Bacterial vaginosis as risk factor

Genital infection, particularly bacterial vaginosis (BV), increases the rel ative risk of prematurity. Detection of disturbances of vaginal milieu at a n early stage and the use of suitable countermeasures such as intervention with antimicrobial substances can reduce the preterm birth rate. Pregnant women being given prenatal care in 16 of the 29 outpatient offices in Erfurt, have been informed about the Prematurity Prevention Programme a nd 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 vag inal milieu. The pregnant women taking part in the programme were instructe d to see their physician immediately, if abnormal values (pH greater than o r equal to 4.7) were present, in order to get them confirmed and to start l actobacillus acidophilus therapy or, in case of BV, to treat with clindamyc in cream i.vag. Patients being given prenatal care in the 13 outpatient off ices not participating and other pregnant women who were not interested in the programme served as control group. Up to now 73 out of 381 women in the intervention group have been identifie d as risk cases. 58 of them were treated with a lactobacillus preparation, and 24 additionally with clindamycin cream,3 patients refused to have any t herapy. In this ongoing study the prematurity rate was 8.1% in the self-mea surement/intervention group vs. 12.3% in the control group (n=2.341); 0.3% vs. 3.3% of the neonates belonged to the group of very early prematures wit h a gestational age of <32+0 weeks (p<0.01). FROM was registered in 22.8% v s. 30.8% (p<0.001) respectively. Self-measurement of vaginal pH at close intervals, as recommended by Saling , leads to the early identification of women at risk for prematurity. Earli est possible intervention by the obstetrician appears to result in reducing the rate of prematures and in particular of very early prematures (<32+0 w eeks).