Maternal Birth-Related NeuroMuscular Injury and Recovery

描述（由申请人提供）：磁共振成像数据显示分娩和盆底结构性损伤之间有很强的关系，可能源于分娩排出期母体组织的拉伸或挤压。我们的初步研究表明，骨盆底肌肉最容易受到损伤的是耻骨尾骨横纹肌（PCM）；11-20%的产妇在产后一年出现肌肉缺损。虽然几种类型的肌肉或神经损伤可能导致PCM异常，但这些损伤类型的发生尚未明确。盆底连续MRI有可能提供随时间观察PCM缺陷的能力，并区分：1)神经源性损伤伴迟发性萎缩缺陷形成，2)肌源性损伤如肌肉撕裂，3)可恢复性损伤无持久缺陷。本研究的目的是：目的1)证明三种假设的PCM损伤类型中的每一种都发生在序列MRI上，目的2)获得试点数据以确定所需的样本量，以证明损伤类型解释产后6个月观察到的肌肉力量，盆腔器官支持和尿失禁状态的差异。我们将招募20名初产妇女，她们因分娩时使用产钳或吸尘机、会阴三度或四度撕裂或第二产程持续时间过长而导致PCM损伤的风险增加。我们将在产后2周和6个月获得mri，并在6个月时通过量化PCM强度（通过仪器窥器）、盆腔器官支持（通过盆腔器官脱垂量化）和尿失禁（通过标准尿动力学和调查测量）进行功能性PCM测试。我们的短期目标是为R01应用程序生成试点数据，旨在测试损伤类型和骨盆底功能之间的关系。我们的长期目标是预防和治疗尿失禁和脱垂，护理基于对病理损伤的更好理解。

DESCRIPTION (provided by applicant): Magnetic resonance imaging data suggest a strong relationship between childbirth and structural pelvic floor injury, likely originating from stretch or crush of maternal tissues during the expulsive phase of labor. Our preliminary studies show that the pelvic floor muscle most vulnerable to injury is the striated pubococcygeal muscle (PCM); 11-20% of parous women demonstrate a muscle defect a year postpartum. Although several types of muscle or nerve injury might cause PCM abnormalities, the occurrence of these injury types have not been clarified. Serial MRI of the pelvic floor potentially offers the ability to observe PCM defects over time and differentiate: 1) neurogenic injury with delayed atrophic defect formation, 2) myogenic injury as in muscle tear, and 3) recoverable injury without lasting defect. The Aims of this study are to: AIM 1) demonstrate that each of the three hypothesized PCM types of injuries occur on serial MRI, and AIM 2) obtain pilot data to determine the sample size needed to demonstrate that the type of injury explains differences in muscle strength, pelvic organ support, and continence status observed at 6-months postpartum. We will recruit 20 primiparous women at increased risk for PCM injury from a delivery that involved forceps or vacuum, 3rd or 4th degree perineal tears, or long duration of the 2nd stage of labor. We will obtain MRIs at 2 weeks and 6 months postpartum and perform functional PCM testing at 6-months by quantifying PCM strength (by instrumented speculum), pelvic organ support (by pelvic organ prolapse quantification) and incontinence (by standard urodynamic and survey measures). Our short-term goals are to generate pilot data for an R01 application Aimed at testing the relationship between injury type and pelvic floor function. Our long-term goal is prevention and treatment of incontinence and prolapse, with care based on an improved understanding of the injury responsible for the pathology.