Effect of Autologous Platelet–Rich Plasma on Cesarean Section Scar; A Randomized, Double-Blinded Pilot Study

Abstract

Background: One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar. Methods: In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks. Results: The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P > 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P < 0.001). Conclusions: Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings. Keywords Cesarean Scar Defect Niche, Platelet-Rich Plasma Cesarean Section