Title : Analysis of risk factors and development of a predictive model for placental abruption-a single-center retrospective study
Abstract:
Background and objective: Placental abruption (PA) causes numerous neonatal and maternal complications and increases their mortality. However, PA might occur asymptomatically, and the diagnosis was made only when fresh or long-standing clots were detected on placental examination, or during cesarean section or delivery of the placenta. Therefore, early recognition of PA is particularly important. The aim of this study was to identify risk factors for PA and to construct a predictive model for PA in order to facilitate early identification of patients with PA.
Methods: This retrospective study included 5181 pregnancies delivered from January 2013 to December 2023 in XX hospital. Pregnancies with combined placenta praevia, multiple pregnancies and fetal anomalies were excluded. There were 50 cases of PA (0.97%) and 5131 cases without placental abruption (99.03%). General and treatment-related information of patients was collected. Univariate and multivariate logistic regression was used to correct for potential confounding variables and to identify independent risk factors for placenta abruption. A prediction model was constructed based on the independent risk factors, and the predictive efficacy of the prediction model was validated by the area under the ROC curve and the clinical decision curve.
Results: Independent risk factors for PA included preterm premature rupture of membranes (adjusted OR=6.4; 95% CI=4.9-9.4), gestational hypertension (adjusted OR=6.3; 95% CI=4.1-9.2), preeclampsia (adjusted OR=1.9; 95% CI=1.1-2.6), smoking during pregnancy (adjusted OR=8.4; 95% CI=3.0-14.1), oligohydramnios in pregnancy (adjusted OR=4.7; 95% CI=2.9-6.1), and polyhydramnios in pregnancy (adjusted OR=3.3; 95% CI=1.4-7.7). A risk prediction model for PA was constructed by independent risk factors. The ROC curve of the prediction model suggested a good discrimination of the outcome (AUC = 0.878, 95% CI 0.814 ~ 0.926). the DCA curve demonstrated that the prediction map had a good clinical application.
Conclusion: Risk factors for placental abruption include preterm labor with premature rupture of membranes, gestational hypertension, preeclampsia, smoking during pregnancy, hyponatremia in pregnancy, and polyhydramnios in pregnancy. We can improve the prognosis of high-risk pregnancies by early identification of placental abruption through nomogram and appropriate monitoring or treatment.
Keywords: Placental abruption; early identification; pregnancy; risk factor.
