Carolyn W Swenson1, Jiajia Luo2, Luyun Chen3, James A Ashton-Miller2,3, John O L DeLancey4. 1. Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA. scarolyn@med.umich.edu. 2. Department of Mechanical Engineering, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA. 3. Department of Biomedical Engineering, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA. 4. Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: This study aimed to describe a novel strategy to determine the traction forces needed to reproduce physiologic uterine displacement in women with and without prolapse. METHODS: Participants underwent dynamic stress magnetic resonance imaging (MRI) testing as part of a study examining apical uterine support. Physiologic uterine displacement was determined by analyzing uterine location in images taken at rest and at maximal Valsalva. Force-displacement curves were calculated based on intraoperative cervical traction testing. The intraoperative force required to achieve the uterine displacement measured during MRI was then estimated from these curves. Women were categorized into three groups based on pelvic organ support: group 1 (normal apical and vaginal support), group 2 (normal apical support but vaginal prolapse present), and group 3 (apical prolapse). RESULTS: Data from 19 women were analyzed: five in group 1, five in group 2, and nine in group 3. Groups were similar in terms of age, body mass index (BMI), and parity. Median operating room (OR) force required for uterine displacement measured during MRI was 0.8 N [interquartile range (IQR) 0.62-3.22], and apical ligament stiffness determined using MRI uterine displacement was 0.04 N/mm (IQR 0.02-0.08); differences between groups were nonsignificant. Uterine locations determined at rest and during maximal traction were lower in the OR compared with MRI in all groups. CONCLUSIONS: Using this investigative strategy, we determined that only 0.8 N of traction force in the OR was required to achieve maximal physiologic uterine displacement seen during dynamic (maximal Valsalva) MRI testing, regardless of the presence or absence of prolapse.
INTRODUCTION AND HYPOTHESIS: This study aimed to describe a novel strategy to determine the traction forces needed to reproduce physiologic uterine displacement in women with and without prolapse. METHODS:Participants underwent dynamic stress magnetic resonance imaging (MRI) testing as part of a study examining apical uterine support. Physiologic uterine displacement was determined by analyzing uterine location in images taken at rest and at maximal Valsalva. Force-displacement curves were calculated based on intraoperative cervical traction testing. The intraoperative force required to achieve the uterine displacement measured during MRI was then estimated from these curves. Women were categorized into three groups based on pelvic organ support: group 1 (normal apical and vaginal support), group 2 (normal apical support but vaginal prolapse present), and group 3 (apical prolapse). RESULTS: Data from 19 women were analyzed: five in group 1, five in group 2, and nine in group 3. Groups were similar in terms of age, body mass index (BMI), and parity. Median operating room (OR) force required for uterine displacement measured during MRI was 0.8 N [interquartile range (IQR) 0.62-3.22], and apical ligament stiffness determined using MRI uterine displacement was 0.04 N/mm (IQR 0.02-0.08); differences between groups were nonsignificant. Uterine locations determined at rest and during maximal traction were lower in the OR compared with MRI in all groups. CONCLUSIONS: Using this investigative strategy, we determined that only 0.8 N of traction force in the OR was required to achieve maximal physiologic uterine displacement seen during dynamic (maximal Valsalva) MRI testing, regardless of the presence or absence of prolapse.
Entities:
Keywords:
Apical support; Prolapse; Uterine movement
Authors: J R Fielding; E Versi; R V Mulkern; M H Lerner; D J Griffiths; F A Jolesz Journal: J Magn Reson Imaging Date: 1996 Nov-Dec Impact factor: 4.813
Authors: Yvonne Hsu; Luyun Chen; Aimee Summers; James A Ashton-Miller; John O L DeLancey; James O L DeLancey Journal: Int Urogynecol J Pelvic Floor Dysfunct Date: 2007-06-20
Authors: Erin C Crosby; Kristen M Sharp; Adrian Gasperut; John O L Delancey; Daniel M Morgan Journal: Female Pelvic Med Reconstr Surg Date: 2013 Sep-Oct Impact factor: 2.091
Authors: Caroline Kieserman-Shmokler; Carolyn W Swenson; Luyun Chen; Lisa M Desmond; James A Ashton-Miller; John O DeLancey Journal: Am J Obstet Gynecol Date: 2019-10-19 Impact factor: 8.661
Authors: Carolyn W Swenson; Tovia M Smith; Jiajia Luo; Giselle E Kolenic; James A Ashton-Miller; John O DeLancey Journal: Am J Obstet Gynecol Date: 2016-09-08 Impact factor: 8.661
Authors: Pamela A Moalli; Shaniel T Bowen; Steven D Abramowitch; Mark E Lockhart; Michael Ham; Michael Hahn; Alison C Weidner; Holly E Richter; Charles R Rardin; Yuko M Komesu; Heidi S Harvie; Beri M Ridgeway; Donna Mazloomdoost; Amanda Shaffer; Marie G Gantz Journal: Int Urogynecol J Date: 2020-09-01 Impact factor: 2.894