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    Am J Obstet Gynecol. 2005 May;192(5):1669-76.

    Pudendal nerve stretch during vaginal birth: a 3D computer simulation.

    Lien KC, Morgan DM, Delancey JO, Ashton-Miller JA.

    Department of Mechanical Engineering, University of Michigan, Ann Arbor 48109-2125, USA. kclien@umich.edu

    OBJECTIVE: The purpose of this study was to determine the increase in pudendal nerve branch lengths using a 3D computer model of vaginal delivery. STUDY DESIGN: The main inferior rectal and perineal branches of the pudendal nerve were dissected in 12 hemi-pelves from 6 adult female cadavers. Their 3D courses were digitized in the 4 specimens with the most characteristic nerve branching pattern, and the data were imported into a published 3D computer model of the pelvic floor. Each nerve branch was then represented by a stretchable cord with a fixation point at the ischial spine. The length change in each branch was then quantified as the fetal head descended through the pelvic floor. The maximum nerve strains ([final length minus original length/original length] x 100) were calculated for 5 degrees of perineal descent: reference descent from the literature, 1.25 cm and 2.5 cm caudal and cephalad. The effect of alternative fixation points on resultant nerve strain was also studied. RESULTS: The inferior rectal branch exhibited the maximum strain, 35%, and this strain varied by 15% from the scenario with the least perineal descent to that with the most perineal descent. The strain in the perineal nerve branch innervating the anal sphincter reached 33%, while the branches innervating the posterior labia and urethral sphincter reached values of 15% and 13%, respectively. The more proximal the nerve fixation point, the greater the nerve strain. CONCLUSION: During the second stage: (1) nerves innervating the anal sphincter are stretched beyond the 15% strain threshold known to cause permanent damage in appendicular peripheral nerve, and (2) the degree of perineal descent is shown to influence pudendal nerve strain.

    PMID: 15902175 [PubMed - indexed for MEDLINE]

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