Precision medicine exploration of postpartum rectus abdominis muscle separation: from basic research to clinical practice

Postpartum diastasis recti abdominis (PDRA), characterized by pathological separation of the rectus abdominis muscles, affects 30%-60% of women, with many cases persisting beyond 6 months postpartum and having significant impacts on musculoskeletal function and quality of life. This review synthesizes recent advancements across molecular pathogenesis, precision diagnostics, and therapeutic innovations. Key findings reveal that PDRA pathophysiology involves pregnancy-induced hormonal fluctuations, extracellular matrix remodeling, and mechanical overloading, necessitating individualized management. Artificial intelligence (AI)-enhanced ultrasonography achieves superior diagnostic accuracy (Dice score: 85.93%, r = 0.944 vs. manual measurements) over traditional methods, while minimally invasive techniques including laparoscopic "Slim-Mesh" repair demonstrate reduced recurrence rates (< 10%) and enhanced recovery compared to open surgery. Biomaterial integration (such as synthetic and bioabsorbable meshes) promotes anatomical reconstruction. Intelligent rehabilitation systems combining surface electromyography and wearable sensors improve inter-rectus distance (IRD) reduction through real-time biomechanical feedback. Critical challenges persist regarding the lack of standardized diagnostic criteria, long-term outcome validation of emerging technologies (> 5-year follow-up gaps), and optimization of AI-driven predictive models. We propose a potential precision medicine framework that integrates dynamic imaging, molecular profiling, and patient-specific interventions to optimize functional recovery and address heterogeneity in PDRA management.