Results and potential consequences of the thuringia prematurity preventional campaign 2000

In two prospective investigations the effectiveness of the self-care program for prematurity prevention, developed by Salina., was investigated. Pregnant women in Erfurt have been offered to perform self-measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal milieu. The women were instructed to see their physician immediately, if abnormal values (pH greater than or equal to 4.7) or other risk factors were present, in order to get them confirmed and to start lactobacillus acidophilus therapy or, in case of bacterial vaginosis, to treat with clindamycin cream i. vag. Patients who were not interested in the program served as control group. 73 out of 381 women in the intervention group have been identified as risk cases. 58 of them were treated with a lactobacillus preparation, and 24 with clindamycin cream, 3 patients refused to have any therapy. In this study the prematurity rate was 8.1 % in the self-measurement/intervention group vs. 12.3 % in the control group (p < 0.05, n = 2341); 0.3 % vs. 3.3 % of the neonates belonged to the group of very early prematures with a gestational age of < 32 + 0 weeks (p < 0.01). PROM was registered in 22.8 % vs. 30.8 % (p < 0.001) respectively. Starting March 1, 2000 a similar statewide pH-screening program was initiated in order to reduce prematurity in the State of Thuringia. According to the study design a significant decrease of prematurity was hypothetically expected for the second half of the year 2000. In Erfurt an overall decrease of prematurity from 7.68 to 6.81 % and a reduction of cases less than or equal to32 wks. from 3.22 to 2.39% was observed; premature rupture of the membranes was seen in 19 vs. 0 pregnancies with early prematurity (n = 1600). Data from 16,276 women are available for the state of Thuringia. On this basis a significant reduction of early prematurity from 1.58 to 0.99 % was seen respectively (p < 0.001). Comparing low birthweights a significant reduction of cases was achieved as well in all groups. On the basis of the data obtained we recommend the extension of the campaign in the whole of Germany.