Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury : a pilot study

Introduction and hypothesis Vaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood. We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6 months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary/bowel/sexual symptoms, to inform future definitive prospective studies. Methods In this pilot study, we measured postnatal PFM stiffness by vaginal elastometry in 54 women. A subset of participants (n = 14) underwent magnetic resonance imaging (MRI) to define any levator ani (LA) muscle defects from vaginal childbirth. We investigated the association of PFM stiffness with demographics, labour and delivery characteristics, clinical features and MRI evidence of LA damage. Results Raised maternal BMI was associated with reduced pelvic floor stiffness (r = −0.4; p < 0.01). Higher stiffness values were associated with forceps delivery for delayed second stage of labour (n = 14) vs non-forceps vaginal delivery (n = 40; 630 ± 40 N/m vs 500 ± 30 N/m; p < 0.05), and a non-significant trend towards longer duration of the second stage of labour. Women with urinary, bowel or sexual symptoms (n = 37) demonstrated higher pelvic floor stiffness values than those without (570 ± 30 N/m vs 450 ± 40 N/m; p < 0.05). Conclusions A history of delayed second stage of labour and forceps delivery was associated with higher PFM stiffness values in the postnatal period. Whether high pelvic muscle stiffness antenatally is a risk factor for instrumental vaginal delivery and LA avulsion is unknown

CellML and associated tools and techniques

10.1098/rsta.2008.0094Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences36618783017-304

High performance computer simulations of cardiac electrical function based on high resolution MRI datasets

In this paper, we present a set of applications that allow performance of electrophysiological simulations on individualized models generated using high-resolution MRI data of rabbit hearts. For this purpose, we propose a pipeline consisting of: extraction of significant structures from the images, generation of meshes, and application of an electrophysiological solver. In order to make it as useful as possible, we impose several requirements on the development of the pipeline. It has to be fast, aiming towards real time in the future. As much as possible, it must use non-commercial, freely available software (mostly open source). In order to verify the methodology, a set of high resolution MRI images of a rabbit heart is investigated and tested; results are presented in this work. © 2008 Springer-Verlag Berlin Heidelberg