Conservative versus invasive management of symptomatic hydronephrosis in pregnancy: maternal and fetal outcomes

Both conservative and invasive management strategies appear feasible and clinically acceptable for symptomatic hydronephrosis during pregnancy, with no clinically significant differences in maternal or neonatal outcomes. Although a statistically significant difference in birth weight was observed, neonatal outcomes, including Apgar scores, were comparable between groups, and birth weights did not fall into categories of small for gestational age or fetal growth restriction. Invasive procedures may be necessary in severe cases with refractory symptoms, infection, or deteriorating renal function. Treatment selection should be individualized based on clinical severity rather than expected outcome differences.