Evaluation of risk factors in wound dehiscence following caesarean section in sir salimullah medical college & Mitford hospital

Context: The caesarean section rate is at rising trend. The prevalence of caesarean section currently in SSMC&MH is 49.72% (Statistics 2018). Wound dehiscence rate is quite high. The risk factors contributing to wound dehiscence in not known. There are limited numbers of studies in this field and literature available is also scanty. The present study attempts to determine the prevalence of different risk factors associated with surgical wound dehiscence in post Caesarean Section patients. Thus, this study is attempted. Objectives: To evaluate the different risk factors contributing to wound dehiscence following Caesarean section in Sir Salimullah Medical College & Mitford Hospital.Results: This study was a case control study enrolling 100 female patients in total who underwent caesarean section and 50 patients in each of case and control groups. The mean age was 25.20 (±1.83) years. Most of the patients (76) were Muslim. The mean weight was 68 (±2.43) kg, mean height was 150.02 (±4.32) cm, and mean BMI was 32.30 (±1.83) for all patients. BMI was 34.56 (±2.34) kg/m2, which was much greater than 31.78 (±2.11) kg/m2 in case groups. The difference was statistically significant (p=0.043). Most of the patients came from urban (40). Most of the patients were primi-para (52). Among the patients, 22 had history of prior Caesarean section. None had HIV serology positive. Anemia was the most common medical disorder present in 32 patients followed by hypertension (12) and diabetes (11). Most of the patients (56) had irregular antenatal visits, among them 36 were cases and 20 were in control groups. Regularity of antenatal visits was associated with development of wound dehiscence (p=0.043). Prior Caesarean section was also associated with development of wound dehiscence (p=0.033). Those who had prior Caesarean section had 1.5 (1.1-2.7) times higher odd of developing wound dehiscence. Intrapartum steroid use was also associated with development of wound dehiscence (p=0.027). Those who had history of intrapartum steroid use had 2.7 (2.0-4.9) times higher odd of developing wound dehiscence. In our study, commonest recorded indications for CS were: previous CS (28), fetal distress (18), cephalo-pelvic disproportion (12), prolonged obstructed labor (9). The most common organism was S. aureus (15) followed by Klebsiella pneumoniae (11) and then E. coli (9) and Pseudomonas aeruginosa(3).Conclusion: Increased BMI, irregularity of antenatal visits, prior Caesarean section, intrapartum steroid use were the risk factors associated with development of wound dehiscence.