The Influence of Pelvic Muscle Activation During Vaginal Delivery

Parente, Marco; Jorge, R.M. Natal; Mascarenhas, Teresa; Silva-Filho, Agnaldo L.

doi:10.1097/aog.0b013e3181d534cd

Cited by 44 publications

(29 citation statements)

References 17 publications

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“…Although active contraction of the pelvic floor muscle tends to hinder fetal head descent (Parente et al, 2010), the present model most accurately simulates a short second stage of labor during which the mother successfully inhibits contraction of her levator muscles.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Lien et al (2004) used a 3-D geometric model to calculate the average stretch of the levator ani muscles at the end of the second stage of labor. Subsequently, a series of finite element models have appeared (d'Aulignac et al, 2005; Martins et al, 2007; Noakes et al, 2008; Hoyte et al, 2008; Parente et al, 2008, 2009a, 2009b, 2010). While these models have provided insight, they are limited by a paucity of pelvic floor muscle constitutive data derived from biaxial tests; rather, constitutive models derived from uniaxial tests have been the norm.…”

Section: Introductionmentioning

confidence: 99%

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A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor

Jing

Ashton‐Miller

DeLancey

2012

Journal of Biomechanics

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Objectives To develop an improved model representation of the biomechanics of the levator muscles during the second stage of labor and to use a sensitivity analysis to explore the pathomechanics of levator muscle injury. Methods A subject-specific finite element model of human pelvic floor and fetal head was developed based on in vivo MRI data of a fetal head and maternal pelvis. An anisotropic visco-hyperelastic constitutive model employed material parameters estimated from biaxial tests on pelvic floor tissues. Boundary conditions reflected both anatomic constraints and the curve of Carus. A short second stage of labor, scaled to 10 minutes, was then simulated using a single expulsive push made in the absence of levator co-contraction. Results Large levator stresses occured near the levator hiatus reaching 9 MPa at the pubovisceral muscle enthesis. The dominant principal stresses were located at, and aligned with, the edge of the hiatus. Muscle stretch bordering the levator hiatus was inhomogeneous: The average levator was 3.55 with a high of 4.64 at the pubovisceral muscle enthesis. Decreasing perineal body stiffness by 40%, 50%, and 60% led to reductions in the maximum principal stretch ratio at the pubovisceral muscle enthesis of 8%, 13%, and 18%, respectively. Conclusions The pubovisceral muscle enthesis and the muscle near the perineal body are the regions of greatest strain thereby placing them at highest risk for stretch-related injury. Decreasing perineal body tissue stiffness significantly reduced tissue stress and strain, and therefore injury risk, in those regions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor

Jing

Ashton‐Miller

DeLancey

2012

Journal of Biomechanics

View full text Add to dashboard Cite

show abstract

“…Women also have displayed higher satisfaction levels and greater probability of spontaneous deliveryrather than CS. (6,7,8) Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on.... Significance of the study Most of the women are giving birth in health-care facilities in lying down position on the bed which is rooted as convenience methods by health care providers, which is not based on scientific research.…”

Section: Introductionmentioning

confidence: 99%

Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

Zaky¹

2016

IOSR

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“…16,30 In addition, uncontrolled activation of MAP, with or without abdominal muscles training, can increase the PFM tension, resulting in a resistance of the delivery canal, representing an obstacle to the passage of the baby. 28,30 However, other studies claim that antenatal TMAP improves flexibility, strength and motor control, facilitating the passage of the baby during the second delivery stage, reducing the need for instrumental delivery and the risk of injury. 11,18 Thus, knowing the effects of antenatal methods of pelvic floor preparation on the perineal integrity and function of the PFM as well as compare them will bring scientific knowledge to assist in the decision-making about which method is the best suited to clinical practice aiming the prevention of perineal trauma.…”

Section: Discussionmentioning

confidence: 99%

“…During the second labor stage, the woman needs to contract the abdominal muscles and relax the perineal region muscles, promoting a muscular balance in this active process in order to allow the descendants and rotational movements of the fetal head and drive out the baby with lower perineal trauma risks. [9][10][11][12]28 The stretching techniques promote a controlled deformation of the muscles, i.e., an elastic deformation (not permanent). The type of deformation is influenced by the strength and the duration of the deformation force.…”

Section: Discussionmentioning

confidence: 99%

Effects of antenatal pelvic floor preparation techniques on the perineal integrity: a randomized controlled trial protocol

et al. 2016

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Background: The objective of the present study was to compare the effects of perineal massage, vaginal dilator and pelvic floor muscles training on the perineal integrity of primiparae women. Methods: Primigravidae women over 18 years old will be selected, from the 32th gestational week and wishing to have a vaginal delivery.Pregnant women will be randomly allocated from a sequence generated by a computer program into three groups: perineal massage, vaginal dilator and pelvic floor muscles training. The technique should be practiced from the 34th week of pregnancy until the beginning of labor. Randomization will be done by a researcher who was not involved with the recruitment, assessment and treatment of the participants. All participants will undergo a clinical and functional assessment of the pelvic floor before the beginning of the technique practice, as well as a reassessment of these items and an assessment of perineal integrity between 45 and 60 days after delivery for a blind physiotherapist regarding the interventional procedures. The evaluative procedures will be done by a ‘blinded’ physiotherapist in relation to the intervention procedures. The outcome will be determined by the perineal integrity by the presence or absence of perineal laceration as well as their characteristics observed immediately after delivery. Conclusions: The knowledge of the effects of antenatal pelvic floor preparation techniques on the perineal integrity and pelvic floor muscles function after delivery, will allow a better choice about which approach is the best to pregnant women to prevent perineal trauma.

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The Influence of Pelvic Muscle Activation During Vaginal Delivery

Abstract: III.

Cited by 44 publications

References 17 publications

A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor

A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor

Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

Effects of antenatal pelvic floor preparation techniques on the perineal integrity: a randomized controlled trial protocol

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