On the biomechanics of vaginal birth and common sequelae

Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a bio...

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Bibliographic Details
Published in:Annual review of biomedical engineering 2009-01, Vol.11 (1), p.163-176
Main Authors: Ashton-Miller, James A, Delancey, John O L
Format: Article
Language:English
Subjects:
Biomechanical Phenomena
Delivery, Obstetric - adverse effects
Female
Finite Element Analysis
Humans
Labor, Obstetric
Magnetic Resonance Imaging - methods
Pelvic Floor - injuries
Pregnancy
Risk
Uterine Contraction
Vagina - injuries
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Summary:Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a biomechanical perspective. We first review the functional anatomy of the female pelvic floor, the normal loads acting on the pelvic floor in activities of daily living, and the functional capacity of the pelvic floor muscles. Computer models show that the stretch ratio in the pelvic floor muscles can reach an extraordinary 3.26 by the end of the second stage of labor. Magnetic resonance images provide evidence that show that the pelvic floor regions experiencing the most stretch are at the greatest risk for injury, especially in forceps deliveries. A conceptual model suggests how these injuries may lead to the most common form of pelvic organ prolapse, a cystocele.
ISSN:1523-9829
1545-4274
DOI:10.1146/annurev-bioeng-061008-124823