妊娠合并瘢痕子宫剖宫产患者围术期输血风险预测模型OA

Objective To investigate factors influencing perioperative blood transfusion in patients with scarred uterus during pregnancy undergoing cesarean section,construct and validate a transfusion risk prediction model,and provide evi-dence for preoperative assessment and blood management.Methods Clinical data of 405 patients undergoing cesarean sec-tion for scarred uterus during pregnancy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to De-cember 2024 were retrospectively collected.The dataset was randomly divided into a training set(n=284)and a validation set(n=121)at a 7∶3 ratio.Within the training set,Firth-penalized logistic regression was employed for multivariate analy-sis to identify independent factors influencing perioperative blood transfusion and construct a predictive model.Model per-formance was evaluated in the validation set.Results Multivariate Firth regression analysis showed that severe placenta previa(OR=75.566,95%CI:8.603-9979.174)and placenta accreta(OR=4.591,95%CI:1.120-19.416)were in-dependent risk factors for perioperative blood transfusion,while preoperative red blood cell count(OR=0.189,95%CI:0.083-0.405)and fibrinogen levels(OR=0.588,95%CI:0.395-0.855)were protective factors.The predictive model constructed based on these four variables demonstrated good discriminatory performance,with areas under the receiver oper-ating characteristic curves of 0.803(95%CI:0.740-0.867)and 0.753(95%CI:0.644-0.862)in the training and vali-dation sets,respectively.Conclusion For patients with scarred uterus during pregnancy undergoing cesarean section,se-vere placenta previa and placenta accreta significantly increase the risk of transfusion,while higher preoperative red blood cell count and fibrinogen levels exert a protective effect.The predictive model established in this study facilitates the identi-fication of patients requiring transfusion,thereby enabling preoperative blood preparation and optimized blood management.