Platelet-Rich Plasma in Postpartum Wound and Scar Repair: A Narrative Review of Clinical Evidence, Patient-Centered Outcomes, and Translational Challenges.

Platelet-rich plasma (PRP) is an autologous blood-derived product containing concentrated platelets and platelet-associated mediators involved in hemostasis, inflammation, angiogenesis, epithelialization, fibroblast activity, and extracellular matrix remodeling. In obstetric practice, cesarean abdominal wounds, perineal injury, pelvic floor trauma, and uterine scars represent distinct repair settings with different clinical consequences. This narrative review evaluates current evidence for PRP in postpartum wound and scar repair, with emphasis on patient-centered outcomes and the distinction between superficial abdominal healing and uterine scar remodeling. Evidence is most developed for cesarean abdominal wounds, where several small controlled studies and two recent meta-analyses suggest modest improvement in selected early wound and scar measures; postoperative pain intensity is not consistently reduced. Evidence for perineal repair is more heterogeneous: uncontrolled and case-based reports suggest feasibility, a small comparative study in severe perineal rupture suggests possible functional benefit, and a randomized trial of levator ani injury did not demonstrate improved muscle recovery. Uterine scar application remains exploratory and rests mainly on one small pilot trial. Changes in residual myometrial thickness or niche morphology are surrogate imaging findings and do not establish greater scar strength, improved fertility, lower uterine rupture risk, or safer subsequent pregnancy. Clinical translation is further limited by heterogeneity in PRP source, preparation, platelet dose, leukocyte content, activation, anatomical application site, outcome assessment, and follow-up. Better characterized products, indication-specific trials, patient-reported outcomes, and long-term reproductive follow-up are required before routine postpartum use can be recommended.