Prevention of prematurity by a prematurity-preventionprogram, including “Self-Care”-measures for the pregnant women.
Prevention of early prematurity (< 32 gest.w.) and of very low birthweight infants (< 1500 g) is one of the most urgent tasks of perinatal medicine. Particularly ascending genital infection is the most important avoidable cause of early prematurity. For the prevention of these infections the “protective lactobacillus system” plays a crucial role. Bacterial vaginosis and/or ascending genital infection start mostly with a disturbance of this vaginal milieu–which we consider as a “precursor”.
Our program is based on an anamnestic assessment of prematurity risk, the early detection of warning signs (including screening for preinfection respectively infection signs by regular measurement of the vaginal pH) and, if necessary, the appropriate therapeutic measures. The program includes “Self-Care”-measures by the women themselves (preferably for all pregnant women) and additional special measures for women at risk, for example, the ETCO for women with recurrent premature births.
Design and method
The Self-Care—measures for pregnant women are an additional measure to regular prenatal care. 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 the entire state of Thuringia (Germany). In the second half of the year 2000, the Self- Care Program was employed and the statistically evaluated results for the entire state were compared with those from the first half of 2000 without the program (in each half-year there have been more than 8.000 births). After that, several German health insurance companies used our prenatal-care self-examination program in a pilot project to their pregnant members.
The early total cervix occlusion (ETCO) is a preventive measure particularly for cases with two or more late abortions (> 12 + 0 gw) or early premature births (< 32 + 0 gw) in the patient's history with either infection as cause for these events or when no other cause has been found, but when for instance premature rupture of membranes occurred. The Total Cervix Occlusion creates a complete barrier against ascending infections within the cervical canal (as opposed to the cerclage).
With regards to the Self-Care—measures: In all studies the rate of premature births could be considerably reduced. Most interesting are the results of the prematures at particularly high risk. In our collective, the rate of very low birthweight infants (< 1500 g) could be reduced from 7.8% in the immediate previous pregnancy to 1.3%. In Thuringia, the rate of infants born < 32 + 0 gw was reduced from 1.36 to 0.94% respectively in infants < 1000 g from 0.61 to 0.38%. After the campaign in Thuringia had been finished, the prematurity rates monitored in 2002 were again as high as before. The first evaluation of a health insurance company in the German state North-Rhine-Westfalia (NRW) shows that the insured patients had a prematurity rate of 7% compared with the overall prematurity rate in NRW of 9.6%.
After an ETCO the rate of surviving infants was about 80% in our own population (as opposed to 17% in the pregnancies before the ETCO in the same group). Similar good results have been obtained by other clinicians. With ETCO in multiple pregnancies Schulze (2008) was able to achieve a prematurity rate of only 17% as against a rate of 29% in cases without ETCO.
The Self-Care Program for pregnant women proved to be a very efficient method for the prevention of prematurity and should be recommended to every pregnant woman. In cases where this is not possible, at least doctors and midwives should measure the vaginalpH at each prenatal care examination. The Early Total Cervix Occlusion is an effective preventive measure for women with recurrent late abortions or prematures births and it seems to be also a good measure to prevent premature births in multiple pregnancies. More research in this area is necessary.
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