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[Effectiveness of clinical action in treatment of premature birth problems (author's transl)]
Insights
Intensified clinical actions for imminent premature birth did not lower the rate. Improved prenatal, intranatal, and postnatal care significantly reduced perinatal mortality.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Public Health
Context:
- Study period: 1974-1979 in the District of Erfurt.
- Involved 21,244 childbirths, including twins and stillbirths.
- Focused on imminent premature birth cases.
Purpose:
- To evaluate the effectiveness of intensified clinical interventions on premature birth rates.
- To assess the impact of enhanced clinical actions on perinatal mortality.
- To identify factors contributing to reduced perinatal mortality.
Summary:
- Despite increased clinical attention and interventions (hospitalization, tocolysis, cerclage, etc.) for imminent premature births, no significant reduction in the absolute premature birth rate was observed.
- Neither was there a significant restriction of premature birth problems to higher age or weight groups.
- A substantial decrease in perinatal mortality was achieved, but this was attributed to advancements in diagnostic and care practices, not to premature birth reduction strategies.
Impact:
- Clinical interventions targeting premature birth reduction were found to be ineffective in this setting.
- Improvements in prenatal, intranatal, and postnatal care are crucial for reducing perinatal mortality.
- The study suggests a need to intensify actions outside the hospital setting to address premature birth effectively.
Abstract:
The effectiveness of clinical action on a general premature birth situation was studied against the background of 21, 244 childbirths (twins and stillbirths included), in the District of Erfurt, between 1974 and 1979. Clinical attention was considerably stepped up in all cases of imminent premature birth. Steps taken included hospitalisation, sedation, medicamentous tocolysis, cerclage, maturity induction, and organisational measures. Many more people than ever before were called in for action. Yet, no significant change was achieved, neither in terms of the absolute premature birth rate nor in restricting such problems to higher age or weight groups. -- Sizable reduction of perinatal mortality in the period under review was in no way related to measures to reduce the premature birth rate, but it was rather attributable to improvement in prenatal and intranatal diagnosis and in postnatal care. -- The conclusion is that action outside hospital should be intensified.