Predictors of blood product transfusion in placental abruption with low neonatal apgar scores: A retrospective cohort study

Placental abruption accompanied by low neonatal Apgar scores represents a clinically important subgroup with a potential maternal hemorrhagic risk. Evidence remains limited regarding the factors associated with blood product transfusions in these patients. This study aimed to identify clinical and laboratory factors associated with transfusion in women with placental abruption and low neonatal Apgar scores and to develop an exploratory prediction model. This retrospective cohort study included women with confirmed placental abruption who delivered at the Fujian Maternity and Child Health Hospital between January 2013 and July 2023. Eligible patients had singleton pregnancies at ≥ 28 weeks of gestation and live-born neonates with 1-minute Apgar scores ≤ 7. Clinical characteristics, laboratory findings, neonatal outcomes, and blood product use were extracted from the electronic medical records. Candidate predictors were evaluated using univariate logistic regression, least absolute shrinkage and selection operator logistic regression, and multivariable logistic regression. A nomogram was developed from the final model and assessed using receiver operating characteristic curve analysis, calibration assessment, 1000 bootstrap resamples, Brier score, and decision curve analysis. Among the 140 women, 32 received blood product transfusions (22.9%). Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0g/L, and lower hemoglobin level were independently associated with transfusion. The nomogram showed good apparent discrimination, with an apparent area under the curve of 0.928 (95% confidence interval: 0.884-0.972). After bootstrap internal validation, the optimism-corrected area under the curve is 0.912. The bootstrap-corrected calibration slope was 0.869 and the Brier score was 0.086. Decision curve analysis suggests a potential net clinical benefit. Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0 g/L, and lower hemoglobin level were associated with blood product transfusion in women with placental abruption and low 1-minute neonatal Apgar scores. This exploratory nomogram may support early peripartum risk stratification and transfusion preparedness.