Platelet-rich plasma for wound healing and scar formation after cesarean section: a systematic review and meta-analysis of randomized controlled trials.

backgroundSurgical wound complications follow 3-15% of cesarean deliveries globally. Platelet-rich plasma (PRP), an autologous concentrate of growth factors, has documented regenerative activity across several surgical disciplines, yet no quantitative synthesis of randomized trial evidence has been published for its intraoperative use during cesarean section.

methodsPubMed/MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were systematically searched from inception through March 2026 to identify randomized controlled trials comparing intraoperative PRP with standard care during cesarean section. Primary outcomes were skin scar quality measured with the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), or the Manchester Scar Scale; early wound inflammation measured with the Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale; and uterine scar integrity defined by niche formation rate and residual myometrial thickness. Secondary outcomes were postoperative pain on visual analogue or numeric rating scales and analgesic consumption. Standardized mean differences (Hedges' g) were pooled using a DerSimonian-Laird random-effects model. Ambiguity regarding dispersion measures in one study was resolved through p-value back-calculation, and sensitivity analyses were pre-specified. The protocol was registered prospectively (INPLASY202640041; doi: https://doi.org/10.37766/inplasy2026.4.0041 ).

resultsFive randomized trials enrolling 366 women across five countries were included, with four trials (n = 336) contributing to skin-scar synthesis. PRP improved patient-reported scar quality (POSAS-patient SMD - 0.50, 95% CI - 0.83 to - 0.17; p = 0.003; I² = 0%) and clinician-assessed scar quality (POSAS-observer SMD - 0.42, 95% CI - 0.75 to - 0.10; p = 0.012; I² = 32%), and reduced early wound inflammation (REEDA SMD - 0.52, 95% CI - 0.84 to - 0.20; p = 0.002; I² = 0%; sensitivity analysis under the naive SD assumption produced I² = 98% and was uninterpretable). In a single small trial that targeted the uterine scar, PRP reduced niche formation from 46.7% to 13.3% (RR 0.29, 95% CI 0.07-1.16; Fisher's exact p = 0.109 on the binary 2 × 2 table). Vancouver Scar Scale heterogeneity precluded pooling (I² = 94%). Visual analogue pain at early time points was not significantly reduced (pooled SMD - 0.22, 95% CI - 0.50 to + 0.06; p = 0.12). No safety event attributable to PRP was reported in any trial.

conclusionsAcross a small and clinically heterogeneous evidence base of five randomized trials, intraoperative PRP improves cesarean skin scar quality and reduces early wound inflammation, while early pain intensity does not appear to be affected. The single trial that addressed the uterine scar suggests a substantial reduction in niche formation, but with only thirty patients, an unreproducible study-reported p-value, and a Fisher's exact p of 0.109 on the binary outcome, this signal is hypothesis-generating and requires confirmation in adequately powered trials before any change in practice can be considered. PROTOCOL REGISTRATION: INPLASY202640041 (doi: https://doi.org/10.37766/inplasy2026.4.0041 ).