Movements of the pelvic bones of expectant mothers during vaginal delivery
Authors:
Marika Bajerová 1,2
; Lukáš Hruban 3,4
Authors place of work:
Rehabilitační oddělení, FN Brno
1; Katedra fyzioterapie a rehabilitace, LF MU, Brno
2; Gynekologicko-porodnická klinika LF MU a FN Brno
3; Ústav zdravotních věd, LF MU, Brno
4
Published in the journal:
Ceska Gynekol 2024; 89(4): 335-342
Category:
Přehledová práce
doi:
https://doi.org/10.48095/cccg2024335
Summary
Subtle but demonstrable movements in the expectant mother’s pelvis occur during vaginal delivery in all the pelvic joints and anatomical planes of the body (sagittal, frontal, and transverse). The purpose of these movements is to gradually expand the space in the lesser pelvis via widening of the individual pelvic planes so that the newborn‘s head can enter the pelvic inlet, safely pass through the narrow planes of the pelvis, and through the pelvic outlet. From the point of view of biomechanics, these movements are described in literature as counternutation and nutation of the sacrum and iliac bone. The counternutation of the sacrum helps to expand the plane of the pelvic inlet. The nutation of the sacrum assists in expanding the plane of the pelvic width, height, and outlet. These physiological movements are affected by the body constitution, the state of the myofascial and skeletal systems of the mother, and furthermore, by hormonal disjunction of the connections in the expectant mother’s pelvis together with the progress of the delivery mechanism itself. The main factor that determines the range of movement in the individual joints, and therefore adequate expansion of the individual pelvic planes, is the position of the mother during delivery. Engagement of active movements of the mother together with application of passive stretching of the soft tissues in the lower lumbar area and in the hip joints are both needed for maximum expansion of the individual pelvic planes and utilization of the maximum useful capacity of the mother‘s pelvis during delivery. These movements help invoke the abduction forces on muscles, tendons, and ligaments in the pelvis that lead to the optimum setting of the joints during which delivery movements happen. The specific movements in the pelvic joints predetermine whether nutation or counternutation is possible, and therefore if the newborn’s head can progress to the pelvic inlet or pass through the narrow and wide pelvic planes, and the pelvic outlet. The knowledge of these biomechanical principles and movements in the pelvis during delivery enables obstetricians and midwives to understand how the movements in the hip joints of the expectant mother can positively impact the spatial ratios in the lesser pelvis, and how to support further progress in the event of non-progressive labour.
Keywords:
Pelvis – vaginal delivery – counternutation – nutation – pelvic planes – hip joints – non-progessive labour
Zdroje
1. Rustamova S, Predanic M, Sumersile M et al. Changes in symphysis pubis width during labor. J Perinat Med 2009; 37 (4): 370–373. doi: 10.1515/JPM.2009.051.
2. Lewit K. Manipulační léčba v myoskeletální medicíně. 5. přeprac. vyd. Praha: Sdělovací technika 2003.
3. Kapandji AI. The physiology of the joints: the spinal column, pelvic girdle and head. 7th ed. London: Handspring Publishing 2018.
4. Tichý M. Dysfunkce kloubu. Podstata konceptu funkční manuální medicíny. 1. vyd. Praha: Miroslav Tichý 2005.
5. Kolář P et al. Rehabilitace v klinické praxi. Praha: Galén 2009.
6. Rychlíková E. Manuální medicína: průvodce diagnostikou a léčbou vertebrogenních poruch. 3. rozš. vyd. Praha: Maxdorf 2004.
7. Russel JG. Moulding of the pelvic outlet. J Obstet Gynaecol Br Commonw 1969; 76 (9): 817–820. doi: 10.1111/j.1471-0528.1969.tb06185.x.
8. Duncan JM. The behavior of the pelvic articulations in the mechanism of parturition. Dublin Quart J Med Sci 1854; 18: 60–69.
9. Borell U, Fernström I. Pelvimetric method for the assess ment of pelvic mouldability. Acta Radiol 1957; 47 (5): 365–369. doi: 10.3109/00016 925709170908.
10. Borell V, Fernström I. Radiologic pelvimetry. Acta Radiol Suppl 1960; 191: 3–97.
11. Rustamova S, Predanic M, Sumersille M et al. Changes in symphysis pubis width during labor. J Perinat Med 2009; 37 (4): 370–373. doi: 10.1515/JPM.2009.051.
12. Garagiola DM, Tarver RD, Gibson L et al. Anatomic changes in the pelvis after uncomplicated vaginal delivery: a CT study on 14 women. Am J Rhinol 1989; 153 (6): 1239–1241. doi: 10.2214/ajr.153.6.1239.
13. Thoms H. Relaxation of the symphysis pubis in pregnancy. J Am Med Assoc 1936; 106 (16): 1364–1366. doi: 10.1001/jama.1936.02770160022007.
14. Soma-Pillay P, Nelson-Piercy C, Tolppanen H et al. Physiological changes in pregnancy. Cardiovasc J Afr 2016; 27 (2): 89–94. doi: 10.5830/cvja-2016-02.
15. Sipko T, Grygier D, Barczyk K et al. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther 2010; 33 (5): 370–377. doi: 10.1016/j.jmpt.2010.05.006.
16. Damen L, Buyruk HM, Güler-Uysal F. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 2001; 80 (11): 1019–1024. doi: 10.1034/j.1600-0412.2001.801109.x.
17. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev 2015; 2015 (9): CD001139. doi: 10.1002/14651858.CD001139.pub4.
18. Stolarczyk A, Stępiński P, Sasinowski Ł et al. Peripartum pubic symphysis diastasis-practical guidelines. J Clin Med 2021; 10 (11): 2443. doi: 10.3390/jcm10112443.
19. Becker I, Woodley SJ, Stringer MD. The adult human pubic symphysis: a systematic review. J Anat 2010; 217 (5): 475–487. doi: 10.1111/j.1469-7580.2010.01300.x.
20. Björklund K, Lindgren PG, Bergström S et al. Sonographic assessment of symphyseal joint distention intra partum. Acta Obstet Gynecol Scand 1997; 76 (3): 227–232.
21. Young J. Relaxation of the pelvic joints in pregnancy. J Obstet Gynaec Br Emp 940; 47: 493–524.
22. Zhang S, Dumas G, Hemmerich A. Measurement of pubic symphysis width in different birthing positions using ultrasound. J Biomech 2020; 113: 110114. doi: 10.1016/j.jbiomech. 2020.110114.
23. Borges M, Moura R, Oliveira D et al. Effect of the birthing position on its evolution from a biomechanical point of view. Comput Methods Programs Biomed 2021; 200: 105921. doi: 10.1016/ j.cmpb.2020.105921.
24. Routzong MR, Moalli PA, Maiti S et al. Novel simulations to determine the impact of superficial perineal structures on vaginal delivery. Interface Focus 2019; 9 (4): 20190011. doi: 10.1098/rsfs.2019.0011.
25. Ami O, Maran JC, Gabor P et al. Three-dimensional magnetic resonance imaging of fetal head molding and brain shape changes during the second stage of labor. PLoS One 2019; 14 (5): e0215721. doi: 10.1371/journal.pone.021 5721.
26. Martin LC, Routzong MR, Moalli PA. Sacrum and coccyx shape changes during pregnancy and after delivery. Ann Biomed Eng 2024; 52 (2): 292–301. doi: 10.1007/s10439-023-03375-y.
27. Berta M, Lindgren H, Christensson K et al. Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19 (1): 466. doi: 10.1186/s12884-019-2620-0.
28. Hemmerich A, Bandrowska T, Dumas DA. The effects of squatting while pregnant on pelvic dimensions: a computational simulation to understand childbirth. J Biomech 2019; 87: 64–74. doi: 10.1016/j.jbiomech.2019.02.017.
29. Desseauve D, Fradet L, Lacouture P et al. Position for labor and birth: state of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol 2017; 208: 46–54. doi: 10.1016/j.ejogrb.2016.11.006.
30. Reitter A, Daviss BA, Bisits A et al. Does pregnancy and/or shifting positions create more room in a woman’s pelvis? Am J Obstet Gynecol 2014; 211 (6): 662.e1–662.e9. doi: 10.1016/j.ajog.2014.06.029.
31. Chang SC, Chou MM, Lin KC et al. Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery 2011; 27 (6): 825–831. doi: 10.1016/j.midw.2010.08.009.
32. Regaya LB, Fatnassi R, Khlifi A et al. Role of deambulation during labour: a prospective randomized study. J Gynecol Obstet Biol Reprod 2010; 39 (8): 656–662. doi: 10.1016/j.jgyn.2010. 06.007.
33. Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2012; 5: CD002006. doi: 10.1002/14651858.CD002006.pub3.
34. Souza JP, Miquelutti MA, Cecatti JG et al. Maternal position during the first stage of labor: a systematic review. Reprod Health 2006; 3: 10. doi: 10.1186/ 1742-4755-3-10.
Štítky
Dětská gynekologie Gynekologie a porodnictví Reprodukční medicínaČlánek vyšel v časopise
Česká gynekologie
2024 Číslo 4
Nejčtenější v tomto čísle
- Pohyby pánevních kostí rodičky v průběhu vaginálního porodu
- Předoperační rozlišení děložních myomů a sarkomů
- Výskyt stresové inkontinence moči po laparoskopické sakrokolpopexi
- DNA hypermetylace tumor supresorových genů TWIST1, GATA4, MUS81 a NTRK1 u hyperplazie endometria