The influence of an occipito-posterior malposition on the biomechanical behavior of the pelvic floor.

OBJECTIVES Contribute to the clarification of the mechanisms behind pelvic floor disorders related to a vaginal delivery. Verify the effect of an occipito-posterior malposition of the fetus during delivery on the stretch values when compared to the normal occipito-anterior position. STUDY DESIGN A numerical simulation based on the Finite Element Method was carried out. The Finite Element Model intends to represent the effects that the passage of a fetal head can induce on the muscles of the pelvic floor, from a mechanical point of view. The model used for the simulation represents the pelvic bones, with the attached pelvic floor muscles and the fetus. In this work the movements of the fetus during birth, in vertex position, with the fetus presenting in an occipito-posterior malposition were simulated. The results obtained were compared with a simulation in which the fetus presents in the normal occipito-anterior position. RESULTS A maximum stretch value of 1.73 was obtained in the numerical simulation conducted on this work, where the occipito-posterior malposition was simulated. CONCLUSION During a vaginal delivery, the levator ani muscle and the pubococcygeus muscle are the muscles that are subjected to the largest values of stretch and strain. These muscles are the ones at greater risk for a stretch related injury. When compared to the normal occipito-anterior position, the occipito-posterior malposition produces substantially higher stretch vales for the pelvic floor muscles, increasing the risk for a stretch related injury.