Abstract
Objective: The aim of this study was to develop a nomogram to predict the risk of placenta accreta in scarred uterus patients in China.Methods: We retrospectively analyzed 8,371 singleton pregnancies with scarred uterus at Shengjing Hospital, affiliated with China Medical University. Two thirds of the patients were randomly assigned to the training set (n = 5,581), and one third were assigned to the validation set (n = 2,790). Multivariate logistic regression was performed by using the training set, and the nomogram was developed. Discrimination and calibration were performed by using both the training and validation sets.Results: The multivariate logistic regression model identified number of previous cesarean section, number of vaginal bleeding, medication during pregnancy, and placenta previa as covariates associated with placenta accreta. A nomogram was developed to predict the risk of placenta accreta in the training set with a Harrell's C-index of 0.93 and 0.927 in the training set and validation set, respectively. Calibration of the nomogram predicted placenta accreta corresponding closely with the actual placenta accreta.Conclusion: We developed a nomogram predicting the risk of placenta accreta in scarred uterus patients in China. Validation using both the training set and the validation set demonstrated good discrimination and calibration, suggesting good clinical utility.
Highlights
With the introduction of the two-child policy in China, there have been increases in numbers of women with scarred uterus, who are prone to uterine rupture, postpartum hemorrhage, placenta previa, and placenta accreta (PA) [1,2,3,4,5].Placenta accreta refers to abnormal adherence of placental chorionic villi to the underlying myometrium with an absence of decidua basalis
We developed and validated a new nomogram that included number of previous cesarean section (CS), number of vaginal bleeding, medications during pregnancy, and placenta previa as covariates for estimating the risk of PA in pregnancy with scarred uterus
This can be explained by the fact that in this study, the study population was limited to scarred uterus patients who had a history of CS or myomectomy
Summary
Placenta accreta refers to abnormal adherence of placental chorionic villi to the underlying myometrium with an absence of decidua basalis. Differences in study population and diagnostic criteria may account for this wide range Another major risk factor for PA after CS is placenta previa [10, 12, 13, 16,17,18,19,20]. Several other risk factors have been reported, including cryopreserved embryo transfer, older maternal age, prior uterine surgery, parity, a higher body mass index, tobacco use, coexisting hypertension or diabetes, elevated second-trimester levels of α-fetoprotein and β-human chorionic gonadotropin, and a previous retained placenta or PA [16, 18,19,20,21]
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