The effect of a pelvic floor training program on perineal trauma during birth: a patient-preference controlled clinical trial

Pelvic floor muscle training (PFMT) is widely recommended for the prevention of urinary incontinence, but its potential to prevent perineal trauma during childbirth remains uncertain. We investigated whether a structured antenatal PFMT program could reduce severe perineal trauma and positively influence selected obstetric and neonatal outcomes. This prospective, non-randomized, patient-preference controlled trial was conducted at two tertiary centers between December 2, 2024, and September 2, 2025. Low-risk nulliparous women (defined as singleton, cephalic pregnancy at term without medical complications) at ≥ 28 gestational weeks were invited to participate. Those who consented formed the PFMT group, and those who declined received standard antenatal care. The intervention consisted of twice-weekly supervised PFMT sessions plus daily home exercises (3 sets of 8–12 maximal contractions) until 34 weeks of gestation. To minimize detection bias, clinicians assessing perineal outcomes were blinded to group allocation. The primary outcome was severe perineal trauma, defined as third- or fourth-degree obstetric anal sphincter injury (OASI). Secondary outcomes included episiotomy rate, first- and second-degree perineal tears, duration of the second stage of labor, postpartum urinary incontinence, and 5-minute Apgar score < 7. Between-group comparisons were performed using t-tests or chi-square tests, with effect sizes and 95% confidence intervals reported. Of 358 women screened, 300 completed the study (PFMT n = 150, Control n = 150). Severe perineal trauma was significantly lower in the PFMT group (4.0% vs. 14.7%; OR 0.24, 95% CI 0.09–0.64, p = 0.009). The second stage of labor was significantly shorter in the PFMT group (49.7 ± 6.4 vs. 58.8 ± 20.4 min, p < 0.001). No significant between-group differences were observed regarding secondary outcomes, including episiotomy rates (p = 0.157), postpartum urinary incontinence (p = 0.645), or adverse neonatal outcomes. Structured antenatal PFMT may reduce severe perineal trauma and shorten the second stage of labor without compromising neonatal outcomes. These findings support the integration of PFMT into antenatal care, although larger randomized trials with long-term follow-up are warranted to confirm these results.