A holistic view of the effects of episiotomy on pelvic floor. (14th June 2017)

• Record Type: Journal Article
• Authors: Oliveira, Dulce A.; Parente, Marco P.L.; Calvo, Begoña; Mascarenhas, Teresa; Natal Jorge, Renato M.
• Is Part Of: International journal for numerical methods in biomedical engineering. Volume 33:Number 12(2017:Dec.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-06-14
• Subjects: finite element analysis -- pelvic cavity modeling -- pelvic floor dysfunction; Biomedical engineering -- Periodicals; Imaging systems in medicine -- Periodicals; Numerical analysis -- Periodicals; Engineering mathematics -- Periodicals; 610.28
• DOI: 10.1002/cnm.2892
• Languages: English
• ISSNs: 2040-7939

Abstract

Abstract: Vaginal delivery is commonly accepted as a risk factor in pelvic floor dysfunction; however, other obstetric procedures (episiotomy) are still controversial. In this work, to analyze the relationship between episiotomy and pelvic floor function, a finite element model of the pelvic cavity is used considering the pelvic floor muscles (PFMs) with damaged regions from spontaneous vaginal delivery and from deliveries with episiotomy. Common features assessed at screening of pelvic floor dysfunction are evaluated during numerical simulations of both Valsalva maneuver and contraction. As stated in literature, a weakening of the PFM, represented by damaged regions in the finite element model, would lead to a bladder neck hypermobility measured as a variation between the α angle (angle between the bladder neck and the symphysis pubis line and the midline of the symphysis) during straining and withholding. However, the present work does not associate bladder neck hypermobility to a more damaged muscle, suggesting that other supportive structures also play an important role in the stabilization of the pelvic organs. Furthermore, considering passive behavior of the PFM, independently of the amount of damage considered, the resultant displacements of the pelvic structures are the same. Regarding the PFM contraction, the less the muscle is damaged, the greater the movements of the pelvic organs. Furthermore, the internal organs of the female genital system are the most affected by the unhealthy of the PFM. Additionally, the present study shows that the muscle damage affects more the active muscle component than the passive. Abstract : A biocomputational model is used to analyze the relationship between episiotomy and pelvic floor function, analyzing the damage in the pelvic floor muscles from such obstetric procedures. Common features assessed at screening of pelvic floor dysfunction are evaluated during numerical simulations of both Valsalva maneuver and contraction. Weakened muscles do not lead to bladder neck hypermobility indicating that other supportive structures also have an important role in the pelvic organs stabilization. However, weakened muscles have a reduced contraction ability.