干旱区生态环境知识资源中心(Arid): A biomechanical perspective on perineal injuries during childbirth

Arid

DOI	10.1016/j.cmpb.2023.107874
	A biomechanical perspective on perineal injuries during childbirth
	Moura, Rita; Oliveira, Dulce A.; Parente, Marco P. L.; Kimmich, Nina; Jorge, Renato M. Natal
通讯作者	Moura, R
来源期刊	COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE
ISSN	0169-2607
EISSN	1872-7565
出版年	2024
卷号	243
英文摘要	Background and Objective: Childbirth trauma is a major health concern that affects millions of women worldwide. Severe degrees of perineal trauma, designated as obstetric anal sphincter injuries (OASIS), and levator ani muscle (LAM) injuries are associated with long-term morbidity. While significant research has been conducted on LAM avulsions, less attention has been given to perineal trauma and OASIS, which affect up to 90% and 11% of vaginal deliveries, respectively. Despite being widely discussed, childbirth trauma remains unpredictable. This work aims to enhance the modeling of the maternal musculature during childbirth, with a particular focus on understanding the mechanisms underlying the often overlooked perineal injuries. Methods: A geometrical model of the pelvic floor muscles (PFM) and perineum (including the perineal body, ischiocavernosus, bulbospongiosus, superficial and deep transverse perineal muscles) was created. The muscles were characterized by a transversely isotropic visco-hyperelastic constitutive model. Two simulations of vaginal delivery were conducted with the fetus in the vertex presentation and occipito-anterior position, with and without the perineum. Results: The simulation that considered the perineum exhibited higher stresses over an extended area of the PFM, which suggests that including additional structures can impact the obtained results. The maximum stretch of the urogenital hiatus was 2.94 and the maximum stress was 23.86 kPa. The perineal body reached a maximum stretch of 1.95, which was more pronounced near the urogenital hiatus, where perineal tears may occur. The external anal sphincter's transverse diameter decreased by 51% and the maximum principal stresses were observed in the area close to the perineal body, where OASIS can occur. Conclusions: The present study emphasizes the importance of including most structures involved in vaginal delivery in its biomechanical analysis and represents another step further in the understanding of perineal injuries and OASIS. The superior region of the perineal body and its connection to the urogenital hiatus and anal sphincter have been identified as the most critical regions, highly susceptible to injury.
英文关键词	Perineal trauma Biomechanics of labor Finite element method Computational modeling
类型	Article
语种	英语
开放获取类型	hybrid
收录类别	SCI-E
WOS记录号	WOS:001096604600001
WOS关键词	PELVIC FLOOR MUSCLES ; ANAL-SPHINCTER ; NUMERICAL-SIMULATION ; PUBOVISCERAL MUSCLE ; MODEL ; 2ND-STAGE ; DELIVERY ; BEHAVIOR ; IMPACT
WOS类目	Computer Science, Interdisciplinary Applications ; Computer Science, Theory & Methods ; Engineering, Biomedical ; Medical Informatics
WOS研究方向	Computer Science ; Engineering ; Medical Informatics
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/403245
推荐引用方式 GB/T 7714	Moura, Rita,Oliveira, Dulce A.,Parente, Marco P. L.,et al. A biomechanical perspective on perineal injuries during childbirth[J],2024,243.
APA	Moura, Rita,Oliveira, Dulce A.,Parente, Marco P. L.,Kimmich, Nina,&Jorge, Renato M. Natal.(2024).A biomechanical perspective on perineal injuries during childbirth.COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE,243.
MLA	Moura, Rita,et al."A biomechanical perspective on perineal injuries during childbirth".COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 243(2024).