₂ indexes were added to the systolic parameters at the distal and mesial 1/3 of M1 segment in MCA，and the prediction ability was the best. Systolic parameters in different segments of M1 had different predictive values，in which the AUC of distal RI，mesial 1/3 RI and S/D were 0.926（95%CI：0.992-0.826），0.904 （95%CI：0.979-0.785）and 0.917（95%CI：0.984-0.807），respectively. Conclusion：Systolic parameters of different M1 segments in fetal MCA way predict the occurrence of FD to a certain extent. RI at the distal part of M1 segment，as well as RI and SD at mesial 1/3 of M1 segment in MCA have a high predictive performance. The establishment of a risk prediction model for FD way be used to accurately predict the risk of FD in PE patients and provide targeted intervention for FD.