The effect of platelet rich plasma(PRP) injection at the site of uterine incision during cesarean section in preventing isthmocele

Isthmocele or uterine niche represents an inadequate healing of myometrium at the site of cesarean section which might lead to severe obstetric complications during subsequent pregnancies. Objective: The purpose of this study was to evaluate the impact of platelet rich plasma(PRP)injection to the surgical incision site on the occurrence of isthmocele and their parameters. A randomized controlled trial(prospective) included 50 pregnant women meeting inclusion criteria, who were admitted at the department of obstetrics, Lattakia University Hospital, during two-years period(2023-2025).  Women were divided into groups; group 1(13 cases) with injection of PRP to the incision site between decidua and myometrium and group 2 (37 cases) without PRP injection, in which demographic characteristics and variables related to isthmocele parameters were compared between two groups. The mean age was 28.56±5.1 with range of 17-38 years, without significant differences between two groups regarding of age, gestational age and body mass index(BMI) (p>0.05). Cesarean scare defect was detected in 2 cases(15.4%) in PRP group versus 5 cases(13.5%) in other group, p:0.8. Regarding of isthmocele parameters, residual myometrium thickness(RMT) and the ratio of residual myometrium thickness to adjunct myometrium thickness (RMT/AMT) were significantly higher in PRP group as follows;(5.27±1.1 vs. 4.28±1.5,p:0.04) and(0.67±0.08 vs. 0.58±0.1,p:0.04) without presence of significant differences between two groups regarding of width, depth and AMT(p>0.05). The current study demonstrated that applying PRP to the uterine incision represents a safe and effective method  in prompting tissue healing and improving final outcome.