Feasibility and safety of antepartum tactile imaging
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ORIGINAL ARTICLE
Feasibility and safety of antepartum tactile imaging Zdenek Rusavy 1,2,3
&
Vladimir Kalis 1,2 & Salavat Aglyamov 4 & Vladimir Egorov 5
Received: 13 May 2020 / Accepted: 27 September 2020 # The Author(s) 2020
Abstract Introduction and hypothesis Quantitative characterization of the birth canal and critical structures before delivery may provide risk assessment for maternal birth injury. The objective of this study was to explore imaging capability of an antepartum tactile imaging (ATI) probe. Methods Twenty randomly selected women older than 21 years with completed 35th week of pregnancy and a premise of vaginal delivery were enrolled in the feasibility study. The biomechanical data were acquired using the ATI probe with a doublecurved surface, shaped according to the fetal skull and equipped with 168 tactile sensors and an electromagnetic motion tracking sensor. Software package COMSOL Multiphysics was used for finite element modeling. Subjects were asked for assessment of pain and comfort levels experienced during the ATI examination. Results All 20 nulliparous women were successfully examined with the ATI. Mean age was 27.8 ± 4.1 years, BMI 30.7 ± 5.8, and week of pregnancy 38.8 ± 1.4. Biomechanical mapping with the ATI allowed real-time observation of the probe location, applied load to the vaginal walls, and a 3D tactile image composition. The nonlinear finite element model describing the stress– strain relationship of the pelvic tissue was developed and used for calculation of Young’s modulus (E). Average perineal elastic modulus was 11.1 ± 4.3 kPa, levator ani 4.8 ± 2.4 kPa, and symphysis–perineum distance was 30.1 ± 6.9 mm. The pain assessment level for the ATI examination was 2.1 ± 0.8 (scale 1–4); the comfort level was 2.05 ± 0.69 (scale 1–3). Conclusions The antepartum examination with the ATI probe allowed measurement of the tissue elasticity and anatomical distances. The pain level was low and the comfort level was comparable with manual palpation. Keywords Perineal elasticity . Tactile imaging . Elastography . Finite element model . Biomechanics of parturition
Introduction Childbirth may be associated with trauma, which can have severe consequences and impact on the woman’s health. In the course of a vaginal delivery, significant deformations of
The results were presented at the 45th IUGA Annual Meeting * Zdenek Rusavy [email protected] 1
Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic
2
Biomedical Center, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic
3
Department of Gynecology and Obstetrics, University Hospital in Pilsen, Pilsen, Czech Republic
4
University of Houston, Houston, TX, USA
5
Advanced Tactile Imaging, Trenton, NJ, USA
pelvic floor soft tissues occur that may damage its integrity. Observational studies from the UK show that merely 9.6% of women have an intact perineum after their first vaginal delivery [1]. Former studies have shown that about 85% of women suffer
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