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分娩前的妊娠状态：整体力学视角。

Pregnancy state before the onset of labor: a holistic mechanical perspective.

机构信息

Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), R. Dr. Roberto Frias 400, 4200-465, Porto, Portugal.

Mechanical Department (DEMec), Faculty of Engineering of University of Porto (FEUP), R. Dr. Roberto Frias, 4200-465, Porto, Portugal.

出版信息

Biomech Model Mechanobiol. 2024 Oct;23(5):1531-1550. doi: 10.1007/s10237-024-01853-3. Epub 2024 May 17.

DOI:10.1007/s10237-024-01853-3
PMID:38758337
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11436406/
Abstract

Successful pregnancy highly depends on the complex interaction between the uterine body, cervix, and fetal membrane. This interaction is synchronized, usually following a specific sequence in normal vaginal deliveries: (1) cervical ripening, (2) uterine contractions, and (3) rupture of fetal membrane. The complex interaction between the cervix, fetal membrane, and uterine contractions before the onset of labor is investigated using a complete third-trimester gravid model of the uterus, cervix, fetal membrane, and abdomen. Through a series of numerical simulations, we investigate the mechanical impact of (i) initial cervical shape, (ii) cervical stiffness, (iii) cervical contractions, and (iv) intrauterine pressure. The findings of this work reveal several key observations: (i) maximum principal stress values in the cervix decrease in more dilated, shorter, and softer cervices; (ii) reduced cervical stiffness produces increased cervical dilation, larger cervical opening, and decreased cervical length; (iii) the initial cervical shape impacts final cervical dimensions; (iv) cervical contractions increase the maximum principal stress values and change the stress distributions; (v) cervical contractions potentiate cervical shortening and dilation; (vi) larger intrauterine pressure (IUP) causes considerably larger stress values and cervical opening, larger dilation, and smaller cervical length; and (vii) the biaxial strength of the fetal membrane is only surpassed in the cases of the (1) shortest and most dilated initial cervical geometry and (2) larger IUP.

摘要

成功妊娠高度依赖于子宫体、宫颈和胎膜之间的复杂相互作用。这种相互作用是同步的，通常遵循正常阴道分娩的特定顺序：(1)宫颈成熟，(2)子宫收缩，和(3)胎膜破裂。在分娩开始前，通过使用完整的子宫、宫颈、胎膜和腹部的妊娠晚期模型来研究宫颈、胎膜和子宫收缩之间的复杂相互作用。通过一系列数值模拟，我们研究了(i)初始宫颈形状、(ii)宫颈刚度、(iii)宫颈收缩和(iv)宫腔内压力的力学影响。这项工作的结果揭示了几个关键观察结果：(i)在更扩张、更短和更柔软的宫颈中，宫颈的最大主应力值降低；(ii)降低宫颈刚度会导致宫颈扩张增加、宫颈开口更大和宫颈长度减小；(iii)初始宫颈形状会影响最终的宫颈尺寸；(iv)宫颈收缩会增加最大主应力值并改变应力分布；(v)宫颈收缩会增强宫颈缩短和扩张；(vi)较大的宫腔内压力 (IUP) 会导致相当大的应力值和宫颈开口增大、扩张增大和宫颈长度减小；和 (vii)只有在(i)最短和最扩张的初始宫颈几何形状和(ii)较大的 IUP 的情况下，胎膜的双轴强度才会被超过。

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