Abstract
Background/Objectives: Among women with a history of cesarean section (CS), scar abnormalities are observed in 20-32% of cases. The presence of a scar in the lower abdomen may cause pain, dysmenorrhea, dyspareunia, and postural dysfunction. The aim of the study was to conduct a feasibility study and secondary exploratory analysis of the factors determining scar stiffness and elasticity in women after CS. Methods: The study involved 30 women aged 26 to 45 who had undergone at least one CS no earlier than six months before the start of the study. The following feasibility endpoints were analyzed: recruitment rate, completion rate, protocol deviations, and device usability. Myotonometry was performed to quantify the stiffness and decrement (a parameter that inversely reflects tissue elasticity) of the CS scar. The correlation between stiffness and decrement and age, BMI, time since the las CS, and the number of CSs was assessed. Results: All predefined feasibility criteria were met. Recruitment exceeded the target rate (3.3 participants/week), with a high completion rate (90%). One minor protocol deviation occurred without impact on safety or data integrity. The MyotonPro device showed good usability, with no reported discomfort and successful completion of all measurements. Secondary exploratory correlation analyses suggested a tendency toward a negative correlation between BMI and the stiffness and decrement (indicating increased elasticity) across most scar regions. No consistent correlations were observed between age and the examined scar parameters. Exploratory analyses further indicated a probable positive correlation between time elapsed since the last CS and stiffness and decrement (indicating reduced elasticity), which was observed only in the central region of the scar. The number of cesarean section procedures showed sporadic, region-specific correlations with scar parameters, limited to selected measurement points. Conclusions: These findings suggest that the study design is feasible and acceptable. Future research protocols should also include a comparison with healthy skin in the scar area. Preliminary exploratory analyses suggest a potential influence of BMI and time since last CS on scar stiffness and elasticity. However, due to the limitations of the pilot study, these observations should be considered preliminary and hypothesis-generating and may be used to design future confirmatory studies.