title: A biomechanical analysis on the impact of episiotomy during childbirth.
abstract: Episiotomy is still a controversy issue among physicians, despite the enormous growth of clinical research. Therefore, the potential of numerical modeling of anatomical structures to simulate biomechanical processes was exploited to realize quantitatively the real effects of the episiotomy and its consequences on the pelvic floor muscle. As such, a numerical model was used composed of pelvic floor muscles, a surface delimiting the anterior region, and a fetus body. A normal vaginal delivery without and with different episiotomies was simulated with the fetus in vertex presentation and occipitoanterior position. According to our numerical results, a mediolateral episiotomy has a protective effect, reducing the stress on the muscles, and the force required to delivery successfully up to 52.2 %. The intervention also has benefits on muscle injury, reducing the damage to a small zone. This study demonstrates the feasibility of using a computational modeling approach to study parturition, namely the capability to isolate and evaluate the mechanical significance of a single feature. It must, however, be taken into account that the numerical model does not assess problems that may occur as blood loss, infections and others, so it is necessary to examine whether the benefits of an intervention outweigh the risks.
authors.affiliation: INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465, Porto, Portugal. dulce.oliv85@gmail.com.
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 Saragossa, Calle María de Luna 3, 50018, Saragossa, Spain.|Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Calvo
authors.affiliation: Department of Gynecology and 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 Natal
authors.initials: RM
authors.lastname: Jorge
mesh_terms: D001696:Biomechanical Phenomena; D004841:Episiotomy; D005260:Female; D005333:Fetus / Q000502:physiology; D020342:Finite Element Analysis; D006801:Humans; D009132:Muscles / Q000502:physiology; D036801:Parturition / Q000502:physiology*; D017773:Pelvic Floor / Q000502:physiology; D011247:Pregnancy; D013314:Stress, Mechanical
keywords: Childbirth; Damage; Episiotomy; Pelvic floor muscles