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

项目总结/摘要 在怀孕和分娩期间，女性会经历骨盆软组织损伤。这种损伤与 出现症状性盆底疾病（PFDs），包括盆腔器官脱垂、泌尿和粪便 失禁预防产伤和产后出血后遗症的最大障碍之一是我们的 缺乏对何时以及如何受伤的了解。模拟模型表明，长期交付需要 伸展到母体骨盆底肌肉组织的程度大于骨骼肌正常 不受伤害的经历。因此，足月阴道分娩，几乎普遍的伤害将是预期的。 以前的研究使用解剖学和功能学方法来探讨这种神经肌肉损伤，但我们 仍然缺乏对产妇骨盆底损伤和恢复模式的全面了解。我们还拥有 对母体软组织在怀孕期间发生的变化的了解有限，可能是为了促进 无创伤分娩我们的机构拥有SQUID阵列生殖评估（SARA）系统，一种新颖的 和非侵入性工具，以评估生物磁信号，如由去极化发生 肌肉收缩。我们建议使用SARA系统来记录生物磁信号产生的 产妇骨盆底的提肛肌（LAMs）。这些磁记录（MMG）将被 用于研究产妇分娩前后的盆底神经肌肉功能。我们的项目将是第一个 利用MMG技术评估母体LAMs。我们将结合联合收割机的临床，解剖，和生理 终点，以提高我们对母体骨盆肌肉适应性和损伤恢复模式的认识， 我们已经证明，这是一项全面的方案，在初产妇中获得了有希望的初步数据。我们 总体假设是MMG将允许检测妊娠期间母体LAM适应， 确定产后损伤和恢复模式。目的1：扩展MMG测量的可行性 LAM复合体对妊娠的信号。目的2：跟踪和描述产时提肛肌的变化 MMG信号从第一到第三个三个月怀孕。目的3：确定LAM产伤的MMG模式， 恢复和相关MMG损伤证据与经会阴US可见的损伤。

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.