Mechanisms for pelvic organ prolapse after obstetrical levator muscle injury

产科提肌损伤后盆腔器官脱垂的机制

基本信息

批准号：
9204314
负责人：
VICTORIA Lynn HANDA
金额：
$ 33.96万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-01-12 至 2018-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9204314
关键词：
3-Dimensional 3D ultrasound Address Adult Aging Area Barbering Biological Birth Bladder Bladder Dysfunction Case-Control Studies Cesarean section Childbirth Chronic Clinical Complex Complication Data Development Discipline of obstetrics Evaluation Event Female Functional disorder Goals High Prevalence Injury Intestines Lead Life Longitudinal cohort study Measures Mission Muscle Muscle Weakness Muscle function National Institute of Child Health and Human Development Operative Surgical Procedures Organ Pathway interactions Pelvic Examination Pelvic Floor Disorders Pelvis Prevention Prevention strategy Public Health Reconstructive Surgical Procedures Reproductive Process Research Residual state Risk Risk Factors Risk Marker Role Structure Three-Dimensional Imaging Time Ultrasonography Uterine Prolapse Uterus Vagina Vaginal Prolapses Vaginal delivery procedure Woman burden of illness cohort cost epidemiology study imaging study levator ani muscle lifetime risk muscle strength muscular structure operation pelvic organ prolapse public health relevance tool

项目摘要

DESCRIPTION (provided by applicant): Female pelvic organ prolapse (POP) is a disabling, chronic condition in which the uterus and vaginal walls protrude through the vagina, causing discomfort as well as bladder and bowel dysfunction. A woman's lifetime risk of POP surgery is 19%. Prevention strategies have not been identified because the biological mechanisms underlying POP are uncertain. Other than aging, the only known risk factor for POP is vaginal childbirth. Specifically, prior research by this team demonstrated that vaginal delivery is associated with a 5-fold increase in the odds of POP. However, the mechanisms for this association remain unknown. Studies proposed in this application will investigate whether obstetrical levator ani muscle injury (LAMI) contributes to POP through alterations in the structure and/or the function of the levator muscles. LAMI, which occurs after 20% of vaginal births, can be detected with 3-dimensional ultrasound imaging. The central hypothesis of this proposal is that LAMI leads to POP through two discrete mechanisms: chronic widening of the levator hiatus (change in structure) and weakness of the levator muscle complex (change in function). The specific aims of this proposal are: (1) to compare levator ani muscle structure and function between women with and without LAMI, as identified on 3D ultrasound; (2) to determine the relative contributions of LAMI, levator ani muscle structure and function to POP. To accomplish these aims, 460 vaginally parous women from this team's established longitudinal cohort study (R01HD056275) will be evaluated 5-15 years from delivery. Evaluation will include quantitative assessment of pelvic organ support, 3D imaging of the levator muscle complex, and objective measures of levator strength. 3D ultrasound is an exciting tool that provides dynamic, real time views of the levator muscle and will enable us to detect LAMI and to distinguish structural and functional differences between those with and without LAMI. Thus, the proposed studies will consider not only the role of LAMI in the development of POP, but also the long term sequelae of LAMI (such as chronic changes to the levator hiatus). LAMI has emerged as an important obstetrical complication that is currently not preventable, except by elective cesarean birth. This research will be significant because POP prevention will not be possible until the pathophysiology is elucidated and markers for POP risk are identified. The studies proposed in this application are expected to provide markers that will identify women at greatest risk for POP and will serve as a platform for developing effective prevention strategies. Given the high prevalence of POP, prevention is critical to reduce the public health burden.

描述（由申请人提供）：雌性骨盆器官脱垂（POP）是一种残疾，慢性病，子宫和阴道壁通过阴道伸出，导致不适以及膀胱和肠功能障碍。女性的终生流行手术风险为19％。尚未确定预防策略，因为尚不确定的生物学机制尚不确定。除衰老外，唯一已知的流行风险因素是阴道分娩。具体而言，该团队的先前研究表明，阴道分娩与POP的几率增加了5倍。但是，该关联的机制仍然未知。本应用中提出的研究将研究妇产科左手ANI肌肉损伤（LAMI）是否通过改变左旋肌肉的结构和/或功能而导致流行。 LAMI在阴道分娩20％后发生，可以通过3维超声成像检测到。该提议的中心假设是LAMI导致通过两种离散机制流行：悬浮液的慢性增长（结构变化）和悬臂肌肉复合物的弱点（功能变化）。该提案的具体目的是：（1）比较有和没有LAMI的女性之间的左旋肌肉结构和功能，如3D超声所述；（2）确定LAMI的相对贡献，左右ANI肌肉结构和功能对POP的功能。为了实现这些目标，该团队已建立的纵向队列研究（R01HD056275）的460名阴道繁殖的妇女将从分娩后5 - 15年进行评估。评估将包括对骨盆器官支撑的定量评估，悬臂肌肉复合物的3D成像以及悬臂强度的客观度量。 3D Ultrasound是一种令人兴奋的工具，可提供左右肌肉的动态，实时视图，并使我们能够检测LAMI并区分有和没有LAMI的人之间的结构和功能差异。因此，拟议的研究不仅会考虑LAMI在POP发展中的作用，还将考虑Lami的长期后遗症（例如左旋裂隙的慢性变化）。 Lami已成为一种重要的产科并发症，除了通过剖宫产外，目前无法预防。这项研究将是重要的，因为在阐明病理生理并确定了POP风险标记之前，不可能进行流行预防。预计本申请中提出的研究将提供标记，以确定POP最大风险的女性，并将成为制定有效预防策略的平台。鉴于POP的高度流行，预防对于减轻公共卫生负担至关重要。