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Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth

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Abstract

Purpose of the study

To describe the observable MRI changes in the urogenital sinus during the second stage of labor and delivery by comparing the changes in the positions of the anatomical structures of the maternal perineum using MRI-based vector 3-D models.

Materials and methods

Seven pregnant women underwent 3-D MRI sequences using a Philips 1 T Panorama open MRI during the pre-labor period and during the second stage of labor. A 3-D vector reconstruction platform (BABYPROGRESS, France) enabled the transformation of volumes of 2-D images into finite element meshes. The polygonal meshes labeled with the principal components of the urogenital sinus were used as part of a biomechanical study of the pressure exerted on the perineum during fetal descent.

Results

The expansion of the urogenital sinus was observed in all patients. Qualitative stretching was observed toward the rear and bottom of the iliococcygeus, pubococcygeus, puborectalis and obturator internus muscles. Significant length differences were measured along the iliococcygeus and pubococcygeus muscles but not along the tendinous arch of the levator ani or the puborectalis muscle. The inversion of the levator ani muscle curvature was accompanied by the transmission of pressure generated during fetal descent to the pubic muscle insertions and the descent of the tendinous arch of the levator ani.

Conclusion

Mechanical pressures responsible for the tensioning of the constituent muscles of the urogenital sinus were qualitatively identified during the second stage of labor. MRI-based vector 3-D models allow the quantitative assessment of levator ani muscle stretching during labor, but 2-D MRI is not sufficient for describing perineal expansion. Vector 3-D models from larger scale studies have the potential to aid in the calibration of a realistic simulation based on the consideration of the reaction of each muscular element. These models offer perspectives to enhance our knowledge regarding perineal expansion during childbirth as a risk factor for postpartum perineal defects.

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Abbreviations

MRI:

Magnetic resonance imaging

UGS:

Urogenital sinus

TALA:

Tendinous arch of levator ani

ICM:

Iliococcygeus muscle

PCM:

Pubococcygeus muscle

PRM:

Puborectalis muscle

IRB:

Institutional review board

ANSM:

French National Agency for Drug and Medical Product Safety

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Author information

Authors and Affiliations

  1. Plateforme de recherche IMAGINAITRE, Paris, France

    Jean-Christophe Maran & Olivier Ami

  2. Unité de Recherche en Développement, Imagerie et Anatomie (URDIA), Université Paris Descartes, EA 4465, Paris, France

    Jean-Christophe Maran & Vincent Delmas

  3. Institut Pascal, Image Guided Therapies (IGT), UMR UCA-CNRS 6602, Aubière, France

    Jean-Christophe Maran, Lucie Cassagnes, Louis Boyer & Olivier Ami

  4. CHU de Clermont Ferrand 1-Pôle de Radiologie, Clermont Ferrand, France

    Lucie Cassagnes & Louis Boyer

  5. Université Paris Sud 11, Orsay, France

    Dominique Musset

  6. Université Paris Descartes, Paris, France

    René Frydman

  7. Service de gynécologie-obstétrique, CHU de Clermont Ferrand 1, Clermont Ferrand, France

    Gérard Mage & Michel Canis

  8. Service de gynécologie-obstétrique, Clinique de l’Essonne, 2 bd des Champs Elysées, F91000, Evry, France

    Olivier Ami

  9. Clinique de la Muette, Ramsay Générale de Santé, Paris, France

    Olivier Ami

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  1. Jean-Christophe Maran
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  2. Lucie Cassagnes
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  3. Vincent Delmas
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Correspondence to Jean-Christophe Maran.

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The authors declare that they have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Maran, JC., Cassagnes, L., Delmas, V. et al. Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth. Surg Radiol Anat 40, 371–380 (2018). https://doi.org/10.1007/s00276-017-1925-9

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  • DOI: https://doi.org/10.1007/s00276-017-1925-9

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