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.