Reduction of prematurity by pH-screening

Objectives Genital infection particularly bacterial vaginosis (BV) increase s the relative risk of prematurity. Detection of disturbances of vaginal mi lieu at an early stage and the use of suitable countermeasures such as inte rvention with antimicrobial substances, e.g, clindamycin, can reduce the pr eterm 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 Pr ematurity Prevention Programme and have been offered to take part and to pe rform self-measurements of their vaginal pH twice a week in order to screen for any disturbances in the vaginal milieu. Special CarePlan(R)-VpH gloves (Selfcare, Oberhaching) were used to identify patients a risk (pH > 4.7). The pregnant women taking part in the program me were instructed to see the ir physician immediately, if abnormal values were present, in order to get them confirmed and to start lactobacillus acidophilus therapy (Gynoflor, No urypharma, Oberschleissheim) or, in case of BV, to treat with clindamycin c ream (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 i dentified as risk cases (p greater than or equal to 4.7). 52 of them were t reated with a lactobacillus preparation, and 19 additionally with clindamyc in 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. 1 3.0% 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 w eeks (p < 0.01). FROM was registered in 22.3% vs. 32.1% (p < 0.001) respect ively. Conclusion Self-measurement of vaginal pH at close intervals, as recommende d by Saling, leads to the early identification of women at risk for prematu rity. Earliest possible intervention by the obstetrician appears to result in reducing the rate of prematures and in particular of very early prematur es ( < 32 + 0 weeks).