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Medline ® Abstract for Reference 35

of 'Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth'

Deformation of the pelvic floor muscles during a vaginal delivery.
Parente MP, Jorge RM, Mascarenhas T, Fernandes AA, Martins JA
Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):65. Epub 2007 May 24.
Pelvic floor dysfunction is a hidden problem with a magnitude unknown to many. Statistics show that one in every ten women will have pelvic floor dysfunction so severe that it will require surgery. Several studies have shown that pelvic floor injuries during a vaginal delivery can be considered a significant factor in the development of urinary incontinence, fecal incontinence, and pelvic organ prolapse. The objective of the present work is to contribute to the clarification of the mechanisms behind pelvic floor disorders related to a vaginal delivery. For this purpose, a numerical simulation based on the finite element method was carried out. The finite element model intends to represent the effects that the passage of a fetal head can induce on the muscles of the pelvic floor, from a mechanical point of view. The model used for the simulation represents the pelvic bones, with the attached pelvic floor muscles and the fetus. In this work, we simulated the movements of the fetus during birth, in vertex position. We simulated the engagement, descent, flexion, internal rotation, and extension of the fetal head. Results for the pelvic floor stretch values obtained during the passage of the fetus head are presented; the deformation field is also shown. The results were obtained using the finite element method and a three-dimensional computer model of the pelvic floor and fetus. The maximum deformation obtained was 0.66 for a vertical displacement of the fetal head of approximately 60 mm.
IDMEC, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal.