Spontaneous hemoperitoneum in the postpartum period is a rare and potentially life-threatening obstetric emergency that may present with sudden hemodynamic collapse. We report the case of a 30-year-old gravida 3, para 1, living 1, abortion 1 woman at 39 weeks of gestation with a previous lower-segment cesarean section who underwent a successful vaginal birth after cesarean (VBAC) of a healthy female neonate weighing 2.95 kg. One hour after delivery, despite stable vital signs and absence of vaginal bleeding, she developed sudden circulatory collapse with abdominal distension and hypovolemic shock. Laboratory investigations revealed severe anemia with hemoglobin of 6.7 g/dL, thrombocytopenia, and metabolic acidosis with elevated lactate levels. Bedside ultrasonography demonstrated significant intraperitoneal free fluid, and diagnostic tapping confirmed hemoperitoneum. Emergency exploratory laparotomy revealed approximately 3.8 liters of hemoperitoneum with clots. The uterus was exteriorized and systematically examined; the previous cesarean scar was intact, with no evidence of uterine rupture or dehiscence. The adnexa, broad ligaments, pelvic and retroperitoneal regions, and upper abdominal viscera were carefully examined, but no definite source of bleeding could be identified. Stepwise surgical devascularization with bilateral uterine artery ligation and descending cervical artery ligation was performed as an empirical hemorrhage-control measure. The patient received massive transfusion support, recovered satisfactorily in the intensive care unit, and was discharged in stable condition. This case highlights the importance of maintaining a high index of suspicion for spontaneous hemoperitoneum in postpartum women presenting with unexplained shock, even in the absence of vaginal bleeding.

Recurrent pregnancy loss (RPL) is a multifactorial reproductive disease that is typified by repeated pregnancy loss with immune dysregulation emerging as a critical contributing factor. Immunoglobulins are among the immune components that are instrumental in preserving tolerance between the mother and the fetus, regulating inflammatory responses, and supporting placental development. This review provides a comprehensive overview of the role of immunoglobulins in recurrent pregnancy loss, with particular emphasis on immune dysregulation, emerging biomarkers, and therapeutic implications. The immunoglobulin profiles, such as the changes in IgG subclasses and the presence of pathogenic autoantibodies, e.g. antiphospholipid and antinuclear antibodies, are highly correlated with unfavourable pregnancy outcomes. These changes, in a mechanistic manner, lead to poor trophoblast invasion, endothelial dysfunction, thrombosis and cytokine imbalance. Emerging evidence also highlights the contribution of regulatory B cells and the antibody-mediated immune network in maintaining pregnancy homeostasis. Immunoglobulin profiling has clinical potential as a diagnostic and prognostic methodology that can be used to stratify patients and provide customised therapy. Immunomodulatory therapies, especially intravenous immunoglobulin (IVIG), are potentially effective in a limited range of patient populations, but clinical response is variable. On the whole, this review demonstrates the role of immunoglobulin-mediated mechanisms in RPL and their future potential in enhancing precision medicine approaches to better diagnosis and management.

Female nurses face unique health challenges due to pregnancy and physiological factors, yet the association between reproductive factors and blood pressure remains debated. This cross-sectional study surveyed 122 533 female nurses in Hebei Province using questionnaires and standardized blood pressure measurements. Data were collected on reproductive factors (menstrual status, number of abortions and deliveries), BMI, history of hypertensive disorders of pregnancy, and other potential confounders. Abortion was defined as pregnancy loss before 28 weeks of gestation, including both spontaneous miscarriage and induced termination, which are clinically and biologically distinct but were combined in this study due to data availability. Logistic regression and multifactorial analysis of variance were used to assess the associations of these reproductive factors with hypertension prevalence and blood pressure levels, respectively, including interaction terms for BMI and hypertensive disorders of pregnancy history. After adjusting for age, BMI, and other covariates, irregular menstruation (OR = 1.388, 95%CI: 1.302-1.478), menopause (OR = 1.328, 95%CI: 1.185-1.489), and having one delivery (OR = 1.215, 95%CI:1.004-1.471) were independently associated with higher odds of hypertension. Among nurses with prior hypertensive disorders of pregnancy, those with more than three abortions had significantly higher systolic (by 7.63 mmHg) and diastolic (by 6.38 mmHg) blood pressure compared to those with no abortion history. The findings indicate that reproductive factors are significantly associated with blood pressure in female nurses. We recommend regular blood pressure monitoring for nurses with irregular menstruation, menopause, or one delivery, proactive management of menstrual irregularities, and individualized reproductive counselling for those with a history of hypertensive disorders of pregnancy.

The maternal-fetal interface (MFI) serves as a crucial bidirectional crosstalk site between the mother and the developing fetus, wherein precisely orchestrated immune regulatory networks are indispensable for sustaining tolerance toward the semi-allogeneic fetus while concurrently defending effectively against pathogenic challenges. Excessive inflammatory activation can perturb immune homeostasis at the MFI, particularly during the first trimester, and can compromise placental development and function, thereby contributing to adverse pregnancy outcomes, including recurrent spontaneous abortion, preeclampsia of placental origin, and even aberrant embryonic development. Therefore, a detailed understanding of the cellular composition of the MFI and its dynamic relationship with placental development is fundamental to elucidating disease etiology and informing interventional research on placenta-related pregnancy complications. This review summarizes the major immune cell populations present at the MFI (namely T cells, decidual Natural Killer cells and decidual macrophages) and their functional characteristics, examines their roles in physiological placental formation and remodeling, and evaluates their associations with several common adverse pregnancy outcomes. Collectively, the findings highlight the central role of major maternal immune cells in establishing immune tolerance during early gestation and underscore the potential clinical value of immune profiling in predicting and managing adverse pregnancy outcomes.

Recurrent pregnancy loss (RPL) is a heterogeneous reproductive condition, and unexplained recurrent pregnancy loss (URPL) denotes repeated pregnancy losses for which no established cause is identified after standard evaluation. Recurrent miscarriage (RM) and recurrent spontaneous abortion (RSA) are overlapping terms used in the literature, whereas recurrent implantation failure (RIF) is a related but distinct infertility context. In this Mini Review, URPL is treated as an exclusion-based clinical category rather than a single disease entity. This review examines the hypothesis that a subset of URPL reflects abnormalities in specific cellular and molecular components of the maternal-fetal interface. We focus on maternal compartments, including endometrial epithelial lineage states, decidual stromal dysfunction, and stromal-immune interactions, as well as fetal/trophoblast compartments such as trophoblast lineage defects and broader maternal-fetal interactions, incorporating insights from recent advances in molecular and cellular technologies and human model systems. Particular attention is given to single-cell, spatial, organoid, assembloid, implantation model, trophoblast stem cell, and placental explant studies published from 2024 to 2026. Current data do not establish clinical subtypes for URPL or support treatment selection in routine practice. However, recent molecular and cellular technologies now make it possible to define interface phenotypes with higher resolution and to test whether patient-derived abnormalities are reproducible and perturbable in experimental systems. An interface-centered framework may therefore help move URPL research from broad exclusion-based labels toward experimentally testable subtype identification based on epithelial, decidual, trophoblast, immune, and embryo-endometrial phenotypes.

Tropical theileriosis is a significant health risk for cattle especially in tropical and subtropical regions where it contributes to high mortality rates and economic losses. Tick-borne protozoan parasites belonging to Theileria genera are responsible for this infection. Theileriosis has been associated with abortion and stillbirth in cattle, primarily as an indirect consequence of maternal illness; however, this association has not been investigated in Pakistan. Therefore, the present study aimed to determine the molecular prevalence and distribution of Theileria species in cattle with a recent history of abortion across three districts of Punjab, Pakistan. A total of 138 blood samples were collected from cattle in Bahawalpur, Lodhran and Muzaffargarh districts during February 2024 till March 2025 having recent history of abortion. Genomic DNA of cattle was screened for the presence of Theileria spp. by targeting a fragment from their conserved 18S rRNA gene. Out of the screened samples, 56 (40.6%) tested positive for Theileria spp. and DNA sequencing confirmed the presence of T. annulata and T. orientalis in 21/138 (15%) and 1/138 (0.7%) cattle, respectively. Phylogenetic analysis revealed that sequences amplified in this study were similar to 18S rRNA gene of T. annulata and T. orientalis deposited from different countries worldwide. The highest Theileria spp. and T. annulata infection rate was recorded in Holstein-Friesian cattle (73% and 36%) followed by Sahiwal (40% and 15%), Dajal (35% and 12%) and Cholistani (32% and 12%, respectively). Age, ectoparasite infestation, grazing mode, and use of acaricides were not significantly associated with Theileria spp. infection. In conclusion, detection of Theileria spp., especially T. annulata, in a notable proportion of cattle with a history of abortion suggests a potential role in reproductive losses. Further studies are required to confirm the causal link. Additionally, regular screening, effective tick control and proper herd management are recommended to reduce the risk of infection and associated reproductive issues.

Heterotopic cesarean scar pregnancy (HCSP) is a rare condition in which an intrauterine pregnancy coexists with an ectopic pregnancy implanted in a cesarean scar. Due to its rarity, no standardized management has been established. Here, we report a 38-year-old Japanese woman diagnosed with HCSP, who experienced massive bleeding associated with spontaneous abortion (SA) of the cesarean scar pregnancy (CSP) at 8 weeks of gestation. The coexisting intrauterine pregnancy remained viable. As she desired pregnancy continuation, she was managed expectantly. At 33[5/7] weeks, she developed massive bleeding leading to hemorrhagic shock, necessitating emergency cesarean section. Bilateral uterine artery embolization was performed postoperatively to achieve hemostasis. Both the mother and her baby were discharged uneventfully. Although expectant management following SA of CSP in a dichorionic twin pregnancy may permit survival of the co-twin, pregnancy continuation carries a persistent risk of sudden-onset heavy bleeding. Active intervention for CSP in HCSP may improve perinatal outcomes.

The present investigation seeks to clarify the molecular underpinnings through which perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) precipitate recurrent miscarriage (RM). Initially, prospective targets of PFOA (6050 in total) and PFOS (8896 in total) were systematically compiled from three repositories-CTD, ChEMBL, and Super-PRED-while 1822 pathogenic targets linked to RM were cataloged through the amalgamation of GeneCards, OMIM, and NCBI resources. Venn diagrammatic assessment disclosed 699 overlapping targets shared between PFOA and RM, alongside 832 shared between PFOS and RM. Thereafter, PPI networks were assembled utilizing the STRING platform. By applying median filtering coupled with CytoHubba-based evaluation, central targets were distilled-362 for the PFOA-RM axis and 502 for the PFOS-RM axis-together with their respective top 10 hub genes. Functional enrichment conducted via DAVID pointed toward platelet coagulation elements as potentially critical mediators in PFOA- and PFOS-triggered RM. Moreover, the distinctive enrichment of transcriptional co-regulatory complexes observed specifically for PFOS, coupled with divergent pathway involvements including adipocytokine signaling, TNF cascades, and fluid shear stress transduction between the two agents, implies compound-specific pathogenic modalities. Overlapping target scrutiny pinpointed TP53 as the exclusive pathogenic gene candidate. SMART-based verification affirmed its essential structural domains, with documented subcellular residence in cytoplasmic, nuclear, and mitochondrial compartments. TP53 engages functionally with MDM2 and MDM4 among other interactors, exhibiting pronounced expression within female reproductive tissues such as the cervix and ovary. Notably, its expression proved markedly elevated in healthy villous tissues (encompassing cytotrophoblast and chorionic cavity cells) relative to decidual counterparts. Single-cell interrogation further substantiated prominent TP53 expression within migratory extravillous trophoblasts, extravillous trophoblast populations, and endometrial vascular endothelial cells. Ex vivo investigations demonstrated that PFOA and PFOS exposure markedly suppressed HTR8/Svneo cell proliferation while promoting programmed cell death, concomitantly attenuating TP53 protein abundance. Computational molecular docking corroborated favorable binding energetics between both perfluorinated compounds and the TP53 protein. Collectively, these observations furnish novel mechanistic perspectives on PFAS-driven RM pathogenesis, highlighting TP53 as a promising molecular marker for environmentally triggered RM. Also, this study is limited by its in vitro nature, the use of a single SV40-immortalized trophoblast cell line, and the absence of primary human trophoblast or organoid validation.