ASSOCIATION BETWEEN CESAREAN SCAR AND PELVIC FLOOR MUSCLE TONE AT 6-8 WEEKS POSTPARTUM

Abstract

Background: Pregnancy and childbirth are major contributors to pelvic floor dysfunction (PFD), with mode of delivery influencing postpartum pelvic floor muscle (PFM) strength. While caesarean section (CS) may preserve pelvic floor function compared with normal vaginal delivery (NVD), the influence of CS scar characteristics on early postpartum PFMS remains poorly understood. This study evaluated the association between CS scar type and PFMS at 6–8 weeks postpartum and compared PFMS between women undergoing CS and NVD.

Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad, from September 2025 to January 2026. A total of 132 women aged 18-45 years, 6-8 weeks postpartum after singleton pregnancies, were enrolled using consecutive sampling. Participants comprised 66 women with NVD and 66 with CS, including 44 with normal scars and 22 with hypertrophic scars. PFMS was assessed using the Modified Oxford Grading Scale, while scar morphology was evaluated clinically.

Results: Women who underwent CS had significantly higher PFM Strength than those with NVD (median score 4.0 vs. 3.0; p<0.001). PFMS differed significantly according to scar type (p<0.001), with women having normal CS scars demonstrating the highest strength, whereas hypertrophic scars were associated with reduced PFMS and significantly higher rates of vaginal bulge, pelvic pressure, urinary incontinence, and sexual dysfunction (all p<0.05). Multivariable analysis showed that increasing body mass index (adjusted OR=0.89, 95% CI: 0.80–1.00; p=0.049) and NVD (adjusted OR=0.36, 95% CI: 0.13–0.99; p=0.049) were independently associated with lower PFM Strength, whereas multiparity was associated with higher PFM Strength compared with grand multiparity (adjusted OR=3.17, 95% CI: 1.02–9.91; p=0.047).

Conclusions: Caesarean delivery was associated with better preservation of PFM Strength during the early postpartum period than NVD. However, hypertrophic CS scars were associated with poorer pelvic floor function and a greater burden of PFD symptoms than normal scars. Early postpartum assessment should include evaluation of both pelvic floor function and scar characteristics to facilitate timely rehabilitation and optimise maternal recovery.