nach oben

International Urogynecology Journal

Erschienen in:

29.11.2017 | Original Article

Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results

verfasst von: Estelle Jean Dit Gautier, Olivier Mayeur, Julien Lepage, Mathias Brieu, Michel Cosson, Chrystele Rubod

Erschienen in: International Urogynecology Journal | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

We studied the geometry of and changes in structures that play an important role in stabilizing the pelvic system during pregnancy using a numerical system at different gestational ages and postpartum.

Methods

We developed a parturient numerical model to assess pelvic structures at different gestational stages (16, 32, and 38 weeks) and postpartum (2 months and 1 year) using magnetic resonance imaging (MRI). Organs, muscles, and ligaments were segmented to generate a 3D model of the pelvis. We studied changes in the length of uterosacral ligaments (USL) and thickness of the puborectal portion of the levator ani muscle (LAM) during and after pregnancy. We used this model to perform finite element (FE) simulation and analyze deformations of these structures under stress from the increase in uterine weight.

Results

Analysis reveals an increase in the length of US ligaments at 16, 32, and 38 weeks. Two months after delivery, it decreases without returning to the length at 16 weeks of pregnancy. Similar changes were observed for the puborectal portion of the LAM. Variations observed in these structures are not equivalent to other anatomical structures of pelvic suspension. FE simulation with increased uterus weight does not lead to those findings.

Conclusion

This analysis brings new elements and a new focus for discussion relating to changes in pelvic balance of parturient women that are not simply linked to the increase in uterine volume.

Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403.CrossRefPubMed

O’Boyle AL, O’Boyle JD, Ricks RE, Patience TH, Calhoun B, Davis G. The natural history of pelvic organ support in pregnancy. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(1):46–9. discussion 49 CrossRefPubMed

Rahn DD, Ruff MD, Brown SA, Tibbals HF, Word RA. Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol. 2008 May;198(5):590.e1–6.CrossRef

Mayeur O, Witz J-F, Lecomte P, Brieu M, Cosson M, Miller K. Influence of Geometry and Mechanical Properties on the Accuracy of Patient-Specific Simulation of Women Pelvic Floor. Ann Biomed Eng. 2015.

Jeanditgautier E, Mayeur O, Brieu M, Lamblin G, Rubod C, Cosson M. Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system. Int Urogynecol J. 2016.

Parente MPL, Natal Jorge RM, Mascarenhas T, Fernandes AA, Martins J. a. C. The influence of the material properties on the biomechanical behavior of the pelvic floor muscles during vaginal delivery. J Biomech. 2009;42(9):1301–6.CrossRefPubMed

Ashton-Miller JA, Delancey JOL. On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009;11:163–76.CrossRefPubMedPubMedCentral

Wei JT, De Lancey JOL. Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol. 2004;47(1):3–17.CrossRefPubMed

C. Courpotin, C Polonovski, M Voyer, J-C Chaumeil. Importance de la nutrition prénatale. In: Nutrition et renutrition en pratique pédiatrique. 1992.

10.

Nichols DH. Types of genital prolapse. Postgrad Med. 1969;46(5):183–7.CrossRefPubMed

11.

Buller JL, Thompson JR, Cundiff GW, Krueger Sullivan L, Schön Ybarra MA, Bent AE. Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol. 2001;97(6):873–9.PubMed

12.

Lepage J, Cosson M, Mayeur O, Brieu M, Rubod C. The role of childbirth research simulators in clinical practice. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2015.

13.

Yan X, Kruger JA, Li X, Nielsen PMF, Nash MP. Modeling the second stage of labor. Wiley Interdiscip Rev Syst Biol Med. 2016;8(6):506–16.CrossRefPubMed

14.

Lepage J, Jayyosi C, Lecomte-Grosbras P, Brieu M, Duriez C, Cosson M, et al. Biomechanical pregnant pelvic system model and numerical simulation of childbirth: impact of delivery on the uterosacral ligaments, preliminary results. Int Urogynecology J. 2014.

15.

Oliveira DA, Parente MPL, Calvo B, Mascarenhas T, Natal Jorge RM. Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth. J Biomech. 2016;49(4):594–601.CrossRefPubMed

16.

Umek WH, Morgan DM, Ashton-Miller JA, DeLancey JOL. Quantitative analysis of uterosacral ligament origin and insertion points by magnetic resonance imaging. Obstet Gynecol. 2004;103(3):447–51.CrossRefPubMedPubMedCentral

17.

Cosson M, Rubod C, Vallet A, Witz JF, Dubois P, Brieu M. Simulation of normal pelvic mobilities in building an MRI-validated biomechanical model. Int Urogynecology J. 2013;24(1):105–12.CrossRef

18.

Li X, Kruger JA, Nash MP, Nielsen PMF. Anisotropic effects of the levator ani muscle during childbirth. Biomech Model Mechanobiol. 2011;10(4):485–94.CrossRefPubMed

19.

Hoyte L, Damaser MS, Warfield SK, Chukkapalli G, Majumdar A, Choi DJ, et al. Quantity and distribution of levator ani stretch during simulated vaginal childbirth. Am J Obstet Gynecol. 2008 Aug;199(2):198.e1–5.CrossRef

20.

Ulrich D, Edwards SL, Su K, White JF, Ramshaw JAM, Jenkin G, et al. Influence of reproductive status on tissue composition and biomechanical properties of ovine vagina. PLoS One. 2014;9(4):e93172.CrossRefPubMedPubMedCentral

21.

Chen Y, Li F-Y, Lin X, Chen J, Chen C, Guess M. The recovery of pelvic organ support during the first year postpartum. BJOG Int J Obstet Gynaecol. 2013;120(11):1430–7.CrossRef

22.

Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen K. Pelvic organ prolapse and incontinence 15-23 years after first delivery: a cross-sectional study. BJOG Int J Obstet Gynaecol. 2015;122(7):964–71.CrossRef

23.

Baker PN, Johnson IR, Harvey PR, Gowland PA, Mansfield P. A three-year follow-up of children imaged in utero with echo-planar magnetic resonance. Am J Obstet Gynecol. 1994;170(1 Pt 1):32–3.CrossRefPubMed

24.

Elster AD. Does MR imaging have any known effects on the developing fetus? AJR Am J Roentgenol. 1994;162(6):1493.CrossRefPubMed

25.

Revised guidance on acceptable limits of exposure during nuclear magnetic resonance clinical imaging. Br J Radiol. 1983 Dec;56(672):974–7.

26.

Mayeur O, Jeanditgautier E, Witz J-F, Lecomte-Grosbras P, Cosson M, Rubod C, et al. Evaluation of Strains on Levator Ani Muscle: Damage Induced During Delivery for a Prediction of Patient Risks. In: Computational Biomechanics for Medicine [Internet]. Springer, Cham; 2017 [cited 2017 Jun 21]. p. 135–46. Available from: https://link.springer.com.doc-distant.univ-lille2.fr/chapter/10.1007/978-3-319-54481-6_12

Titel: Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results
verfasst von: Estelle Jean Dit Gautier
Olivier Mayeur
Julien Lepage
Mathias Brieu
Michel Cosson
Chrystele Rubod
Publikationsdatum: 29.11.2017
Verlag: Springer London
Erschienen in: International Urogynecology Journal / Ausgabe 3/2018
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-017-3520-3

Neu im Fachgebiet Gynäkologie und Geburtshilfe

16.04.2024 | Maligne primäre ZNS-Tumoren | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Das Ende der vollständigen axillären Lymphknotendissektion

Update Gynäkologie

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2018

The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry

Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors

Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia

Risk factors for obstetric anal sphincter injuries (OASI) at a tertiary centre in south India

How to attract talented juniors to urogynaecology

A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Das Ende der vollständigen axillären Lymphknotendissektion

Update Gynäkologie