Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study
Abstract Background Poor wound healing (PWH) are significant complications following cesarean deliveries, particularly in patients with gestational diabetes mellitus (GDM) due to hyperglycemia-induced immune dysfunction and impaired wound healing. Identifying specific risk factors is essential for d...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12893-025-03086-2 |
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| author | Yan Liu Ye Wang Shao-Hua Gao Hui Wu Chun-Yu Zhang Jia-Li Yao Pei-Xia Cai |
| author_facet | Yan Liu Ye Wang Shao-Hua Gao Hui Wu Chun-Yu Zhang Jia-Li Yao Pei-Xia Cai |
| author_sort | Yan Liu |
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| description | Abstract Background Poor wound healing (PWH) are significant complications following cesarean deliveries, particularly in patients with gestational diabetes mellitus (GDM) due to hyperglycemia-induced immune dysfunction and impaired wound healing. Identifying specific risk factors is essential for developing effective preventive strategies and improving maternal outcomes. Methods This retrospective study, conducted from January 2020 to August 2023, followed STROBE guidelines. A total of 268 GDM patients who underwent cesarean delivery were included, with 5 lost to follow-up, yielding a 98.2% follow-up rate. Patients were divided into two groups: the PWH group (n = 26) and the control group (n = 242). Comprehensive data on maternal age, gestational age, pre-pregnancy BMI, IVF-ET use, uterine scarring, surgery type (emergency vs. elective), operative time, and infections (Candida albicans and Group B Streptococcus) were collected. Statistical analyses included Chi-square, Fisher’s exact tests, and multivariate logistic regression to identify independent risk factors for PWH. Results The overall incidence of PWH was 9.7%, with the majority being superficial infections, including suture reactions (38.5%), bleeding and exudation (30.8%), abscesses (15.4%), and fat liquefaction (11.5%). Deep infections were rare, with only 3.8% presenting as endometritis and no cases of pelvic abscess. Multivariate logistic regression identified the following significant independent risk factors for PWH: premature rupture of membranes (OR = 10.88, 95% CI: 1.70–71.25, P = 0.002), Candida infection (OR = 5.77, 95% CI: 1.89–18.65, P = 0.003), emergency cesarean delivery (OR = 2.32, 95% CI: 1.02–5.48, P = 0.047), a scarred uterus (OR = 3.68, 95% CI: 1.43–9.39, P = 0.006), and prolonged operative time (≥ 1 h; OR = 2.55, 95% CI: 1.02–3.73, P = 0.031). Conclusions Prolonged operative time, premature rupture of membranes (PROM), emergency cesarean delivery, and uterine scarring were identified as independent risk factors for PWH in GDM patients. Candida infection also showed a statistical association but was based on limited case numbers and should be interpreted cautiously. Targeted perioperative strategies may help reduce PWH risk in this population. |
| format | Article |
| id | doaj-art-05d8899fda364be4a829888ef87b6e6e |
| institution | Kabale University |
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| spelling | doaj-art-05d8899fda364be4a829888ef87b6e6e2025-08-20T03:42:37ZengBMCBMC Surgery1471-24822025-08-012511810.1186/s12893-025-03086-2Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective studyYan Liu0Ye Wang1Shao-Hua Gao2Hui Wu3Chun-Yu Zhang4Jia-Li Yao5Pei-Xia Cai6Department of Obstetrics, Ningbo Mingzhou Hospital Co., LtdDepartment of Obstetrics, Ningbo Mingzhou Hospital Co., LtdDepartment of Obstetrics, Ningbo Mingzhou Hospital Co., LtdXiaying Community Health CenterDepartment of Obstetrics, Ningbo Mingzhou Hospital Co., LtdDepartment of Obstetrics, Ningbo Mingzhou Hospital Co., LtdDepartment of Obstetrics, Ningbo Mingzhou HospitalAbstract Background Poor wound healing (PWH) are significant complications following cesarean deliveries, particularly in patients with gestational diabetes mellitus (GDM) due to hyperglycemia-induced immune dysfunction and impaired wound healing. Identifying specific risk factors is essential for developing effective preventive strategies and improving maternal outcomes. Methods This retrospective study, conducted from January 2020 to August 2023, followed STROBE guidelines. A total of 268 GDM patients who underwent cesarean delivery were included, with 5 lost to follow-up, yielding a 98.2% follow-up rate. Patients were divided into two groups: the PWH group (n = 26) and the control group (n = 242). Comprehensive data on maternal age, gestational age, pre-pregnancy BMI, IVF-ET use, uterine scarring, surgery type (emergency vs. elective), operative time, and infections (Candida albicans and Group B Streptococcus) were collected. Statistical analyses included Chi-square, Fisher’s exact tests, and multivariate logistic regression to identify independent risk factors for PWH. Results The overall incidence of PWH was 9.7%, with the majority being superficial infections, including suture reactions (38.5%), bleeding and exudation (30.8%), abscesses (15.4%), and fat liquefaction (11.5%). Deep infections were rare, with only 3.8% presenting as endometritis and no cases of pelvic abscess. Multivariate logistic regression identified the following significant independent risk factors for PWH: premature rupture of membranes (OR = 10.88, 95% CI: 1.70–71.25, P = 0.002), Candida infection (OR = 5.77, 95% CI: 1.89–18.65, P = 0.003), emergency cesarean delivery (OR = 2.32, 95% CI: 1.02–5.48, P = 0.047), a scarred uterus (OR = 3.68, 95% CI: 1.43–9.39, P = 0.006), and prolonged operative time (≥ 1 h; OR = 2.55, 95% CI: 1.02–3.73, P = 0.031). Conclusions Prolonged operative time, premature rupture of membranes (PROM), emergency cesarean delivery, and uterine scarring were identified as independent risk factors for PWH in GDM patients. Candida infection also showed a statistical association but was based on limited case numbers and should be interpreted cautiously. Targeted perioperative strategies may help reduce PWH risk in this population.https://doi.org/10.1186/s12893-025-03086-2Poor wound healingCesarean deliveryGestational diabetes mellitusRisk factorsEmergency cesarean |
| spellingShingle | Yan Liu Ye Wang Shao-Hua Gao Hui Wu Chun-Yu Zhang Jia-Li Yao Pei-Xia Cai Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study BMC Surgery Poor wound healing Cesarean delivery Gestational diabetes mellitus Risk factors Emergency cesarean |
| title | Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study |
| title_full | Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study |
| title_fullStr | Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study |
| title_full_unstemmed | Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study |
| title_short | Evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus: a retrospective study |
| title_sort | evaluation of risk factors for poor wound healing after cesarean delivery in patients with gestational diabetes mellitus a retrospective study |
| topic | Poor wound healing Cesarean delivery Gestational diabetes mellitus Risk factors Emergency cesarean |
| url | https://doi.org/10.1186/s12893-025-03086-2 |
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