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[Initial results of the Erfurt Prevention of Prematurity Campaign]
U B Hoyme1, A Grosch, V M Roemer
1Frauenklinik Erfurt.
Insights
Early detection of vaginal pH changes through self-measurement can significantly reduce preterm birth rates. Prompt intervention for bacterial vaginosis (BV) and other vaginal disturbances lowers the risk of premature birth and very early premature births.
Area of Science:
- Obstetrics and Gynecology
- Microbiology
- Maternal-Fetal Medicine
Context:
- Bacterial vaginosis (BV) is a known risk factor for preterm birth.
- Early detection of vaginal milieu disturbances is crucial for effective intervention.
- Current methods for diagnosing vaginal conditions may not be sufficiently accessible or timely.
Purpose:
- To evaluate the effectiveness of a self-measurement program for vaginal pH in identifying pregnant women at risk for preterm birth.
- To assess the impact of early intervention, including antimicrobial therapy, on reducing prematurity rates.
- To compare prematurity rates between a self-measurement/intervention group and a control group.
Summary:
- Pregnant women performed twice-weekly vaginal pH self-measurements using special gloves to screen for disturbances (pH > 4.7).
- Women identified as high-risk received immediate medical confirmation and treatment, including lactobacillus acidophilus and/or clindamycin cream for BV.
- The intervention group showed a significantly lower rate of prematurity (8.3% vs. 13.0%) and very early prematurity (< 32 weeks) (0.3% vs. 3.3%) compared to the control group.
Impact:
- Self-monitoring of vaginal pH enables early identification of at-risk pregnancies.
- Timely obstetric intervention, guided by self-measurement results, effectively reduces preterm birth rates.
- The program demonstrates a significant reduction in both overall and very early premature births, highlighting the importance of proactive vaginal health management during pregnancy.
Objectives:
Genital infection particularly bacterial vaginosis (BV) increases the relative risk of prematurity. Detection of disturbances of vaginal milieu at an early stage and the use of suitable countermeasures such as intervention with antimicrobial substances, e.g. clindamycin, can reduce the preterm birth rate, provided the diagnosis is made early enough.
Study Design:
Since October 1996 pregnant women being given prenatal care in 16 of the 29 outpatient offices in Erfurt, have been informed about the Prematurity Prevention Programme and have been offered to take part and to perform self-measurements of their vaginal pH twice a week in order to screen for any disturbances in the vaginal milieu. Special CarePlan-VpH gloves (Selfcare, Oberhaching) were used to identify patients a risk (pH > 4.7). The pregnant women taking part in the programme were instructed to see their physician immediately, if abnormal values were present, in order to get them confirmed and to start lactobacillus acidophilus therapy (Gynoflor, Nourypharma, Oberschleissheim) or, in case of BV, to treat with clindamycin cream (Sobelin, Upjohn, Erlangen) i.vag. Patients being given prenatal care in the 13 outpatient offices not participating and other pregnant women in Erfurt who were not interested in the programme served as control group.
Results:
Up to now 59 out of 314 women in the intervention group have been identified as risk cases (p > or = 4.7). 52 of them were treated with a lactobacillus preparation, and 19 additionally with clindamycin cream, 3 patients refused to have any therapy. In this ongoing study the prematurity rate was 8.3% in the self-measurement/intervention group vs. 13.0% in the control group (n = 1,842); 0.3% vs. 3.3% of the neonates belonged to the group of very early prematures with a gestational age of < 32 + 0 weeks (p < 0.01). PROM was registered in 22.3% vs. 32.1% (p < 0.001) respectively.
Conclusion:
Self-measurement of vaginal pH at close intervals, as recommended by Saling, leads to the early identification of women at risk for prematurity. Earliest possible intervention by the obstetrician appears to result in reducing the rate of prematures and in particular of very early prematures (< 32 + 0 weeks).