Objective To construct a nomogram model for predicting adverse perinatal outcomes in hypertensive disorders of pregnancy based on placental blood flow perfusion ultrasound measurements uterine artery pulsatility index (PI), umbilical artery resistance index (RI) combined with coagulation function indicators (D-dimer, thromboelastography).

Methods A total of 600 pregnant women who underwent routine prenatal examinations at Chengde Central Hospital from December 2021 to December 2024 were selected (including 382 in the gestational hypertension group and 218 in the preeclampsia group). Additionally, 600 pregnant women with normal blood pressure during pregnancy who underwent routine prenatal examinations during the same period were selected as the normal blood pressure group. Parameters such as PI, RI, D-dimer, and thromboelastography indicators ( reaction time R, kinetic time K, alpha angle α, and maximum amplitude MA ) were compared across the different groups. Logistic regression analysis was used to explore the influencing factors of pregnancy outcomes in women with gestational hypertension. R language was employed to establish a risk nomogram prediction model for adverse pregnancy outcomes. The internal performance of the prediction model was evaluated using receiver operating characteristic (ROC) curves, and the consistency between predicted and observed probabilities was assessed using calibration curves. The clinical utility of the nomogram model was evaluated using clinical decision curve analysis.

Results Compared with the normotensive pregnancy group, the preeclampsia and gestational hypertension groups had higher levels of D-dimer, α, MA, PI, and RI, and lower levels of R and K, with all differences being statistically significant (all P ＜ 0.05). Among 600 pregnant women with hypertensive disorders in pregnancy, 176 (29.4%) experienced adverse pregnancy outcomes, including 16 cases of fetal distress (9.1%), 24 cases of fetal growth restriction (13.6%), 10 cases of postpartum hemorrhage (5.7%), 60 cases of preterm birth (34.1%), 18 cases of oligohydramnios (10.2%), and 38 cases of low birth weight (21.6%). Compared with the group without adverse pregnancy outcomes, the adverse pregnancy outcome group had higher serum levels of D-dimer, α, MA, PI, and RI, and lower levels of R and K, with all differences being statistically significant (all P＜0.05). Multivariate logistic regression analysis showed that PI (OR = 1.416, 95%CI: 1.047–1.915), RI (OR = 1.988, 95%CI:1.204–3.283), D-dimer (OR = 2.113, 95%CI: 1.284–3.476), R (OR = 0.614, 95%CI: 0.410–0.920), K (OR = 0.655, 95%CI: 0.475–0.903), α (OR = 1.097, 95%CI: 1.011–1.192), and MA (OR = 1.100, 95%CI: 1.023–1.182) were influencing factors for adverse perinatal outcomes in pregnant women (all P ＜ 0.05). The area under the ROC curve of the nomogram model for predicting adverse perinatal outcomes in gestational hypertension was 0.85 (95%CI: 0.77–0.89), with a sensitivity of 83%, a specificity of 80%, and a Youden index of 0.61, indicating good discriminative ability. The calibration curve results for predicting adverse perinatal outcomes in gestational hypertension showed that the predicted probabilities were consistent with the observed probabilities. The Hosmer-Lemeshow test yielded χ² = 3.124 and P = 0.879. Decision curve analysis results indicated that the model had good discriminative ability within a threshold probability range of 0.10–0.85.

Conclusion This study developed a nomogram risk prediction model for adverse perinatal outcomes in patients with gestational hypertension, based on placental blood perfusion ultrasound detection combined with coagulation function indicators. The model demonstrated good discrimination and calibration.