Around 80% of women experience vaginal tears during labor when the diameter of the vagina must increase from ~2.5 cm to ~9.5 cm to allow the passage of a full-term baby. Vaginal tears vary from superficial cuts of the mucosal lining to tears propagating through the entire vaginal wall and into the surrounding tissues and organs. Complications associated with vaginal tears include postpartum hemorrhaging, fecal incontinence, urinary incontinence, and dyspareunia. Beyond the agonizing pain, these complications are emotionally and psychologically traumatic for women. Prevention, evaluation, and treatment of vaginal tears and subsequent conditions are limited due to the lack of studies examining the mechanical behavior of the pelvic floor tissues. Therefore, the mechanical response of healthy and torn vaginal tissue is investigated here to establish quantitative metrics for maternal healthcare.
Toward this end, swine and rat vaginal tissue is subjected to biaxial loads until tearing to reveal its mechanical properties. The resulting large inhomogeneous deformations are measured by the digital image correlation optical method to calculate material strain. The influence of these strains near to and far from the immediate vicinity of the tears on the tearing behavior is studied. Coupling mechanisms of the mechanical properties in the circumferential and axial directions as well as their effect on the nature of tear resistance is studied. Collagen fibers, the component within tissue responsible for its strength under tension, are imaged using a multiphoton microscopy technique known as second-harmonic generation imaging to investigate the change in organization with mechanical loading. Furthermore, imaging is performed in the near-regions of tears to reveal the relationship between collagen fibers and tearing resistance. The data collected through these studies provide new knowledge on the nonlinear elastic behavior of vaginal tissue, the geometrical and micro-structural characteristics of tears, and the mechanisms that contribute to the formation and propagation of tears.
The mechanical properties and tearing mechanisms of vaginal tissue will be crucial in developing new prevention and treatment methods for maternal trauma following childbirth. Episiotomy, late-term stretching, surgical treatment with graft materials and other protocols will all benefit from a mechanically-informed perspective. It is our hope that this work will raise awareness to the serious complexities of pelvic floor trauma and encourage a more refined and systematic approach to the inspection, imaging, and treatment of all vaginal tears following delivery.
This work was supported in part by the National Science Foundation fund #1511603 and the Institute for Critical Technology and Sciences at Virginia Tech. / Doctor of Philosophy / Every year nearly three million women give birth vaginally with 80% experiencing vaginal tears. These injuries sustained during delivery vary with severity and are associated with several conditions, including pelvic floor disorders. These disorders are a set of long-term conditions of the pelvic region presently affecting one-fourth of adult women in the United States. Pelvic floor disorders are: pelvic organ prolapse - a pelvic organ such as the uterus "falls" from its natural position, urinary incontinence - difficulty controlling urination, and fecal incontinence - difficulty controlling bowel movements. Pelvic floor disorders lower the quality of life for women not only physically due to pain and daily discomfort, but also mentally as the disorders are generally perceived as an embarassing and private matter.
The pelvic floor represents a complex system of muscles, organs, and support structures that work together to ensure everything stays in place and is functioning properly. Injury to any of these structures poses the risk of developing a disorder. As a central supporting organ, injuries to the vagina may be particularly worrisome. Surprisingly, little is known about the magnitude of forces and/or stretching that is placed on the pelvic floor during delivery, how much force and/or stretching is required for an injury, or how various injuries relate to future complications.
The goal of this research is to describe how much the normal, healthy vagina stretches to various forces including forces that will result in injuries. The research further examines the stretching of injured vaginas to quantify any observable differences due to this injury. Finally, the relationships between the biological components of the vagina, such as collagen, and the forces placed on the vagina are examined.
The result of this work will provide doctors and engineers with guidelines for understanding the conditions that produce vaginal injuries. The relationships examined between the tissue makeup and forces exerted onto the tissue may also aid in identifying any irregularities that would place a woman at risk for injury. Many of the medical procedures surrounding childbirth as well as surgical treatment for pelvic floor disorders will benefit from knowing how far the vagina can stretch before being injured. It is our hope that this work will raise awareness to the serious complexities of pelvic floor injuries and encourage a more refined and systematic approach to the inspection, imaging, and treatment of all vaginal tears following delivery.
This work was supported in part by the National Science Foundation fund #1511603 and the Institute for Critical Technology and Sciences at Virginia Tech.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/107008 |
| Date | 22 June 2020 |
| Creators | McGuire, Jeffrey Allen |
| Contributors | Mechanical Engineering, De Vita, Raffaella, Paul, Mark R., Cimini, Daniela, Nain, Amrinder, Leonessa, Alexander |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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