High-Risk Factors for Surgical Complications for Retained Products of Conception and Development of a Reproductive Prognosis Model
LI Minmin
ZHANG Li
WU Fengyi
HAN Sitian
LI Canyu
Abstract：Objective To investigate the high-risk factors associated postoperative complications in the surgical treatment of retained products of conception(RPOC),and to develop a predictive model for reproductive prognosis.Methods The data of 207 cases who underwent RPOC surgery in the Third Affiliated Hospital of Zhengzhou University from February 2016 to May 2023 were retrospectively collected.The patients were followed up for 0.5 to 3.5 years.Based on the presence or absence of postoperative complications,all patients were divided into a no-complication group and a complication group,based on whether they conceived after surgery.All patients were divided into a pregnancy group and a non-pregnancy group.By performing univariate and multivariate logistic regression analyses,as well as LASSO regression analysis,independent risk factors for postoperative complications were identified,and factors for developing a predictive model for postoperative reproductive outcomes were determined.The constructed predictive model was statistically evaluated and clinically assessed using receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Multivariate logistic regression analysis revealed that deep myometrial implantation of gestational tissue and a history of≥4 uterine cavity procedures were independent risk factors for postoperative complications(P＜0.05).High levels of natural logarithm of humanchorionic gonadotrophin(lnHCG),deep myometrial implantation of gestational tissue,age ≥35 years,and postoperative intrauterine adhesions were independent risk factors for postoperative infertility(P＜0.05).A nomogram-based clinical prediction model based on lnHCG,implantation depth of gestational tissue,age,and postoperative intrauterine adhesion had demonstrated a good predictive value(area under the curve＞0.7 in both the training and validation sets),as well as good calibration and clinical benefit.Conclusion Prior to the operation of RPOC,the complications of the operation should be evaluated according to the factors such as the patient's age,HCG levels,depth of myometrial implantation,and history of uterine procedures.Appropriate preoperative management should be implemented to minimize surgical complications.Additionally,reproductive outcomes can be assessed using a nomogram prediction model to guide clinical decision-making.
Keywords：retained products of conceptionpostoperative complicationclinical prediction modelnomogramreproductive outcomes
Publication Date：2025-05-13
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：7( 1556-1562 )