ArticleJournal of biomechanics2012
A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor.
Article in Journal of biomechanics, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 102 citations in OpenAlex.
- Comparative effectiveness of physical interventions for preventing perineal trauma during vaginal delivery: a systematic review and Bayesian network meta-analysis.Frontiers in medicine · 2026Pooled it
- Episiotomy in vacuum extraction, do we cut the levator ani muscle? A prospective cohort study.International urogynecology journal · 2022Trial
- Advanced FE simulation coupled with statistical surrogate modeling toward a multifactorial view on the pelvic floor muscle damage and perineal tearing during childbirth.Medical & biological engineering & computing · 2026Article
- Experimental characterization of the non-linear viscoelastic properties of human female perineal tissue.Scientific reports · 2025Article
- Finite element modeling in obstetrics and gynecology: advances, applications, and challenges.Frontiers in medicine · 2025Review
- Comprehensive Analysis of the Biomechanical Research of Pelvic Organ Prolapse: A Scientometric Approach.Journal of multidisciplinary healthcare · 2025Article
- On the uncertainty quantification of the active uterine contraction during the second stage of labor simulation.Medical & biological engineering & computing · 2024Article
- Proregenerative extracellular matrix hydrogel mitigates pathological alterations of pelvic skeletal muscles after birth injury.Science translational medicine · 2023Article
- Hiatal failure: effects of pregnancy, delivery, and pelvic floor disorders on level III factors.International urogynecology journal · 2023Review
- International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP).International urogynecology journal · 2022Review
- Analysis of the drainage effect of different incisions for high complex anal fistula based on FLUENT hydrodynamic simulation.Frontiers in surgery · 2022Article
- A Simulation Analysis of Maternal Pelvic Floor Muscle.International journal of environmental research and public health · 2021Article
- Finite element modeling of maximum stress in pelvic floor structures during the head expulsion (FINESSE) study.International urogynecology journal · 2021Article
- Feasibility and safety of antepartum tactile imaging.International urogynecology journal · 2021Article
- Biomechanical trade-offs in the pelvic floor constrain the evolution of the human birth canal.Proceedings of the National Academy of Sciences of the United States of America · 2021Article
- Investigating the birth-related caudal maternal pelvic floor muscle injury: The consequences of low cycle fatigue damage.Journal of the mechanical behavior of biomedical materials · 2020Article
- A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging.Female pelvic medicine & reconstructive surgery · 2020Article
- Force reversal and energy dissipation in composite tubes through nonlinear viscoelasticity of component materials.Proceedings. Mathematical, physical, and engineering sciences · 2020Article
- Persistent occiput posterior position and stress distribution in levator ani muscle during vaginal delivery computed by a finite element model.International urogynecology journal · 2020Article
- Comparison of Biaxial Biomechanical Properties of Post-menopausal Human Prolapsed and Non-prolapsed Uterosacral Ligament.Scientific reports · 2020Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo develop an improved model representation of the biomechanics of the levator muscles during the second stage of labor and to use a sensitivity analysis to explore the pathomechanics of levator muscle injury.
methodsA subject-specific finite element model of human pelvic floor and fetal head was developed based on in vivo MRI data of a fetal head and maternal pelvis. An anisotropic visco-hyperelastic constitutive model employed material parameters estimated from biaxial tests on pelvic floor tissues. Boundary conditions reflected both anatomic constraints and the curve of Carus. A short second stage of labor, scaled to 10 min, was then simulated using a single expulsive push made in the absence of levator co-contraction.
resultsLarge levator stresses occurred near the levator hiatus reaching 9 MPa at the pubovisceral muscle enthesis. The dominant principal stresses were located at, and aligned with, the edge of the hiatus. Muscle stretch bordering the levator hiatus was inhomogeneous: the average levator stretch was 3.55 with a high of 4.64 at the pubovisceral muscle enthesis. Decreasing perineal body stiffness by 40%, 50%, and 60% led to reductions in the maximum principal stretch ratio at the pubovisceral muscle enthesis of 8%, 13%, and 18%, respectively.
conclusionsThe pubovisceral muscle enthesis and the muscle near the perineal body are the regions of greatest strain thereby placing them at highest risk for stretch-related injury. Decreasing perineal body tissue stiffness significantly reduced tissue stress and strain, and therefore injury risk, in those regions.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.