Background: Due to the increasing rates of cesarean deliveries worldwide, the cesarean scar niche has emerged as a significant concern, leading to various obstetric and gynecological complications.  Platelet-rich plasma [PRP] has gained considerable attention for its potential to promote angiogenesis, fibroplasia, and reepithelialization, ultimately facilitating tissue regeneration. However, to the authors' knowledge, there is a lack of studies investigating the efficacy of PRP injections in enhancing the thickness and completeness of uterine scars.
Aim of the work: This study aimed to assess the efficacy of autologous PRP injection in preventing the formation of post-cesarean section niche.  
Patients and Methods: A prospective randomized controlled trial was conducted involving 58 full-term women who underwent cesarean sections. Participants were randomly assigned to two groups: the intervention group [n = 29] and the control group [n = 29]. After the closure of the uterine incision, the intervention group received an intra-myometrial injection of PRP, extracted from a sample of the patient's blood. In contrast, the control group received an intra-myometrial injection of normal saline [0.9%] along the same incision. Transvaginal ultrasound examinations were performed on women in both groups 12 weeks after cesarean delivery to investigate the presence of niches and related parameters.
Results: The rate of niche formation was 13.8% in the intervention group compared to 37.9% in the control group, demonstrating a significant difference between the two groups. When comparing the niche parameters of the PRP group with those of the control group, the PRP group exhibited significantly higher mean values for healing ratio and residual myometrial thickness, as well as significantly lower mean values for niche height and depth.
Conclusion: Intraoperative intra-myometrial injection of autologous PRP is an effective, and safe technique for enhancing myometrial tissue regeneration and thereby preventing CS niche formation.