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Louwagie EM, Rajasekharan D, Feder A, Fang S, Nhan-Chang CL, Mourad M, Myers KM. Parametric Solid Models of the At-Term Uterus From Magnetic Resonance Images. J Biomech Eng 2024; 146:071008. [PMID: 38491978 PMCID: PMC11080951 DOI: 10.1115/1.4065109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Birthing mechanics are poorly understood, though many injuries during childbirth are mechanical, like fetal and maternal tissue damage. Several biomechanical simulation models of parturition have been proposed to investigate birth, but many do not include the uterus. Additionally, most solid models rely on segmenting anatomical structures from clinical images to generate patient geometry, which can be time-consuming. This work presents two new parametric solid modeling methods for generating patient-specific, at-term uterine three-dimensional geometry. Building from an established method of modeling the sagittal uterine shape, this work improves the uterine coronal shape, especially where the fetal head joins the lower uterine wall. Solid models of the uterus and cervix were built from five at-term patients' magnetic resonance imaging (MRI) sets. Using anatomy measurements from MRI-segmented models, two parametric models were created-one that employs an averaged coronal uterine shape and one with multiple axial measurements of the coronal uterus. Through finite element analysis, the two new parametric methods were compared to the MRI-segmented high-fidelity method and a previously published elliptical low-fidelity method. A clear improvement in the at-term uterine shape was found using the two new parametric methods, and agreement in principal Lagrange strain directions was observed across all modeling methods. These methods provide an effective and efficient way to generate three-dimensional solid models of patient-specific maternal uterine anatomy, advancing possibilities for future research in computational birthing biomechanics.
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Affiliation(s)
- Erin M. Louwagie
- Department of Mechanical Engineering, Columbia University, New York, NY 10027
| | - Divya Rajasekharan
- Department of Mechanical Engineering, Columbia University, New York, NY 10027
| | - Arielle Feder
- Department of Mechanical Engineering, Columbia University, New York, NY 10027
- Tel Aviv University
| | - Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY 10027
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics & Gynecology, Irving Medical Center, Columbia University, New York, NY 10032
| | - Mirella Mourad
- Department of Obstetrics & Gynecology, Columbia University, Irving Medical Center, New York, NY 10032
- Columbia University Irving Medical Center
| | - Kristin M. Myers
- Department of Mechanical Engineering, Columbia University, New York, NY 10027
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Nguyen TNT, Ballit A, Lecomte-Grosbras P, Colliat JB, Dao TT. On the uncertainty quantification of the active uterine contraction during the second stage of labor simulation. Med Biol Eng Comput 2024; 62:2145-2164. [PMID: 38478304 DOI: 10.1007/s11517-024-03059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/23/2024] [Indexed: 06/21/2024]
Abstract
Uterine contractions in the myometrium occur at multiple scales, spanning both organ and cellular levels. This complex biological process plays an essential role in the fetus delivery during the second stage of labor. Several finite element models of active uterine contractions have already been developed to simulate the descent of the fetus through the birth canal. However, the developed models suffer severe reliability issues due to the uncertain parameters. In this context, the present study aimed to perform the uncertainty quantification (UQ) of the active uterine contraction simulation to advance our understanding of pregnancy mechanisms with more reliable indicators. A uterus model with and without fetus was developed integrating a transversely isotropic Mooney-Rivlin material with two distinct fiber orientation architectures. Different contraction patterns with complex boundary conditions were designed and applied. A global sensitivity study was performed to select the most valuable parameters for the uncertainty quantification (UQ) process using a copula-based Monte Carlo method. As results, four critical material parameters (C 1 , C 2 , K , Ca 0 ) of the active uterine contraction model were identified and used for the UQ process. The stress distribution on the uterus during the fetus descent, considering first and second fiber orientation families, ranged from 0.144 to 1.234 MPa and 0.044 to 1.619 MPa, respectively. The simulation outcomes revealed also the segment-specific contraction pattern of the uterus tissue. The present study quantified, for the first time, the effect of uncertain parameters of the complex constitutive model of the active uterine contraction on the fetus descent process. As perspectives, a full maternal pelvis model will be coupled with reinforcement learning to automatically identify the delivery mechanism behind the cardinal movements of the fetus during the active expulsion process.
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Affiliation(s)
- Trieu-Nhat-Thanh Nguyen
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France
| | - Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France
| | - Pauline Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France
| | - Jean-Baptiste Colliat
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France.
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Tao R, Grimm MJ. Simulation of the Childbirth Process in LS-DYNA. J Biomech Eng 2024; 146:061002. [PMID: 38299474 DOI: 10.1115/1.4064594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
Childbirth or labor, as the final phase of a pregnancy, is a biomechanical process that delivers the fetus from the uterus. It mainly involves two important biological structures in the mother, the uterus-generating the pushing force on the fetus-and the pelvis (bony pelvis and pelvic floor muscles)-resisting the movement of the fetus. The existing computational models developed in this field that simulate the childbirth process have focused on either the uterine expulsion force or the resistive structures of the pelvis, not both. An FEM model including both structures as a system was developed in this paper to simulate the fetus delivery process in LS-DYNA. Uterine active contraction was driven by contractile fiber elements using the Hill material model. The passive portion of the uterus and pelvic floor muscles were modeled with Neo Hookean and Mooney-Rivlin materials, respectively. The bony pelvis was modeled as a rigid body. The fetus was divided into three components: the head, neck, and body. Three uterine active contraction cycles were modeled. The model system was validated based on multiple outputs from the model, including the stress distribution within the uterus, the maximum Von Mises and principal stress on the pelvic floor muscles, the duration of the second stage of the labor, and the movement of the fetus. The developed model system can be applied to investigate the effects of pathomechanics related to labor, such as pelvic floor disorders and brachial plexus injury.
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Affiliation(s)
- Ru Tao
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824
| | - Michele J Grimm
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824; Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824; College of Nanotechnology, Science, and Engineering, University at Albany, Albany, NY 12222
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Ballit A, Ferrandini M, Dao TT. Novel hybrid rigid-deformable fetal modeling for simulating the vaginal delivery within the second stage of labor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108168. [PMID: 38604009 DOI: 10.1016/j.cmpb.2024.108168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/14/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND OBJECTIVE The fetal representation as a 3D articulated body plays an essential role to describe a realistic vaginal delivery simulation. However, the current computational solutions have been oversimplified. The objective of the present work was to develop and evaluate a novel hybrid rigid-deformable modeling approach for the fetal body and then simulate its interaction with surrounding fetal soft tissues and with other maternal pelvis soft tissues during the second stage of labor. METHODS CT scan data was used for 3D fetal skeleton reconstruction. Then, a novel hybrid rigid-deformable model of the fetal body was developed. This model was integrated into a maternal 3D pelvis model to simulate the vaginal delivery. Soft tissue deformation was simulated using our novel HyperMSM formulation. Magnetic resonance imaging during the second stage of labor was used to impose the trajectory of the fetus during the delivery. RESULTS Our hybrid rigid-deformable fetal model showed a potential capacity for simulating the movements of the fetus along with the deformation of the fetal soft tissues during the vaginal delivery. The deformation energy density observed in the simulation for the fetal head fell within the strain range of 3 % to 5 %, which is in good agreement with the literature data. CONCLUSIONS This study developed, for the first time, a hybrid rigid-deformation modeling of the fetal body and then performed a vaginal delivery simulation using MRI-driven kinematic data. This opens new avenues for describing more realistic behavior of the fetal body kinematics and deformation during the second stage of labor. As perspectives, the integration of the full skeleton body, especially the upper and lower limbs will be investigated. Then, the completed model will be integrated into our developed next-generation childbirth training simulator for vaginal delivery simulation and associated complication scenarios.
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Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000 Lille, France
| | - Morgane Ferrandini
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000 Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000 Lille, France.
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Ballit A, Dao TT. Multiphysics and multiscale modeling of uterine contractions: integrating electrical dynamics and soft tissue deformation with fiber orientation. Med Biol Eng Comput 2024; 62:791-816. [PMID: 38008805 DOI: 10.1007/s11517-023-02962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
The development of a comprehensive uterine model that seamlessly integrates the intricate interactions between the electrical and mechanical aspects of uterine activity could potentially facilitate the prediction and management of labor complications. Such a model has the potential to enhance our understanding of the initiation and synchronization mechanisms involved in uterine contractions, providing a more profound comprehension of the factors associated with labor complications, including preterm labor. Consequently, it has the capacity to assist in more effective preparation and intervention strategies for managing such complications. In this study, we present a computational model that effectively integrates the electrical and mechanical components of uterine contractions. By combining a state-of-the-art electrical model with the Hyperelastic Mass-Spring Model (HyperMSM), we adopt a multiphysics and multiscale approach to capture the electrical and mechanical activities within the uterus. The electrical model incorporates the generation and propagation of action potentials, while the HyperMSM simulates the mechanical behavior and deformations of the uterine tissue. Notably, our model takes into account the orientation of muscle fibers, ensuring that the simulated contractions align with their inherent directional characteristics. One noteworthy aspect of our contraction model is its novel approach to scaling the rest state of the mesh elements, as opposed to the conventional method of applying mechanical loads. By doing so, we eliminate artificial strain energy resulting from the resistance of soft tissues' elastic properties during contractions. We validated our proposed model through test simulations, demonstrating its feasibility and its ability to reproduce expected contraction patterns across different mesh resolutions and configurations. Moving forward, future research efforts should prioritize the validation of our model using robust clinical data. Additionally, it is crucial to refine the model by incorporating a more realistic uterus model derived from medical imaging. Furthermore, applying the model to simulate the entire childbirth process holds immense potential for gaining deeper insights into the intricate dynamics of labor.
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Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, 59000, Lille, France.
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Moura R, Oliveira DA, Parente MPL, Kimmich N, Natal Jorge RM. A biomechanical perspective on perineal injuries during childbirth. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107874. [PMID: 37866128 DOI: 10.1016/j.cmpb.2023.107874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Childbirth trauma is a major health concern that affects millions of women worldwide. Severe degrees of perineal trauma, designated as obstetric anal sphincter injuries (OASIS), and levator ani muscle (LAM) injuries are associated with long-term morbidity. While significant research has been conducted on LAM avulsions, less attention has been given to perineal trauma and OASIS, which affect up to 90% and 11% of vaginal deliveries, respectively. Despite being widely discussed, childbirth trauma remains unpredictable. This work aims to enhance the modeling of the maternal musculature during childbirth, with a particular focus on understanding the mechanisms underlying the often overlooked perineal injuries. METHODS A geometrical model of the pelvic floor muscles (PFM) and perineum (including the perineal body, ischiocavernosus, bulbospongiosus, superficial and deep transverse perineal muscles) was created. The muscles were characterized by a transversely isotropic visco-hyperelastic constitutive model. Two simulations of vaginal delivery were conducted with the fetus in the vertex presentation and occipito-anterior position, with and without the perineum. RESULTS The simulation that considered the perineum exhibited higher stresses over an extended area of the PFM, which suggests that including additional structures can impact the obtained results. The maximum stretch of the urogenital hiatus was 2.94 and the maximum stress was 23.86 kPa. The perineal body reached a maximum stretch of 1.95, which was more pronounced near the urogenital hiatus, where perineal tears may occur. The external anal sphincter's transverse diameter decreased by 51% and the maximum principal stresses were observed in the area close to the perineal body, where OASIS can occur. CONCLUSIONS The present study emphasizes the importance of including most structures involved in vaginal delivery in its biomechanical analysis and represents another step further in the understanding of perineal injuries and OASIS. The superior region of the perineal body and its connection to the urogenital hiatus and anal sphincter have been identified as the most critical regions, highly susceptible to injury.
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Affiliation(s)
- Rita Moura
- Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 400, 4200-465 Porto, Portugal.
| | - Dulce A Oliveira
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 400, 4200-465 Porto, Portugal.
| | - Marco P L Parente
- Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
| | - Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Renato M Natal Jorge
- Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
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Ballit A, Hivert M, Rubod C, Dao TT. Fast soft-tissue deformations coupled with mixed reality toward the next-generation childbirth training simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02864-5. [PMID: 37382859 DOI: 10.1007/s11517-023-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand. In the present work, we developed a virtual childbirth simulator based on the Mixed-Reality (MR) technology coupled with HyperMSM (Hyperelastic Mass-Spring Model) formulation for real-time soft-tissue deformations, providing intuitive user interaction with the virtual physical model and a quantitative assessment to enhance the trainee's gestures. Microsoft HoloLens 2 was used and the MR simulator was developed including a complete holographic obstetric model. A maternal pelvis system model of a pregnant woman (including the pelvis bone, the pelvic floor muscles, the birth canal, the uterus, and the fetus) was generated, and HyperMSM formulation was applied to simulate the soft tissue deformations. To induce realistic reactions to free gestures, the virtual replicas of the user's detected hands were introduced into the physical simulation and were associated with a contact model between the hands and the HyperMSM models. The gesture of pulling any part of the virtual models with two hands was also implemented. Two labor scenarios were implemented within the MR childbirth simulator: physiological labor and forceps-assisted labor. A scoring system for the performance assessment was included based on real-time biofeedback. As results, our developed MR simulation application was developed in real-time with a refresh rate of 30-50 FPS on the HoloLens device. HyperMSM model was validated using FE outcomes: high correlation coefficients of [0.97-0.99] and weighted root mean square relative errors of 9.8% and 8.3% were obtained for the soft tissue displacement and energy density respectively. Experimental tests showed that the implemented free-user interaction system allows to apply the correct maneuvers (in particular the "Viennese" maneuvers) during the labor process, and is capable to induce a truthful reaction of the model. Obtained results confirm also the possibility of using our simulation's outcomes to objectively evaluate the trainee's performance with a reduction of 39% for the perineal strain energy density and 5.6 mm for the vertical vaginal diameter when the "Viennese" technique is applied. This present study provides, for the first time, an interactive childbirth simulator with an MR immersive experience with direct free-hand interaction, real-time soft-tissue deformation feedback, and an objective performance assessment based on numerical outcomes. This offers a new perspective for enhancing next-generation training-based obstetric teaching. The used models of the maternal pelvic system and the fetus will be enhanced, and more delivery scenarios (e.g. instrumental delivery, breech delivery, shoulder dystocia) will be designed and integrated. The third stage of labor will be also investigated to include the delivery of the placenta, and the clamping and cutting of the umbilical cord.
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Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
| | - Mathieu Hivert
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France.
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Chen S, Grimm MJ. Childbirth Computational Models: Characteristics and Applications. J Biomech Eng 2021; 143:050801. [PMID: 33269787 DOI: 10.1115/1.4049226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/08/2022]
Abstract
The biomechanical process of childbirth is necessary to usher in new lives-but it can also result in trauma. This physically intense process can put both the mother and the child at risk of injuries and complications that have life-long impact. Computational models, as a powerful tool to simulate and explore complex phenomena, have been used to improve our understanding of childbirth processes and related injuries since the 1990s. The goal of this paper is to review and summarize the breadth and current state of the computational models of childbirth in the literature-focusing on those that investigate the mechanical process and effects. We first summarize the state of critical characteristics that have been included in computational models of childbirth (i.e., maternal anatomy, fetal anatomy, cardinal movements, and maternal soft tissue mechanical behavior). We then delve into the findings of the past studies of birth processes and mechanical injuries in an effort to bridge the gap between the theoretical, numerical assessment and the empirical, clinical observations and practices. These findings are from applications of childbirth computational models in four areas: (1) the process of childbirth itself, (2) maternal injuries, (3) fetal injuries, and (4) protective measures employed by clinicians during delivery. Finally, we identify some of the challenges that computational models still face and suggest future directions through which more biofidelic simulations of childbirth might be achieved, with the goal that advancing models may provide more efficient and accurate, patient-specific assessment to support future clinical decision-making.
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Affiliation(s)
- Sheng Chen
- Departments of Mechanical and Biomedical Engineering, Michigan State University, 428 S. Shaw Lane, East Lansing, MI 48824
| | - Michele J Grimm
- Departments of Mechanical and Biomedical Engineering, Michigan State University, 428 S. Shaw Lane, East Lansing, MI 48824
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Dominoni M, Gardella B, Gritti A, Spinillo A. Uterus-sparing surgery and mesh implantation: New insights. Eur J Obstet Gynecol Reprod Biol 2021; 261:244-245. [PMID: 33895035 DOI: 10.1016/j.ejogrb.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Mattia Dominoni
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Gritti
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Xu Y, Liu H, Hao D, Taggart M, Zheng D. Uterus Modeling from Cell to Organ Level: towards Better Understanding of Physiological Basis of Uterine Activity. IEEE Rev Biomed Eng 2020; 15:341-353. [PMID: 32915747 DOI: 10.1109/rbme.2020.3023535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relatively limited understanding of the physiology of uterine activation prevents us from achieving optimal clinical outcomes for managing serious pregnancy disorders such as preterm birth or uterine dystocia. There is increasing awareness that multi-scale computational modeling of the uterus is a promising approach for providing a qualitative and quantitative description of uterine physiology. The overarching objective of such approach is to coalesce previously fragmentary information into a predictive and testable model of uterine activity that, in turn, informs the development of new diagnostic and therapeutic approaches to these pressing clinical problems. This article assesses current progress towards this goal. We summarize the electrophysiological basis of uterine activation as presently understood and review recent research approaches to uterine modeling at different scales from single cell to tissue, whole organ and organism with particular focus on transformative data in the last decade. We describe the positives and limitations of these approaches, thereby identifying key gaps in our knowledge on which to focus, in parallel, future computational and biological research efforts.
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Gatellier MA, Dit Gautier EJ, Mayeur O, Brieu M, Cosson M, Rubod C. Complete 3 dimensional reconstruction of parturient pelvic floor. J Gynecol Obstet Hum Reprod 2019; 49:101635. [PMID: 31499277 DOI: 10.1016/j.jogoh.2019.101635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/05/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The women pelvic floor is a complex system, which seems to endure several modifications during pregnancy and childbirth. Our primary purpose was to build an extensive 3 dimensional (3D) numerical anatomical model of the women pelvic floor. METHODS First, the role and the location of each organ, muscle, or ligament, were identified through an extensive literature review. Then, different entities were selected because of their visibility and importance in the pelvic floor. Each entity was identified using anatomical knowledge, and outlined on 2 dimensional (2D) MRI images, that were carried out on 4 pregnant women, using sequences T1, T2 and proton density weighted, through AVIZO program. The overlay of these 2D outlines produced a 3D geometrical reconstruction, which was then reworked with the program CATIA to obtain a usable geometric model. RESULTS We identified and integrated 15 anatomical structures to the geometrical model, including organs, ligament and muscles from the pelvis and perineum. This geometrical model allowed us to obtain a visual interactive representation with 3D images. These different steps resulted in the creation of a complete numerical model of the female pelvic floor, which might be used in Finite Element simulation. CONCLUSION A new complete and accurate 3D numerical anatomical model of the women pelvic floor was elaborated. It presents simultaneously analytical prospects, through the observation of the strains and deformations that are imposed on the different structures, and educational prospects, through the detailed visual representation of several situations.
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Affiliation(s)
- Marie-Anne Gatellier
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France.
| | - Estelle Jean Dit Gautier
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Olivier Mayeur
- CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Mathias Brieu
- CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Michel Cosson
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Chrystele Rubod
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
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Conway CK, Qureshi HJ, Morris VL, Danso EK, Desrosiers L, Knoepp LR, Goergen CJ, Miller KS. Biaxial biomechanical properties of the nonpregnant murine cervix and uterus. J Biomech 2019; 94:39-48. [PMID: 31353018 DOI: 10.1016/j.jbiomech.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/12/2019] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
Abstract
From a biomechanical perspective, female reproductive health is an understudied area of research. There is an incomplete understanding of the complex function and interaction between the cervix and uterus. This, in part, is due to the limited research into multiaxial biomechanical functions and geometry of these organs. Knowledge of the biomechanical function and interaction between these organs may elucidate etiologies of conditions such as preterm birth. Therefore, the objective of this study was to quantify the multiaxial biomechanical properties of the murine cervix and uterus using a biaxial testing set-up. To accomplish this, an inflation-extension testing protocol (n = 15) was leveraged to quantify biaxial biomechanical properties while preserving native matrix interactions and geometry. Ultrasound imaging and histology (n = 10) were performed to evaluate regional geometry and microstructure, respectively. Histological analysis identified a statistically significant greater collagen content and significantly smaller smooth muscle content in the cervix as compared to the uterus. No statistically significant differences in elastic fibers were identified. Analysis of bilinear fits revealed a significantly stiffer response from the circumferentially orientated ECM fibers compared to axially orientated fibers in both organs. Bilinear fits and a two-fiber family constitutive model showed that the cervix was significantly less distensible than the uterus. We submit that the regional biaxial information reported in this study aids in establishing an appropriate reference configuration for mathematical models of the uterine-cervical complex. Thus, may aid future work to elucidate the biomechanical mechanisms leading to cervical or uterine conditions.
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Affiliation(s)
- Cassandra K Conway
- Department of Biomedical Engineering, Tulane University, 6823 St. Charles Ave, New Orleans, LA 70118, USA.
| | - Hamna J Qureshi
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907, USA.
| | - Victoria L Morris
- Department of Biomedical Engineering, Tulane University, 6823 St. Charles Ave, New Orleans, LA 70118, USA.
| | - Elvis K Danso
- Department of Biomedical Engineering, Tulane University, 6823 St. Charles Ave, New Orleans, LA 70118, USA.
| | - Laurephile Desrosiers
- Department of Female Pelvic Medicine & Reconstructive Surgery, Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Leise R Knoepp
- Department of Female Pelvic Medicine & Reconstructive Surgery, Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907, USA.
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University, 6823 St. Charles Ave, New Orleans, LA 70118, USA.
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Oliveira DA, Parente MPL, Calvo B, Mascarenhas T, Natal Jorge RM. A holistic view of the effects of episiotomy on pelvic floor. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33. [PMID: 28444997 DOI: 10.1002/cnm.2892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/18/2017] [Accepted: 04/23/2017] [Indexed: 06/07/2023]
Abstract
Vaginal delivery is commonly accepted as a risk factor in pelvic floor dysfunction; however, other obstetric procedures (episiotomy) are still controversial. In this work, to analyze the relationship between episiotomy and pelvic floor function, a finite element model of the pelvic cavity is used considering the pelvic floor muscles (PFMs) with damaged regions from spontaneous vaginal delivery and from deliveries with episiotomy. Common features assessed at screening of pelvic floor dysfunction are evaluated during numerical simulations of both Valsalva maneuver and contraction. As stated in literature, a weakening of the PFM, represented by damaged regions in the finite element model, would lead to a bladder neck hypermobility measured as a variation between the α angle (angle between the bladder neck and the symphysis pubis line and the midline of the symphysis) during straining and withholding. However, the present work does not associate bladder neck hypermobility to a more damaged muscle, suggesting that other supportive structures also play an important role in the stabilization of the pelvic organs. Furthermore, considering passive behavior of the PFM, independently of the amount of damage considered, the resultant displacements of the pelvic structures are the same. Regarding the PFM contraction, the less the muscle is damaged, the greater the movements of the pelvic organs. Furthermore, the internal organs of the female genital system are the most affected by the unhealthy of the PFM. Additionally, the present study shows that the muscle damage affects more the active muscle component than the passive.
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Affiliation(s)
- Dulce A Oliveira
- INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Begoña Calvo
- Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
- Biomedical Research Networking Centre on Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Teresa Mascarenhas
- Department of Gynecology and Obstetrics, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Porto, Portugal
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Jean Dit Gautier E, Mayeur O, Lepage J, Brieu M, Cosson M, Rubod C. Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results. Int Urogynecol J 2017; 29:425-430. [DOI: 10.1007/s00192-017-3520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022]
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Maran JC, Cassagnes L, Delmas V, Musset D, Frydman R, Mage G, Canis M, Boyer L, Ami O. Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth. Surg Radiol Anat 2017; 40:371-380. [DOI: 10.1007/s00276-017-1925-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023]
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Hogan AM, Tejedor P, Lindsey I, Jones O, Hompes R, Gorissen KJ, Cunningham C. Pregnancy after laparoscopic ventral mesh rectopexy: implications and outcomes. Colorectal Dis 2017; 19:O345-O349. [PMID: 28710784 DOI: 10.1111/codi.13818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/11/2017] [Indexed: 12/14/2022]
Abstract
AIM Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ventral mesh rectopexy in young women until they have completed their family. The aim of the present study was to review outcomes of pregnancy following laparoscopic ventral mesh rectopexy from a tertiary referral centre over a 10-year period (2006-2016) and to review the impact on pelvic floor symptoms. METHOD We undertook a retrospective review of a prospectively compiled database of patients who had undergone laparoscopic ventral rectopexy in a single centre over a 10-year period. Pelvic floor symptom scores (Vaizey for incontinence and Longo for obstructive defaecation) were collected at initial presentation (pre-intervention), post-intervention and after child birth. RESULTS In all, 954 rectopexies were performed over this 10-year period. 225 (24%) patients were women and under 45 years of age (taken as an arbitrary cut-off for decreased likelihood of pregnancy). Eight (4%) of these patients became pregnant following rectopexy. The interval between rectopexy and delivery was 42 months (21-50). Six patients delivered live babies by elective lower segment caesarean section and two by spontaneous vaginal delivery. Six were first babies and two were second. No mesh related adverse outcome was reported. No difference in pelvic floor symptoms was demonstrated on comparison of post-rectopexy and post-delivery scores. CONCLUSION This study provides the first description in the English language literature of safe delivery by elective lower segment caesarean section or spontaneous vaginal delivery following laparoscopic ventral mesh rectopexy. No adverse impact on pelvic floor related quality of life was detected.
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Affiliation(s)
- A M Hogan
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - P Tejedor
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - O Jones
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - K J Gorissen
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
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Oliveira DA, Parente MPL, Calvo B, Mascarenhas T, Jorge RMN. The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth. Comput Methods Biomech Biomed Engin 2017; 20:1249-1259. [DOI: 10.1080/10255842.2017.1349762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Begoña Calvo
- Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
- Biomedical Research Networking Centre on Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Teresa Mascarenhas
- Faculty of Medicine, Department of Gynecology & Obstetrics, Centro Hospitalar de São João–EPE, University of Porto, Porto, Portugal
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Desseauve D, Pierre F, Gachon B, Decatoire A, Lacouture P, Fradet L. New approaches for assessing childbirth positions. J Gynecol Obstet Hum Reprod 2017; 46:189-195. [PMID: 28403977 DOI: 10.1016/j.jogoh.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND An overview of labor based only on epidemiological data cannot identify or explain the mechanisms involved in childbirth. Data about the position that women should take in giving birth are discordant. None of the studies of birth positions adequately define or describe them or their biomechanical impact (pelvic orientation, position of the back). The measurement of the effect of one position relative to that of another requires precise definitions of each position and of their maternal biomechanical consequences, as well as safe measurement methods. METHODOLOGY We have developed a system to analyze the position of labor by quantifying the posture of the woman's body parts (including thighs, trunk, and pelvis), using an optoelectronic motion capture device (Vicon™, Oxford Metrics) widely used in human movement analysis and a system for measuring the lumbar curve (Epionics spine system). A specific body model has also been created to conduct this biomechanical analysis, which is based on external markers. With this methodology and model, it should be possible to define: (1) the hip joint angles (flexion/extension, abduction/adduction, internal/external rotation); (2) the ante/retroversion of the pelvis; (3) the lumbar curve. DISCUSSION This methodology could become a reference for assessing delivery postures, one that makes it possible to describe the relation between the postures used in the delivery room and their impact on the pelvis and the spine in an integrated and comprehensive model. TRIAL REGISTRATION No. Eudract 2013-A01203-42.
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Affiliation(s)
- D Desseauve
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France; Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France.
| | - F Pierre
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - B Gachon
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - A Decatoire
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
| | - P Lacouture
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
| | - L Fradet
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
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Gachon B, Desseauve D, Fradet L, Decatoire A, Lacouture P, Pierre F, Fritel X. [Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects]. Prog Urol 2016; 26:385-94. [PMID: 26952013 DOI: 10.1016/j.purol.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. METHODS From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. RESULTS Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. CONCLUSION Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Gachon
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France.
| | - D Desseauve
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - L Fradet
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - A Decatoire
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - P Lacouture
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - X Fritel
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Inserm CIC-P 1402, centre d'investigation clinique pluri-thématique du CHU de Poitiers, 86021 Poitiers, France; CESP UMR Inserm U1018, équipe 7 : genre, santé sexuelle et reproductive, 94270 Kremlin-Bicêtre, France
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The role of childbirth research simulators in clinical practice. Int J Gynaecol Obstet 2015; 132:234-5. [PMID: 26617247 DOI: 10.1016/j.ijgo.2015.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/06/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
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