Predicting intraoperative blood loss during cesarean sections based on multi-modal information: a two-center study

Purpose To develop and validate a nomogram model that combines radiomics features, clinical factors, and coagulation function indexes (CFI) to predict intraoperative blood loss (IBL) during cesarean sections, and to explore its application in optimizing perioperative management and reducing maternal morbidity. Methods In this retrospective consecutive series study, a total of 346 patients who underwent magnetic resonance imaging (156 for training and 68 for internal test, center 1; 122 for external test, center 2) were included. IBL+ was defined as more than 1000 mL estimated blood loss during cesarean sections. The prediction models of IBL were developed based on machine-learning algorithms using CFI, radiomics features, and clinical factors. ROC analysis was performed to evaluate the performance for IBL diagnosis. Results The support vector machine model incorporating all three modalities achieved an AUC of 0.873 (95% CI 0.769–0.941) and a sensitivity of 1.000 (95% CI 0.846–1.000) in the internal test set, with an AUC of 0.806 (95% CI 0.725–0.872) and a sensitivity of 0.873 (95% CI 0.799–0.922) in the external test set. It was also scored significantly higher than the CFI model ( P = 0.035) on the internal test set, and both the CFI ( P = 0.002) and radiomics-CFI models ( P = 0.007) on the external test set. Additionally, the nomogram constructed based on three modalities achieved an internal testing set AUC of 0.960 (95% CI 0.806–0.999) and an external testing set AUC of 0.869 (95% CI 0.684–0.967) in the pregnant population without a pernicious placenta previa. It is noteworthy that the AUC of the proposed model did not show a statistically significant improvement compared to the Clinical-CFI model in both internal ( P = 0.115) and external test sets ( P = 0.533). Conclusion The proposed model demonstrated good performance in predicting intraoperative blood loss (IBL), exhibiting high sensitivity and robust generalizability, with potential applicability to other surgeries such as vaginal delivery and postpartum hysterectomy. However, the performance of the proposed model was not statistically significantly better than that of the Clinical-CFI model. Graphical abstract