Anisotropic effects of the levator ani muscle during childbirth |
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Authors: | Xinshan Li Jennifer A Kruger Martyn P Nash and Poul M F Nielsen |
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Institution: | (1) Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand;(2) Department of Sport and Exercise Science, The University of Auckland, Auckland, New Zealand |
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Abstract: | Pelvic floor dysfunction and pelvic organ prolapse have been associated with damage to the levator ani (LA) muscle, but the
exact mechanisms linking them remain unknown. It has been postulated that factors such as vaginal birth and ageing may contribute
to long-term, irreversible LA muscle damage. To investigate the biomechanical significance of the LA muscle during childbirth,
researchers and clinicians have used finite element models to simulate the second stage of labour. One of the challenges is
to represent the anisotropic mechanical response of the LA muscle. In this study, we investigated the effects of anisotropy
by varying the relative stiffness between the fibre and the matrix components, whilst maintaining the same overall stress–strain
response in the fibre direction. A foetal skull was passed through two pelvic floor models, which incorporated the LA muscle
with different anisotropy ratios. Results showed a substantial decrease in the magnitude of the force required for delivery
as the fibre anisotropy was increased. The anisotropy ratio markedly affected the mechanical response of the LA muscle during
a simulated vaginal delivery. It is apparent that we need to obtain experimental data on muscle mechanics in order to better
approximate the LA muscle mechanical properties for quantitative analysis. These models may advance our understanding of the
injury mechanisms of pelvic floor during childbirth. |
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