Download or read book Modelling the Second Stage of Labour written by Xiani Yan and published by . This book was released on 2016 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second stage of labour is the primary cause of levator ani (LA) muscle injury, which is in turn the leading factor contributing to pelvic floor disorders including pelvic organ prolapse and urinary stress incontinence. Understanding the mechanics of vaginal delivery is important for the development of preventative strategies for such disorders. This thesis presents a finite element (FE) biomechanical modelling framework to quantitatively analyse the mechanics of the second stage of labour. This childbirth model will enable the identification of potential risk factors that are associated with a difficult labour and LA muscle injuries. Anatomically realistic, individual-specific FE models were constructed from medical images of 26 nulliparous healthy female volunteers and 28 newborn infants. The models of the pelvic floor included the LA muscles, part of the obturator internus muscles, external sphincter muscles, perineal body, superficial anococcygeal ligament, and full bony pelvis. The models of the fetal head represented the vault that comes into direct contact with the pelvic floor during labour. Statistical shape analyses were conducted on these models and the primary shape variations are presented with reference to clinically important parameters. A new modelling framework of the second stage of labour was created based on an existing model. Additional anatomical structures, including the bony pelvis, external sphincter muscle, perineal body, and superficial anococcygeal ligament, were incorporated to provide more complete constraints for the deformation of the levator ani (LA) muscles and fetal head motion. Through a series of biomechanical simulations, it was found that the presence of the perineal body, external sphincter muscles, and inferior pubic rami played important roles in the mechanics of vaginal delivery. The effects of the mechanical properties of pelvic floor structures were investigated by altering the constitutive parameters of the pelvic floor within their physiological ranges of values. It was shown that the mechanical properties of the pelvic floor muscles influenced the delivery forces and the distributions of the maximum principal stretch ratios significantly. The largest maximum principal stretch ratios occurred at the anterior LA muscle- pubis insertions where injuries are most frequently observed clinically. The modelling framework was then applied to explore the effects of shape variations in the pelvic floor and fetal head on the maximum force required by delivery. Several features of the pelvic floor, including a reduction in the area of the levator hiatus, a constriction in the subpubic angle, a decrease in angle between the coccyx and the axial plane, and an increase in the size of the fetal head, increased the maximum delivery force substantially. Statistical regression models were also constructed to demonstrate the feasibility of generating approximations of childbirth simulations using fetal head geometries as input. With further development, such models could take both the pelvic floor and fetal head geometries as input and could be implemented in a clinical setting as a predictive model for childbirth planning.