A Nomogram Based on Ultrasound Features for Predicting Major Intra-Operative Hemorrhage in Patients With Placenta...

Area of Science:

• Maternal-Fetal Medicine
• Diagnostic Imaging
• Surgical Risk Prediction

Background:

• Placenta accreta spectrum (PAS) poses significant risks of major intra-operative hemorrhage.
• Accurate prediction of hemorrhage is crucial for effective perioperative management.
• Ultrasound features offer potential for pre-operative risk stratification.

Purpose of the Study:

• To develop and validate a predictive nomogram for major intra-operative hemorrhage in PAS patients.
• To utilize pre-operative ultrasound findings for hemorrhage risk assessment.
• To guide clinical decision-making in PAS management.

Main Methods:

• Retrospective cohort study of 196 PAS patients with pre-operative ultrasound.
• Random allocation to training (70%) and validation (30%) cohorts.
• Logistic regression identified predictors; nomogram developed and validated using ROC curves, calibration curves, and DCA.

Main Results:

• Four independent predictors identified: placental lacunae feeder vessels, sub-placental hypervascularity/bridging vessels, intra-cervical lakes, and incomplete cervical morphology.
• Nomogram showed good discriminative capacity (AUC 0.877 training, 0.851 validation).
• Model demonstrated good calibration and clinical utility via DCA.

Conclusions:

• A robust and clinically applicable nomogram for predicting intra-operative hemorrhage in PAS was developed and validated.
• The nomogram provides actionable insights for perioperative decision-making.
• This tool enhances hemorrhage prevention and management strategies in PAS.