Recruitment during pandemic was impossible to achieve

This study aims to examine the effects of an osteopathic treatment on adhesions related to c-sections scars.

The rates of caesarean sections are growing throughout the world, with recent rates (in 2016) in Europe of 25%, in North America of 32.3% and in South America of 40.5%.

The incidence of intra-abdominal adhesions in women undergoing to repeated caesarean sections is constantly increasing.

Labor and surgical time are significantly longer in patients with adhesions compared to patients without adhesions.

Furthermore, it has been estimated that about 10% of patients undergoing cesarean section experience chronic pain.

Despite of the big impact on the quality of life of patients and high cost for public health, treatments for adhesions are mostly surgical.

The identification of non-surgical treatments that aim to reduce cicatricial adhesions' formation is essential to decrease hospitalization times and associated complications.

The purpose of this study is to evaluate the effects of osteopathic treatment and self-massage on scars in women who underwent to a cesarean section. The main aim is to assess whether there is a change in the number, size and vascularization of of cesarean section adhesionsthrough Superb Microvascular Imaging (SMI).

Inclusion Criteria:

• primiparous or multipara who have undergone a cesarean section with a completely healed scar will be included.
• women who had first menstruation after childbirth
• Women with or without pain or symptoms related to scarring or the presence of isthmocele will be included.

Exclusion Criteria:

• caesarean section performed in a period less than 6 months and over 3 years
• uterine prolapse
• scar treatments already performed (both manual and medical)
• absence of scar adhesions

Women underwent to a c-section

The gynecologist, the radiologist and the statistician will be blinded to group allocation.

Participants will have similar manual treatments.