Thromboelastography combined with conventional coagulation parameters for developing a nomogram model to predict postpartum hemorrhage risk: A retrospective analysis

Abstract

Objectives: To construct a quantitative nomogram for predicting the risk of PPH in parturients by integrating thromboelastography(TEG) with conventional coagulation parameters [prothrombin time (PT), activated partial thromboplastin time(APTT), and fibrinogen(FIB)] to provide a clinical tool for early intervention.

Methodology: A retrospective analysis was conducted on the clinical data of 500 parturients who delivered at Affiliated Hospital of Chengde Medical College between January 2021 and September 2025. Participants were divided into a PPH group (n = 85) and a non-PPH group (n = 415) based on whether PPH occurred. Collected the clinical characteristics, TEG parameters, and conventional coagulation parameters [thrombin time (TT), APTT, PT, FIB, D-dimer (D-D), and antithrombin-III (AT-III]) of the enrolled participants.

Results: There were statistically significant differences in the comparison of the number of previous abortions, history of preterm birth, previous cesarean section,prior PPH, anemia, prolonged labor, placenta previa, placental abruption, placenta accreta, coagulation index (CI), FIB, D-D, and AT-III between the non-PPH group and the PPH group (all P < 0.05). Logistic regression identified previous cesarean section,previous PPH, anemia,coagulation index (CI), D-D and AT-III as independent risk factors for PPH (all P < 0.05), whereas FIB were protective factors (all P < 0.05). The bootstrap-based internal validation (1,000 resamplings) with an optimism-corrected bias of 0.007.

Conclusion: The nomogram integrating TEG parameters with conventional coagulation parameters demonstrates excellent discrimination, calibration, and predictive accuracy for assessing PPH risk in parturients.