Beyond the cut: a cross-sectional analysis of the long-term clinical and functional impact of cesarean section scars

Abstract

Objective: This study aims to evaluate the clinical and functional implications of cesarean section (CS) skin scars on women's lives, emphasizing the relationship between scar characteristics and quality of life.

Methods: In this cross-sectional study, women older than 18 years old who had undergone CS with a Pfannenstiel incision within the past 6-36 months were evaluated. The Patient Scar Assessment Questionnaire (PSAQ) and the Patient and Observer Scar Assessment Scale (POSAS) were used to assess clinical scar parameters. Functionality was appraised using eight questions derived from the International Classification of Functionality, Disability, and Health (ICF). The association between scar appearance scores and functionality questions was analyzed statistically.

Results: Ninety-six women were assessed, revealing that appearance and satisfaction with appearance had the worst scores on the PSAQ. Scar irregularity was the most frequently reported scar characteristic on the POSAS. On the ICF-derived questionnaire, the "self-care" domain was the most affected, with women reporting problems on activities such as choosing swimwear and lingeries. There was a significant correlation (p < 0,05) between the women dissatisfaction with the scar appearance and impairment in 'interpersonal interactions and relationships' and 'self-care', as the "domestic life" domain wasn't affected.

Conclusions: Cesarean section skin scars can lead to dissatisfaction and functional impairments, affecting women's quality of life. These findings underscore the necessity for multidisciplinary care and thorough discussions about delivery methods to improve post-surgical outcomes.

Keywords: Cesarean section; Cicatrix; Multidisciplinary care team; Personal satisfaction; Postpartum period; Quality of life; Scars; Self care; Surveys and questionnaires; Treatment outcome.

Figure 1. Results of the WHO's International Classification of Functionality, Disability, and Health (ICF) derived questionnaire

Figure 2. Association beetween funcionality according to WHO's International Classification of Functionality, Disability, and Health (ICF) derived questionnaire and the total Patient Scar Assessment Questionnaire (PSAQ) score. The total PSAQ score ranged from 28 (best score) to 112 (worst score)

Figure 3. Association beetween funcionality acording to WHO's International Classification of Functionality, Disability, and Health (ICF) and total Patient Scar Assessment Scale (PSAS) score. The total PSAS score ranged from 6 (best score) to 60 (worst score)