Preoperative risk score for invasive uterus-sparing hemostasis at cesarean delivery: a retrospective cohort study

To develop a simple preoperative risk score identifying women requiring invasive hemostatic interventions during cesarean delivery.

This retrospective cohort included women undergoing cesarean delivery at a Hainan maternity hospital. The primary outcome was intraoperative use of intrauterine balloon tamponade and/or uterine artery ligation. Continuous variables were compared using Student's t test or Mann-Whitney U test, and categorical variables using chi-square or Fisher's exact test. Multivariable logistic regression identified independent risk factors, which were translated into an integer-based risk score. Model performance was assessed using discrimination and calibration metrics. Women were classified into three risk categories. For each risk group, mean scores were calculated and radar-chart personas was created.

Among 8,687 cesarean deliveries, 386 (4.44%) required invasive hemostatic interventions. These women had greater blood loss, larger hemoglobin declines, higher transfusion rates, and more frequent peripartum hysterectomy. Independent predictors included placenta previa, low-lying placenta, severe preoperative anemia, prior postpartum hemorrhage, multiple gestation, preeclampsia, large leiomyoma, chorioamnionitis, and low platelet count. Based on these factors, we derived a preoperative risk score demonstrated good discrimination (AUC 0.7642, 95% CI: 0.7430-0.8305). The estimated probability of invasive hemostasis increased from about 2% in the low-risk group to (2.80 ~ 5.84)% in the medium-risk group and approximately 8% in the high-risk group. Although comprising only 8.28% of the cohort, the high-risk group accounted for 44% of all procedures.

A simple preoperative risk score using routinely available variables can stratify the likelihood of invasive uterus-sparing hemostatic interventions during cesarean delivery and may help optimize perioperative preparedness.