Transforming Women's Health
Synergy between Pitt Bioengineering, School of Medicine, and UPMC are focused on improving women's everyday lives
Steven Abramowitch ’98, PhD ’04, was in his final year of graduate studies in bioengineering when his advisor, Savio L-Y. Woo, PhD, DSc, DEng invited him to a meeting about a prospective collaboration. Pitt urogynecological surgeon Pamela Moalli MD, PhD, regularly saw patients at UPMC Magee-Womens Hospital with pelvic organ prolapse—a condition in which the muscles and ligaments of the pelvic floor weaken, allowing the bladder, rectum, or uterus to impinge upon the vagina, affecting fecal and urinary continence, sexual function, and quality of life.
Bioengineers like Woo and Abramowitch were already well on their way to turning torn ligaments in the knee from a career-ending injury to a minor interruption in a professional athlete’s career. Moalli wanted collaborators who could help her do the same for pelvic organ prolapse, a complex and poorly understood condition that affects as many as 1 in 2 women and leads to some 300,000 surgeries annually.
Abramowitch signed on to a pilot project and Moalli invited him to visit the clinic. “I could see the immediate impact pelvic floor disorders were having on patients,” he says. “Dr. Moalli once told me, ‘there are many disorders that can kill someone—pelvic floor disorders kill the soul,’ and I have seen that first-hand.”
Yet when Abramowitch sought the kinds of detail about pelvic anatomy and biomechanical function that are common knowledge in orthopedics, answers were hard to come by. “It was eye-opening to realize there’s this whole field where there are so many unanswered questions,” he says.
Now the William Kepler Whiteford Professor of Bioengineering, Abramowitch has dedicated the last two decades to answering those questions. He holds a secondary appointment in Pitt’s Department of Laboratory. “My goal is to transform women’s health and make it as important [in the world of bioengineering] as orthopedics or cardiovascular medicine,” says Abramowitch.
The Translational Biomechanics Laboratory has two major lines of inquiry. The first seeks to characterize the biological and immune risk factors among patients that currently lead to high levels of complications after surgical repair of pelvic organ prolapse. Increasingly, says Abramowitch, his team is homing in on how the mechanics of mesh implants affect the immune response of nearby cells during post-surgical healing, leading to painful scar tissue. The second is to develop novel mesh implants that avoid those hazards and achieve better functional outcomes.
Both projects depend on robust partnerships that leverage the tools of bioengineering to produce nuanced, evidence-based models of pelvic biomechanics in humans.
Drs. Steven Abramowitch and Pamela Moalli are transforming women's health research by merging obstetrics, gynecology, and reproductive sciences with biomechanics and computational modeling.
The Difference a Model Makes
Bioengineers studying the knee have their pick of animal models—dogs, guinea pigs, horses, mice, rabbits, rats, and sheep. But our bipedal locomotion makes human pelvic anatomy and biomechanics unique.
To understand how the muscles and ligaments of the human pelvic floor stretch and flex—during pregnancy and childbirth, at their most extreme, as well as during the activities of daily living—Abramowitch has turned to increasingly sophisticated computational models, based on data mined from existing MRI, ultrasound, and other human imaging. “Because there are so many unanswered questions,” he says, “we haven’t exhausted what we can learn from rigorous analysis of those human images.”
Consider, for example, the first paper Megan Routzong, PhD ’21, drafted as a member of the Translational Biomechanics Laboratory. Abramowitch had asked Routzong to assemble data on “the pelvic floor muscles.” A newcomer to the field, Routzong didn’t know that only the levator ani muscles are typically included. Her version included the superficial perineal muscles, as well.
When the team realized why her work diverged from existing models, they analyzed how inclusion of the additional muscles affected a simulation of childbirth, which can predispose some people to pelvic organ prolapse. They discovered that the superficial perineal muscles play a critical—and previously unacknowledged—role in maternal birth injury and are more vulnerable than previously understood.
More recently, a pair of papers on stress urinary incontinence with a urogynecologist at the University of Chicago addressed a long-standing debate on the physiology of stress urinary incontinence—a condition in which a sneeze or cough allows leakage through the urethra. Again, the Translational Biomechanics Laboratory analyzed data from human imaging to advance a novel theory of the biomechanics involved in the disorder. The resulting computational models accommodate individual variation and lay the groundwork for improved clinical evaluation and patient-specific surgical treatments.
Now a postdoctoral fellow in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Diego, Routzong credits Abramowitch with opening her eyes to the ways in which bioengineering could transform clinical care in women’s health.
Abramowitch sees a bright future unfolding. “If I could pull the genie from the lantern and get a wish,” he says, “it would be to understand what’s going on in the delivery process, identify injury, and prevent pelvic floor disorders from developing later in life.”
This article was authored by Sharon Tregaskis, contributing writer for the Swanson School of Engineering.