Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

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Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3585 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1903-1910

Author(s):

Xiaolan Wang ◽

Fan Yang ◽

Wenjuan Chen ◽

Xiaohong Yuan

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Pelvic Floor Muscles ◽

Labor Analgesia ◽

Natural State ◽

Levator Ani Muscle ◽

Pelvic Floor Function ◽

Floor Function

Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.

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Pelvic floor dysfunction after levator trauma one year postpartum: a prospective case-control study

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0034-1374754 ◽

2014 ◽

Vol 74 (05) ◽

Author(s):

RM Laterza ◽

L Schrutka ◽

W Umek ◽

S Albrich ◽

H Koelbl

Keyword(s):

Pelvic Floor ◽

Case Control Study ◽

Pelvic Floor Dysfunction ◽

Case Control ◽

Levator Trauma ◽

One Year ◽

Control Study ◽

Prospective Case Control Study

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MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0065-0 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Heba Azzam ◽

Manal Halim ◽

Hany El-Assaly ◽

Aya Heiba

Keyword(s):

Pelvic Floor ◽

Treatment Plan ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Control Group ◽

Puborectalis Muscle ◽

Levator Ani Muscle ◽

Vaginal Deliveries ◽

Significant Difference ◽

Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

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Biofeedback for Pelvic Muscle Dysfunction

Biofeedback ◽

10.5298/1081-5937-44.2.02 ◽

2016 ◽

Vol 44 (2) ◽

pp. 55-57

Author(s):

Debbie Callif

Keyword(s):

Pelvic Floor ◽

Pelvic Pain ◽

Control Strategies ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Bowel Function ◽

Pelvic Floor Muscles ◽

Muscle Dysfunction ◽

Reduction Techniques ◽

Obturator Internus

Biofeedback for pelvic floor muscle dysfunction provides a practical and effective intervention for elimination disorders. Dysfunction in the pelvic floor muscles can affect bladder and bowel function and can cause pelvic pain. According to the National Association of Continence, there are 25 million Americans affected by bladder or bowel incontinence. Surface electromyographic (sEMG) sensors monitor the electrical activity of the pelvic floor muscles. Additional muscle co-contractions of the obturator internus, hip adductors, and transverse abdominis can facilitate improvements in symptoms affected by pelvic floor dysfunction. Pelvic floor therapy incorporates urge reduction techniques and functional control strategies. Dietary and lifestyle recommendations are also provided. The Biofeedback Certification International Alliance (BCIA) is the primary certifying body in the fields of biofeedback and neurofeedback. BCIA has a Blueprint of Knowledge specific for certification in pelvic muscle dysfunction biofeedback (PMDB). The Blueprint outlines the fundamental science, history, and theory of sEMG biofeedback as used for elimination disorders and chronic pelvic pain. You can find more information on PMDB at www.bcia.org.

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Prediction Index of Levator Ani Muscle Avulsion After Vaginal Delivery: An Evidence-Based Appraisal

Advanced Science Letters ◽

10.1166/asl.2018.12689 ◽

2018 ◽

Vol 24 (8) ◽

pp. 6214-6217

Author(s):

Budi Iman Santoso ◽

Adly Nanda Al-Fattah ◽

Raymond Surya ◽

Surrahman Hakim

Keyword(s):

Pelvic Floor ◽

Vaginal Delivery ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Influential Factors ◽

Cochrane Library ◽

Levator Ani Muscle ◽

Second Stage Of Labor ◽

Second Stage ◽

Levator Ani Muscle Avulsion

Pelvic floor dysfunction (PFD) due to vaginal delivery is related to tear of levator ani muscle (LAM) that potentially lead to the impairment of quality of life among women. A number of attempts to predict LAM injury after vaginal delivery had been conducted. This study aims to appraise the accuracy of several prediction index determining LAM injury after vaginal delivery. We conducted a search in Cochrane Library®, Pubmed®, and Medline® with the keywords of “pelvic floor dysfunction” AND “vaginal delivery” AND “prediction.” Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by 2 independent authors. After 6 weeks to 3 months’ duration of follow up, the incidence of LAM avulsion was varied from 15.4% to 35.6% from three studies. Multivariate analysis showed that forceps delivery, OASIS, and active second stage (OR 3.8; 3.1; 1.61; respectively) as the most influential factors for LAM incidence. Maternal age and time spent in active pushing were also contributed to LAM incidence. OASIS and second stage of labor could be used as the most influential components of prediction index for LAM incidence. Prediction indexes for LAM incidence are developed. OASIS and second stage of labor are acknowledged as two most influential variables among three appraised studies.

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P26.02: Correlation of ultrasound evidence of levator ani trauma with clinical functional testing of pelvic floor muscles

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.8667 ◽

2010 ◽

Vol 36 (S1) ◽

pp. 269-270

Author(s):

A. Bord ◽

S. Yagel ◽

L. Shick-Naveh ◽

M. Lipschuetz ◽

R. Drai-Hassid ◽

...

Keyword(s):

Pelvic Floor ◽

Levator Ani ◽

Pelvic Floor Muscles ◽

Functional Testing ◽

Ultrasound Evidence

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Focal levator ani eventrations: detection and characterization by magnetic resonance in patients with pelvic floor dysfunction

International Urogynecology Journal ◽

10.1007/s00192-003-1037-4 ◽

2003 ◽

Vol 14 (2) ◽

pp. 89-93 ◽

Cited By ~ 9

Author(s):

H. K. Pannu ◽

R. Genadry ◽

S. Gearhart ◽

H. S. Kaufman ◽

G. W. Cundiff ◽

...

Keyword(s):

Magnetic Resonance ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Levator Ani

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Task-specific differences in respiration-related activation of deep and superficial pelvic floor muscles

Journal of Applied Physiology ◽

10.1152/japplphysiol.00704.2018 ◽

2019 ◽

Vol 126 (5) ◽

pp. 1343-1351 ◽

Cited By ~ 3

Author(s):

Rafeef Aljuraifani ◽

Ryan E. Stafford ◽

Leanne M. Hall ◽

Wolbert van den Hoorn ◽

Paul W. Hodges

Keyword(s):

Pelvic Floor ◽

Deep Layer ◽

Pelvic Floor Dysfunction ◽

Muscle Layer ◽

Superficial Layer ◽

Pelvic Floor Muscles ◽

Abdominal Pressure ◽

Quiet Breathing ◽

Abdominal Organs ◽

Deep Layers

The female pelvic floor muscles (PFM) are arranged in distinct superficial and deep layers that function to support the pelvic/abdominal organs and maintain continence, but with some potential differences in function. Although general recordings of PFM activity show amplitude modulation in conjunction with fluctuation in intra-abdominal pressure such as that associated with respiration, it is unclear whether the activities of the two PFM layers modulate in a similar manner. This study aimed to investigate the activation of the deep and superficial PFM during a range of respiratory tasks in different postures. Twelve women without pelvic floor dysfunction participated. A custom-built surface electromyography (EMG) electrode was used to record the activation of the superficial and deep PFM during quiet breathing, breathing with increased dead space, coughing, and maximal and submaximal inspiratory and expiratory efforts. As breathing demand increased, the deep PFM layer EMG had greater coherence with respiratory airflow at the frequency of respiration than the superficial PFM ( P = 0.038). During cough, the superficial PFM activated earlier than the deep PFM in the sitting position ( P = 0.043). In contrast, during maximal and submaximal inspiratory and expiratory efforts, the superficial PFM EMG was greater than that for the deep PFM ( P = 0.011). These data show that both layers of PFM are activated during both inspiration and expiration, but with a bias to greater activation in expiratory tasks/phases. Activation of the deep and superficial PFM layers differed in most of the respiratory tasks, but there was no consistent bias to one muscle layer.NEW & NOTEWORTHY Although pelvic floor muscles are generally considered as a single entity, deep and superficial layers have different anatomies and biomechanics. Here we show task-specific differences in recruitment between layers during respiratory tasks in women. The deep layer was more tightly modulated with respiration than the superficial layer, but activation of the superficial layer was greater during maximal/submaximal occluded respiratory efforts and earlier during cough. These data highlight tightly coordinated recruitment of discrete pelvic floor muscles for respiration.

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