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Basic aspects of prematurity prevention and results achieved by a suitable, simple program
Insights
A new prenatal screening program using self-pH measurement significantly reduces very early premature births. This simple self-examination empowers pregnant individuals and lowers the incidence of low birth weight infants.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Public Health
Background:
- Very early premature births (<32 weeks) lead to significant long-term infant impairments.
- Ascending genital infections are a primary cause of early prematurity.
- Effective prevention strategies are urgently needed in modern obstetrics.
Purpose of the Study:
- To evaluate the effectiveness of a prophylactic screening program for preventing very early premature births.
- To assess the impact of 'Prenatal Care Self-Examination,' including self-pH measurement, on prematurity rates.
Main Methods:
- Implementation of a 'Prenatal Care Self-Examination' program involving vaginal pH self-measurement by pregnant patients.
- Prospective study in Erfurt, Germany, involving 16 practitioners and approximately 1,500 annual deliveries.
- Comparison of prematurity rates between patients participating in the self-examination program and those who did not.
Main Results:
- In a cohort of 1,120 multigravidae, participation in the program reduced very small premature births (<1,500g) from 7.8% to 1.3%.
- Extremely small infants (<1,000g) decreased from 3.9% to 0.9% in program participants.
- In Erfurt, patients performing self-examinations had an 11-fold lower rate of very early prematures (0.3%) compared to non-participants (3.3%).
Conclusions:
- The 'Prenatal Care Self-Examination' program is a highly effective and practical method for preventing very early premature births.
- Self-monitoring of vaginal pH by pregnant individuals significantly reduces the incidence of prematurity and associated adverse outcomes.
- This approach represents a significant advancement in the efficiency and feasibility of prematurity prevention strategies.
Abstract:
An urgent task for modern obstetrics is to reduce the number of unwanted very early prematures. Long-term impairments of these infants still occur too frequently. Ascending genital infections, particularly before 32 gestational weeks, are the most significant cause of prematurity. The best chance of preventing early prematurity is to employ a prophylactic screening program, preferably including self-pH-measurement by all pregnant patients and paying attention to all other important risk factors. The results of this "Prenatal Care Self-Examination" program are encouraging. The rate of very small prematures, with a birth weight of less than 1,500 g, in all 1,120 multigravidae who have taken part in this program is clearly lower, at 1.3%, than in immediate previous pregnancies when it was 7.8%. The rate of extremely small infants of less than 1,000 g amounted to 0.9%, compared with 3.9% in previous pregnancies. Results from a prospective study recently presented confirm in a convincing way what can be achieved in an entire city. In Erfurt, with 208,000 inhabitants and about 1,500 deliveries per year, all in the one maternity department in this city, 16 practitioners taking care of the pregnant patients, i.e. nearly one half of them in Erfurt, motivated their patients to take part in our prematurity prevention program with its "Prenatal Care Self-Examination", where the patients themselves measured their vaginal pH twice a week. The results are very interesting. In the group of 1,842 patients without prenatal self-examination activity, the frequency of very early prematures--i.e. less than 32 weeks gest.--was 3.3% (n = 61). In the group of 314 patients who performed prenatal self-examinations, the corresponding frequency was only 0.3% (n = 1). This is an eleven-fold, and significantly lower rate. On account of such positive results, a definitive step has been made with regard to practicability and efficiency of prevention of very early premature birth.