{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:16:15Z","timestamp":1779351375658,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["10.54499\/2021.05876.BD"],"award-info":[{"award-number":["10.54499\/2021.05876.BD"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["10.54499\/2020.01522.CEECIND\/CP1612\/CT0001"],"award-info":[{"award-number":["10.54499\/2020.01522.CEECIND\/CP1612\/CT0001"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006752","name":"Universidade do Porto","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006752","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Biomech Model Mechanobiol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Childbirth is a complex process influenced by physiological, mechanical, and hormonal factors. While natural vaginal delivery is the safest, it is not always feasible due to diverse circumstances. In such cases, assisted delivery techniques, such as vacuum-assisted delivery (VAD), may facilitate vaginal birth. However, this technique can be associated with a higher risk of maternal injuries, potentially resulting in long-term conditions such as pelvic organ prolapse or incontinence. This study investigates the biomechanical impact of VAD on maternal tissues, aiming to reduce these risks. A finite element model was developed to simulate VAD, incorporating maternal musculature, a deformable fetal head, and a vacuum cup. Twelve simulations were conducted, varying contraction durations, resting intervals, and the number of pulls required for fetal extraction. Results revealed that prolonged contraction durations, coupled with extended resting intervals, lead to a reduction in pelvic floor stress. Elevated stress levels were observed when fetal extraction involved two pulls, with an 8.43% decrease in maximum stress from two pulls to four. The peak stress recorded was 0.81 MPa during a 60-second contraction, followed by a 60-second rest period. These findings indicate that longer maneuvers may reduce trauma, as extended pulls allow muscles more time to relax and recover during both contraction and rest phases. Furthermore, an increased number of pulls extends the duration of the maneuver, facilitating fetal rotation and improved adjustment to the birth canal. This study offers crucial insights into the biomechanics of childbirth, providing clinicians with valuable information to enhance maternal outcomes and refine assisted delivery techniques.<\/jats:p>","DOI":"10.1007\/s10237-025-01977-0","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:35:50Z","timestamp":1750293350000},"page":"1435-1446","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Computational modeling of vacuum-assisted delivery: biomechanics of maternal soft tissues"],"prefix":"10.1007","volume":"24","author":[{"given":"Rita","family":"Moura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dulce A.","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Kimmich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato M. Natal","family":"Jorge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco P. L.","family":"Parente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"issue":"5","key":"1977_CR1","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1067\/mob.2000.105403","volume":"182","author":"R Angioli","year":"2000","unstructured":"Angioli R, G\u00f3mez-Mar\u00edn O, Cantuaria G, O\u2019Sullivan MJ (2000) Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 182(5):1083\u20131085. https:\/\/doi.org\/10.1067\/mob.2000.105403","journal-title":"Am J Obstet Gynecol"},{"key":"1977_CR2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.ejogrb.2016.07.236","volume":"206","author":"O Ami","year":"2016","unstructured":"Ami O, Maran J, Moyal M, Musset D, Frydman R, Boyer L, Mage G (2016) 3D MRI imaging during the 2nd phase of labor and delivery: fetal heald molding. Eur J Obstet & Gynecol Reprod Biol 206:88. https:\/\/doi.org\/10.1016\/j.ejogrb.2016.07.236","journal-title":"Eur J Obstet & Gynecol Reprod Biol"},{"key":"1977_CR3","unstructured":"Ali, U.A., Norwitz, E.R.: Vacuum-Assisted Vaginal Delivery. Reviews in Obstetrics and Gynecology, 5\u201317 (2009)"},{"key":"1977_CR4","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.cmpb.2013.04.005","volume":"111","author":"R Buttin","year":"2013","unstructured":"Buttin R, Zara F, Shariat B (2013) Biomechanical simulation of the fetal descent without imposed theoretical trajectory. Comput Methods Programs Biomed 111:389\u2013401. https:\/\/doi.org\/10.1016\/j.cmpb.2013.04.005","journal-title":"Comput Methods Programs Biomed"},{"issue":"6","key":"1977_CR5","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1007\/s00192-024-05785-5","volume":"35","author":"HH Chill","year":"2024","unstructured":"Chill HH, Dick A, Zarka W, Vilk Ayalon N, Rosenbloom JI, Shveiky D, Karavani G (2024) Factors Associated with Obstetric Anal Sphincter Injury During Vacuum-Assisted Vaginal Delivery. Int Urogynecol J 35(6):1183\u20131189. https:\/\/doi.org\/10.1007\/s00192-024-05785-5","journal-title":"Int Urogynecol J"},{"issue":"7","key":"1977_CR6","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1007\/s00192-021-04769-z","volume":"32","author":"H Cechova","year":"2021","unstructured":"Cechova H, Kalis V, Havelkova L, Rusavy Z, Fiala P, Rybarova M, Hyncik L, Krofta L, Ismail KM (2021) Finite element modeling of maximum stress in pelvic floor structures during the head expulsion (FINESSE) study. Int Urogynecol J 32(7):1997\u20132003. https:\/\/doi.org\/10.1007\/s00192-021-04769-z","journal-title":"Int Urogynecol J"},{"issue":"1","key":"1977_CR7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/0954411920956467","volume":"235","author":"D Goordyal","year":"2021","unstructured":"Goordyal D, Anderson J, Alazmani A, Culmer P (2021) An engineering perspective of vacuum assisted delivery devices in obstetrics: A review. Proc Inst Mech Eng [H] 235(1):3\u201316. https:\/\/doi.org\/10.1177\/0954411920956467","journal-title":"Proc Inst Mech Eng [H]"},{"issue":"16","key":"1977_CR8","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1080\/14767058.2016.1228104","volume":"30","author":"JA Garc\u00eda Mejido","year":"2017","unstructured":"Garc\u00eda Mejido JA, Gutierrez L, Fernandez-Palac\u00edn A, Aquise A, Sainz JA (2017) Levator ani muscle injuries associated with vaginal vacuum assisted delivery determined by 3\/4D transperineal ultrasound. J Matern-Fetal & Neonatal Med 30(16):1891\u20131896. https:\/\/doi.org\/10.1080\/14767058.2016.1228104","journal-title":"J Matern-Fetal & Neonatal Med"},{"key":"1977_CR9","doi-asserted-by":"crossref","unstructured":"Hoyte, L.P.J., Damaser, M.: Biomechanics of the Female Pelvic Floor. Academic Press, London, UK; San Diego, CA, USA (2016). https:\/\/doi.org\/10.1016\/C2014-0-03658-1","DOI":"10.1016\/C2014-0-03658-1"},{"issue":"4","key":"1977_CR10","doi-asserted-by":"publisher","first-page":"723","DOI":"10.3390\/polym14040723","volume":"14","author":"C-Y Huang","year":"2022","unstructured":"Huang C-Y, Su K-M, Pan H-H, Chang F-W, Lai Y-J, Chang H-C, Chen Y-C, Lin C-K, Su K-C (2022) Investigating the Effects of Different Sizes of Silicone Rubber Vacuum Extractors during the Course of Delivery on the Fetal Head: A Finite Element Analysis Study. Polymers 14(4):723. https:\/\/doi.org\/10.3390\/polym14040723","journal-title":"Polymers"},{"issue":"5","key":"1977_CR11","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1515\/jpm-2020-0433","volume":"49","author":"K Kamijo","year":"2021","unstructured":"Kamijo K, Shigemi D, Nakajima M, Kaszynski RH, Ohira S (2021) Association between the number of pulls and adverse neonatal\/maternal outcomes in vacuum-assisted delivery. J Perinat Med 49(5):583\u2013589. https:\/\/doi.org\/10.1515\/jpm-2020-0433","journal-title":"J Perinat Med"},{"key":"1977_CR12","unstructured":"Lapeer, R., Gerikhanov, Z., Audinis, V.: A computer-based simulation of vacuum extraction during childbirth. 2014 SIMULIA UK Regional User Meeting (2014)"},{"issue":"4","key":"1977_CR13","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1007\/s00192-014-2498-3","volume":"26","author":"J Lepage","year":"2015","unstructured":"Lepage J, Jayyosi C, Lecomte-Grosbras P, Brieu M, Duriez C, Cosson M, Rubod C (2015) Biomechanical pregnant pelvic system model and numerical simulation of childbirth: impact of delivery on the uterosacral ligaments, preliminary results. Int Urogynecol J 26(4):497\u2013504. https:\/\/doi.org\/10.1007\/s00192-014-2498-3","journal-title":"Int Urogynecol J"},{"key":"1977_CR14","unstructured":"Loyd, A.: Studies of the Human Head from Neonate to Adult: An Inertial, Geometrical and Structural Analysis with Comparisons to the ATD Head. PhD thesis, Duke University, Durham (2011)"},{"issue":"1","key":"1977_CR15","doi-asserted-by":"publisher","first-page":"3411","DOI":"10.1002\/cnm.3411","volume":"37","author":"R Moura","year":"2020","unstructured":"Moura R, Borges M, Vila Pouca M, Oliveira DA, Parente M, Kimmich N, Mascarenhas T, Natal RM (2020) A numerical study on fetal head molding during labor. Int J Numer Methods Biomed Eng 37(1):3411. https:\/\/doi.org\/10.1002\/cnm.3411","journal-title":"Int J Numer Methods Biomed Eng"},{"key":"1977_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2024.106736","volume":"160","author":"R Moura","year":"2024","unstructured":"Moura R, Oliveira DA, Parente M, Kimmich N, Hyn\u010d\u00edk L, Hymp\u00e1nov\u00e1 LH, Jorge R (2024) Patient-specific surrogate model to predict pelvic floor dynamics during vaginal delivery. J Mech Behav Biomed Mater 160:106736. https:\/\/doi.org\/10.1016\/j.jmbbm.2024.106736","journal-title":"J Mech Behav Biomed Mater"},{"key":"1977_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107874","volume":"243","author":"R Moura","year":"2024","unstructured":"Moura R, Oliveira DA, Parente M, Kimmich N, Natal Jorge RM (2024) A biomechanical perspective on perineal injuries during childbirth. Comput Methods Programs Biomed 243:107874. https:\/\/doi.org\/10.1016\/j.cmpb.2023.107874","journal-title":"Comput Methods Programs Biomed"},{"issue":"3\u20134","key":"1977_CR18","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/S0045-7825(97)00162-X","volume":"151","author":"J Martins","year":"1998","unstructured":"Martins J, Pires EB, Salvado R, Dinis PB (1998) A numerical model of passive and active behavior of skeletal muscles. Comput Methods Appl Mech Eng 151(3\u20134):419\u2013433. https:\/\/doi.org\/10.1016\/S0045-7825(97)00162-X","journal-title":"Comput Methods Appl Mech Eng"},{"key":"1977_CR19","unstructured":"Osterman MJ, Martin JA (2011) Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 59(5):1\u201316"},{"issue":"6","key":"1977_CR20","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/s10237-016-0781-6","volume":"15","author":"DA Oliveira","year":"2016","unstructured":"Oliveira DA, Parente M, Calvo B, Mascarenhas T, Natal Jorge RM (2016) A biomechanical analysis on the impact of episiotomy during childbirth. Biomech Model Mechanobiol 15(6):1523\u20131534. https:\/\/doi.org\/10.1007\/s10237-016-0781-6","journal-title":"Biomech Model Mechanobiol"},{"issue":"4","key":"1977_CR21","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.jbiomech.2016.01.014","volume":"49","author":"DA Oliveira","year":"2016","unstructured":"Oliveira DA, Parente M, Calvo B, Mascarenhas T, Natal Jorge RN (2016) Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth. J Biomech 49(4):594\u2013601. https:\/\/doi.org\/10.1016\/j.jbiomech.2016.01.014","journal-title":"J Biomech"},{"issue":"1","key":"1977_CR22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s00192-007-0388-7","volume":"19","author":"M Parente","year":"2008","unstructured":"Parente M, Nata Jorge RM, Mascarenhas T, Fernandes AA, Martins J (2008) Deformation of the pelvic floor muscles during a vaginal delivery. Int Urogynecol J 19(1):65\u201371. https:\/\/doi.org\/10.1007\/s00192-007-0388-7","journal-title":"Int Urogynecol J"},{"issue":"9","key":"1977_CR23","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/j.jbiomech.2009.03.011","volume":"42","author":"M Parente","year":"2009","unstructured":"Parente M, Natal Jorge RM, Mascarenhas T, Fernandes AA, Martins J (2009) The influence of the material properties on the biomechanical behavior of the pelvic floor muscles during vaginal delivery. J Biomech 42(9):1301\u20131306. https:\/\/doi.org\/10.1016\/j.jbiomech.2009.03.011","journal-title":"J Biomech"},{"issue":"1","key":"1977_CR24","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12884-022-04440-5","volume":"22","author":"A Svelato","year":"2022","unstructured":"Svelato A, Carabaneanu A, Sergiampietri C, Mannella P, D\u2019Avino S, De Luca C, Bartolone M, Angioli R, Ragusa A (2022) \u201cTo get the baby out off the hook\u2019\u2019: a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery. BMC Pregnancy Childbirth 22(1):128. https:\/\/doi.org\/10.1186\/s12884-022-04440-5","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"1977_CR25","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1007\/s00192-021-04952-2","volume":"33","author":"LS Sng","year":"2022","unstructured":"Sng LS, Yip WH, Hong SY, Fook-Chong S, Tan W, Kanagalingam D, Lim J (2022) Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit. Int Urogynecol J 33(6):1529\u20131537. https:\/\/doi.org\/10.1007\/s00192-021-04952-2","journal-title":"Int Urogynecol J"},{"issue":"04","key":"1977_CR26","doi-asserted-by":"publisher","first-page":"1650046","DOI":"10.1142\/S0219519416500469","volume":"16","author":"K-M Su","year":"2016","unstructured":"Su K-M, Yu M-H, Su H-Y, Wang Y-C, Su K-C (2016) Investigating biomechanics of different material and angles of blades of forceps for operative delivery by finite element analysis. J Mech Med Biol 16(04):1650046. https:\/\/doi.org\/10.1142\/S0219519416500469","journal-title":"J Mech Med Biol"},{"issue":"3","key":"1977_CR27","doi-asserted-by":"publisher","first-page":"2927","DOI":"10.1002\/cnm.2927","volume":"34","author":"M Vila Pouca","year":"2017","unstructured":"Vila Pouca M, Ferreira J, Oliveira DA, Parente M, Natal Jorge RM (2017) Viscous effects in pelvic floor muscles during childbirth: A numerical study. Int J Numer Methods Biomed Eng 34(3):2927. https:\/\/doi.org\/10.1002\/cnm.2927","journal-title":"Int J Numer Methods Biomed Eng"},{"issue":"9","key":"1977_CR28","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1016\/j.jbiomech.2015.02.062","volume":"48","author":"X Yan","year":"2015","unstructured":"Yan X, Kruger JA, Nielsen P, Nash MP (2015) Effects of fetal head shape variation on the second stage of labour. J Biomech 48(9):1593\u20131599. https:\/\/doi.org\/10.1016\/j.jbiomech.2015.02.062","journal-title":"J Biomech"},{"key":"1977_CR29","doi-asserted-by":"publisher","first-page":"1176360","DOI":"10.3389\/fmed.2023.1176360","volume":"10","author":"M Zhou","year":"2023","unstructured":"Zhou M, Shui W, Bai W, Wu X, Ying T (2023) Ultrasonographic study of female perineal body and its supportive function on pelvic floor. Front Med 10:1176360. https:\/\/doi.org\/10.3389\/fmed.2023.1176360","journal-title":"Front Med"}],"container-title":["Biomechanics and Modeling in Mechanobiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10237-025-01977-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10237-025-01977-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10237-025-01977-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:14:25Z","timestamp":1752153265000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10237-025-01977-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["1977"],"URL":"https:\/\/doi.org\/10.1007\/s10237-025-01977-0","relation":{},"ISSN":["1617-7959","1617-7940"],"issn-type":[{"value":"1617-7959","type":"print"},{"value":"1617-7940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"assertion":[{"value":"13 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}