BACKGROUND Paradoxical vocal fold motion disorder (PVFM) is a rare condition consisting of episodic upper airway obstruction, resulting in recurrent stridor and respiratory distress. Limited data exists regarding its presentation, implications, and consequences during pregnancy. In this report, we present the case of a 23-year-old primigravida woman with known PVFM and recurrent stridor who developed acute respiratory distress requiring endotracheal intubation, followed by emergency bedside cesarean delivery, during which an incidental placental abruption was identified. CASE REPORT A 23-year-old primigravida woman with known history of PVFM underwent bilateral vocal fold botulinum toxin injections. She was re-admitted one week after being discharged with recurrent stridor, which temporarily responded to symptomatic management. However, she subsequently developed acute respiratory distress necessitating intubation. She then required emergency bedside cesarean section in the intensive care unit (ICU) for non-reassuring fetal heart tones, in which a placental abruption was incidentally discovered. CONCLUSIONS This case highlights the potential for pregnancy-related anatomic and physiologic airway changes to exacerbate PVFM, creating challenges for emergency airway management in non-operating room settings. It also suggests an association between acute-on-chronic PVFM episodes and placental abruption. We conclude that pregnant patients with PVFM must be monitored closely and considered to be at increased risk for difficult emergency airways and maternal respiratory distress than can lead to placental abruption.

Etanercept, a selective inhibitor of the cytokine tumor necrosis factor (TNF), delivered by perispinal administration, has been used clinically for 15 years to treat chronic, intractable, post-stroke and post-brain injury neurological dysfunction. We report the case of a 19-year-old patient with cerebral palsy (CP) who experienced rapid and sustained neurological improvement after treatment with perispinal etanercept (PSE). The patient was born at 25 weeks gestation following a twin pregnancy complicated by abruptio placentae and premature onset of labor. The initial head ultrasound, performed four weeks after birth, demonstrated grade four intraventricular hemorrhage (IVH) with acquired ventriculomegaly and the patient was subsequently diagnosed with CP, hydrocephalus, and retinopathy of prematurity. She presented at age 19 to our clinic with chronic right hemiparesis, bilateral upper limb fine motor dysfunction, painful spasticity and multiple, additional chronic neurological symptoms. The patient received an initial 25mg dose of PSE, followed by doses at weeks three, 24 and 49. The patient reported reduced painful spasticity and improved sensation within 30 minutes of each dose. Clinically meaningful improvements that persisted over the entire one-year period of observation were noted in painful spasticity, sensation, gait, mobility, balance, coordination, fine motor function, strength, fatigue, and headaches; some of the improvements were progressive. PSE was well tolerated. Further study of PSE for selected patients with CP in properly designed, randomized, controlled trials is warranted.

Placental abruption is a serious complication in pregnant women with preeclampsia. This study investigated the risk factors for placental abruption and developed a predictive model using the Synthetic Minority Over-sampling Technique (SMOTE). A total of 280 pregnant women with preeclampsia treated between September 2020 and September 2025 were enrolled and classified into placental abruption and non-placental abruption groups. Logistic regression showed that parity ≥3, severe preeclampsia, anemia, polyhydramnios, and short umbilical cord were independent risk factors for placental abruption. ROC analysis demonstrated that the SMOTE-based model had better predictive performance than the original model, with a higher AUC (0.863, 95% CI: 0.817-0.901 vs 0.792, 95% CI: 0.739-0.838; z=2.163, P=0.031). The SMOTE-based model also showed higher F-score and positive predictive value, although its true positive rate was lower than that of the original model. These findings indicate that a SMOTE-based predictive model may provide useful support for early risk assessment and prevention of placental abruption in women with preeclampsia.

Placental abruption accompanied by low neonatal Apgar scores represents a clinically important subgroup with a potential maternal hemorrhagic risk. Evidence remains limited regarding the factors associated with blood product transfusions in these patients. This study aimed to identify clinical and laboratory factors associated with transfusion in women with placental abruption and low neonatal Apgar scores and to develop an exploratory prediction model. This retrospective cohort study included women with confirmed placental abruption who delivered at the Fujian Maternity and Child Health Hospital between January 2013 and July 2023. Eligible patients had singleton pregnancies at ≥ 28 weeks of gestation and live-born neonates with 1-minute Apgar scores ≤ 7. Clinical characteristics, laboratory findings, neonatal outcomes, and blood product use were extracted from the electronic medical records. Candidate predictors were evaluated using univariate logistic regression, least absolute shrinkage and selection operator logistic regression, and multivariable logistic regression. A nomogram was developed from the final model and assessed using receiver operating characteristic curve analysis, calibration assessment, 1000 bootstrap resamples, Brier score, and decision curve analysis. Among the 140 women, 32 received blood product transfusions (22.9%). Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0g/L, and lower hemoglobin level were independently associated with transfusion. The nomogram showed good apparent discrimination, with an apparent area under the curve of 0.928 (95% confidence interval: 0.884-0.972). After bootstrap internal validation, the optimism-corrected area under the curve is 0.912. The bootstrap-corrected calibration slope was 0.869 and the Brier score was 0.086. Decision curve analysis suggests a potential net clinical benefit. Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0 g/L, and lower hemoglobin level were associated with blood product transfusion in women with placental abruption and low 1-minute neonatal Apgar scores. This exploratory nomogram may support early peripartum risk stratification and transfusion preparedness.

A 37-year-old nulliparous woman was admitted to the hospital for mild bleeding. Intrauterine fetal death and placental abruption were diagnosed. The patient had a severe form of preeclampsia associated with fetal growth restriction and anuric renal failure. The delivery was associated with significant blood loss. Immediately after the termination of pregnancy by emergency caesarean section, the patient's condition required hospitalization in the intensive care unit and temporary dialysis. In parallel with the demanding care of the patient's physical health, early perinatal palliative intervention was initiated, i.e. accompanying the family after the death of the child. SPIKES communication protocol makes it easier to navigate a difficult conversation in limited time. Commonly established hospital processes may not be prepared for such a complex and demanding situation and require exceptional involvement of the staff from all departments. Sharing our communication skills improves the cooperation with an aggressive patient. Presence of her family is beneficial for communication during difficult times.

This retrospective study of 4143 women at Fujian Maternal and Child Health Hospital (2012-2022) investigated how maternal risk levels influence clinical characteristics and perinatal outcomes in singleton pregnancies complicated by preeclampsia. Utilizing class-imbalance-adjusted and random forest algorithms, participants were stratified into high-risk (17.38%), moderate-risk (34.08%), and low-risk (48.54%) groups. The analysis revealed that women in the high-risk category were diagnosed at a significantly earlier gestational age and faced higher rates of severe, early-onset, and preterm preeclampsia compared to the other groups. Although high-risk pregnancies were associated with increased incidences of renal impairment, hypoproteinemia, and aminotransferase abnormalities, no significant differences were observed in rates of thrombocytopenia, placental abruption, postpartum hemorrhage, or stillbirth. Regarding delivery and neonatal outcomes, the high-risk group demonstrated markedly higher rates of Cesarean sections, fetal distress, and neonatal intensive care unit (NICU) admissions. Key drivers of these adverse outcomes included chronic hypertension, chronic kidney disease, prior fetal growth restriction (FGR), and maternal age over 40 years. Ultimately, while high-risk status is a strong predictor of early-onset disease and specific maternal-neonatal complications, it does not uniformly predict all adverse fetal outcomes, suggesting that clinical management should focus heavily on the specific impacts of hypertension, renal health, and advanced maternal age.

Adverse outcomes after motor-vehicle crashes are the leading cause of death among individuals aged 5-29 years. The objective was to assess the risks of maternal and fetal complications associated with traffic accidents during pregnancy. This systematic review and meta-analysis included searches in PubMed, MEDLINE, EMBASE, LILACS, SciELO, Scopus, and COCHRANE databases up to February 2024, focusing on observational cohort studies. Article selection was performed independently by two authors. Fixed and random-effects meta-analyses with odds ratios (OR) were conducted. Analyses were performed using R software. The study was registered with PROSPERO (CRD42024508710). A total of 6147 articles were identified, with 1519 duplicates. From the 4628 articles reviewed, 108 were selected for full-text review, and finally, seven studies were included in the systematic review, with six included in the meta-analysis. The combined effect sizes for evaluated outcomes were as follows: maternal mortality [OR = 1.66, 95% CI 0.78-3.53], placental abruption [OR = 2.43, 95% CI 1.12-5.29], premature rupture of membranes [OR = 1.05, 95% CI 0.98-1.13], preterm birth [OR = 2.02, 95% CI 0.63-6.44], and cesarean delivery [OR = 1.12, 95% CI 0.92-1.36]. In conclusion, motor-vehicle crashes during pregnancy may increase the risk of maternal mortality, premature rupture of membranes, preterm birth, cesarean delivery, and placental abruption. However, statistical significance was observed only for placental abruption. These findings highlight the importance of understanding country-specific statistics to develop tailored protocols aimed at improving prehospital and hospital care for this vulnerable population.

Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, 2 Scientific and Standardization Committees, the Women's Health Issues in Thrombosis and Hemostasis and Disseminated Intravascular Coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries); 104 of them included patients' clinical and laboratory information. Placental abruption is the leading cause for ante- and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (ie, placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy-specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy-specific DIC score than those without such complications at the time of diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the 2 groups.

To assess the prevalence and clinical impact of antinuclear antibodies (ANA) and low complement levels on fetal-maternal outcomes in pregnant women within the spectrum of obstetric antiphospholipid syndrome (APS).

Pregnancy placental syndromes, including preeclampsia, fetal growth restriction, placental abruption, and placental-related stillbirth, are major contributors to maternal and perinatal morbidity worldwide. Beyond their immediate obstetric impact, these conditions are increasingly recognized as sentinel events that unmask underlying maternal susceptibility to chronic disease. This narrative review synthesizes contemporary evidence linking pregnancy placental syndromes to long-term maternal and offspring health outcomes. Epidemiologic data consistently demonstrate that affected women face substantially elevated risks of cardiovascular disease, cerebrovascular disease, chronic kidney disease, metabolic syndrome, and microvascular complications, independent of traditional risk factors. These risks often emerge early in the postpartum period and persist for decades, reinforcing pregnancy as a physiologic stress test that reveals preexisting or pregnancy-induced pathology. Recognition of pregnancy placental syndromes as early indicators of chronic disease carries important clinical implications. The postpartum period represents a critical window for risk stratification, targeted surveillance, and preventive intervention. Multidisciplinary, longitudinal follow-up that incorporates obstetric history into cardiovascular and metabolic risk assessment offers a meaningful opportunity to reduce long-term morbidity and advance preventive women's health care.