Background: The prevalence of both placenta previa and cesarean are on the rise. Multiple adverse outcomes are critically increased when placenta previa is subsequent to prior cesarean. The purpose of the present study is to develop a pre-surgical method for predicting adverse outcomes in pregnancy complicated with both placenta previa and prior cesarean. Methods: Clinical data was obtained from the medical history system at the First Affiliated Hospital of Sun Yat-sen University from February 2003 to December 2016. All cases with a final diagnosis of “placenta previa/low lying placenta (ICD:O44.001-105)” and “scarred uterus complicated with pregnancy (ICD: O34.200-202)” were collected and reviewed. Hysterectomy was taken as the primary outcome; and blood loss was taken as the secondary outcome. Results: Of 219 pregnant women in the final analysis, 25 received a hysterectomy following delivery, and 48 had blood loss exceeding 1000 ml. Pre-surgical risk factors for hysterectomy are ultrasonic signs of vascular lacunae, central placenta previa, and loss of normal hypoechoic retroplacental zone. A pre-surgical predictive equation referred to as “Hysterectomy Index in Placenta Previa with Prior cesarean (HIPs)” was generated and each risk factor was weighted to create an 8-point scale. This index yielded an area under the curve of 0.972 for the prediction of hysterectomy. Conclusions: Application of the HIPs score may provide an effective pre-surgical prediction of cesarean hysterectomy in pregnant women complicated with both placenta previa and prior cesarean.

Early pregnancy is a critical window for metabolic adaptation, marked by coordinated regulation of glucose and lipid metabolism. Disruption of this balance may contribute to gestational diabetes mellitus (GDM), a condition increasingly recognized as metabolically heterogeneous. Whether early-pregnancy glucose-lipid indices capture this heterogeneity and extend to hypertensive disorders of pregnancy (HDP) remains unclear. This retrospective multicenter cohort included 13,419 pregnancies (11,765 singleton and 1,654 twin pregnancies). Fasting glucose and lipid measurements obtained at 5-16 weeks of gestation were used to derive eight composite indices, including the triglyceride-glucose (TyG) index, TyG-BMI, METS-IR, SPISE, AIP, CHG, NHHR, and lnRC. Multinomial logistic regression evaluated associations with GDM subtypes (post-load, isolated fasting, and combined GDM), using normoglycemia as the reference. Extension analyses assessed GDM-HDP phenotypes (GDM-only, HDP-only, and combined GDM-HDP) relative to normoglycemic-normotensive pregnancies. Restricted cubic spline models examined dose-response relationships, and receiver operating characteristic analyses assessed discriminative performance. Early-pregnancy glucose-lipid indices showed a clear gradient across GDM subtypes, with progressively stronger associations from post-load GDM to isolated fasting GDM and combined GDM; adjusted odds ratios (ORs) per unit increase in TyG index were 2.54, 6.21, and 8.91, respectively. When analyses were extended to hypertensive outcomes, the strongest association was observed for combined GDM-HDP (adjusted OR, 4.81; 95% confidence interval, 3.35-6.89). Significant interaction with prepregnancy overweight status was observed for TyG-BMI, with more pronounced heterogeneity across HDP-related phenotypes, whereas associations were directionally similar across singleton and twin pregnancies after accounting for center composition. For the highest-risk phenotypes, area under the curve (AUC) values were 0.786 for combined GDM (TyG index and TyG-BMI) and 0.811 for combined GDM-HDP (TyG-BMI). A significant interaction between fasting glucose and high-density lipoprotein cholesterol was detected for both combined GDM (interaction OR 3.61) and combined GDM-HDP (interaction OR 3.79). Early-pregnancy glucose-lipid indices are associated with a graded pattern of metabolic heterogeneity across GDM subtypes, and a similar pattern is observed for hypertensive comorbidity. These findings are consistent with shared metabolic perturbations underlying glycemic and vascular complications during pregnancy and may inform future approaches to early-pregnancy risk assessment.