Development of Analysis Tools to Enhance Magnetomyographic Assessment of Pelvic Floor Muscles

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和功能的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。我们建议采用SARA系统来记录生物磁信号产生的 肛提肌（LAM）的产妇骨盆底，并应用先进的信号处理技术， 提取并表征LAM电生理学。这些磁测记录（MMG）将用于 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 综合应用MMG技术评价母源性LAMs。我们将结合联合收割机的临床，解剖， 生理终点，以提高我们对母体骨盆肌肉适应和损伤恢复的认识 模式使用一个全面的协议，我们已经证明了有前途的初步数据，在小 未孕和未产孕妇的队列。本提案是对NIBIB的PAR-19-158的回应 生物工程研究赠款，我们采用多学科综合团队的方法来解决 关于母体肌肉适应性和母体LAM损伤的知识的缺乏因此提供了一个 未来损伤预防和康复研究创新的框架。我们的总体假设是MMG 将允许在怀孕期间检测母体LAMs适应，并识别损伤和恢复 产后模式目的1：使基于生物磁技术的系统适应高时空记录 MMG LAM复合体并应用先进的信号处理方法提取相关的盆底肌肉 参数目的2：跟踪和表征分娩时提肛肌MMG信号的变化， 妊娠三个月至产后早期和晚期。目的3：将LAM产伤的MMG模式与 恢复和相关MMG损伤证据与PFD症状和经会阴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 adapt SARA system to record the biomagnetic signals generated by the levator ani muscles (LAMs) of the maternal pelvic floor and apply advanced signal processing techniques to extract and characterize the LAM electrophysiology. 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 comprehensively 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 small cohorts of nulligravidas and nulliparous gravidas. This proposal is in response to NIBIB’s PAR-19-158 Bioengineering Research Grants, where we apply a multidisciplinary integrative team approach to address the paucity of knowledge regarding maternal muscular adaptations and maternal LAM injury thus provide a framework for future innovation in injury prevention and recovery research. 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 adapt biomagnetic technology based system to record high spatial temporal MMG LAM complex and apply advanced signal processing methods to extract relevant pelvic floor muscle parameters. Aim 2: To track and characterize changes in levator MMG signals with parturition comparing 3rd trimester pregnancy to early and late postpartum. Aim 3: To correlate MMG patterns of LAM birth injury and recovery and associate MMG evidence of injury with PFD symtpoms and injury visible by transperineal US.