{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:56:54Z","timestamp":1790575014407,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether antihypertensive therapy guided by maternal hemodynamic assessment improves maternal and perinatal outcomes in women with hypertensive disorders of pregnancy (HDP) compared with standard care based on blood\u2010pressure thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a systematic review and meta\u2010analysis of randomized and non\u2010randomized comparative studies comparing hemodynamics\u2010guided management\n                      <jats:italic>vs<\/jats:italic>\n                      standard antihypertensive care in women with HDP. PubMed\/MEDLINE and The Cochrane Library were searched from inception until 15 June 2025 for eligible studies. Outcome data were extracted for pre\u2010eclampsia\/eclampsia, HELLP syndrome, severe hypertension, fetal growth restriction, placental abruption, preterm birth and perinatal death. The composite adverse outcome included all abovementioned outcomes. The risk of bias was assessed using the Risk Of Bias In Non\u2010Randomized Studies of Interventions tool, the revised Cochrane Risk\u2010of\u2010Bias tool and the Newcastle\u2013Ottawa scale. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Odds ratios (OR) were pooled using random\u2010effects models, with heterogeneity quantified by\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      . Leave\u2010one\u2010out analyses were performed to investigate sensitivity to outliers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The literature search retrieved six studies, including one randomized controlled trial, four non\u2010randomized comparative studies and one multicenter prospective cohort study. Depending on the outcome analyzed, 418\u2013614 patients were included in the intervention group and 617\u2013731 patients in the control group. Compared with standard care, hemodynamics\u2010guided therapy reduced the odds of pre\u2010eclampsia\/eclampsia by 53% (OR, 0.47 (95%\u2009CI, 0.33\u20130.65);\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), severe hypertension by 61% (OR, 0.39 (95%\u2009CI, 0.18\u20130.88);\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200931%), fetal growth restriction by 46% (OR, 0.54 (95%\u2009CI, 0.38\u20130.76);\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) and preterm birth by 60% (OR, 0.40 (95%\u2009CI, 0.16\u20130.99);\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980%). The OR for the composite adverse outcome was 0.27 (95%\u2009CI, 0.21\u20130.36) (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). The overall certainty of evidence according to the GRADE framework was low to very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hemodynamics\u2010guided antihypertensive management of women with HDP was associated with reductions in several adverse maternal and perinatal outcomes compared with standard care. Given the predominance of non\u2010randomized study designs, measurement heterogeneity and risk of residual confounding, these associations should be interpreted as hypothesis\u2010generating and require confirmation in adequately powered randomized controlled trials. \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70250","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:46:14Z","timestamp":1781239574000},"page":"319-328","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamics\u2010guided treatment of hypertensive disorders of pregnancy: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6010-3234","authenticated-orcid":false,"given":"G. P.","family":"Novelli","sequence":"first","affiliation":[{"name":"Division of Cardiology Policlinico di Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4942-5742","authenticated-orcid":false,"given":"B.","family":"Vasapollo","sequence":"additional","affiliation":[{"name":"Department of Surgical Science Tor Vergata University  Rome Italy"},{"name":"Division of Obstetrics and Gynecology Policlinico Casilino  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Attini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Nuovo Ospedale degli Infermi  Biella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Valensise","sequence":"additional","affiliation":[{"name":"Department of Surgical Science Tor Vergata University  Rome Italy"},{"name":"Division of Obstetrics and Gynecology Policlinico Casilino  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6601-944X","authenticated-orcid":false,"given":"A.","family":"Natale","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St David's Medical Center  Austin TX USA"},{"name":"Department of Biomedicine and Prevention, Division of Cardiology Tor Vergata University  Rome Italy"},{"name":"Case Western Reserve University School of Medicine  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Ghi","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart Rome, Department of Women Child and Public Health Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Mecacci","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Chianchiano","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Buccheri La Ferla Fatebenefratelli Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Castellini","sequence":"additional","affiliation":[{"name":"Unit of Clinical Epidemiology, IRCCS Ospedale Galeazzi Sant'Ambrogio  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9080-3848","authenticated-orcid":false,"given":"T.","family":"Stampalija","sequence":"additional","affiliation":[{"name":"Unit of Fetal Medicine and Prenatal Diagnosis Institute for Maternal and Child Health IRCCS \u2018Burlo Garofolo\u2019  Trieste Italy"},{"name":"Department of Medicine, Surgery and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2011.01.006"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000208"},{"key":"e_1_2_6_4_1","volume-title":"StatPearls [Internet]","author":"Trammel JE","year":"2024"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2267-3994"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03475-w"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.16502"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2019.1695771"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2024.101368"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11103"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.10.033"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17341"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5234"},{"issue":"5","key":"e_1_2_6_14_1","first-page":"725","article-title":"Prevention of preeclampsia: a randomized trial of atenolol in hyperdynamic patients before onset of hypertension","volume":"93","author":"Easterling TR","year":"1999","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003739"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.108.117358"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01013.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.105858"},{"issue":"24","key":"e_1_2_6_19_1","article-title":"Maternal cardiovascular profile is altered in the preclinical phase of normotensive early and late intrauterine growth restriction","volume":"0002","author":"Vasapollo B","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2025.102626"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2025.102618"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2024.04.014"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27640"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.028"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24852"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26288"},{"issue":"10","key":"e_1_2_6_27_1","article-title":"Antihypertensive drug therapy for mild to moderate hypertension during pregnancy","volume":"10","author":"Abalos E","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52312"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.0522"},{"key":"e_1_2_6_31_1","unstructured":"Cochrane Bias Methods Group.RoB 2: A revised tool for assessing risk of bias in randomized trials. Accessed June 15 2025.https:\/\/methods.cochrane.org\/bias\/resources\/rob\u20102\u2010revised\u2010cochrane\u2010risk\u2010bias\u2010tool\u2010randomized\u2010trials"},{"key":"e_1_2_6_32_1","unstructured":"Cochrane Bias Methods Group.Risk Of Bias In Non\u2010Randomized Studies of Interventions (ROBINS\u2010I). Accessed June 15 2025.https:\/\/methods.cochrane.org\/bias\/risk\u2010bias\u2010non\u2010randomized\u2010studies\u2010interventions"},{"key":"e_1_2_6_33_1","unstructured":"WellsGA SheaB O'ConnellD et al.The Newcastle\u2010Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses. Accessed June 15 2025.https:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_6_35_1","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions.Identifying and measuring heterogeneity. The Cochrane Collaboration. Accessed June 15 2025.https:\/\/training.cochrane.org\/handbook\/archive\/v5.0.2\/chapter_9\/9_5_2_identifying_and_measuring_heterogeneity.htm"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17454"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.70250","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.70250","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.70250","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:38:05Z","timestamp":1790573885000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.70250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/uog.70250"],"URL":"https:\/\/doi.org\/10.1002\/uog.70250","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"assertion":[{"value":"2025-09-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}