ArticleBMC pregnancy and childbirth2026
Preoperative risk score for invasive uterus-sparing hemostasis at cesarean delivery: a retrospective cohort study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTo develop a simple preoperative risk score identifying women requiring invasive hemostatic interventions during cesarean delivery.
methodsThis retrospective cohort included women undergoing cesarean delivery at a Hainan maternity hospital. The primary outcome was intraoperative use of intrauterine balloon tamponade and/or uterine artery ligation. Continuous variables were compared using Student's t test or Mann-Whitney U test, and categorical variables using chi-square or Fisher's exact test. Multivariable logistic regression identified independent risk factors, which were translated into an integer-based risk score. Model performance was assessed using discrimination and calibration metrics. Women were classified into three risk categories. For each risk group, mean scores were calculated and radar-chart personas was created.
resultsAmong 8,687 cesarean deliveries, 386 (4.44%) required invasive hemostatic interventions. These women had greater blood loss, larger hemoglobin declines, higher transfusion rates, and more frequent peripartum hysterectomy. Independent predictors included placenta previa, low-lying placenta, severe preoperative anemia, prior postpartum hemorrhage, multiple gestation, preeclampsia, large leiomyoma, chorioamnionitis, and low platelet count. Based on these factors, we derived a preoperative risk score demonstrated good discrimination (AUC 0.7642, 95% CI: 0.7430-0.8305). The estimated probability of invasive hemostasis increased from about 2% in the low-risk group to (2.80 ~ 5.84)% in the medium-risk group and approximately 8% in the high-risk group. Although comprising only 8.28% of the cohort, the high-risk group accounted for 44% of all procedures.
conclusionsA simple preoperative risk score using routinely available variables can stratify the likelihood of invasive uterus-sparing hemostatic interventions during cesarean delivery and may help optimize perioperative preparedness.
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