Study on the Influencing Factors of Severe Postpartum Hemorrhage in Pa-tients with Placenta Accreta Spectrum Disorders and the Predictive Effica-cy of Prediction Models

ZHANG Jingxiao; ZHANG Zhimin; ZHANG Jiaying; YIN Xin; ZHANG Jiajia; CAO Cuiying

doi:10.3969/j.issn.1002-3429.2025.10.013

Abstract：Objective To explore the influencing factors of severe postpartum hemorrhage in patients with placenta accreta spectrum disorders(PAS)and the predictive efficacy of the prediction model based on the influencing factors.Meth-ods The data of 164 patients with PAS admitted to our hospital from January 2022 to January 2024 were retrospectively ana-lyzed.According to the occurrence of severe postpartum hemorrhage(bleeding volume≥1000 mL within 24 h following birth),they were divided into hemorrhage group(n=76,with severe postpartum hemorrhage)and non-hemorrhage group(n=88,without severe postpartum hemorrhage).The general data of the two groups were analyzed by univariate analysis.Bi-nary logistic regression was used to analyze the related factors of severe postpartum hemorrhage in patients with PAS,and a prediction model was constructed,to evaluate its predictive efficacy.Results The type of placenta previa(central type),the relationship between the placenta and myometrium(penetrating implantation),the boundary between the lower segment of the uterus and the placenta(unclear),the hyperechoic decidual interface between the uterine wall and the placenta(disappear-ance),and uterine contraction fatigue were all risk factors for severe postpartum hemorrhage in patients with PAS,while he-moglobin(≥110 g/L)on admission was a protective factor(P＜0.05,P＜0.01).The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the prediction model constructed according to the above influencing factors for severe postpartum hemorrhage in patients with PAS was 0.931(95%CI:0.894,0.968),the sensitivi-ty was 78.9%and the specificity was 93.2%.Conclusion The type of placenta previa(central type),the relationship be-tween the placenta and uterine muscle wall(penetrating implantation),the boundary between the lower segment of the uterine muscle layer and the placenta(unclear),the hyperechoic decidual interface between the uterine wall and the placenta(disap-pearance),uterine contraction fatigue,and hemoglobin on admission(≥110 g/L)are all the influencing factors of severe postpartum hemorrhage in patients with PAS.The prediction model constructed based on the above factors has good predictive value.