ORIGINAL RESEARCH article
Front. Surg.
Sec. Obstetrics and Gynecological Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1524507
This article is part of the Research TopicTransforming Surgical Care in the Global South: Enhancing Quality and AccessibilityView all 4 articles
Avoidable severe morbidity from wound dehiscence after caesarean section. Practice and experience from a tertiary referral hospital in low-income setting, Tanzania - A mixed methods study
Provisionally accepted
- 1Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- 2Department of Women's and Children's Health, Uppsala University, Uppsala, Uppsala, Sweden
- 3Department of Anaesthesia, Muhimbili National Hospital, Dar es Salaam, Tanzania
- 4Department of Obstetrics and Gynaecology, St. Joseph Uniersity Colleges of Health and Alied Sciences, Dar es Salaam, Tanzania
- 5School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Introduction: The study aimed to determine care related risk factors, and explore women’s and care providers’ perspective towards complete wound dehiscence after caesarean section at a tertiary referral and university hospital. Methods: A mixed-methods study was conducted at Muhimbili National Hospital in Dar es Salaam from April 2019 to December 2020. A case control survey compared characteristics of interest of 131 cases of complete wound dehiscence to 393 randomly selected controls comprising of caesarean deliveries from January 2015 to December 2020. Additionally, six semi structured individual in-depth interviews with women, one focus group discussion with care providers, and unstructured direct observations were also performed from July to December 2020. Pearson’s Chi-square test and Fischer’s exact test were used to determine the percentage difference of risk factors of complete wound dehiscence between cases and controls. Thereafter, multivariate regression analysis determined the role of the independent risk factors. Thematic analysis was used to describe qualitative data. Results: Out of 524 women (133 cases and 393 controls), three quarters were delivered by obstetric registrars and residents. Cases of complete wound dehiscence were more likely from caesarean deliveries performed by junior resident (Odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-5.4). Wound failure was characterized by complete wound dehiscence with intact sutures (70%) on loosely binding wound margins (62%) or avulsed from the fascial layers (38%). Women’s and care provider’s perspective was categorized into four themes: wound dehiscence as an indicator of quality of care; effectiveness of clinical skill transfer and team work; maternal fear, stress and socio-economic burden; and reputed external factors influencing care. Conclusion: Complete wound dehiscence after caesarean section was highly associated with suboptimal surgical technique, ineffective structure and process of clinical skills transfer and negative experience of care from patients and their families. The identified care related gaps in the quality of CS stemmed from modifiable clinical and educational practices.
Keywords: Caesarean Section, wound dehiscence, surgical skills transfer, perinatal experiences, Developingcountries
Received: 10 Mar 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Mgaya, Samuel, Mhando, Kimwela and Mgaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Andrew Mgaya, Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
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