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Modeling childbirth: elucidating the mechanisms of labor

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The process of childbirth and the mechanisms of labor have been studied for over a century, beginning with simple measurements of fetal skull and maternal pelvis dimensions. More recently, X‐rays, ultrasound, and magnetic resonance imaging have been used to try and quantify the biomechanics of labor. With the development of computational technologies, biomechanical models have emerged as a quantitative analysis tool for modeling childbirth. These methods are well known for their capabilities to analyze function at the organ scale. This review provides an overview of the state‐of‐the‐art finite element models of the mechanics of vaginal delivery, with detailed descriptions of the data sources, modeling frameworks, and results. We also discuss the limitations and improvements required in order for the models to be more accurate and clinically useful. Some of the major challenges include: modeling the complex geometry of the maternal pelvic floor muscles and fetal head motion during the second stage of labor; the lack of experimental data on the pelvic floor structures; and development of methods for clinical validation. To date, models have had limited success in helping clinicians understand possible factors leading to birth‐induced pelvic floor muscle injuries and dysfunction. However, much more can be achieved with further development of these quantitative modeling frameworks, such as tools for birth planning and medical education. Copyright © 2009 John Wiley & Sons, Inc.

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Figure 1.

Models of the female pelvic floor structures in anterior (left) and inferior (right) views.

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Figure 2.

Left lateral view: H is head, LA is levator ani, C is coccyx, S is symphysis pubis, TB is ties. (Reprinted with permission from Ref 40. Copyright 2008 Elsevier).

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Figure 3.

Right lateral view of the fetal head model with bone (red), and sutures (blue). (Reprinted with permission from Ref 37. Copyright 2001 Elsevier).

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Figure 4.

Right lateral view of the fetal head (grey), pelvic floor muscles (gold), the support mesh (brown) and the pubis (blue).

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Figure 5.

Left lateral view: 1 is puborectalis, 2–8 are pubococcygeus, 9–24 are iliococcygeus, urethra (umber), vagina (pink), rectum (brown), and arcus tendineus (white). (Reprinted with permission from Ref 41. Copyright 2004 Wolters Kluwer Health).

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Figure 6.

Right lateral view of the fetus, the pelvic floor muscles (dark grey), and the bony pelvis (pale grey). (Reprinted with permission from Ref 47. Copyright 2009 Elsevier).

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Figure 7.

Drawing of major pelvic floor muscles and surrounding bony structures. Pr, puborectalis; Pc, pubococcygeus; Ic, iliococcygeus; C, coccygeus; and Oi, obturator internus. (Reprinted with permission from Ref 57. Copyright 1997 Wiley Periodicals, Inc.).

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Blanche Capel

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earned her Ph.D. at the University of Pennsylvania and has been at Duke University since 1993. She earned her endowed professorship, the James B. Duke Professor of Cell Biology, for the meaningful discoveries she has made since her postdoctoral work in genetics at the National Institute for Medical Research in London. The broad goal of the research in Dr. Capel’s laboratory is to characterize the cellular and molecular basis of morphogenesis – how the body forms. She uses gonadal (gender/sex) development in the mouse as her model system and investigates a gene she helped discover, Sry, the male sex determining gene. Gonad development is unique in that a single rudimentary tissue can be induced to form one of two different organs, an ovary or testis, and she is learning all she can about this central mystery of biology.

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