Predicting the Risk of Cesarean Hysterectomy in the Management of Placenta Accreta Spectrum Disorders: A New Model Based on Clinical Findings and Ultrasonography

Purpose To develop a nomogram that can predict the probability of cesarean hysterectomy in patients for operation due to placenta accreta spectrum disorders(PASD). Methods Data from 520 patients who underwent surgery with a preliminary diagnosis of PASD at a tertiary center in eastern Turkey between 2013 and 2023 were recorded, and 302 were included in the study. A prediction model was developed using Penalized Maximum Likelihood Estimation (PMLE) regression analysis with clinical evaluation and ultrasonography findings as variables. Results The multivariate PMLE regression model included demographic data such as advanced age (aOR: 1.22, 95% CI: 1.08–1.44, p = 0.001), prior uterine surgeries (aOR: 3.18, 95% CI: 1.57–8.29, p = 0.001) were associated with an increased likelihood of cesarean hysterectomy. Regarding ultrasonographic findings, the multiple lacunaes (aOR: 48.53, 95% CI: 18.42–257.40, p < 0.001) and irregularity in the interface between the bladder and uterine serosa or signs of hypervascularization with Doppler Flow (aOR: 7.90, 95% CI: 2.66–35.12, p < 0.001) significantly increased the probability of hysterectomy. A retro-placental myometrial thickness of < 1mm showed borderline significance (aOR: 2.49, 95% CI: 0.89–8.27, p = 0.08). An anterior placental location (aOR: 9.60, 95% CI: 2.96–50.76, p < 0.001) increased the probability of hysterectomy, whereas advanced gestational age showed a negative correlation (OR: 0.78, 95% CI: 0.56–1.02, p = 0.07). The model's performance, evaluated using Harrell’s C-Index, was 0.974, and the Kappa Value was 0.819. Conclusion A nomogram predicting the probability of cesarean hysterectomy in the management of PASD patients has been developed, incorporating advanced age, gestational age, number of uterine surgeries, ultrasound findings, and placental location.