INJURY RECOVERY

伤病康复

• 批准号: 8134472
• 负责人: JANIS M MILLER
• 金额: $ 23.14万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8134472
• 关键词: Address; American; Birth; Categories; Cesarean section; Childbirth; Clinical; Data; Defect; Discipline of obstetrics; Etiology; Evaluation; Event; Goals; Incontinence; Infant; Injury; Investigation; Knowledge; Laceration; Link; Magnetic Resonance Imaging; Measurement; Measures; Modeling; Muscle; Nerve; Operative Surgical Procedures; Organ; Outcome; Pathology; Pelvic Floor Disorders; Pelvic Floor Muscle; Pelvic floor dysfunction; Pelvic floor structure; Pelvis; Phase; Pilot Projects; Postpartum Period; Pregnancy; Prevention; Probability; Ptosis; Recovery; Recovery of Function; Risk; Risk Factors; Sampling; Science; Signal Transduction; Speculums; Staging; Stress Urinary Incontinence; Stretching; Symptoms; Testing; Time; Tissues; United States National Institutes of Health; Vaginal delivery procedure; Woman; cohort; experience; functional decline; high risk; injured; insight; instrument; levator ani muscle; muscle strength; neuromuscular; symposium

Maternal Birth-Related Neuromuscular Injury and Recovery: Phase II 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. The pelvic floor muscle most vulnerable to injury is the striated pubovisceral muscle (PVM); 11-20% of parous women demonstrate a muscle defect at a year postpartum. A link between this defect and pelvic floor disorders has been found in our preliminary studies; women with prolapse and incontinence have a 4 foldand 2 fold- higher rate of PVM defects respectively. This finding offers a plausible causal link between pelvic floor disorders and a structural injury that occurs at childbirth. The cause of the defect is not yet known; nerve or muscle injury might be the underlying mechanism. Serial MRI offers the ability to observe PVM defects overtime and differentiate: 1) neurogenic injury (degeneration overtime), 2) myogenic injury (early and permanent avulsion), or 3) fully recoverable injury. Injury type can then be correlated with obstetric risk factors and functional recovery. This study's aims are to: 1) Establish the validity of factors used to identify women with greatest likelihood of PVM injury by estimating the probability of each injury outcome classified at 6 months postpartum in a sample (n=125) enriched for risk factors of long duration of 2nd stage, instrumented delivery, 3rd or 4th degree perineal lacerations, macrosomic infant. 2) Establish that PVM injuries are associated with vaginal births vs. pregnancy by comparing our 125 women who birthed vaginally to 50 women who birthed by elective Caesarean. 3) Determine the extent to which an array of clinical parameters observed at 6 weeks postpartum will predict long term (6 months) muscle outcomes. To do so, we will obtain MRI's at 2 weeks and 6 months postpartum and perform functional PVM testing at the standard 6-week postpartum evaluation. We will classify putative injury types and correlate with risk factors and functional parameters. We will try to address the knowledge gaps identified at the March 2006 NIH convened State-of-the-Science Conference: Cesarean Delivery on Maternal Request, which highlighted the need for understanding the mechanisms and risk factors for PVM injury. The short-term goal is new insights on injury mechanism. The long-term goal is prevention of and better treatment for pelvic floor disorders.

产妇分娩相关的神经肌肉损伤和恢复：第二阶段 磁共振成像数据表明分娩与盆底结构之间存在密切关系 损伤，可能源于分娩阶段母体组织的拉伸或挤压。这 最容易受伤的盆底肌肉是耻骨内脏横纹肌 (PVM)；经产的 11-20% 女性在产后一年就会出现肌肉缺陷。这种缺陷与盆底之间的联系 我们的初步研究发现了疾病；患有脱垂和失禁的女性有 4 倍 PVM 缺陷率分别高出 2 倍。这一发现提供了骨盆之间可能的因果关系 分娩时发生的地板障碍和结构性损伤。缺陷原因尚不清楚； 神经或肌肉损伤可能是潜在的机制。串行 MRI 提供了观察 PVM 的能力 缺陷加班并区分：1）神经源性损伤（加班退化），2）肌源性损伤（早期 和永久性撕脱），或 3）完全可恢复的损伤。损伤类型可以与产科风险相关 因素和功能恢复。本研究的目的是： 1) 确定用于识别的因素的有效性 通过估计每种损伤结果分类的概率，最有可能发生 PVM 损伤的女性 产后 6 个月时，在富含第二阶段长期持续危险因素的样本 (n=125) 中， 器械助产、会阴三度或四度撕裂、巨大婴儿。 2) 建立 PVM 通过比较 125 名阴道分娩的女性，伤害与阴道分娩与怀孕的相关性 50 名通过选择性剖腹产分娩的妇女。 3) 确定一系列临床症状的程度 产后 6 周观察到的参数将预测长期（6 个月）的肌肉结果。为此， 我们将在产后 2 周和 6 个月时进行 MRI 检查，并在产后进行功能性 PVM 测试。 标准 6 周产后评估。我们将对假定的伤害类型进行分类并与风险因素相关联 和功能参数。我们将努力解决 2006 年 3 月 NIH 所确定的知识差距 召开了科学状况会议：根据产妇要求进行剖腹产，其中强调了 需要了解 PVM 损伤的机制和危险因素。短期目标是新的见解 关于损伤机制。长期目标是预防和更好地治疗盆底疾病。