Predictive model for perioperative blood transfusion risk in patients with scarred uterus during pregnancy undergoing cesarean section
10.13303/j.cjbt.issn.1004-549x.2026.04.012
- VernacularTitle:妊娠合并瘢痕子宫剖宫产患者围术期输血风险预测模型
- Author:
Yurong CHEN
1
;
Yan XING
1
;
Na WANG
1
;
Xia QI
1
;
Yining ZHANG
1
;
Ying CUI
1
Author Information
1. Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
- Publication Type:Journal Article
- Keywords:
pregnancy with scarred uterus;
cesarean section;
perioperative period;
blood transfusion
- From:
Chinese Journal of Blood Transfusion
2026;39(4):501-505
- CountryChina
- Language:Chinese
-
Abstract:
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 evidence for preoperative assessment and blood management. Methods: Clinical data of 405 patients undergoing cesarean section for scarred uterus during pregnancy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to December 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 analysis to identify independent factors influencing perioperative blood transfusion and construct a predictive model. Model performance 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 independent 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 operating characteristic curves of 0.803 (95%CI: 0.740-0.867) and 0.753 (95%CI: 0.644-0.862) in the training and validation sets, respectively. Conclusion: For patients with scarred uterus during pregnancy undergoing cesarean section, severe 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 identification of patients requiring transfusion, thereby enabling preoperative blood preparation and optimized blood management.
