Predicting the risk of cesarean hysterectomy in the management of placenta accreta spectrum disorders: a new model based on clinical findings and ultrasonography

To develop a nomogram to predict the probability of cesarean hysterectomy (CH) in placenta accreta spectrum disorders (PASD) patients. Data from 520 patients who underwent surgery with a preliminary diagnosis of PASD at a tertiary center in southeast Turkey between 2013 and 2023 were collected, and 302 patients were included in the study. A predictive model based on clinical and ultrasonographic variables was developed using penalized maximum likelihood estimation (PMLE) regression analysis. Maternal age (aOR = 1.22, 95% CI 1.08-1.44, p = 0.001) and prior uterine surgeries (aOR = 3.18, 95% CI 1.57-8.29, p = 0.001) were identified as demographic factors with an increased likelihood of CH in the nomogram, and advanced gestational weeks demonstrated a negative correlation (aOR: 0.78, 95% CI 0.56-1.02, p = 0.07). Regarding the ultrasonographic findings, the presence of the "multiple lacunae within the placenta" (aOR = 48.53, 95% CI 18.42-257.40, p