Related Experiment Video
Updated: Apr 30, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 28, 2010
"Every Centimetre Counts" The Association Between Cesarean Scar Size and Acute Postoperative Pain: A Prospective
Azra Shivji1, Abirami Kirubarajan2, Anna Gryn3
1Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Unity Health St. Michael's Hospital, Toronto, ON.
Objectives:
To determine the relationship between cesarean delivery (CD) incision size, and acute postoperative pain and longer-term outcomes.
Methods:
This prospective cohort study was conducted at a tertiary hospital in Ontario, Canada from 2021 to 2023. Participants were women aged 18-45 years who delivered via low transverse cesarean incision. CD incision size was reported as a continuous exposure per centimetre, and further dichotomized into CD incision size <15 cm and CD incision size ≥15 cm. The primary outcome was pain via numeric rating scale (NRS) on postoperative day (POD) 1, with NRS ≥4 considered clinically significant. Other outcomes included intraoperative outcomes, postoperative opioid use, and 6-week postpartum complications. Statistical analyses included Mann-Whitney U tests (continuous variables), χ2 or Fisher exact tests (categorical variables), and logistic regression for adjusted models.
Results:
A total of 117 participants were enrolled, with 58 having CD incision size <15 cm and 59 with CD incision size ≥15 cm. The primary outcome demonstrated that 36.2% of participants in the CD incision size <15 cm group and 54.2% in the CD incision size ≥15 cm group reported NRS ≥4 on POD 1 (OR 2.09; 95% CI 1.02-4.38, P = 0.05). Each additional centimetre of CD incision size had an OR 1.30 (95% CI 1.02-1.66, P = 0.03) for clinically significant pain in univariate analysis. There were no differences in fetal extraction or total procedure times based on incision size. The relationship between CD incision size and postoperative pain was maintained after adjustment for potential confounders. There were no significant differences 6-week postpartum outcomes (e.g., wound complications, maternal mental health, scar satisfaction).
Conclusions:
This study suggests that smaller cesarean incisions are associated with less postoperative pain, without detriment to fetal extraction time or total cesarean time.
