Independent Risk Factors for Placental Abruption in Preeclampsia and a Preliminary Prediction Model: A Retrospective Study with Internal Validation.

Objective: To identify independent risk factors for placental abruption (PA) in preeclamptic (PE) women and to develop a preliminary predictive tool based on routinely available clinical indicators. Methods: This single-center retrospective cohort study included 51 PE women with PA and 357 PE women without PA (control group) admitted between August 2020 and January 2025. Independent risk factors were identified using univariate and multivariable logistic regression. A nomogram was constructed. Internal validation was performed using bootstrap resampling. Results: Systolic blood pressure (SBP), placental growth factor (PLGF), fibrinogen (FIB), and aspartate aminotransferase (AST) were independent risk factors (SBP: OR = 1.064, 95% CI: 1.035-1.095; PLGF: OR = 0.967, 95% CI: 0.953-0.979; FIB: OR = 0.435, 95% CI: 0.294-0.625; AST: OR = 1.060, 95% CI: 1.025-1.097; all P < 0.01). The combined model achieved an AUC of 0.888 (95% CI: 0.833-0.944), with a sensitivity of 88.2% and specificity of 80.1%. The bootstrap-corrected AUC was 0.885. An exploratory risk stratification based on PLGF and FIB classified patients into low- (0.7%), moderate- (9.1%), and high-risk (45.2%) groups (P for trend < 0.001). Conclusion: The preliminary four-factor predictive tool shows promising internal performance. However, due to the lack of external validation and modest sample size, these findings are hypothesis-generating. External validation in large, multicenter prospective cohorts is required before clinical application.