INJURY RECOVERY

产妇分娩相关的神经肌肉损伤和康复：II期 磁共振成像数据显示分娩与盆底结构密切相关 产伤，很可能源于分娩过程中母体组织的拉伸或挤压。这个 盆底肌肉最容易受伤的是耻骨内脏横纹肌(PVM)；11%-20%的产妇 女性在产后一年会出现肌肉缺陷。这种缺陷和骨盆底之间的联系 在我们的初步研究中已经发现了疾病；患有脱垂和大小便失禁的女性有4倍于 PVM缺陷率分别高2倍。这一发现提供了一个貌似合理的骨盆之间的因果联系 分娩时发生的地板紊乱和结构性损伤。缺陷的原因尚不清楚； 神经或肌肉损伤可能是潜在的机制。序列MRI提供了观察PVM的能力 缺陷超时与鉴别：1)神经源性损伤(变性超时)，2)肌源性损伤(早期 和永久性撕脱)，或3)完全可恢复的损伤。然后，伤害类型可以与产科风险相关 因素与功能恢复。本研究的目的是：1)建立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来估计最有可能发生PVM损伤的女性 在产后6个月时(n=125)，在第二阶段持续时间长的危险因素丰富的样本中， 器械分娩，会阴三度或四度撕裂，巨大儿。2)建立PVM 通过对125名经阴道分娩的妇女进行比较，发现伤害与阴道分娩和怀孕有关。 给50名择期剖腹产的妇女。3)确定一系列临床 产后6周观察的参数将预测长期(6个月)肌肉结果。要做到这一点， 我们将在产后2周和6个月进行MRI检查，并在产后2周和6个月进行功能性PVM测试 标准的产后6周评估。我们将对推定的伤害类型进行分类，并与风险因素相关联 和功能参数。我们将努力解决在2006年3月的NIH会议上发现的知识差距 召开科学状况会议：应产妇要求进行剖腹产，会议突出了 需要了解PVM损伤的机制和危险因素。短期目标是新的见解 关于损伤机制的研究。长期目标是预防和更好地治疗盆底疾病。

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.