Burst abdomen: a preventable risk of severe maternal morbidity in a developing country (a case-control study at a university teaching hospital in Tanzania).

ABSTRACT

Introduction: burst abdomen is a preventable complication of caesarean section that carries an increased risk of maternal death, especially in developing countries including Tanzania. The study aimed to identify the risk factors and high-risk patients for burst abdomen at Muhimbili National Hospital in Tanzania. Methods: a case-control study was performed at Muhimbili National Hospital in Dar es Salaam from 2nd April to 27th December 2019. Characteristics of interest of one case of burst abdomen were compared to three randomly selected controls that consisted of caesarean deliveries either 24 hours before or after the time of delivery of cases. The chi-square test, Fischer´s exact test, and multivariate analysis were used. The level of significance was p < 0.05. Results: a total of 524 women that met the inclusion criteria, comprising 131 cases and 393 controls, delivered by caesarean section in the most recent pregnancy at Muhimbili National Hospital. Cases were independently associated with perioperative illness, including cough (OR 3.8, 95%CI 1.9-7.6), chorioamnionitis (OR 4.5, 95% CI 1.3-14.7), and surgical site infection (OR 3.2, 95% CI 1.7-6.4), and a vertical midline incision wound (OR 1.9, 95% CI 1.2-3.1) compared to control group. Most cases (70%) had intact sutures and loose surgical knots. Conclusion: burst abdomen remains a cause of unnecessary severe maternal morbidity and is independently associated with perioperative illnesses such as cough, chorioamnionitis surgical site infection, and a vertical midline abdominal incision. Thus, there is a need for modifying abdominal fascia closure techniques for patients at risk.