{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:06:34Z","timestamp":1770422794695,"version":"3.49.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cesarean section rates have risen globally. While a cesarean section offers benefits, it is associated with complications like infection, fluid collection, and wound dehiscence. The psychological impact of cesarean section scars can also affect women\u2019s quality of life. Amniotic membrane and fluid have shown promise in enhancing wound healing due to their rich content of growth factors and nonimmunogenic properties. This study aims to assess the effects of autologous amniotic membrane and amniotic fluid on wound healing, surgical site infection, pain, and complications following cesarean section.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This controlled, randomized, double-blind (participants and the physician assessing outcomes are blinded), 2\u2009\u00d7\u20092 factorial trial with a sample size of 228 is being conducted at Arash Women\u2019s Hospital, Tehran, Iran. It involves four groups: amniotic membrane dressing, amniotic fluid spray, a combination of both, and one group receiving standard of care, assessing the effects of autologous amniotic membrane and amniotic fluid on cesarean section wound healing, infection, pain, and complications. Primary outcome (wound healing) would be measured by the Patient and Observer Scar Assessment Scale. Secondary outcomes are surgical site infection, pain via the Visual Analog Scale, surgical wound dehiscence, seroma, hematoma, and bleeding. Results will be analyzed using two-way ANOVA and logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This research protocol is the first to examine autologous amniotic membrane and amniotic fluid effects on cesarean section scar healing and complications. If effective, amniotic membrane and amniotic fluid could enhance CS scar aesthetics and reduce complications without extra cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      This trial was registered at the Iranian Registry of Clinical Trials (Registration number:\n                      <jats:bold>IRCT20220408054454N1<\/jats:bold>\n                      , Registration date:\n                      <jats:bold>2024-07-15<\/jats:bold>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337907","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T18:39:12Z","timestamp":1766169552000},"page":"e0337907","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of autologous amniotic membrane and fluid on wound healing and complications of cesarean section: Study protocol of a factorial randomized controlled trial"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1029-1000","authenticated-orcid":true,"given":"Kasra","family":"Jafari","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzieh","family":"Vahid-Dastjerdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SeyedAhmad","family":"SeyedAlinaghi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0207-5677","authenticated-orcid":true,"given":"Amene","family":"Abiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"issue":"2","key":"pone.0337907.ref001","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148343","article-title":"The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014","volume":"11","author":"AP Betr\u00e1n","year":"2016","journal-title":"PLoS One"},{"issue":"4","key":"pone.0337907.ref002","first-page":"221","article-title":"Prevalence, causes, and complications of cesarean delivery in Iran: a systematic review and meta-analysis","volume":"16","author":"M Rafiei","year":"2018","journal-title":"Int J Reprod Biomed"},{"issue":"11","key":"pone.0337907.ref003","first-page":"663","article-title":"Cesarean or cesarean epidemic?","volume":"22","author":"A Jafarzadeh","year":"2019","journal-title":"Arch Iran Med"},{"key":"pone.0337907.ref004","volume-title":"WHO statement on caesarean section rates","author":"Who HRP","year":"2015"},{"issue":"1","key":"pone.0337907.ref005","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1055\/s-0031-1285829","article-title":"Cesarean versus vaginal delivery: whose risks? 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