Self-Care-Program for pregnant women
Prof. Erich Saling MD FRCOG, Jürgen Lüthje MD
and Monika Schreiber MD.
Institute of Perinatal Medicine, Berlin, Germany.
(Translation into English: Amos Grunebaum MD FACOG, Cornell
University, New York)
Introduction
Pregnancy is a time of happy anticipation and
planning, but it’s also a time of doubts and concern. The biggest
worry which future parents have is naturally the concern whether
their baby develops normally and arrives in a healthy condition.
The chances of having a healthy baby are optimized because early
recognition of abnormal developments in the course of pregnancy
can be achieved by modern regular prenatal care.
However, despite good prenatal care the rate of
prematures (<37 gestational weeks) in Germany has increased
from 7.1% in 2001 to 9.4% in 2004 and e.g. in the USA from 11.9%
in 2001 to 12.3% in 2003. Despite the progress of neonatal
intensive care medicine, babies born very early, especially those
before 32 weeks of pregnancy, often have severe problems during
the early neonatal period, and possibly throughout
their lives. It is therefore important to do everything possible
to prevent the child and the whole family from having to cope
with such a heavy burden.
There are some observations and examinations which
you can do yourself at home to prevent a threatened preterm
birth. That’s why we developed a Self-Care-Program for pregnant
women in addition to our Prematurity-Prevention-Program for
physicians. The explanation is simple: During regular prenatal
care the physician sees a pregnant woman usually only once every
4 weeks. But within the framework of the Self-Care Program the
pregnant woman can examine herself much more frequently, every
3-4 days. Chances are therefore improved to diagnose and solve
potential problems much earlier.
Since it’s introduction in 1993 more than
9000 pregnant women have participated in our Self-Care-Program.
More than 2000 mothers returned the questionnaire after the end of
the pregnancy. 1120 of them have been multiparous. The rate of
extreme prematurity (birthweight under 1500 g) among the
multiparous was significantly lowered from 7.8% in the immediate
prior pregnancy to 1.3%.
After this study two large campaigns with our
program were performed by U. Hoyme and coworkers. These
campaigns led to a significant decrease of prematurity rates:
The first was carried out in Erfurt (the capital
of Thuringia, Germany), where pregnant women have been offered to
perform self-measurements of their vaginal pH by means of test
gloves. Patients who were not interested in participating served
as a control group. In this study, the prematurity rate was 8.1%
in the self-measurement/intervention group and 12.3% in the
control group. Likewise, 0.3% versus 3.3% of the neonates
belonged to the group of very early prematures with a gestational
age of < 32+0.
Encouraged by these results, in 2000 a similar pH
screening campaign was initiated in the whole state of Thuringia,
in order to reduce prematurity. A significant reduction of early
prematurity from 1.58% to 0.99%, and a significant reduction of
low birth weight cases in all groups was achieved.
After this campaign had been finished, the
prematurity rates monitored in 2002 were as high as they had been
prior to the introduction of the activities. That’s why the new
Thuringia prematurity prevention campaign 2004/2005 started on
September 1st 2004.
The success rates are inasmuch a breakthrough, as
for decades no other simple approach has been successful in
significantly and permanentely reducing prematurity rates on a
large country-wide level. One important factor is that no other
measure has been able to identify such an early stage of the
prematurity process and to intervene so early with successful
countermeasures.
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Please note that the Self-Care-Program for
pregnant women is an additional step to regular obstetric
prenatal care visits.
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