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Mechanical Effects of a Maylard Scar During a Vaginal Birth After a Previous Caesarean

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Abstract

Caesarean section is one of the most common surgeries worldwide, even though there is no evidence supporting maternal and perinatal long-term benefits. Furthermore, the mechanical behavior of a caesarean scar during a vaginal birth after caesarean (VBAC) is not well understood since there are several questions regarding the uterine wound healing process. The aim of this study is to investigate the biomechanical Maylard fiber reorientation and stiffness influence during a VBAC through computational methods. A biomechanical model comprising a fetus and a uterus was developed, and a chemical–mechanical constitutive model that triggers uterine contractions was used, where some of the parameters were adjusted to account for the matrix and fiber stiffness increase in the caesarean scar. Several mechanical simulations were performed to analyze different scar fibers arrangements, considering different values for the respective matrix and fibers stiffness. The results revealed that a random fiber arrangement in the Maylard scar has a much higher impact on its mechanical behavior during a VBAC than the common fibers arrangement present in the uninjured uterine tissue. An increase of the matrix scar stiffness exhibits a lower impact, while an increase of the fiber’s stiffness has no significant influence.

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Abbreviations

VBAC:

Vaginal birth after caesarean

CS:

Caesarean section

FE:

Finite element

MLCK:

Myosin Light Chain Kinase

HGO:

Holzapfel-Gasser-Ogden

CM:

Control Model

IM:

Increased Matrix Stiffness Model

IF:

Increases Fiber Stiffness Model

RF:

Random Fiber Distribution Model

CF:

Circumferential Fibers Model

LF:

Longitudinal Fibers Model

SVB:

Second Vaginal Birth

MR:

Magnetic Resonance

DTI:

Diffusion Tensor Imaging

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Acknowledgments

The authors truly acknowledge the support from the Portuguese Foundation for Science and Technology (FCT) under Grant 2020.05400.BD and the Junior Researcher Contract 2020.01522.CEECIND. The support from the Associated Laboratory for Energy and Aeronautics (LAETA), trough project UIDB/50022/2020, and by the research project NORTE-01-0145-FEDER-030062 (SIM4SafeBirth) financed by NORTE2020, through FEDER are also acknowledged.

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Authors and Affiliations

  1. INEGI – Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal

    D. S. Fidalgo, M. C. P. Vila Pouca, D. A. Oliveira, R. M. Natal Jorge & M. P. L. Parente

  2. Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Szczecin, Poland

    E. Malanowska

  3. Department of Mechanical Engineering, Columbia University, New York, NY, USA

    K. M. Myers

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  1. D. S. Fidalgo
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Correspondence to D. S. Fidalgo.

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Associate Editor Stefan M Duma oversaw the review of this article.

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Fidalgo, D.S., Pouca, M.C.P.V., Oliveira, D.A. et al. Mechanical Effects of a Maylard Scar During a Vaginal Birth After a Previous Caesarean. Ann Biomed Eng 49, 3593–3608 (2021). https://doi.org/10.1007/s10439-021-02805-z

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