Predictive value and risk factors of embryo implantation site for placenta previa

KUANG Na; HE Wenjiao; XIONG Xi; CHEN Zhengqiong

doi:10.16016/j.2097-0927.202504006

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Predictive value and risk factors of embryo implantation site for placenta previa

Clinical Medicine | 更新时间：2025-07-25

- Predictive value and risk factors of embryo implantation site for placenta previa
- Journal of Army Medical University Vol. 47, Issue 14, Pages: 1670-1675(2025)
- 作者机构：
  
  陆军军医大学（第三军医大学）第二附属医院妇产科，重庆
- 作者简介：
  
  CHEN Zhengqiong， E-mail： chenzhengqiong75@163.com
- 基金信息：
  
  the Key Project of Technological Innovation and Application Development of Chongqing(CSTB2022TIAD-KPX0182)
- DOI：10.16016/j.2097-0927.202504006
  CLC： R181.23;R321.3;R714.56
- Received：07 April 2025，
  
  Revised：15 June 2025，
  
  Published：30 July 2025
- 稿件说明：
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况娜，何文娇，熊希，等.胚胎着床位置对前置胎盘的预测价值及相关影响因素分析［J］.陆军军医大学学报，2025，47（14）：1670-1675.DOI：10.16016/j.2097-0927.202504006.

KUANG N，HE W J，XIONG X，et al.Predictive value and risk factors of embryo implantation site for placenta previa［J］.J Army Med Univ，2025，47（14）：1670-1675.DOI：10.16016/j.2097-0927.202504006.
况娜，何文娇，熊希，等.胚胎着床位置对前置胎盘的预测价值及相关影响因素分析［J］.陆军军医大学学报，2025，47（14）：1670-1675.DOI：10.16016/j.2097-0927.202504006. DOI：

KUANG N，HE W J，XIONG X，et al.Predictive value and risk factors of embryo implantation site for placenta previa［J］.J Army Med Univ，2025，47（14）：1670-1675.DOI：10.16016/j.2097-0927.202504006. DOI：

摘要

目的

通过分析胚胎着床位置及相关临床因素，建立早孕期前置胎盘预测模型，为临床早期识别高风险人群提供客观依据。

方法

采用回顾性队列研究设计，纳入2020年9月至2024年3月于陆军军医大学第二附属医院分娩的232例单胎妊娠孕妇。根据分娩前末次超声检查结果分为前置胎盘组（

=78）和非前置胎盘组（

=154）。通过电子病历系统收集：①超声参数：孕囊下缘至宫颈内口距离、胚胎着床上下位置（下段/中上段）、胚胎着床前后位置（后壁/前壁）；②临床资料：年龄、孕次、产次、宫腔操作史等。采用单因素分析（

0.1）筛选潜在预测因素，通过多因素Logistic回归（

0.05）确定独立危险因素，并基于回归结果构建列线图预测模型。通过Bootstrap法（1 000次重采样）进行内部验证，采用受试者工作特征曲线下面积（AUC）和Hosmer-Lemeshow检验评估模型性能。

结果

通过单因素分析显示，前置胎盘组在高龄（≥35岁）、低学历（高中及以下）、多孕次（≥2次）、多产次（≥2次）、宫腔操作史、孕囊下缘距宫颈内口

5.5 mm及胚胎着床下段的比例高于非前置胎盘组（

0.1）；而胚胎着床后壁、剖宫产史和ART组间差异无统计学意义（

0.1）。多因素Logistic回归分析进一步证实，胚胎着床于下段（

=40.40，95%

：14.68~136.19，

0.001）、着床于后壁（

=2.73，95%

：1.27~6.28，

=0.013）和宫腔操作史（

=3.48，95%

：1.65~7.70，

=0.001）是前置胎盘的独立危险因素。基于这些因素构建的预测模型具有较高的区分度（AUC=0.84，95%

：0.79~0.90）和良好的校准度（Hosmer-Lemeshow检验，χ²=3.455，

=0.750）。

结论

胚胎着床于下段、着床于后壁和宫腔操作史是前置胎盘的独立危险因素。基于这些因素构建的列线图模型具有良好的预测效能，可为临床早期识别前置胎盘高风险孕妇提供参考。

Abstract

Objective‍　‍To develop a prediction model for placenta previa in early pregnancy by analyzing embryo implantation sites and related clinical factors

in order to provide an objective basis for early risk identification. Methods‍　‍A retrospective cohort study was conducted on 232 singleton pregnant women delivering

in our hospital between September 2020 and March 2024. According to the final pre-delivery ultrasound findings

they were divided into placenta previa group (

=78) and a non-placenta previa group (

=154). Their ultrasound parameters [distance from lower gestational sac margin to cervical os

implantation site (lower/middle-upper uterine segment)

and implantation position (anterior/posterior wall)

]

and clinical data [age

gravidity (categorized as

2 or ≥2 pregnancies)

parity (

2 or ≥2 deliveries)

and history of intrauterine procedures were collected through electronic medical records. Univariate analysis was used to screen potential predictors (

0.1)

and multivariate logistic regression analysis was employed to identify the predictors (

0.05) for placenta previa. Then a nomogram prediction model was constructed

which was internally validated with Bootstrap (1 000 bootstrap resamples) and assessed for discrimination with area under the receiver operating characteristic curve (AUC) and for calibration with Hosmer-Lemeshow goodness-of-fit test. Results‍　‍The placenta previa group showed significantly advanced age (≥35 years)

lower education level (≤high school)

multigravidity (≥2 pregnancies)

multiparity (≥2 deliveries)

more intrauterine procedures

distance of gestational sac-to-cervical os

5.5 mm

and larger proportion of lower uterine segment implantation than the non-placenta previa group (all

0.1). But there were no statistical differences between the 2 groups in proportion of posterior wall implantation

history of cesarean section or assisted reproductive technology (ART). Multivariate logistic regression analysis confirmed lower uterine segment implantation (

=40.40

95%

: 14.68~136.19

0.001)

posterior wall implantation (

=2.73

95%

:1.27~6.28

=0.013)

and intrauterine procedures

(

=3.48

95%

: 1.65~7.70

=0.001) as independent risk factors. The model based on these predictors demonstrated excellent discrimination (AUC value=0.84

95%

: 0.79~0.90) and calibration (Hosmer-Lemeshow test

Chi

-square=3.455

=0.750). Conclusion‍　‍Lower uterine segment/posterior wall implantation and intrauterine procedures are independent risk factors for placenta previa. Our nomogram model based on these factors shows good predictive efficiency

and can provide reference for early recognition of pregnant woman with high-risk placenta previa.

关键词

Keywords

references

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