A computer-based simulation of vacuum extraction during childbirth

Vacuum extraction is an instrumental method used in obstetrics when childbirth labour fails to progress. The instrument used during vacuum extraction is the ventouse. It comprises of a suction cup attached to the fetal scalp through a vacuum, and a chord or chain to apply a traction force to expedite the delivery of the baby. It is claimed in the obstetric literature that incorrect placement of the cup, in particular across the anterior fontanelle, may cause serious injury to the fetal scalp. Here we put this theory to the test using a computerised simulation with finite element analysis. The results show substantially larger soft tissue deformations near the anterior fontanelle which may constitute quantitative evidence of qualitative assessments reported in the obstetric literature

Effects of fetal position on the loading of the fetal brain during the onset of the second stage of labour

During vaginal labour, the delivery requires the fetal head to mould to accommodate the geometric constraints of the birth canal. Excessive moulding can produce brain injuries and long-term sequelae. Understanding the loading of the fetal brain during the second stage of labour (fully dilated cervix, active pushing, and expulsion of fetus) could thus help predict the safety of the newborn during vaginal delivery. To this end, this study proposes a finite element model of the fetal head and maternal canal environment that is capable of predicting the stresses experienced by the fetal brain at the onset of the second phase of labour. Both fetal and maternal models were adapted from existing studies to represent the geometry of full-term pregnancy. Two fetal positions were compared: left-occiput-anterior and left-occiput-posterior. The results demonstrate that left-occiput-anterior position reduces the maternal tissue deformation, at the cost of higher stress in the fetal brain. In both cases, stress is concentrated underneath the sutures, though the location varies depending on the presentation. In summary, this study provides a patient-specific simulation platform for the study of vaginal labour and its effect on both the fetal brain and maternal anatomy. Finally, it is suggested that such an approach has the potential to be used by obstetricians to support their decision-making processes through the simulation of various delivery scenarios

A computer‑based simulation of childbirth using the partial Dirichlet–Neumann contact method with total Lagrangian explicit dynamics on the GPU

During physiological or ‘natural’ childbirth, the fetal head follows a distinct motion pattern—often referred to as the cardinal movements or ‘mechanisms’ of childbirth—due to the biomechanical interaction between the fetus and maternal pelvic anatomy. The research presented in this paper introduces a virtual reality-based simulation of physiological childbirth. The underpinning science is based on two numerical algorithms including the total Lagrangian explicit dynamics method to calculate soft tissue deformation and the partial Dirichlet–Neumann contact method to calculate the mechanical contact interaction between the fetal head and maternal pelvic anatomy. The paper describes the underlying mathematics and algorithms of the solution and their combination into a computer-based implementation. The experimental section covers first a number of validation experiments on simple contact mechanical problems which is followed by the main experiment of running a virtual reality childbirth. Realistic mesh models of the fetus, bony pelvis and pelvic floor muscles were subjected to the intra-uterine expulsion forces which aim to propel the virtual fetus through the virtual birth canal. Following a series of simulations, taking variations in the shape and size of the geometric models into account, we consistently observed the cardinal movements in the simulator just as they happen in physiological childbirth. The results confirm the potential of the simulator as a predictive tool for problematic childbirths subject to patient-specific adaptations

Biomechanics of foetal movement.

© 2015, AO Research Institute. All rights reserved.Foetal movements commence at seven weeks of gestation, with the foetal movement repertoire including twitches, whole body movements, stretches, isolated limb movements, breathing movements, head and neck movements, jaw movements (including yawning, sucking and swallowing) and hiccups by ten weeks of gestational age. There are two key biomechanical aspects to gross foetal movements; the first being that the foetus moves in a dynamically changing constrained physical environment in which the freedom to move becomes increasingly restricted with increasing foetal size and decreasing amniotic fluid. Therefore, the mechanical environment experienced by the foetus affects its ability to move freely. Secondly, the mechanical forces induced by foetal movements are crucial for normal skeletal development, as evidenced by a number of conditions and syndromes for which reduced or abnormal foetal movements are implicated, such as developmental dysplasia of the hip, arthrogryposis and foetal akinesia deformation sequence. This review examines both the biomechanical effects of the physical environment on foetal movements through discussion of intrauterine factors, such as space, foetal positioning and volume of amniotic fluid, and the biomechanical role of gross foetal movements in human skeletal development through investigation of the effects of abnormal movement on the bones and joints. This review also highlights computational simulations of foetal movements that attempt to determine the mechanical forces acting on the foetus as it moves. Finally, avenues for future research into foetal movement biomechanics are highlighted, which have potential impact for a diverse range of fields including foetal medicine, musculoskeletal disorders and tissue engineering

Dynamic finite-element simulations reveal early origin of complex human birth pattern

Human infants are born neurologically immature, potentially owing to conflicting selection pressures between bipedal locomotion and encephalization as suggested by the obstetrical dilemma hypothesis. Australopithecines are ideal for investigating this trade-off, having a bipedally adapted pelvis, yet relatively small brains. Our finite-element birth simulations indicate that rotational birth cannot be inferred from bony morphology alone. Based on a range of pelvic reconstructions and fetal head sizes, our simulations further imply that australopithecines, like humans, gave birth to immature, secondary altricial newborns with head sizes smaller than those predicted for non-human primates of the same body size especially when soft tissue thickness is adequately approximated. We conclude that australopithecines required cooperative breeding to care for their secondary altricial infants. These prerequisites for advanced cognitive development therefore seem to have been corollary to skeletal adaptations for bipedal locomotion that preceded the appearance of the genus Homo and the increase in encephalization

Hybrid foetus with an FE head for a pregnant occupant model for vehicle safety investigations

‘Expecting’, a computational pregnant occupant model, developed to simulate the dynamic response to crash impacts, possesses anthropometric properties of a fifth percentile female at around the 38th week of pregnancy. The model is complete with a finite element uterus and a multi-body foetus which is a novel feature in models of this kind. In this paper, the effect of incorporating a foetus with a finite element head into ‘Expecting’ is investigated. The finite element head was developed using detailed anatomic geometry and projected material properties. Then it was integrated with the ‘Expecting’ model and validated using the lap belt loading and the rigid bar impact tests. The model is then used to simulate frontal impacts at a range of crash severities with seatbelt and airbag, seatbelt only, airbag only as well as no restraint cases to investigate the risk of placental abruption and compare it with the model featuring the original multi-body foetus. The maximum strains developed in the utero-placental interface are used as the main criteria for foetus safety. The results show comparable strain levels to those from the multi-body foetus. It is, therefore, recommended to use the multi-body foetus in simulations as the computation time is more favourable

A Haptic User Interface to Assess the Mobility of the Newborn's Neck

A virtual reality program has been developed to assess the strength and flexibility of a computer based model of a term fetus or newborn baby's neck. The software has a haptic/force feedback user interface which allows clinical experts to adjust the mechanical properties, including range of motion and mechanical stiffness of a newborn neck model, at runtime. The developed software was assessed by ten clinical experts in obstetrics. The empirically obtained stiffness and range of motion values corresponded well with values reported in the literature