Departments of Mechanical and Biomedical Engineering, Michigan State University, 428 S. Shaw Lane, East Lansing, MI 48824.
J Biomech Eng. 2021 May 1;143(5). doi: 10.1115/1.4049226.
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.
分娩的生物力学过程是迎接新生命所必需的，但也可能导致创伤。这个身体强度很高的过程会使母亲和孩子都面临受伤和并发症的风险，这些风险会对他们的一生产生影响。计算模型作为一种模拟和探索复杂现象的有力工具，自 20 世纪 90 年代以来就被用于提高我们对分娩过程和相关损伤的理解。本文的目的是回顾和总结文献中分娩计算模型的广度和现状——重点关注那些研究机械过程和影响的模型。我们首先总结了分娩计算模型中包含的关键特征的状态（即母体解剖结构、胎儿解剖结构、基本运动和母体软组织力学行为）。然后，我们深入研究了过去关于分娩过程和机械损伤的研究结果，努力弥合理论、数值评估与经验、临床观察和实践之间的差距。这些发现来自四个领域的分娩计算模型的应用：（1）分娩过程本身，（2）产妇损伤，（3）胎儿损伤，（4）临床医生在分娩过程中采取的保护措施。最后，我们确定了计算模型仍然面临的一些挑战，并通过提出未来的方向来建议如何实现更仿生的分娩模拟，目标是通过推进模型来提供更高效、更准确的、针对患者的评估，以支持未来的临床决策。
