Identification of high-risk factors and construction of a risk stratification prediction model for postpartum hemorrhage in women with scarred uterus

This retrospective single-center study aimed to identify high-risk factors for postpartum hemorrhage (PPH) in women with scarred uterus and to construct a risk stratification prediction model. Clinical data from 271 women with scarred uterus who delivered between January 2019 and January 2025 were collected. PPH was defined as blood loss >500 mL after vaginal delivery or >1000 mL after cesarean section. The above women were randomly classified into train set (n=189) and test set (n=82) at a 7:3 ratio.. Univariate analysis was applied to screen the potential risk factors, and multivariate logistic regression analysis was performed to identify independent predictors of PPH and establish a prediction model. The results showed that production times≥2, placenta accreta, and hemoglobin level were independent risk factors for PPH. A prediction model was constructed based on these variables. Receiver operating characteristic (ROC) analysis demonstrated a good discriminatory ability, with area under the curve (AUC) values exceeding 0.7 in both the train and test sets. Hosmer-Lemeshow test indicated a good model calibration degree, and decision curve analysis suggested favorable clinical utility. This model may provide a practical tool for early identification and risk stratification of PPH in women with scarred uterus.