Pregnancy represents a biopsychosocial phenomenon with profound physiological adaptations, including overload of the pelvic floor muscles (PFM) due to fetal weight, biomechanical changes, and hormonal shifts. These factors predispose women to pelvic floor dysfunctions (PFDs) such as stress urinary incontinence (SUI), urge urinary incontinence (UUI), overactive bladder syndrome, pelvic organ prolapse, and anal incontinence, which affect up to 30% of adult women and escalate with parity and age. Despite high prenatal care coverage through the Brazilian Unified Health System (SUS), the literature indicates routine gaps in PFM education, leading to reliance on unreliable sources like the internet. Hypothesis: Women in late pregnancy exhibit low PFM knowledge, high urinary symptom prevalence, and severe quality of life (QoL) impairment, despite prenatal satisfaction. Aims: (i) Assess prenatal care attendance and satisfaction; (ii) Evaluate PFM knowledge and professional guidance; (iii) Describe urinary symptoms in the last four gestational weeks; (iv) Quantify symptom impact on QoL via validated tools.

Descriptive, observational, cross-sectional study conducted from November to December 2023 at Maternity in Brazil. Convenience sample of 98 women in the immediate postpartum period (following vaginal delivery or cesarean section; exclusions: recent urinary tract infection, incomplete interviews). Retrospective interviews focused on the last four gestational weeks. Instruments included a custom 20-item questionnaire (assessing prenatal satisfaction, PFM knowledge/sources/functions/orientation/exercises, and urinary symptoms: SUI/UUI/urgency/nocturia/pollakiuria); QUID-Br (6 items; SUI cutoff ≥4/15, UUI ≥6/15); and ICIQ-SF (QoL impact: total score 0-21; categories: none [0], mild [1-3], moderate [4-6], severe [7-9], very severe [>10]; daily interference 0-10). PFM contraction was assessed via verbal commands and visual inspection (voluntary contraction and accessory muscle use). Data from medical records and interviews were transferred to evaluation sheets; a PFM education booklet was provided post-interview. Statistical analysis involved frequencies, percentages, and means ± SD using BioEstat 5.0.

Participants (n=98): mean age 29.6 ± 6.9 years; BMI 31.2 ± 7.1 kg/m²; 66.3% pardo [brown]; 69.4% with >8 years of education; 79.6% partnered; 39.8% with ≥3 gestations. Prenatal care: 98% via Brazilian Unified Health System (SUS) (93.9% with ≥6 visits); 77.3% satisfied (excellent/good); 58.2% desired vaginal birth, but 69.4% received no delivery incentives. PFM: 77.6% unaware (internet as source in 63.6% of informed [22.4%]); 82.7% unaware of functions (sexual activity cited by 82.4%); 93.9% received no professional guidance; 11.2% performed perineal exercises. Contraction: 89.8% voluntary (adductor muscles 80.8%, gluteal muscles 75.2%, abdominal muscles 44.9%). Symptoms: 50% SUI (coughing 72.9%, sneezing 70.8%); 19.4% UUI; 58.2% urgency; 90.8% nocturia; 82.7% pollakiuria. QUID-Br: 21.4% SUI, 14.3% UUI, 8.2% mixed UI. ICIQ-SF (symptomatic 50%): mean 10.8 ± 4.9; frequency mostly 1-3x/week/small amount/coughing; interference 6.0 ± 3.3/10; severe 34.7%, very severe 46.9%.

High prenatal satisfaction starkly contrasts with profound PFM knowledge deficits (77.6% unaware), consistent with national studies (57.9-60.8% ignorance) and systematic reviews highlighting socioeconomic and ethnic disparities. The dominance of internet sources risks misinformation overload and anxiety. Low perineal exercise uptake (11.2%) despite good voluntary contraction ability indicates coordination deficits with accessory muscle overuse, aligning with postpartum studies. Symptom prevalence (SUI 50%, nocturia 90.8%) exceeds literature baselines (9.5-59.5% UI), with multiparity exacerbating QoL impairment (>80% of symptomatic women reported severe to very severe impact). QUID-Br under-detection compared to self-reports underscores diagnostic nuances. Overall, while SUS prenatal care excels in access, it falls short in PFD prevention due to the absence of physiotherapists, perpetuating reliance on non-professional sources.

Brazilian prenatal care must integrate physiotherapists to deliver routine PFM education, guidance on anatomy and function, and pelvic floor muscle training (PFMT)—interventions proven by meta-analyses to prevent urinary incontinence (UI) and prolapse. Policy advocacy, such (e.g., PL 906/22), is essential to empower women, enhance quality of life (QoL), and reduce postpartum pelvic floor dysfunctions (PFDs).

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