INJURY RECOVERY

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，分娩和结构性骨盆底之间有很强的关系 损伤，可能是在分娩的排出阶段由于母体组织的拉伸或挤压引起的。的 最容易受伤的骨盆底肌肉是横纹耻骨内脏肌（PVM）; 11 - 20%的经产 妇女在产后一年出现肌肉缺陷。这种缺陷和骨盆底之间的联系 在我们的初步研究中发现了一种疾病;脱垂和失禁的女性有4倍， PVM缺陷率分别高出2倍。这一发现提供了一个合理的因果关系之间的骨盆 分娩时发生的地板紊乱和结构损伤。缺陷的原因尚不清楚; 神经或肌肉损伤可能是潜在机制。串行MRI提供了观察PVM的能力 缺陷随时间推移和分化：1）神经源性损伤（变性随时间推移），2）肌源性损伤（早期 和永久性撕脱），或3）完全可恢复的损伤。损伤类型与产科风险相关 因素和功能恢复。本研究的主要目的是：1）建立用于识别的因素的有效性 最有可能发生PVM损伤的女性，通过估计每种损伤结果的概率分类 在产后6个月时，在富含第二阶段持续时间长的风险因素的样本（n = 125）中， 器械分娩，3度或4度会阴裂伤，巨大儿。2)建立PVM 通过比较我们的125名阴道分娩的妇女， 50名选择剖腹产的妇女。3)确定一系列临床 在产后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2周和6个月时进行功能性PVM测试。 标准产后6周评估。我们将对假定的损伤类型进行分类，并与风险因素相关联 功能参数。我们将努力解决2006年3月NIH确定的知识差距， 召开的科学现状会议：应产妇要求进行剖腹产，会议强调了 需要了解PVM损伤的机制和危险因素。短期目标是新的见解 损伤机制。长期目标是预防和更好地治疗骨盆底疾病。

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.