UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction?

Vaginal childbirth is likely the most significant factor in the aetiology of pelvic floor dysfunction (PFD) and results in the combination of some or all of the following conditions: urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Until now, it has been challenging to advise women antenatally regarding risk factors for subsequent PFD, as there has been little good-quality, long-term information available. There is now moderately robust epidemiological data at 12 and 20 years after delivery and objective pathophysiological data (pudendal nerve trauma and levator defects/avulsion). In this commentary a scoring system (UR-CHOICE) to predict the risk of future PFD based on several major risk factors (UI before pregnancy, ethnicity, age at birth of first child, body mass index, family history (mother and sister) of PFD and baby’s weight and maternal height (if 4 kg) that have been identified for subsequent PFD risk is proposed. This scoring system will assist with counselling for women regarding PFD prevention.