Magnetomyography of levator muscle complex in pregnancy and postpartum: Adaptation, injury, and recovery patterns

项目摘要/摘要 在怀孕和分娩期间，妇女会经历骨盆软组织损伤。这一损伤与 症状性盆底疾病(PFD)的发展，包括盆腔器官脱垂、尿液和粪便 大小便失禁。预防产伤及其后遗症后遗症的最大障碍之一是我们的 对伤害发生的时间和方式缺乏了解。模拟模型表明，学期交付需要 伸展到母体盆底肌肉的程度比正常情况下骨骼肌的伸展程度要大 在没有受到伤害的情况下进行。因此，对于足月阴道分娩，预计会出现近乎普遍的伤害。 以前的研究已经使用解剖学和功能方法学来探索这种神经肌肉损伤，但我们 仍然缺乏对产妇盆底损伤和康复模式的完整了解。我们还拥有 对母体软组织在怀孕期间所经历的变化的了解有限，可能是为了促进 无创性分娩。我们的机构拥有用于生殖评估的SQUID阵列(SARA)系统，这是一种新颖的 和非侵入性工具，用于评估生物磁信号，例如由以下情况发生的去极化产生的信号 肌肉收缩。我们建议使用SARA系统来记录由 产妇盆底的提肛肌(LAM)。这些磁肌图(MMG)记录将是 用于研究产妇分娩前后盆底神经肌肉功能。我们的项目将是第一个 使用MMG技术评估母体LAM。我们将结合临床、解剖学和生理学 终点，以提高我们对母体骨盆肌肉适应和损伤恢复模式的了解 这是一项全面的协议，我们已经用它展示了有希望的无辐射初步数据。我们的 总体假设是，MMG将允许检测孕妇在怀孕期间的LAM适应情况，并 产后损伤和康复模式的识别。目的1：扩大MMG测量的可行性 LAM复合体对怀孕的信号。目的2：追踪和描述产程中提肌的变化 MMG信号从怀孕的第一个月到第三个月。目的3：确定LAM产伤的MMG模式和 经会超声可见损伤的恢复和相关的MMG证据。

Project Summary/Abstract During pregnancy and delivery women experience pelvic soft tissue injury. This injury is associated with the development of symptomatic pelvic floor disorders (PFDs) including pelvic organ prolapse, urinary, and fecal incontinence. One of the biggest barriers to preventing birth injury and the subsequent sequelae of PFDs is our lack of understanding of when and how injury occurs. Simulation models suggest that term delivery requires stretch to the maternal pelvic floor musculature to a degree greater than that which skeletal muscle can normally undergo without sustaining injury. Thus, with term vaginal birth, near universal injury would be expected. Previous studies have used anatomic and functional methodology to explore this neuromuscular injury, but we continue to lack a complete understanding of maternal pelvic floor injury and recovery patterns. We also possess limited knowledge of the changes which maternal soft tissues undergo during pregnancy, presumably to facilitate atraumatic birth. Our institution houses the SQUID Array for Reproductive Assessment (SARA) system, a novel and noninvasive tool to assess biomagnetic signals such as those created by depolarization occurring with muscle contraction. We propose to use the SARA system to record the biomagnetic signals generated by the levator ani muscles (LAMs) of the maternal pelvic floor. These magnetomyographic (MMG) recordings will be used to study maternal pelvic floor neuromuscular function before and after delivery. Our project will be the first to use MMG technology to assess the maternal LAMs. We will combine clinical, anatomic, and physiologic endpoints to improve our knowledge of maternal pelvic muscular adaptations and injury recovery patterns using a comprehensive protocol with which we have demonstrated promising preliminary data in nulligravidas. Our overall hypothesis is that MMG will allow detection of maternal LAMs adaptation during pregnancy and identification of injury and recovery patterns postpartum. Aim 1: To extend the feasibility of measuring MMG signals of the LAM complex to pregnancy. Aim 2: To track and characterize the intrapartum change in levator MMG signals from 1st to 3rd trimester pregnancy. Aim 3: To determine MMG patterns of LAM birth injury and recovery and associate MMG evidence of injury with injury visible by transperineal US.