Efficient, simple and inexpensive programme for prevention of very early prematurity

Amaç

Prevention of prematurity by use of a self-care program for pregnant women consisting of self-observation of warning signs and self-measurement of the vaginal pH.
Prevention of early prematurity (<32 gest.w.) and of veiy low birthweight infants (<1500 g) is - because of the associated considerably increased risk of mortality and morbidity - one of the most urgent tasks of perinatal medicine. Particularly ascending genital infections are the most important avoidable causes of early prematurity. Consequently our program is concentrated on their prevention.
Ascending genital infection (mostly combined with bacterial vaginosis) starts frequently with a disturbance of the vaginal milieu and then often takes its course asymptomatically. Regular screening for signs of such a disturbance using vaginal pH-measurements (and if necessary further diagnostics and therapy) makes possible the detection of an "early marker" to prevent prematurity in an effective and inexpensive way.
Our prematurity-prevention-program was at first intended for physicians. It is based on an anamnestic assessment of prematurity risk, the early detection of warning signs (including regular measurement of the vaginal pH) and, if necessary, the appropriate therapeutic measures. It should start as early as possible after pregnancy has been diagnosed. In cases of disturbance of the vaginal milieu (only pH increase) a therapy with lactobacillus acidophilus preparations is mostly successful. In cases of bacterial vaginosis however local therapy, for example with metronidazol or clindamycin, is undertaken, and in other infections specific treatment.

Yöntem

As an additional measure we developed the self-care program for pregnant women which has been in use since 1993.The pregnant women receive information about risk factors and warning signs of prematurity and recommendations to measure their vaginal pH twice a week (with an indicator strip or indicator coated test-glove). She should see her doctor if the vaginal pH is elevated to more than 4.4 or any other of the warning signs occur. In our own study we had 1120 multiparae and we compared the outcome of the pregnancy with self-care activities with the outcome of the immediate previous pregnancy. Our program was then used in two prospective projects in Erfurt (Capital of Thu-ringia, Germany) and afterwards in the entire state of Thuringia. In Erfurt half of the practitioners motivated patients to take part in the self-care activities (no. of births: 381). All patients in Erfurt who did noi take part served as control group (no. of births: 2341). In Thuringia during the first half of the year 2000 the women served as control (no. of births: 7870) and in the second half of 2000 the doctors in Thuringia encouraged their patients to take part (no. of births: 8406).

Bulgular
In all studies the rate of premature births could be considerably reduced. Most interesting are the results of the children at particularly high risk: In our collective the rate of veiy low birthweight infants (<1500 g) could be reduced from 7.8% in the immediate previous pregnancy to 1.3%. In Erfurt the rate of veiy early prematures (< 32+0 gw) amounted to only 0.3% in contrast to 3-3%) in the control group. In Thuringia the rate of infants born <32+O gw was reduced from 1,58 % to 0.99% respectively in infants < lOOOg from 0.61% to 0.38%.

Sonuç

The self-care program for pregnant women proved to be a veiy efficient method for the prevention of prematurity and should be recommended to eveiy pregnant woman. In cases where this is not possible, at least the doctors and midwives should measure the vaginal-pH at each prenatal care examination.