Incremental Value of Immediate Postpartum POCUS for Risk Stratification of Adverse Maternal Outcomes in Hypertensive Disorders of Pregnancy

Objective: To evaluate the incremental value of immediate postpartum point-of-care ultrasound (POCUS) parameters for risk stratification of adverse maternal outcomes (AMO) in women with hypertensive disorders of pregnancy (HDP). Methods: This prospective observational cohort study was conducted between January 2024 and March 2025 in the Labor Ward of the Second Affiliated Hospital of Fujian Medical University. Women diagnosed with HDP after 20 weeks of gestation underwent standardized lung and cardiac POCUS examinations within 2 h after delivery. Maternal demographic, laboratory, and ultrasound variables were compared between women with and without AMO during the 42-day postpartum follow-up period. A baseline clinical model was constructed using conventional clinical and laboratory variables. Ultrasound parameters were subsequently added individually to assess their incremental value for risk stratification. Model performance was evaluated using the Brier score, Akaike Information Criterion (AIC), and area under the receiver operating characteristic curve (AUC). Results: A total of 160 women were included, of whom 35 (21.88%) experienced AMO. Compared with women without AMO, those with AMO showed significantly higher echo comet score (ECS), left atrial volume index (LAVI), and left ventricular index of myocardial performance (LIMP), while left ventricular E/A ratio was significantly lower (all p < 0.05). The baseline clinical model yielded an AUC of 0.88. Addition of ECS, LAVI, or LIMP individually improved model discrimination, with corresponding AUCs increasing to 0.93. These ultrasound-enhanced models also demonstrated lower Brier scores and AIC values compared with the baseline clinical model alone. Conclusions: In women with HDP, immediate postpartum lung and cardiac ultrasound parameters differed significantly according to postpartum outcome status. Incorporation of ultrasound-derived maternal hemodynamic indicators provided incremental value beyond conventional clinical variables for risk stratification of AMO. Immediate postpartum POCUS may therefore serve as a practical bedside adjunct for early identification of high-risk women with HDP and may help guide individualized postpartum monitoring. To our knowledge, this is the first prospective study evaluating the incremental value of immediate postpartum lung and cardiac POCUS for risk stratification in women with HDP.