Platelet-Rich Plasma for Wound Healing and Scar Outcomes After Cesarean Section: A Systematic Review and...

Background: Cesarean section (CS) is one of the most frequently performed surgical procedures worldwide, with postoperative wound complications and suboptimal scarring contributing to maternal morbidity. Platelet-rich plasma (PRP) has been proposed as a regenerative adjunct; however, existing evidence remains heterogeneous and incompletely synthesized. Objectives: The purpose of this review was to evaluate the efficacy and safety of PRP for wound healing and scar outcomes after cesarean section, including uterine scar healing outcome Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261383413). Major databases were searched from inception to April 2026 for randomized controlled trials (RCTs) evaluating PRP versus standard care in women undergoing CS. Primary outcomes included scar quality (POSAS) and early wound healing (REEDA), while secondary outcomes included pain (VAS), Vancouver Scar Scale (VSS), and uterine scar parameters. Random-effects models were used, and risk of bias and certainty of evidence were assessed using established tools. Results: Five RCTs (n = 366) were included in the quantitative synthesis. PRP was associated with improved patient-reported scar quality (POSAS-patient: SMD -0.50, 95% CI -0.83 to -0.17) and clinician-assessed scar quality (POSAS-observer: SMD -0.42, 95% CI -0.75 to -0.10), as well as reduced early wound inflammation (REEDA: SMD -0.52, 95% CI -0.84 to -0.20), with low statistical heterogeneity. No significant reduction in early postoperative pain was observed (VAS: SMD -0.22, 95% CI -0.50 to 0.06). Evidence regarding uterine scar outcomes was limited and imprecise. No PRP-related adverse events were reported. Conclusions: Intraoperative PRP may improve scar quality and early wound healing following cesarean section while not significantly affecting early postoperative pain. Given the limited number of RCTs and variability in PRP protocols, these findings should be interpreted with caution. Further well-designed, adequately powered trials with standardized methodologies are required to confirm clinical effectiveness and long-term outcomes.