# Management of Caesarean Scar Keloid in Pregnancy: A Multidisciplinary Approach

## TL;DR

This paper presents a case of a pregnant woman with a large keloid scar from a previous C-section, managed through a multidisciplinary approach to achieve safe and cosmetic outcomes.

## Contribution

The paper demonstrates a successful multidisciplinary strategy for managing extensive keloids during pregnancy.

## Key findings

- Elective caesarean delivery with keloid excision and corticosteroid therapy resulted in satisfactory healing with no recurrence.
- Multidisciplinary coordination improved maternal and cosmetic outcomes in a high-risk patient.
- Adjuvant corticosteroid use reduced keloid recurrence risk from 45-100% to below 20%.

## Abstract

Keloid formation following caesarean section can be a distressing complication. Women of African, Hispanic or Asian descent are more predisposed to abnormal scar healing. During pregnancy, hormonal and mechanical factors may further aggravate keloid growth, leading to pain, cosmetic disfigurement, and emotional distress. Managing such cases requires careful coordination between obstetric, surgical, and dermatological teams to achieve safe maternal and cosmetic outcomes.

A 29-year-old gravida 2 para 1 woman of African origin, with a previous history of emergency caesarean section, was seen at 27+4 weeks of gestation following transfer of care. Examination revealed an extensive keloid extending from the lower abdomen to the vulval region. The pregnancy remained otherwise uncomplicated. After multidisciplinary discussion, an elective caesarean section with simultaneous keloid excision was planned. The patient underwent elective term caesarean delivery with complete excision of the abdominal and vulval keloids, using an incision along the inner edge of the keloid and deep dissection. The wound was closed with tension-free subcuticular sutures, and intralesional triamcinolone was administered to minimise recurrence. Given that recurrence rates following excision alone can reach 45-100%, adjuvant corticosteroid use was chosen to reduce the risk to below 20%. The postoperative period was uneventful, and wound healing was satisfactory with no recurrence of keloid formation.

This case highlights the importance of a multidisciplinary, individualised approach in managing extensive keloids during pregnancy. Combining meticulous surgical technique with corticosteroid therapy can result in good functional and cosmetic outcomes. Early identification and involvement of specialist teams are essential to optimise care for women at higher risk of keloid formation.