Predictive Nomogram for Intraoperative Blood Transfusion in Pernicious Placenta Previa Patients With Placenta Accrete

Background: Packed red blood cells (PRBCs) transfusion is an essential treatment in case of hemorrhage during cesarean section in pernicious placenta previa (PPP) patients with placenta accrete. However, predictive tools to assess the requirement of intraoperative PRBCs transfusion have not been widely estimated in PPP patients with placenta accrete during delivery. Methods: : We first performed a comprehensive analysis of the preoperative and intraoperative clinical data collected from 428 PPP patients with placenta accrete, and constructed a prediction model based on blood routine and coagulation parameters by LASSO regression model. Subsequently, we developed a clinically applicable nomogram that can accurately predict intraoperative PRBCs infusion and performed an internal validation of the performance of this nomogram. Results: : Among the 428 PPP patients with placenta accrete undergoing a cesarean delivery during the study period, 92 had received an intraoperative PRBCs infusion and the PRBCs transfusion rate was 21.49%. According to the results of LASSO regression analysis, RDW, WBC count, HCT, PT, aPTT and D-dimer concentration were screened to establish a predictive model. This model had a good predictive performance with AUCs of 0.841 in training cohort, 0.767 in testing cohort and 0.795 in whole cohort, respectively. In addition, the model could be served as an independent predictive factor for intraoperative PRBCs infusion. A nomogram was finally established combining clinical features and above model and revealed good predictive abilities (C-index: 0.753). Discussion: We constructed a risk stratification instrument to identify PPP patients with placenta accrete at increased risk for intraoperative PRBCs transfusion.