Risk factors for postpartum hemorrhage after pregnancy termination for fetal malformations: a retrospective study and internally validated prediction model

This study aims to elucidate the risk factors contributing to postpartum hemorrhage (PPH) in women undergoing pregnancy termination due to fetal malformations and to construct a predictive model. A retrospective study of 268 women after termination for fetal malformations was conducted. Logistic regression identified risk factors for postpartum hemorrhage, and a nomogram was constructed. Model discrimination, calibration, and goodness of fit were evaluated using the AUC, Hosmer–Lemeshow test, and 1,000 bootstrap resampling iterations. Gravidity, placental adhesion/retention, history of uterine surgery, pregnancy-induced hypertension, and uterine atony were identified as independent risk factors for PPH in women undergoing termination for fetal malformations ( P < 0.05). The predictive model demonstrated an overall accuracy of 89.55% (95% CI 85.31–92.67%), with a sensitivity of 37.14% (95% CI 23.17–53.66%), specificity of 97.42% (95% CI 94.50–98.81%), positive predictive value of 68.42% (95% CI 46.01–84.64%), and negative predictive value of 91.16% (95% CI 86.99–94.09%). The discriminative ability of the model was evaluated using the ROC curve, yielding an AUC of 0.8445 (95% CI 0.7731–0.9158, P < 0.0001). Our proposed model may help identify a subset of women at increased risk of PPH after termination for fetal malformations and support clinical preparedness following internal validation. Further validation in independent cohorts is needed before broader clinical application.