OBJECTIVE: To develop a predictive model for assessing massive hemorrhage risk during dilatation and curettage (D&C) after focused ultrasound ablation surgery (FUAS) in Type 2 cesarean scar pregnancy (CSP) patients. METHODS: A retrospective analysis of 405 Type 2 CSP patients treated at Hunan Maternal and Child Health Hospital (2018-2023) was conducted. Multivariable logistic regression identified independent risk factors, and a nomogram was constructed. Model performance was evaluated using AUC, calibration curves, and decision curve analysis (DCA). Ten-fold cross-validation was performed, and external validation was conducted on 327 patients. RESULTS: Independent risk factors included gestational sac maximum diameter (OR 1.11, 95% CI: [1.07-1.15], CONCLUSION: The predictive model effectively assesses hemorrhage risk in Type 2 CSP patients post-FUAS, offering valuable clinical utility.