Biomechanical Simulation of Vaginal Childbirth: The Colors of the Pelvic Floor Muscles
- 353 Downloads
Childbirth-related trauma is a recurrent and widespread topic due to the disorders it can trigger, such as urinary and/or anal incontinence, and pelvic organ prolapse, affecting women at various levels. Pelvic floor dysfunction often results from weakening or direct damage to the pelvic floor muscles (PFM) or connective tissue, and vaginal delivery is considered the primary risk factor. Elucidating the normal labor mechanisms and the impact of vaginal delivery in PFM can lead to the development of preventive and therapeutic strategies to minimize the most common injuries. By providing some understanding of the function of the pelvic floor during childbirth, the existing biomechanical models attempt to respond to this problem. These models have been used to estimate the mechanical changes on PFM during delivery, to analyze fetal descent, the effect of the fetal head molding, and delivery techniques that potentially contribute to facilitating labor and reducing the risk of muscle injury.
Biomechanical models of childbirth should be sufficiently well-informed and functional for personalized planning of birth and obstetric interventions. Some challenges to be addressed with a focus on customization will be discussed including the in vivo acquisition of individual-specific pelvic floor mechanical properties.
KeywordsComputational biomechanics Physics-based computational model Vaginal delivery Pelvic floor muscles
The authors gratefully acknowledge the support from the Portuguese Foundation of Science under grants IF/00159/2014, and the funding of project 030062 SIM4SafeBirth—A biomechanical approach to improve childbirth outcomes and NORTE-01-0145-FEDER-000022 SciTech—Science and Technology for Competitive and Sustainable Industries, cofinanced by Norte’s Regional Operational Programme (NORTE2020), through European Regional Development Fund (ERDF).
- 11.Cunningham F, Leveno K, Bloom S et al (2018) Williams obstetrics, 25th edn. McGraw-Hill Education/Medical, PennsylvaniaGoogle Scholar
- 20.Crisfield M (2001) Non-linear finite element analysis of solids and structures, volume 2 - advanced topics. Wiley, LondonGoogle Scholar
- 26.Martins PAL (2010) Experimental and numerical studies of soft biological tissues. PhD. Thesis. Faculty of Engineering, University of Porto, PortoGoogle Scholar
- 27.Janda S (2006) Biomechanics of the pelvic floor musculature. PhD. Thesis. Technische Universiteit Delft, DelftGoogle Scholar
- 32.Silva MET, Brandao S, Parente MP et al (2016) Establishing the biomechanical properties of the pelvic soft tissues through an inverse finite element analysis using magnetic resonance imaging. Proc Inst Mech Eng Part H J Eng Med 230:298–309. https://doi.org/10.1177/0954411916630571 CrossRefGoogle Scholar
- 36.Ashton-Miller JA, Delancey JO (2009) On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng 11:163–176. https://doi.org/10.1146/annurev-bioeng-061008-12482337 CrossRefGoogle Scholar
- 38.Li X, Kruger J, Chung J, Nash M, Nielsen P (2008) Modelling the pelvic floor for investigating difficulties in childbirth. In: SPIE (Medical Imaging), vol 6916, p 69160VGoogle Scholar
- 42.Yan X, Kruger J, Li X, Nash M, Nielsen P (2013) Modelling effect of bony pelvis on childbirth mechanics. Neurourol Urodyn 32(6):531–532Google Scholar
- 44.Vila Pouca M, Ferreira J, Oliveira D, Parente M, Mascarenhas T, Natal Jorge R (2018) On the effect of labour durations using an anisotropic visco-hyperelastic-damage approach to simulate vaginal deliveries. J Mech Behav Biomed Mater 88:120–126. https://doi.org/10.1016/j.jmbbm.2018.08.011 CrossRefGoogle Scholar
- 47.Jiang H, Qian X, Carroli G, Garner P (2017) Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev (2):CD000081. https://doi.org/10.1002/14651858.CD000081.pub3
- 49.Oliveira D, Parente M, Calvo B, Mascarenhas T, Natal Jorge R (2017) The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth. Comput Methods Biomech Biomed Engin 20(11):1249–1259. https://doi.org/10.1080/10255842.2017.1349762 CrossRefGoogle Scholar
- 50.Ozkan E, Goksel O (2015) Compliance boundary conditions for simulating deformations in a limited target region. In: 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp 929–932. https://doi.org/10.1109/EMBC.2015.7318515