Quantity and distribution of levator ani stretch during simulated vaginal childbirth.

Abstract

The objective of the study was to develop a model of the female pelvic floor to study levator stretch during simulated childbirth. Magnetic resonance data from an asymptomatic nulligravida were segmented into pelvic muscles and bones to create a simulation model. Stiffness estimates of lateral and anteroposterior levator attachments were varied to estimate the impact on levator stretch. A 9 cm sphere was passed through the pelvis, along the path of the vagina, simulating childbirth. Levator response was interpreted at 4 positions of the sphere, simulating fetal head descent. The levator was color mapped to display the stretch experienced. A maximum stretch ratio of 3.5 to 1 was seen in the posteriomedial puborectalis. Maximum stretch increased with increasing stiffness of lateral levator attachments. Although preliminary, this work may help explain epidemiologic data regarding the pelvic floor impact of a first delivery. The models and simulation technique need refinement, but they may help study the effect of labor parameters on the pelvic floor.