An external validation study of a practical scoring system for identifying patients at risk of pelvic floor dysfunction following childbirth.

OBJECTIVE

To prospectively evaluate the perineal card, a risk-based scoring system, for identifying women at increased risk of postpartum urinary incontinence (UI).

METHODS

This prospective observational study included women without previous vaginal delivery who underwent vaginal birth at a tertiary referral center between June 2023 and October 2024. The perineal card was completed at hospital discharge to assess obstetric and perineal risk factors and classify patients into low-, intermediate-, and high-risk groups. Postpartum pelvic floor outcomes were assessed at follow-up using a standardized screening tool with validated questionnaires. Logistic regression identified factors independently associated with UI, and discriminative performance was evaluated by receiver operating characteristic analysis.

RESULTS

Of 296 enrolled women, 265 were included in the final analysis. At follow-up, 18.3% reported UI. Women with UI had higher median perineal card scores than asymptomatic women. UI during pregnancy, pre-pregnancy body mass index (BMI), labor induction, and postpartum urinary retention lasting more than 24 h were independently associated with postpartum UI. The perineal card showed moderate discriminative ability, with an area under the curve of 0.65.

CONCLUSION

Use of the perineal card at discharge may help identify women at increased risk of postpartum UI and support timely referral for pelvic floor rehabilitation.