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September 2026

Morphological and Biomechanical Characterization of Early Cesarean Section Scars: A Cross-Sectional Observational Study

Authors: Liliya Kiselova 1, Camila Maria Ribeiro Pacheco 2, Ana Carolina Pucci de Mattos 2, Andreia Noites 1, Ana Paula Fontes 3, Elaine Caldeira de Oliveira Guirro 2

Affiliations:

  1. CIR, ESS, Polytechnic of Porto, Rua Dr. Antonio Bernardino de Almeida no 400, 4200-072 Porto, Portugal
  2. Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of Sao Paulo (USP), Ribeirao Preto 14049-900, Brazil
  3. Escola Superior de Saude, Algarve Biomedical Center Research Institute (ABC-Ri), Universidade do Algarve, 8005-139 Faro, Portugal

Journal: International Journal of Environmental Research and Public Health - September 2026, Volume 23, Issue 9, Article no. 1179 (DOI: 10.3390/ijerph23091179)

Cesarean section is a surgical procedure that involves the extraction of the fetus, the placenta, and the fetal membranes through an abdominal and uterine incision. As one of the most common childbirth methods worldwide, its increasing prevalence has raised concerns regarding potential postoperative sequelae that may affect tissue mobility, pain perception, and functional recovery. However, detailed characterization of early cesarean scars remains limited.

This study aimed to characterize the morphological, sensory, and biomechanical properties of cesarean section scars during the early postoperative phase.

A cross-sectional observational study was conducted including 20 women evaluated between 15 and 30 days after cesarean delivery. Clinical and sensory assessments were performed using the Patient and Observer Scar Assessment Scale (POSAS 3.0) and pain evaluation. Tissue mobility was assessed using a modified adheremeter, while biomechanical properties were measured with the MyotonPRO device. Ultrasound imaging was used to evaluate structural tissue characteristics.

The scars predominantly exhibited increased tissue stiffness and heterogeneous texture patterns. Participants reported moderate pain intensity (mean 4.15 ± 2.18), with slightly higher scores in the patient-reported POSAS compared with the observer scale. Ultrasound findings revealed dermal and hypodermal edema in most participants and signs of fibrosis, with regional heterogeneity in tissue adhesions. Biomechanical analysis confirmed reduced tissue deformability in scar tissue compared with adjacent healthy tissue.

These findings indicate that early cesarean scars present relevant structural and functional alterations, highlighting the importance of early assessment to support individualized rehabilitation strategies.

 

Keywords: cesarean section, surgical scar, scar biomechanics, tissue adhesions, physiotherapy

Cesarean section scars in the early postoperative period exhibit morphological, sensory, textural, and biomechanical alterations, with substantial heterogeneity across individuals and scar regions. These findings highlight the complexity of early scar remodeling and the value of multidimensional assessment integrating clinical, biomechanical, and imaging-based measures. As an exploratory characterization, this study provides a baseline for understanding early cesarean scar dynamics and generates hypotheses for future longitudinal and interventional studies investigating scar evolution and rehabilitation strategies in postpartum women.

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