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Pelvic floor muscle injury during a difficult labor. Can tissue fatigue damage play a role?

Maria C P Vila Pouca1,2, Marco P L Parente3,4, Renato M Natal Jorge3,4

  • 1Faculty of Engineering of University of Porto, Porto, Portugal. maria.vp@fe.up.pt.

International Urogynecology Journal
|November 16, 2021
PubMed

Pubovisceral muscle (PVM) injury during a difficult vaginal delivery leads to pelvic organ prolapse later in life. If one could address how and why the muscle injury originates, one might be able to better prevent these injuries in the future. In a recent review we concluded that many atraumatic injuries of the muscle-tendon unit are consistent with it being weakened by an accumulation of passive tissue damage during repetitive loading. While the PVM can tear due to a single overstretch at the end of the second stage of labor we hypothesize that it can also be weakened by an accumulation of microdamage and then tear after a series of submaximal loading cycles. We conclude that there is strong indirect evidence that low cycle fatigue of PVM passive tissue is a possible mechanism of its proximal failure. This has implications for finding new ways to better prevent PVM injury in the future.

Keywords:
Difficult vaginal deliveryMaterial fatiguePelvic muscle injuryRepetitive pushing

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