title: Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth.
abstract: Several studies have shown that pelvic floor injuries during a vaginal delivery can be considered a significant factor in the development of pelvic floor dysfunction. Such disorders include a group of conditions affecting women like urinary incontinence, pelvic organ prolapse and fecal incontinence. Numerical simulations are valuable tools that are contributing to the clarification of the mechanisms behind pelvic floor disorders. The aim of this work is to propose a mechanical model implemented in the finite element method context to estimate the damage in the pelvic floor muscles by mechanical effects during a vaginal delivery of a fetus in vertex presentation and occipitoanterior position. The constitutive model adopted has already been successfully used in the simulation of childbirth and the structural damage model added has previously been applied to characterize the damage process in biological soft tissues undergoing finite deformations. The constitutive parameters were fit to experimental data available in the literature and the final proposed material model is suitable to estimate the mechanical damage in the pelvic floor muscle during a vaginal delivery. The computational model predicts that even an apparently uneventful vaginal delivery inflicts injuries to the pelvic floor muscles, particularly during the extension of the fetus head, having been obtained more than 10% of damaged fibers. As a clinical evidence, the present work allows to conclude that the puborectalis component of the levator ani muscle is the most prone to damage.
authors.affiliation: INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal. Electronic address: deb11005@fe.up.pt.
authors.forename: Dulce A
authors.initials: DA
authors.lastname: Oliveira
authors.affiliation: INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
authors.forename: Marco P L
authors.initials: MP
authors.lastname: Parente
authors.affiliation: Aragón Institute of Engineering Research, University of Zaragoza, Calle María de Luna 3, 50018 Zaragoza, Spain; Biomedical Research Networking Centre on Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Calvo
authors.affiliation: Department of Gynecology & Obstetrics, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Mascarenhas
authors.affiliation: INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
authors.forename: Renato M
authors.initials: RM
authors.lastname: Natal Jorge
mesh_terms: D001696:Biomechanical Phenomena; D003198:Computer Simulation; D005260:Female; D005333:Fetus; D020342:Finite Element Analysis; D006257:Head; D006801:Humans; D055595:Mechanical Phenomena; D036801:Parturition; D017773:Pelvic Floor / Q000293:injuries* / Q000473:pathology; D011247:Pregnancy
keywords: Constitutive model; Damage mechanics; Finite element method; Pelvic floor disorders