Objective To report our single-center multidisciplinary perinatal experience for neonates with prenatally diagnosed isolated congenital complete heart block (CCHB) requiring early epicardial pacemaker implantation.Methods This retrospective case series included four consecutive neonates with prenatally diagnosed isolated CCHB (2016–2020). A multidisciplinary team coordinated perinatal planning. Maternal data, fetal echocardiography, delivery-room resuscitation, vasoactive support, and short-term neonatal outcomes were analyzed descriptively.Results Four neonates (gestation 35 + 6–37 + 6 weeks; birth weight 2270–2500 g) were delivered by cesarean section. Umbilical vein catheterization was achieved rapidly in all. All neonates had a heart rate <50 bpm at birth and received immediate vasoactive resuscitation. All neonates underwent successful epicardial permanent pacemaker implantation within 10 days after birth with improved cardiac function and were discharged home. One infant was readmitted 8 days after discharge due to pocket infection and ultimately died on postnatal day 46.Conclusions Multidisciplinary coordination, early umbilical-vein access, and individualized vasoactive support are critical for managing these high-risk neonates. Our findings provide practical guidance but require validation in larger cohorts.
Objective Fetal and neonatal thrombosis comprises a heterogeneous spectrum of disorders ranging from localized vascular events to rapidly progressive systemic thrombosis involving multiple vascular beds and organs. This review examines thromboinflammation and antiphospholipid antibodies (aPL) in severe fetal-neonatal thrombosis.Methods This narrative, hypothesis-generating review draws on a structured, non-systematic literature search through August 31, 2026, distinguishing direct fetal and neonatal evidence from adult and experimental findings.Results Neonatal hemostasis is characterized by a physiologically balanced but vulnerable state that may become destabilized by infection, hypoxia, endothelial injury, inflammation, and genetic or immune-mediated factors. Current evidence suggests that interactions between endothelial dysfunction, innate immune activation, platelets, coagulation, neutrophil extracellular traps, and the complement system may promote a transition from localized thrombosis to a self-amplifying thromboinflammatory process. However, a common mechanism of such progression has not been established across different fetal and neonatal thrombotic disorders. Maternal IgG aPL may cross the placenta, whereas aPL detected in some neonates may reflect presumed de novo production. The presence of aPL does not necessarily result in neonatal thrombosis, and additional prothrombotic factors reported in selected cases are consistent with, but do not establish, a “second-hit” or “multiple-hit” model.Conclusion We propose catastrophic fetal-neonatal thrombosis as an unvalidated clinical and pathogenetic framework rather than a distinct disease entity. Paired maternal-neonatal testing and longitudinal antibody assessment may help clarify antibody origin, although delayed testing limits causal interpretation. Its potential value for earlier recognition and etiologically directed diagnostic evaluation requires prospective assessment.
Introduction To evaluate the efficacy and safety of hysteroscopic curettage combined with cesarean scar diverticulum canal-opening after focused ultrasound ablation surgery (FUAS) pretreatment in patients with type II and III cesarean scar pregnancy (CSP).Methods Clinical data of 105 patients with type II/III CSP treated between January 2019 and October 2022 were retrospectively analyzed. All patients received FUAS pretreatment. The observation group (n = 47) underwent hysteroscopic curettage combined with niche canal-opening, while the control group (n = 58) received hysteroscopic curettage alone. Surgical parameters, postoperative recovery, complications, reintervention rates, and menstrual outcomes were compared.Results The observation group had significantly shorter operation time [20 (15,25) vs. 25 (20,31) min, p = 0.001], less intraoperative blood loss [5 (5,10) vs. 10 (10,50) mL, p = 0.002], lower complication rate [4.3% vs. 17.2%, p = 0.038], and lower reintervention rate [4.3% vs. 19.0%, p = 0.023]. No between-group differences were observed in postoperative hemoglobin decline, hospital stay, vaginal bleeding duration, human chorionic gonadotropin normalization time, menstrual recovery time, or residual scar myometrial thickness (all p > 0.05). Among patients with preoperative prolonged menstruation, menstrual duration improved in both groups (p < 0.05), with a higher improvement rate in the observation group [75.0% vs. 23.1%, p = 0.005].Conclusions FUAS pretreatment combined with hysteroscopic surgery is safe and effective for type II/III CSP. Adding diverticulum canal-opening to hysteroscopic curettage further optimized surgical outcomes by reducing operation time, intraoperative blood loss, complication rates, and the need for reintervention, while also significantly improving prolonged menstruation. This combined strategy may serve as an optimized minimally invasive alternative for patients desiring fertility, though long-term reproductive safety requires further verification.
Background Chronic hypertension (CHTN) increases the risk of superimposed preeclampsia, contributing to maternal and neonatal morbidity and mortality. Accurate hypertension classification is therefore essential for risk stratification, antenatal surveillance, prevention, and outcomes. The clinical impact of applying the American College of Cardiology/American Heart Association (ACC/AHA) classification, compared with the American College of Obstetricians and Gynecologists (ACOG) criteria, in pregnancy remains uncertain.Objective To determine the impact of ACC/AHA versus ACOG hypertension classifications on the prevalence of CHTN and pregnancy outcomes.Study design This population-based retrospective cohort study used a computerized maternity database from a tertiary hospital. All parturients with singleton gestations initiating prenatal care in the first trimester were included (n = 136,606). CHTN was categorized according to ACOG and ACC/AHA criteria. Maternal, fetal, and neonatal outcomes were assessed. Statistical analyses were performed using R-Studio, with ANOVA and Poisson regression models evaluating associations between CHTN severity and outcomes.Results The prevalence of CHTN was 2.9% (4,127/137,606) by ACOG criteria and 3.9% (5,424/137,606) by ACC/AHA criteria (p < 0.001). Under ACOG classification, both mild and severe range CHTN were independently associated with preeclampsia or eclampsia (RR 4.15, 95% CI 3.69–4.65; and RR 3.19, 95% CI 2.82–3.59, respectively). Using ACC/AHA criteria, elevated blood pressure (EBP), stage 1 CHTN (S1CHTN), and stage 2 CHTN (S2CHTN) were each independently associated with preeclampsia or eclampsia (EBP: RR 2.34, 95% CI 2.04–2.65; S1CHTN: RR 4.00, 95% CI 3.56–4.50; S2CHTN: RR 3.32, 95% CI 2.88–3.80). Mild CHTN, S1CHTN, and S2CHTN were independently associated with small-for-gestational-age neonates, while both ACOG-defined CHTN and ACC/AHA-defined EBP, S1CHTN, and S2CHTN were associated with preterm birth.Conclusion Application of the ACC/AHA classification identifies a larger proportion of pregnant individuals as having CHTN. Notably, even those with elevated blood pressure had a two-fold increased risk of preeclampsia compared with the general obstetric population. These findings support the clinical relevance of the ACC/AHA classification in pregnancy and suggest that its implementation may improve identification of patients who may benefit from targeted preeclampsia prevention strategies.
