Prevention of prematurity. A review of our activities during the last 25 years.
For 25 years we have been engaged in programs for prevention of prematurity. In the initial stages we tried to use lists which might indicate increased risk of prematurity to select groups with higher disposition in this direction, and to initiate more intensive care with these patients. The earlier results have been positive, but such programs required such high expenditure (of time, energy, and cost) that they could not permanently be maintained. Another supporting contribution for prematurity prevention was the introduction of vaginal disinfectant measures in cases of PROM. Historically, one of the most urgent tasks of obstetrics has been and is the reduction in the unwanted birth rate of very small prematures infants. Long-lasting impairments of these infants still occur too frequently. Ascending genital infections, particularly before 32 gestational weeks, are the most important cause of prematurity. This has been confirmed by the excellent results achieved after creating a complete barrier by an operative total cervical occlusion in cases with recurrent late abortions. It is difficult to realize programs for prematurity prevention based on socio-economic factors, because of the expense with the necessary increase in time and staff. Our new "Prematurity-Prevention-Program" is based mainly on the hypothesis that the ascension of genital infection directly affects prematurity. We found that in women with prematurity symptoms, signs of impairment of the immune system could be found, thus reinforcing the assumption that ascending infections are probably enhanced by such impairments. The best chance of preventing early prematurity is to employ a prophylactic screening program, preferably including self pH-measurement of all pregnant patients and paying additional attention to all other risk factors. The preliminary results of our "Prematurity-Prevention-Program" were encouraging. The rate of very small prematures with birth weight of less than 1.500 g in all participating pregnant patients is now clearly lower at 1.4% than in immediately previous pregnancies when the rate was 7.8%. The rate of extremely small infants of less than 1.000 g amounts now to 1.0%, compared to 4.0% previously. From another retrospective evaluation, we found that the earlier in the pregnancy the prematures are born, the more often their mothers have had pathologically elevated vaginal pH-levels upon admission. In premature births at less than 32 weeks of gestation, all fifteen of the mothers had increased pH-levels. For premature births of later gestation, the frequency was only 61%. Further, we noted that in 67% of all the nearly 700 pregnant patients evaluated, consistently normal pH-levels were present, while in 33% they were increased. In cases with increased vaginal pH-levels, lactobacillus acidophilus treatment was successful in more than 80% of the 75 patients after therapy of 5 +/- 3 days. By our program, we feel that a decisive step has been taken in achieving practical and efficient means of preventing premature births.
Saling
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Institute of Prenatal Medicine, Berlin, Fed. Rep. of Germany.
D000022:Abortion, Spontaneous / Q000209:etiology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy