Novel simulations to determine the impact of superficial perineal structures on vaginal delivery.

Abstract

This study's aim was to determine whether the inclusion of superficial perineal structures in a finite-element simulation of vaginal delivery impacts the pubovisceral muscle and perineal body, two common sites of birth-related injury. The hypothesis, inferred from prevailing literature, was that these structures would have minimal influence (differences less than ±10%). Two models were made using the Visible Human Project's female cadaver to create a rigid, fixed pelvis, musculature held by spring attachments to that pelvis, and a rigid, ellipsoidal fetal head prescribed with an inferior displacement to simulate delivery. Injury site stretch ratios and fetal head and perineal body displacements and angles of progression were compared between the Omitted Model (which excluded the superficial perineal structures as is common practice) and the Included Model (which included them). Included Model stretch ratios were +107%, -9.84% and -14.6% compared to Omitted Model perineal body and right and left pubovisceral muscles, respectively. Included Model peak perineal body inferior displacement was +72.5% greater while similar anterior-posterior displacements took longer to reach. These results refute our hypothesis, suggesting superficial perineal structures impact simulations of vaginal delivery by inhibiting perineal body anterior-posterior displacement, which stretches and inferiorly displaces the perineal body.