Advertisement

Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1821–1826 | Cite as

Tissue biomechanical behavior should be considered in the risk assessment of perineal trauma at childbirth

  • Bertrand GachonEmail author
  • Antoine Nordez
  • Fabrice Pierre
  • Xavier Fritel
Guidelines and Position Statements
  • 33 Downloads

Abstract

Perineal trauma at childbirth is associated with strong negative impacts on a woman’s health but remains unpredictable. Pregnancy induces several changes in biomechanical behavior in humans as in animals, namely, an increase in ligamentous laxity and an increase in vaginal distensibility. Pelvic floor muscles in rats are reported to exhibit specific behaviors during pregnancy. Increases in both stiffness and the number of sarcomeres in series are observed and might process that protect against perineal trauma at childbirth. Some data in humans have shown that the risk of perineal trauma is highly linked to the intrinsic characteristics of the tissue, suggesting the potential benefit of incorporating intrinsic biomechanical characteristics in the risk prediction for perineal trauma. Shear wave elastography might be a useful noninvasive tool to investigate the elastic properties of these tissues in pregnant women in vivo, with the goal of implementing these properties as a predictive strategy.

Keywords

Obstetric anal sphincter injury Shear wave elastography Childbirth Ligamentous laxity Perineal trauma Individualized strategy 

Notes

Author contributions

BG: main text writing, data analysis for the initial and the revised manuscript. AN: review of each version of the manuscript, data analysis for the initial and the revised manuscript. FP: review of each version of the manuscript for the initial and the revised manuscript. XF: review of each version of the manuscript, data analysis, draft the work for the initial and the revised manuscript.

Funding

There was no funding for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

This article does not contain any studies with human participants performed by any of the authors. This considered details about informed consent are not applicable to this submission.

References

  1. 1.
    Fritel X, Gachon B, Desseauve D et al (2018) Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention. Gynecol Obstet Fertil Senol 46:419–426PubMedGoogle Scholar
  2. 2.
    Gachon B, Desgranges M, Fradet L et al (2018) Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury? Int Urogynecol J 29:1589–1595CrossRefGoogle Scholar
  3. 3.
    Gachon B, Nordez A, Pierre F et al (2019) In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women. Int Urogynecol J 30:1179–1186CrossRefGoogle Scholar
  4. 4.
    Gachon B, Fritel X, Fradet L et al (2017) Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J 28:1223–1231CrossRefGoogle Scholar
  5. 5.
    Schauberger CW, Rooney BL, Goldsmith L et al (1996) Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol 174:667–671CrossRefGoogle Scholar
  6. 6.
    Marnach ML, Ramin KD, Ramsey PS et al (2003) Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol 101:331–335PubMedGoogle Scholar
  7. 7.
    Okanishi N, Kito N, Akiyama M et al (2012) Spinal curvature and characteristics of postural change in pregnant women. Acta Obstet Gynecol Scand 91:856–861CrossRefGoogle Scholar
  8. 8.
    MacLennan AH, Nicolson R, Green RC et al (1986) Serum relaxin and pelvic pain of pregnancy. Lancet 2:243–245CrossRefGoogle Scholar
  9. 9.
    Vollestad NK, Torjesen PA, Robinson HS (2012) Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy. Man Ther 17:225–230CrossRefGoogle Scholar
  10. 10.
    Hansen M, Kjaer M (2014) Influence of sex and estrogen on musculotendinous protein turnover at rest and after exercise. Exerc Sport Sci Rev 42:183–192CrossRefGoogle Scholar
  11. 11.
    Burgess KE, Person SJ, Onambele GL (2009) Menstrual cycle variations in oestradiol and progesterone have no impact on in vivo medial gastrocnemius tendon mechanical properties. Clin Biomech 24:504–509CrossRefGoogle Scholar
  12. 12.
    Alperin M, Lawley DM, Esparza MC et al (2015) Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles. Am J Obstet Gynecol 213(191):e191–e197Google Scholar
  13. 13.
    Gachon B, Desseauve D, Fradet L et al (2016) Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects. Prog Urol 26:385–394CrossRefGoogle Scholar
  14. 14.
    Bey ME, Marzilger R, Hinkson L et al (2019) Patellar tendon stiffness is not reduced during pregnancy. Front Physiol 10:334CrossRefGoogle Scholar
  15. 15.
    Alperin M, Kaddis T, Pichika R et al (2016) Pregnancy-induced adaptations in intramuscular extracellular matrix of rat pelvic floor muscles. Am J Obstet Gynecol 215(210):e1–e7Google Scholar
  16. 16.
    LaCroix AS, Duenwald-Kuehl SE, Lakes RS et al (2013) Relationship between tendon stiffness and failure: a meta analysis. J Appl Physiol 15:43–51CrossRefGoogle Scholar
  17. 17.
    Catanzarite T, Bremner S, Barlow CL et al (2018) Pelvic muscles' mechanical response to strains in the absence and presence of pregnancy-induced adaptations in a rat model. Am J Obstet Gynecol 218:512.e1–513.e9CrossRefGoogle Scholar
  18. 18.
    Li X, Kruger JA, Nash MP et al (2010) Effects of nonlinear muscle elasticity on pelvic floor mechanics during vaginal childbirth. J Biomech Eng 132:111010CrossRefGoogle Scholar
  19. 19.
    Rahn DD, Ruff MD, Brown SA et al (2008) Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol 198:590e591–6CrossRefGoogle Scholar
  20. 20.
    Lowder JL, Debes KM, Moon DK et al (2007) Biomechanical adaptations of the rat vagina and supportive tissues in pregnancy to accommodate delivery. Obstet Gynecol 109:136–143CrossRefGoogle Scholar
  21. 21.
    Feola A, Endo M, Deprest J (2014) Biomechanics of the rat vagina during pregnancy and postpartum: a 3-dimensional ultrasound approach. Int Urogynecol J 25:915–920CrossRefGoogle Scholar
  22. 22.
    Meriwether KV, Rogers RG, Dunivan GC et al (2016) Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study. Int Urogynecol J 27:1193–1200CrossRefGoogle Scholar
  23. 23.
    Kruger JA, Nielsen PM, Budgett SC et al (2015) An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women. Neurourol Urodyn 34:133–138CrossRefGoogle Scholar
  24. 24.
    Kruger JA, Budgett SC, Wong V et al (2017) Characterising levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand 96:1234–1242CrossRefGoogle Scholar
  25. 25.
    Hug F, Tucker K, Gennisson JL et al (2015) Elastography for muscle biomechanics: toward the estimation of individual muscle force. Exerc Sport Sci Rev 43:125–133CrossRefGoogle Scholar
  26. 26.
    Chen L, Low LK, DeLancey JO et al (2015) In vivo estimation of perineal body properties using ultrasound quasistatic elastography in nulliparous women. J Biomech 48:1575–1579CrossRefGoogle Scholar
  27. 27.
    Kreutzkamp JM, Schäfer SD, Amler S et al (2017) Strain elastography as a new method for assessing pelvic floor biomechanics. Ultrasound Med Biol 43:868–872CrossRefGoogle Scholar
  28. 28.
    Maßlo K, Mollers M, De Murcia KO et al (2019) New method for assessment of levator avulsion injury: a comparative elastography study. J Ultrasound Med 38:1301–1307CrossRefGoogle Scholar
  29. 29.
    Xie M, Zhang X, Zhang X et al (2018) Can we evaluate the levator ani after Kegel exercise in women with pelvic organ prolapse by transperineal elastography? A preliminary study. J Med Ultrason 45:437–441CrossRefGoogle Scholar
  30. 30.
    Eby SF, Song P, Chen S et al (2013) Validation of shear wave elastography in skeletal muscle. J Biomech 46:2381–2387CrossRefGoogle Scholar
  31. 31.
    Jelovsek JE, Chagin K, Gyhagen M et al (2018) Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol 218(222):e19Google Scholar
  32. 32.
    McPherson KC, Beggs AD, Sultan AH et al (2014) Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system? BMC Res Notes 7:471CrossRefGoogle Scholar
  33. 33.
    Meister MR, Cahill AG, Conner SN et al (2016) Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol 215:310e311–7CrossRefGoogle Scholar
  34. 34.
    Jiang H, Qian X, Carroli G et al (2017) Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2:CD000081.  https://doi.org/10.1002/14651858.CD000081.pub3 CrossRefPubMedGoogle Scholar
  35. 35.
    Kwon HY, Park HS (2017) Episiotomy and the risk of severe perineal injuries among Korean women. J Matern Fetal Neonatal Med 30:1745–1749CrossRefGoogle Scholar
  36. 36.
    Klein MC, Gauthier RJ, Robbins JM et al (1994) Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 171:591–598CrossRefGoogle Scholar
  37. 37.
    Oliveira DA, Parente MP, Calvo B et al (2016) A biomechanical analysis on the impact of episiotomy during childbirth. Biomech Model Mechanobiol 15:1523–1534CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Poitiers University HospitalPoitiers UniversityPoitiersFrance
  2. 2.Movement - Interactions – Performance, MIP, EA 4334Nantes UniversitéNantesFrance
  3. 3.Health and Rehabilitation Research Institute, Faculty of Health and Environmental SciencesAuckland University of TechnologyAucklandNew Zealand
  4. 4.INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health TeamUniversity Paris-Sud, UMRS 1018OrsayFrance
  5. 5.INSERM, Poitiers University Hospital, CIC 1402Poitiers UniversityPoitiersFrance

Personalised recommendations