The widespread adoption of the da Vinci robotic systems across medical centres has enabled gynecology oncologists to perform more complex gynecologic procedures by minimally invasive approaches, leading to improved patient outcomes. In this context, conversion - both planned and unplanned - from robotics to laparotomy represent a key metric. We conducted a narrative review to determine the conversion rate from robotic to laparotomy and synthesized the key reasons why conversions take place in gynecologic oncology procedures. A total of 27 retrospective/prospective studies were included in the review, with a total of 474/11,766 (4.0%) documented robotic cases with conversions. The most prominent reason for robotic conversion to laparotomy in gynecologic oncology was for the purpose of specimen removal due to uterine size (N.=105). Second, came the extent of disease (N.=74), and third were adhesions (N.=65). A clear association between conversion and Body Mass Index was gleaned from the data. Our narrative review shows a 4.0% conversion rate from robotic to laparotomy in complex gynecologic oncology procedures. Reasons relate to planned conversion as in the case of specimen removal, whereas a number of cases were related to upholding oncologic principles and avoid tumor spillage or adhesions.
BACKGROUND:Intracytoplasmic sperm injection (ICSI) has not been shown to be superior to conventional insemination for non-male factor infertility indications in cycles using fresh sperm, however fertilization and reproductive outcomes have not been explored in the setting of cryopreserved sperm. METHODS:This retrospective cohort study included 4413 patient couples between 2010 and 2021 that underwent autologous retrieval cycles utilizing cryopreserved donor sperm with linked subsequent fresh and frozen single blastocyst transfers at a large network of private practice fertility clinics in the United States. The primary exposure was insemination method; conventional insemination or ICSI. The primary outcome of interest was fertilization percentage. Secondary outcomes included percentages of blastulation, total fertilization failure, clinical pregnancy, and live birth. Adjusted associations were evaluated accounting for relevant confounders. RESULTS:At first retrieval, patients in the conventional insemination group had a higher mean number of oocytes retrieved (14.29 [7.70] vs. 13.58 [8.84]) and number of fertilized oocytes (8.70 [5.27] vs. 7.89 [5.88]) compared to the ICSI group. Mean fertilization and blastulation percentages were also higher in those who utilized conventional insemination (61% and 45%) compared to those who utilized ICSI (56% and 34%). After multiple retrievals, adjusted associations examining fertilization method and outcomes showed conventional insemination was associated with a 12% (95% CI [0.05, 0.19]) higher mean blastulation percentage, increased likelihood of clinical pregnancy (RR 1.64; 95% CI [1.27, 2.12]), and higher live birth (RR=1.45; 95% CI [1.06, 2.00]) compared to ICSI. CONCLUSIONS:Use of conventional insemination in cycles involving cryopreserved donor sperm was associated with improved blastulation and increased likelihood of clinical pregnancy and live birth compared to ICSI. These findings suggest that routine ICSI use in this population may warrant reconsideration and that conventional insemination could remain an appropriate option in selected cases utilizing cryopreserved donor sperm.
BACKGROUND:Vaginal birth after two cesarean deliveries (VBAC2) is increasingly recognized as a reasonable and, in selected cases, preferable option. Current evidence suggests that successful and safe VBAC2 can be achieved, particularly among carefully selected candidates, including grand multiparous women. However, the factors that reliably predict success and reduce maternal and neonatal risk in this population remain insufficiently defined. METHODS:This retrospective observational study included 541 women with a history of two previous cesarean deliveries who attempted vaginal birth between 2005 and 2022 at a single tertiary teaching hospital. Machine learning models were applied to predict the safety and success of VBAC2 using maternal demographic and clinical characteristics. The primary outcome was successful VBAC2 without uterine rupture. Secondary outcomes included low Apgar score, admission to the Neonatal Intensive Care Unit (NICU), and the need for postpartum blood transfusion. RESULTS:A total of 541 women attempted a trial of labor, and 78.9% achieved a successful VBAC. Uterine rupture occurred in 2.0%. The XGBoost Classifier performed best with a sensitivity of 83%. The most important factors associated with successful VBAC were the time interval since the last cesarean delivery, followed by the number of previous vaginal births and cervical dilatation at admission. CONCLUSIONS:Grand multiparous women had significantly higher VBAC2 success rates, while uterine rupture rates remained low. Machine learning models can help predict the likelihood of safe vaginal delivery after two cesarean deliveries, thereby supporting informed decision-making regarding the preferred mode of delivery in this unique population. Predictive modeling in this study showed that grand multiparous women had high VBAC2 success rates (78.9%) with a low risk of uterine rupture (2%); key predictors included prior vaginal birth and cervical dilatation.
BACKGROUND:Pregnancy is a vulnerable period for intimate partner violence, as violence may emerge or intensify. On this basis, several international guidelines recommend systematic and repetitive screening of domestic violence during pregnancy. However, the adherence to these recommendations is unclear. METHODS:This prospective observational study involved women who delivered in an urban referral obstetrical hospital located in Milan, Northern Italy. Participants were enrolled after delivery and completed an anonymous questionnaire structured into four sections: demographic characteristics, pregnancy-related information, assessment of whether domestic violence screening was performed during gestation, and evaluation of any recent history of abuse. This latter issue was investigated through four different validated questionnaires. RESULTS:Among the 196 participants, nine (4.6%, 95%CI: 2.4-8.5%) reported having been screened at least once during pregnancy about a history of domestic violence. Some differences emerged according to the setting of antenatal care. The frequency of a history of abuses in the studied cohort differed according to the questionnaire used but was not rare, prevalences varying between 1.0% to 5.6%. CONCLUSIONS:Screening for intimate partner violence in pregnancy is seldom performed. A call for action is warranted.
BACKGROUND:Expected poor ovarian responders represent a challenging population in assisted reproduction, in whom controlled ovarian stimulation requires a careful balance between achieving an adequate oocyte yield and limiting cycle cancellation and treatment burden. Algorithm-based follitropin delta dosing has been proposed as an alternative to conventional high-dose follitropin alpha regimens, but comparative real-world data in this population remain limited. METHODS:This retrospective single-center matched cohort study included 423 women fulfilling the Bologna criteria for poor ovarian response undergoing IVF/ICSI. Ovarian stimulation was performed with either algorithm-based follitropin delta (12 mcg/day; N.=141) or follitropin alpha at a minimum daily starting dose of 225 IU (N.=282). Groups were matched for age, ovarian reserve markers, body weight, year of treatment, and recombinant LH supplementation. The primary outcome was the number of oocytes retrieved. Secondary outcomes included ovarian stimulation characteristics, progesterone (P) levels at hCG trigger, incidence of premature progesterone elevation (PPE), feasibility of fresh embryo transfer, and cumulative pregnancy outcomes. RESULTS:Follitropin delta was associated with a lower number of oocytes retrieved (IRR 0.847, 95% CI 0.733-0.979; P=0.025) and mature oocytes (IRR 0.823, 95% CI 0.703-0.963; P=0.016) compared with follitropin alpha. P levels at hCG trigger were significantly lower with follitropin delta (median 0.4 ng/mL, IQR 0.3-0.6) than with follitropin alpha (0.6 ng/mL, IQR 0.4-0.9; P<0.001), resulting in a reduced incidence of PPE (5.4% vs. 16.7%; P=0.006) and a higher likelihood of fresh embryo transfer (64.6% vs. 52.1%; P=0.023). Fertilization rates, embryo development, and cumulative pregnancy outcomes did not differ significantly between groups. CONCLUSIONS:In expected poor responders, algorithm-based follitropin delta resulted in a lower oocyte yield compared with conventional follitropin alpha dosing, while reducing PPE and increasing the feasibility of fresh embryo transfer, without a clear impact on cumulative pregnancy outcomes.
BACKGROUND:Placenta accreta spectrum (PAS) carries substantial hemorrhagic morbidity during cesarean delivery (CD), yet clinically useful antenatal risk indicators of intraoperative hemodynamic instability remain limited. This study aimed to evaluate associations between routinely available preoperative clinical and sonographic factors and intraoperative blood transfusion. METHODS:We conducted a retrospective cohort study of all patients with PAS who underwent CD at a tertiary medical center between 2000 and 2020. Patients were stratified by whether they received intraoperative blood product transfusion. Preoperative clinical characteristics and sonographic findings were analyzed. Multivariable logistic regression was used to evaluate associations between preoperative factors and blood transfusion, with a prespecified subgroup analysis restricted to grade-1 PAS. RESULTS:Of 312 patients with PAS, 97 (40%) required intraoperative blood product transfusion. On multivariable analysis, antenatal diagnosis of placenta previa (odds ratio [OR] 4.99, 95% CI 2.55-9.92) and sonographic suspicion of PAS (OR 3.13, 95% CI 1.40-7.10) were independently associated with transfusion. In the subgroup of patients with grade-1 PAS, placenta previa remained the sole independent predictor of transfusion (OR 6.92, 95% CI 2.96-16.8). Intraoperative factors, including hysterectomy, longer operative duration, and use of general anesthesia, were more common among transfused patients and reflected surgical complexity rather than preoperative risk. CONCLUSIONS:Placenta previa and antenatal suspicion of PAS were the clinical features most strongly associated with intraoperative blood transfusion. These findings support pragmatic preoperative preparation and surgical planning in PAS management.
BACKGROUND:Luteal phase E2 priming is commonly used in patients with DOR to 30 synchronize follicular development before controlled ovarian hyperstimulation (COH). Some protocols 31 incorporate a GnRH antagonist during the luteal phase to further suppress endogenous gonadotropins, 32 though data on its added benefit are limited. METHODS:This retrospective cohort study analyzed 1555 IVF cycles from 1212 patients with AMH <1 ng/mL undergoing COH for oocyte cryopreservation or IVF with PGT-A between 2012 and 2024 at an urban academic center. Patients received either luteal E2 priming alone (Group A, N.=280) or with a GnRH antagonist (Group B, N.=932). The primary outcome was the number of mature oocytes retrieved. Secondary outcomes included total oocytes, cycle cancellation, fertilization, blastocyst conversion, high-quality blastocysts, euploidy, implantation, clinical pregnancy, and live birth. RESULTS:Baseline characteristics were similar between groups. No significant differences were observed in median total (6 [4-9] vs. 6 [4-9]) or mature oocytes retrieved (4 [3-6] vs. 5 [3-7]) between Group A and Group B. Fertilization rates, blastocyst development, quality, and euploidy outcomes were also comparable. Among 227 patients who underwent single euploid embryo transfer, implantation, clinical pregnancy, and live birth rates did not differ significantly between groups. CONCLUSIONS:The addition of a GnRH antagonist to luteal E2 priming did not improve oocyte yield or IVF outcomes in patients with DOR. Given similar efficacy and potential cost savings, luteal E2 priming alone may be a sufficient approach. Prospective trials are needed to validate these findings.
Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrelreleasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to "unexplained infertility" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.
BACKGROUND:Data on the occurrence of gestational diabetes mellitus (GDM) and related offspring macrosomia are limited in women with low and delayed fertility, both of which are increasingly common in high-income countries. METHODS:We evaluated the occurrence of GDM among women who delivered in Abano Terme, Italy, between January 2020 and August 2023. Baseline and clinical characteristics of women with GDM (GDM group) and those with a normal oral glucose tolerance test (control group) were analyzed in relation to neonatal macrosomia (>4000 g). RESULTS:Among 2600 women with low and late fertility included in the analysis, 231 (9.9%) were diagnosed with GDM. Women in the GDM group were older than control subjects (36.0 [31.5-39.0] vs. 33.0 [30.0-37.0] years; P<0.001), whereas parity did not differ between groups (2.00 [1.00-2.00] vs. 1.00 [1.00-2.00, P>0.5]). Pre-pregnancy BMI was significantly higher in the GDM group (63 [56-73] vs. 59 [54-66] kg, P<0.001), while height (164 [160-170] vs. 165 [160-170] cm, P<0.024] and gestational weight gain (GWG) (11 [8.5-14.0] vs. 13 [11.0-16.0] kg; P<0.001), P<0.001) were significantly lower. Neonatal birth weight (3400 [3080-3640] vs. 3360 [3100-3640] g; P>0.09) and the prevalence of macrosomia >4000 g (19 [8.2%] vs. 188 [8.1%]; P>0.9) did not differ between groups (P>0.09). In multivariate logistic regression analysis, the risk of GDM was significantly higher among women with low and late fertility or delayed fertility alone (odds ratios 2.3 and 1.9, respectively; P<0.001). Among maternal variables, only obesity at delivery (BMI ≥30 kg/m2) was independently associated with an increased risk of neonatal macrosomia (odds ratio 1.59; P=0.003). CONCLUSIONS:In women with low and late fertility, appropriate GWG may play a key role in mitigating the risk of neonatal macrosomia, even in the presence of GDM.
BACKGROUND: The aim of this study was to investigate the association of gestational weight gain with carotid artery intima-media thickness (IMT) during late pregnancy, and the association with metabolic parameters, pregnancy outcome and placental histological assessment. METHODS: Pregnant patients admitted with signs of labor were prospectively recruited and categorized into two groups: Group 1 included women with excessive weight gain during pregnancy; Group 2 included women with gestational weight gain within recommended range. IMT of the carotid arteries was measured sonographically. Placental histopathology was assessed by an experienced pathologist. RESULTS: The study group included 59 women, 32 in group 1 and 27 in group 2. Mean carotid artery IMT was thicker in group 1 compared with group 2 (0.7 vs. 0.6 mm, P=0.028). Metabolic parameters including blood glucose and insulin resistance, using the homeostasis model assessment-insulin resistance (HOMA-IR) were also significantly higher in women with excessive weight gain during pregnancy as compared with group 2 (P=0.026 and P=0.045, respectively). Gestational age at delivery was similar in the two groups, while birthweight and the rate of macrosomia were significantly higher in group 1 than in group 2 (P=0.033 and P=0.014, respectively). Placental lesions consistent with fetal thrombo-occlusive disease were more prevalent in group 1 than in group 2. CONCLUSIONS: Excessive weight gain during pregnancy is associated with increased IMT of the carotid arteries that correlate with abnormal metabolic parameters, adverse pregnancy outcome and abnormal placental findings.
BACKGROUND:Despite the large number of studies on embryo invasion, in vitro models investigating early-implantation phase are limited. The aim of this study was to investigate woman-specific blastocyst implantation through the development of a new in vitro model. METHODS:Human endometrial epithelial cells were purified from endometrial tissue biopsies of women in reproductive age. BeWo cells were used to develop blastocyst surrogate spheroids and Ishikawa cells were used to develop an in vitro spheroids adhesion assay. BeWo-spheroids were co-cultured with endometrial epithelial cells monolayer to assess the endometrial receptivity. RESULTS:Our BeWo spheroids culture protocol provided us with 3D embryo surrogates that were homogeneous in shape and their dimensions were comparable to blastocysts size after 48h of spheroids culture. Spheroids adhesion rate on Ishikawa cells after three hours co-incubation was 96.3% and there were no significant differences when compared to later time points. This allowed to assess three hours as the optimal time to run the test on primary endometrial epithelial cells. The average adhesion rate on human endometrial epithelial cells was 70.8%. CONCLUSIONS:In this study we developed an in vitro model to mimic the endometrial exposure to the blastocyst in vitro and to evaluate the maternal tissue response in terms of the amount of trophoblastic spheroids able to adhere to endometrial cultures. Our results underline the high variability existing among healthy patients in their endometrial ability to retain the embryo, pointing out the necessity of developing a test aimed at the customization of in vitro fertilization treatments.
Lower urinary tract symptoms (LUTS) such as frequency, urgency, and sensation of incomplete emptying are frequently attributed to bladder or urothelial disorders, but pelvic floor myofascial dysfunction is underrecognized as an etiologic factor. To present a conceptual framework for myofascial pelvic floor dysfunction (MPFD) as a contributor to urinary symptoms, review its urologic manifestations, discuss, and explore occult contributing factors, and propose integrated diagnostic and interventional therapeutic strategies. This is a narrative review and conceptual synthesis anchored on recent observational studies and existing literature on myofascial pelvic floor dysfunction. MPFD involves failure of appropriate muscle relaxation (or paradoxical contraction), often resistant to standard rehabilitation if underlying drivers remain untreated. The pelvic floor should be conceptualized as a biomechanical "cuboid" interacting with the diaphragm, spine, and abdominal wall. Patients may present with a spectrum of urinary, bowel, sexual, neurogenic, and pain symptoms. Success in rehabilitation demands identification and targeting occult contributors (anatomic, biomechanical, inflammatory, neurologic, behavioral, and central nervous system). Recognizing and addressing myofascial dysfunction as part of the multidimensional pathophysiology of LUTS may improve outcomes in patients' refractory to bladder-centric therapies. Prospective trials are needed to validate integrative treatment strategies.
BACKGROUND:The aim of this study was to find the efficacy of minimal stimulation protocol over antagonist protocol in infertile couples. METHODS:A total of 10769 patients who visited between January 2018 and January 2022 were included in this retrospective study. To reduce potential bias and baseline heterogeneity between the two groups, Propensity Score Matching was employed, so the data after propensity matching was N.=978. Group 1 - minimal stimulation group (N.=347) - received clomiphene citrate 100 mg along with gonadotropin (≤150 IU), either recombinant follicle-stimulating hormone (r-FSH) or human menopausal gonadotropin (hMG). Group 2, the conventional dose antagonist group (N.=631), received a conventional dosage of r-FSH (≥225 IU) as per institutional practice. RESULTS:The minimal stimulation group had a considerably higher live birth rate (58.20%) than the antagonist group (51.20%), with a P value of 0.035, demonstrating a statistically significant benefit for the minimal stimulation procedure. For live birth rate, endometrial thickness (odds ratio [OR] = 1.22, 95% confidence interval [CI]: 1.09-1.36, P<0.001), number of embryos transferred (OR=1.95, 95% CI: 1.37-2.78, P<0.001), and sperm count (OR=1.01, 95% CI: 1.00-1.05, P=0.044) were significant predictors. In the subgroup anti-Müllerian hormone (AMH; 1.5-2.5 ng/mL), the antagonist protocol yielded a significantly higher number of oocytes retrieved and mature oocytes; however, the minimal protocol demonstrated superior blastulation rates, good blastocyst quality, and a notably higher live birth rate. CONCLUSIONS:Compared to the standard treatment, the minimal stimulation group's live birth rate was much higher, indicating that some patient populations might benefit from fewer drugs and less stimulation.
BACKGROUND:To describe a novel laparoscopic technique, prophylactic ureteral suturing (PUS), developed to reinforce structurally weakened ureteral segments following extensive ureterolysis for deep endometriosis, to avoid segmental resection or reimplantation. METHODS:In selected patients with deep ureteral endometriosis, circumferential periureteral fibrosis was dissected after cystoscopic insertion of a double-J ureteral stent. Laparoscopic ureterolysis restored ureteral mobility and revealed a mucosa-only segment, considered at high risk of postoperative stricture or rupture, resulting from complete loss of the muscularis layer. The muscularis layers proximal and distal to the mucosal tract were then gently mobilized and reapproximated using interrupted absorbable 3-0 polyglactin sutures, avoiding mucosal penetration. This suture-based reconstruction restored circumferential wall support while maintaining luminal patency. RESULTS:An observational study was conducted on a cohort of 6 patients using the novel technique. No intraoperative or postoperative complications were observed. Renal function was preserved in all cases. Among three patients with preoperative hydronephrosis and elevated creatinine, imaging confirmed resolution of obstruction and normalization of renal parameters at follow-up. CONCLUSIONS:Prophylactic ureteral suturing may represent a safe and effective conservative alternative to reconstructive procedures in cases of ureteral muscularis loss during ureterolysis. The approach is technically straightforward, preserves ureteral continuity and the native antireflux mechanism, and can be integrated into standard laparoscopic treatment of urinary tract endometriosis. Further studies are warranted to confirm its long-term safety and broader applicability.
INTRODUCTION:Persistent inequities in unintended pregnancy among adolescents across the globe combined with their increased use of technology warrants an increased understanding of technology-based pregnancy prevention interventions designed specifically for this population. The objective of this systematic review was to identify "standalone" (i.e., able to be implemented without facilitation by people) technology-based interventions designed to support pregnancy prevention among adolescents and young adults. EVIDENCE ACQUISITION:We included peer-reviewed articles available on the PubMed database that were published between 2010-2025 if they evaluated a standalone technology-based adolescent pregnancy prevention intervention. Articles went through a title and abstract review and subsequently a full-text review. Intervention characteristics and reported impacts were extracted and summarized from included articles. EVIDENCE SYNTHESIS:From 247 articles identified, 16 articles representing 13 interventions were included. Among the interventions, three were text message-based, four were web-based, and six were smartphone applications. Most of the interventions were developed in the USA for female adolescents and young adults. Five interventions used randomized control trials and demonstrated improvements in behaviors that can reduce the risk of unintended pregnancies. CONCLUSIONS:Several technology-based interventions have been shown to improve adolescent pregnancy prevention behaviors; however, more attention to intervention implementation efforts, mechanisms of action that lead to behavior change, and the impact youth engagement has on the development and implementation has on outcomes is needed. In addition, greater investments and attention to pregnancy prevention efforts that target youth from different cultural backgrounds, countries and contexts are also needed to reach those who have less access to information and care. Future research and practice should also address how engaging males, gender-expansive and sexual minorities in pregnancy prevention efforts can contribute to improved outcomes. There is also a need to standardize behavioral measures to facilitate meta-analysis.
BACKGROUND:Chronic hypertensive disorders in pregnancy are associated with adverse maternal and perinatal outcomes. Hemodynamic-guided management has been proposed to optimize antihypertensive therapy. This study evaluates outcomes before and after the introduction of the USCOM® device - a non-invasive hemodynamic monitor - into clinical practice for tailoring antihypertensive treatment. METHODS:A retrospective, monocentric descriptive study was conducted at the AOU Policlinic of Modena. USCOM® was implemented in March 2022. The control group included 22 pregnant individuals with chronic hypertensive disorder (HD) from 2021, while the USCOM group included 46 individuals from 2023 who received USCOM® hemodynamic monitoring to tailor antihypertensive therapy. Patients with missing delivery data or gestational hypertension were excluded. Maternal and neonatal outcomes were collected retrospectively from electronic medical records and analyzed using SPSS v.28. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages. RESULTS:No significant differences in maternal characteristics were observed between groups. The USCOM group showed a significantly lower incidence of low-birthweight (<2500 g) newborns (6.5% vs. 36.4%; P=0.004) and longer gestational age (38.9 vs. 37.4 weeks; P=0.049). Although not statistically significant, trends indicated fewer extremely preterm births (<34 weeks; P=0.096) and lower Neonatal Intensive Care Unit (NICU) admissions (P=0.096). Multivariate analysis confirmed USCOM® evaluation as the only significant factor reducing the risk of low birth weight (adjusted odds ratio [aOR] 0.118, P=0.004), adjusted for parity, ethnicity, and prepregnancy Body Mass Index (BMI). CONCLUSIONS:While larger studies are needed to confirm these findings, the implementation of USCOM® in routine clinical practice may contribute to improved neonatal outcomes in pregnancies complicated by chronic hypertensive disorders.
