Search Results (102)

Preeclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Although current first-trimester screening strategies have improved risk assessment, their predictive performance remains limited by the biological complexity and heterogeneity of the disease. Artificial intelligence (AI) has emerged as a promising approach capable of integrating multidimensional clinical and biological data to improve early prediction. This review aims to summarize current evidence regarding AI-based prediction models for preeclampsia, compare their performance with conventional screening strategies, and discuss future directions for clinical implementation. A narrative review of published studies evaluating machine learning and deep learning models for first-trimester prediction of preeclampsia was performed. Studies incorporating maternal characteristics, hemodynamic variables, biochemical biomarkers, imaging, radiomics, and multi-omics data were reviewed. Diagnostic performance, predictor variables, and validation strategies were critically compared. Several studies have reported improved predictive performance of AI models compared with conventional statistical approaches, particularly when multimodal datasets were incorporated. High-performing models achieved area under the receiver operating characteristic curve (AUC) values ranging from 0.84 to 0.92. Across studies, maternal clinical characteristics, mean arterial pressure, uterine artery pulsatility index, placental growth factor, and pregnancy-associated plasma protein-A were the most consistently identified predictors. However, direct comparisons remain limited by methodological heterogeneity. Emerging approaches incorporating inflammatory biomarkers, cell-free nucleic acids, radiomics, and multi-omics technologies showed encouraging results but currently lack sufficient prospective multicenter validation for routine clinical implementation. AI has considerable potential to improve first-trimester prediction of preeclampsia, although prospective multicenter validation, standardized reporting, and implementation studies remain necessary before routine clinical adoption. Future research should prioritize prospective multicenter validation, standardized data collection, explainable AI, and seamless integration into clinical workflows to facilitate implementation in precision obstetric care. Full article

Background/Objectives: Umbilical artery thrombosis (UAT) is a rare but potentially catastrophic obstetric complication associated with a high risk of adverse perinatal outcomes. However, clinically applicable risk stratification tools for pregnancies complicated by UAT remain limited. Therefore, this study aimed to develop and validate a multivariable clinical prediction model integrating maternal clinical characteristics, fetal characteristics, and Doppler-derived hemodynamic parameters for fetuses with UAT. The model may facilitate early risk stratification and support individualized prenatal management and clinical decision-making. Methods: This retrospective study included 114 fetuses with UAT at the Women and Children’s Hospital of Chongqing Medical University between January 2017 and January 2025. Candidate predictors were predefined based on previous literature, clinical knowledge, and their potential associations with adverse pregnancy outcomes in UAT, encompassing maternal characteristics, UAT-related factors, Doppler-derived hemodynamic parameters, and relevant clinical factors. Predictors were selected using LASSO with 10-fold cross-validation and entered into multivariable logistic regression to construct a nomogram. Model discrimination, calibration, and clinical utility were assessed using AUC, calibration plots, and decision curve analysis, respectively. The optimal cutoff was determined by the maximum Youden index. Bootstrap resampling was used for internal validation and generalizability assessment. Results: Of the 114 fetuses, 57 (50.0%) experienced adverse pregnancy outcomes. The final nomogram incorporated maternal age, umbilical artery pulsatility index (UA-PI), ductus venosus pulsatility index (DV-PIV), uterine artery pulsatility index (UtA-PI), gravidity, diabetes mellitus, fetal growth restriction (FGR), and UAT laterality. Higher UA-PI (OR, 7.15; 95% CI, 1.01–50.57), higher DV-PIV (OR, 13.18; 95% CI, 2.34–74.41), and FGR (OR, 7.53; 95% CI, 1.77–31.97) were associated with increased odds of adverse outcomes, while UAT laterality showed a borderline association (OR, 2.61; 95% CI, 1.00–6.81). The nomogram achieved an AUC of 0.791 (95% CI, 0.706–0.876), with 70.2% sensitivity and 78.9% specificity at the optimal cutoff. Bootstrap calibration showed a mean absolute error of 0.042. Decision curve analysis demonstrated a positive net benefit across threshold probabilities of 11–92%. Conclusions: This study establishes an internally validated model for predicting adverse perinatal outcomes in fetuses with UAT using clinical characteristics and gestational age-adjusted Doppler hemodynamic parameters available at the time of diagnosis. The model may provide a basis for risk stratification and individualized antenatal surveillance. Full article

Background: Fetal cardiac rhabdomyomas are strongly associated with tuberous sclerosis complex (TSC). Although many remain asymptomatic and regress spontaneously, large tumors may cause ventricular inflow or outflow obstruction, arrhythmia, impaired ventricular function, pericardial effusion, hydrops fetalis and fetal demise. Transplacental mammalian target of rapamycin (mTOR) inhibition has emerged as a potential rescue therapy. Methods: We performed a narrative review of published reports on prenatal sirolimus or everolimus therapy for fetal cardiac rhabdomyomas in suspected or confirmed TSC. Data was extracted on treatment indication, gestational age at initiation, treatment duration, fetal echocardiographic response, maternal adverse effects, delivery and postnatal outcome. Results: Available evidence consists predominantly of case reports, small case series and retrospective cohorts; no prospective controlled trials were identified. Treatment was generally initiated for progressive or hemodynamically significant disease, particularly ventricular inflow or outflow obstruction, worsening valve regurgitation, arrhythmia, pericardial effusion, ventricular dysfunction or hydrops. Therapy was usually started in the late second or third trimester and continued until hemodynamic stabilization, delivery or planned transition to neonatal treatment. Most reports described tumor regression within 1–3 weeks, accompanied by improved cardiac function and high perinatal survival. However, rebound growth after treatment withdrawal, persistent arrhythmic risk and limited long-term safety data remain important concerns. Conclusions: Prenatal mTOR-inhibitor therapy should be considered an individualized rescue or stabilization strategy for fetuses with life-threatening or progressive cardiac compromise, rather than routine treatment for all fetal rhabdomyomas. Management should be multidisciplinary and guided by fetal hemodynamics, treatment response, maternal tolerance and gestational age. Full article

Background: Early-onset preeclampsia (EO-PE) remains a major cause of maternal and perinatal morbidity and mortality, and early risk stratification is still limited by the lack of simple and widely accessible biomarkers. The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a composite marker reflecting systemic inflammation and endothelial dysfunction. Methods: In this retrospective, nested case–control study (n = 1176), we evaluated the predictive performance of first-trimester NPAR for EO-PE (n = 168) versus frequency-matched normotensive controls (n = 840) and its incremental value beyond established clinical and hemodynamic parameters. Multivariable models were adjusted for gestational age at sampling, and internal validation was performed via bootstrapping. Results: NPAR demonstrated superior discrimination (AUC = 0.848) compared with NLR (AUC = 0.629) and MAP (AUC = 0.614) (p < 0.001 for both). At the optimal cutoff of 16.52, NPAR showed a sensitivity of 81.5% (95% CI: 74.8–87.1%) and a specificity of 76.0% (95% CI: 72.9–78.9%), yielding a prevalence-adjusted positive predictive value (PPV) of 6.5% and a negative predictive value (NPV) of 99.5% based on Bayes’ Theorem. In multivariable analysis, NPAR remained independently associated with EO-PE (aOR 2.25, 95% CI 1.81–2.80; p < 0.001, per 1 SD increase). The addition of NPAR significantly improved model performance, increasing the AUC from 0.612 to 0.830 (DeLong p < 0.001), with robust bootstrap stability. Conclusions: First-trimester NPAR stands out as a potential independent clinical risk vector for early-onset preeclampsia and may offer meaningful additive prognostic utility beyond conventional clinical parameters. Given its low cost and routine availability, it may represent an accessible framework for initial frontline triage in early pregnancy risk stratification, particularly in resource-limited clinical settings where advanced multi-marker screening algorithms are unavailable. Rigorous external validation in prospective, multicenter longitudinal cohorts remains an absolute prerequisite before routine implementation in clinical management pathways. Full article

Fetal growth restriction (FGR) has traditionally been attributed to placental insufficiency. However, accumulating evidence suggests that maternal cardiovascular maladaptation contributes to disease expression, clinical heterogeneity, and long-term maternal cardiovascular risk. To review maternal echocardiographic findings in pregnancies complicated by FGR, with or without preeclampsia and to explore the role of cardiovascular phenotyping in risk stratification and clinical management. Narrative review of the current literature, including observational studies, systematic reviews, meta-analyses, and expert consensus statements on maternal hemodynamics and echocardiographic assessment in FGR. FGR is associated with a maladaptive cardiovascular profile characterized by reduced cardiac output, increased systemic vascular resistance and adverse cardiac remodeling. Echocardiography frequently identifies subclinical myocardial dysfunction, including impaired diastolic function and reduced global longitudinal strain despite preserved ejection fraction. Distinct maternal cardiovascular phenotypes emerge across the FGR spectrum, ranging from high-risk hypodynamic, resistance-dominant phenotypes to intermediate and low-risk phenotypes with preserved hemodynamic adaptation. Integration of maternal cardiovascular assessment with fetal Doppler findings may improve risk stratification and support phenotype-guided surveillance and therapeutic decision-making. Persistent postpartum cardiovascular abnormalities further support the concept of pregnancy as a cardiovascular stress test and identify women at increased long-term cardiovascular risk. FGR should be viewed as the clinical manifestation of a complex maternal–placental–cardiovascular interaction rather than an isolated placental disorder. Maternal cardiovascular phenotyping has the potential to refine risk stratification, support hemodynamic-guided management, and identify women who may benefit from structured long-term cardiovascular surveillance. Full article

Background/Objectives: Isolated Left Ventricular Apical Hypoplasia (ILVAH) is a rare congenital anomaly characterized by a truncated, spherical left ventricle (LV) with fibro-fatty apical replacement. Historically considered a benign condition of asymptomatic adults, its hemodynamic behavior under physiological stress remains poorly characterized. We present two distinct cases and a comprehensive literature review (n = 59) to redefine the clinical spectrum of ILVAH. Methods: To contextualize our findings, a comprehensive review of the literature was performed up to February 2026. We searched the PubMed/MEDLINE database using the terms “Isolated Left Ventricular Apical Hypoplasia”, “ILVAH”, “truncated left ventricle”, and “left ventricular apical hypoplasia”. The literature search and study selection were conducted in accordance with the PRISMA guidelines. Case presentations: Case 1 describes a male infant with ILVAH and muscular ventricular septal defects who unexpectedly developed transient systolic heart failure at one month of life, requiring prompt medical therapy (ACE inhibitors and diuretics) for functional recovery. Case 2 describes a 33-year-old woman with a known diagnosis of ILVAH. Serial echocardiography during her first pregnancy revealed progressive left atrial dilation and the onset of mild post-capillary pulmonary hypertension. Immediately following an elective cesarean section at 37 weeks, she experienced acute heart failure. She was successfully managed with pre-emptive volume offloading. Conclusions: ILVAH is not a universally benign anomaly. The morphologically deficient and rigid ventricle is vulnerable to afterload shifts in infancy and rapid volume expansion in adulthood. A review of all previously reported pregnancies in ILVAH reveals a consistent pattern of severe, unrecognized postpartum pulmonary edema. Proactive, multidisciplinary management is suggested to prevent clinical decompensation. Our findings suggest that ILVAH may act as a stress-sensitive restrictive congenital left ventricle disease rather than a universally benign anatomical variant, a hypothesis that warrants further investigation. Full article

Beginning with a general understanding of catastrophic obstetric collapse (COC), it has been established that a catastrophic obstetric collapse is typically the result of sudden massive bleeding requiring emergency peripartum hysterectomy (EPH); this is different from historical views of what constitutes a catastrophic obstetric collapse. Current studies have found evidence that a catastrophic obstetric collapse can be the result of a longer-duration process involving gradual maternal physiological destabilization, the culmination of which creates a “maternal point of no return” for the mother. As a result of disrupting the maternal–fetal interface in placenta accreta spectrum disorders (PASDs), there are many abnormalities present in the decidua, such as: defective decidualization, fragmentation of the extracellular matrix, aberrant angiogenesis, continued hypoxic signals, and the persistence of invasive trophoblastic phenotypes. These structurally fragile vascular interfaces will eventually undergo endothelial dysfunction, oscillatory shear stress, glycocalyx injury, oxidative damage and progressive depletion of the maternal vascular adaptive reserve. Chronic inflammation will also continue to amplify immune thrombosis, alter complement function, facilitate NETosis, and cause widespread instability in diffuse microvasculature, leading to a reduced ability of the maternal system to tolerate physiological stress while maintaining macrocirculatory stability. Additionally, invasive placentation may lead to mitochondrial dysfunction, decreased oxidative phosphorylation, disrupted intracellular calcium homeostasis, ferroptotic lipid peroxidation, and redox-mediated endothelial injury, leading to a progressive limitation in the mother’s bioenergetic adaptability to hemorrhage. Ultimately, these events seem to culminate in a threshold condition where endothelial disorganization exists along with capillary transit time heterogeneity, impaired oxygen diffusion, metabolic instability, and progressive desynchrony of vascular, inflammatory, coagulative and mitochondrial networks before eventual hemodynamic collapse. Therefore, based on these findings, we propose the concept of the “Maternal Point of No Return” as a transitional state in which physiological adaptations begin to fail and irreversibly destabilize at a systems level. Lastly, we review potential applications of current technological advancements, including artificial intelligence (AI), radiomic-based placental phenotyping, exosomal biology, physiological variability analysis, spatial multi-omics, and digital twin physiology, to enable future precision-obstetrics strategies to identify a decline in maternal resilience prior to irreversible decompensation. Full article

Background and Clinical Significance: Uterine atony is the most frequent cause of postpartum hemorrhage and remains a major contributor to maternal morbidity worldwide. Neuraxial opioids are routinely used as adjuvants for labor analgesia and cesarean delivery anesthesia; however, their possible influence on myometrial contractility remains incompletely clarified. We describe a severe case of refractory uterine atony after emergency cesarean delivery in a patient exposed sequentially to epidural fentanyl during labor and intrathecal morphine for cesarean anesthesia; Case Presentation: A 34-year-old primigravida at 39 weeks and 4 days of gestation presented with early labor that had begun less than one hour earlier. Epidural labor analgesia was provided with ropivacaine, and the total epidural fentanyl exposure was 100 mcg over an approximately 7 h catheter period. Labor was complicated by dysfunctional uterine activity and cervical dystocia despite 3 h and 30 min of oxytocin augmentation. Emergency cesarean delivery was performed under spinal anesthesia with hyperbaric bupivacaine and intrathecal morphine. After delivery of a healthy neonate and uncomplicated placental separation, the patient developed severe uterine atony with postpartum hemorrhage. Hemorrhage persisted despite uterotonic therapy, continuous uterine massage, hemostatic suturing, and B-Lynch compression suture. Blood loss, measured using the suction canister and estimated from surgical swabs, was approximately 3800 mL. Progressive hemodynamic instability required transfusion therapy, conversion to general anesthesia, norepinephrine support, and emergency total abdominal hysterectomy. The postoperative course was favorable, and the patient was discharged on the eighth postoperative day; Conclusions: This case illustrates the rapid progression and therapeutic complexity of refractory uterine atony after emergency cesarean delivery in the setting of dysfunctional labor, oxytocin augmentation, cesarean delivery, sequential neuraxial opioid exposure, and subsequent hemorrhagic instability. A possible contribution of sequential neuraxial opioid administration to impaired myometrial contractility cannot be excluded; however, causality cannot be established from a single case. Early recognition, structured escalation, transfusion support, and timely multidisciplinary surgical management remain essential in severe postpartum hemorrhage. Full article

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. Full article

Chronic exposure to fine particulate matter (PM_2.5) derived from wood combustion represents a major environmental health burden, particularly during pregnancy. However, the impact of pregestational and gestational (PM_2.5) exposure on the maternal great vasculature remains largely unexplored. This study evaluates the effects of wood smoke-derived (PM_2.5) on the structural architecture of the maternal aortic arch and associated hemodynamic changes during pregnancy in second-generation Sprague–Dawley rats. Animals were allocated into four groups (n = 12) according to filtered (FA) or non-filtered air (NFA) exposure during pregestational and gestational periods: FA/FA, FA/NFA, NFA/FA, and NFA/NFA. Morphometric analysis revealed significant reductions in tunica media (p = 0.0251) and adventitia thickness (p = 0.0014) in exposed groups, without changes in integrated optical density, suggesting alterations in elastic matrix organization without evidence of net mass loss. Histological analysis supported exposure-dependent structural heterogeneity, including elastic lamellae fragmentation and extracellular matrix disorganization. Each exposed group exhibited a distinct systolic blood pressure trajectory across gestation, with FA/NFA reaching the highest values at day 18 (151.0 ± 17.0 mmHg) and NFA/FA displaying sustained elevations despite gestational low-exposure conditions. Principal component analysis (49.2% explained variance) revealed a structured multivariate distribution of vascular and hemodynamic variables across exposure conditions, consistent with an exposure-window-dependent pattern. These findings suggest that (PM_2.5) exposure is associated with coordinated structural and hemodynamic changes in the aortic arch and support the hypothesis that the pregestational period may represent a window of increased susceptibility. Full article

Pregnancy-associated hemodynamic overload and hormonal changes induce hypertrophy and metabolic remodeling of the maternal heart. Mitochondrial motility, mediated by ras homolog family member T (RHOT) 1 and RHOT2, is essential for cardiac adaptation to increased workload, cardiomyocyte hypertrophy, and sarcomere maturation. To test the hypothesis that Rhot1/2 expression is required for pregnancy- and postpartum-associated adaptations of the maternal heart, female mice with tamoxifen-inducible, cardiomyocyte-selective deletion of Rhot1 and Rhot2 (iRhot1/2-KO) were mated. Following gene deletion in adult mice, cardiac tissue and function were analyzed after three to five successive pregnancies and postpartum nursing periods. Age-matched nulliparous iRhot1/2-KO mice and age-matched mice expressing Rhot1 and Rhot2 served as controls. Motility of mitochondria isolated from iRhot1/2-KO hearts was impaired, as determined by the number of mobile mitochondria in an in vitro motor protein-driven single mitochondrion motility assay performed on surface-immobilized microtubules. Despite loss of Rhot1/2 expression, contractile function assessed by transthoracic echocardiography, mRNA expression of peripartum-associated heart failure markers, cardiac structure, mitochondrial morphology, mitochondrial enzymatic activity, and mitochondrial DNA content were all comparable to controls expressing Rhot1/2 at the investigated time points. RNA sequencing-based gene profiling identified a transcriptional program through which RHOT proteins preserve cardiac energetic and contraction gene expression during pregnancy and postpartum. Together, cardiomyocyte-selective loss of Rhot1/2 expression in the adult heart does not cause peripartum-associated heart failure, despite reduced cardiac energetic and contraction gene expression. Full article

Mechanical tricuspid valve thrombosis during pregnancy is a rare but extremely high-risk condition due to the thrombogenic nature of tricuspid prostheses and the hypercoagulable state of pregnancy, which complicates anticoagulation management. This article reports the case of a 39-year-old pregnant woman who developed thrombosis of a mechanical tricuspid valve after switching from warfarin to low-molecular-weight heparin. Owing to her hemodynamic stability, a conservative approach with intensified anticoagulation and close multidisciplinary monitoring was adopted, allowing continuation of the pregnancy without maternal clinical deterioration. Partial echocardiographic improvement was observed. Delivery was achieved by planned ischemic cesarean section to minimize hemodynamic stress, resulting in a stable preterm neonate. The patient recovered well and subsequently underwent elective replacement of the mechanical valve with a bioprosthesis postpartum. This case highlights the complexity of diagnosing and managing mechanical tricuspid valve thrombosis during pregnancy and emphasizes the importance of individualized, multidisciplinary care, as well as the selective use of ischemic cesarean section in extreme-risk scenarios. Full article

Advances in prenatal diagnosis have improved the perinatal management of congenital heart disease (CHD). However postnatal comorbidities still persist due to multifactorial causes, which limits prenatal prediction of individual outcomes. Oxidative stress (OS), particularly lipid peroxidation, has been suggested to play a role in the development and progression of CHD, with 8-iso-prostaglandin F₂α (8-iso-PGF₂α) serving as a biomarker of oxidative injury. This prospective case–control study aimed to evaluate OS in fetuses with isolated major CHD by comparing amniotic fluid (AF) 8-iso-PGF₂α concentrations with controls. A total of 123 fetuses (83 CHD, 40 controls) were included at a tertiary CHD referral center. CHD cases were subclassified according to anatomical type and expected fetal brain perfusion under placental circulation. Controls were gestational age-matched pregnancies undergoing amniocentesis for indications unlikely to affect OS. All pregnant women underwent standardized fetal biometry, Doppler assessment, and detailed echocardiography. AF samples were obtained by amniocentesis and analyzed for free 8-iso-PGF₂α using a competitive ELISA, with values normalized to creatinine. Clinical, obstetric, and Doppler characteristics were comparable between groups. CHD fetuses showed significantly higher AF 8-iso-PGF₂α concentrations than controls (2849 ± 1377 vs. 2088 ± 1087 ng/mg Cr, p = < 0.001), and remained significant after adjustment for GA, smoking status, diabetes and maternal age and body mass index (BMI). No consistent differences were observed across anatomical or hemodynamic CHD subgroups. These findings provide the first intrauterine evidence of increased lipid peroxidation in fetuses with CHD as reflected by elevated amniotic fluid 8-iso-PGF₂α concentrations. Full article

Background/Objectives: Placenta accreta spectrum (PAS) disorders are a major cause of life-threatening obstetric hemorrhage and frequently necessitate cesarean hysterectomy. Abdominal aorta balloon occlusion (AABO) has been increasingly adopted as a strategy to reduce intraoperative blood loss during cesarean section. This study aims to evaluate the effectiveness and safety of AABO during cesarean delivery in women with PAS disorders. Materials and Methods: A systematic review and meta-analysis of studies published in English from 2015 to April 2025 was conducted using the following databases: Embase, Scopus, PubMed, Google Scholar, and Web of Science. Articles that met inclusion criteria focused on human participants, original studies, female participants, and studied the efficacy of AABO on blood loss during cesarean delivery for PAS. Articles that were reviews, case reports, other occlusion procedures, and animal studies were excluded. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Results: Twenty-four studies comprising 1958 cesarean deliveries with AABO and 1791 without AABO met the inclusion criteria. Data on blood loss, transfusion, hysterectomy, maternal complications, and neonatal outcomes were extracted, synthesized, and analyzed. The majority of studies (91.6%) applied the balloon at the infrarenal level. Cesarean delivery with AABO resulted in substantially lower mean blood loss (1231 ± 688 mL vs. 2253 ± 857 mL, p < 0.001) and reduced requirements for blood transfusion compared with cesarean delivery alone. Hysterectomy rates were threefold lower with AABO (7.8% vs. 25.8%, p < 0.001), and the incidence of hemorrhagic shock and re-laparotomy were markedly reduced. Complications associated with AABO, including lower limb arterial thrombosis and fever, were uncommon and generally manageable. Conclusions: AABO during cesarean delivery for PAS disorders is associated with reduced intraoperative blood loss, lower transfusion requirements, and decreased hysterectomy rates, suggesting improved maternal hemodynamic stability. Although the procedure is generally safe, vigilance for vascular and thromboembolic complications is essential, and preventive strategies should be incorporated into perioperative care. These findings support the integration of AABO into multidisciplinary management protocols for women with PAS disorders. Future randomized prospective studies should be performed to improve patient selection criteria, standardize the protocols, and further evaluate the long-term maternal and neonatal safety/outcomes of the procedure. Full article

Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies. Full article