Results of self-examination
The results evaluated up to now appear to justify
the pH self-measurement by pregnant patients and demonstrate the
efficiency of our Self-Care-Program. The results have already
been published in detail e.g. [Saling et al. 1995 a, Saling 1995 b,
Saling et al.
1999, Saling et al. 2001], here just the
main figures:
In a study by our department [Riedewald et al. 1992] of 100
women who had measured their vaginal pH themselves using
indicator paper, 91% of the measurements corresponded with the
results later measured by a physician with a pH-meter. In 9% of
cases, the results were false-positive; this means that with the
indicator paper an increased pH value was measured, but the value
controlled by pH-meter was normal. This is not a grave error as
there were no false-negative results, i.e. no pathological
findings were overlooked.
Furthermore, we found that in about 70% of the
patients who had increased pH values measured both by indicator
paper and by the pH-meter, evidence of pathogenous organisms was
found in the vagina and/or the cervix, whereas when the pH values
were normal, the figure was only 8%.
The full Self-Care-Program was started in
September 1993. The program was advertised in publications that
are frequently read by pregnant women.
To date, about 10000 pregnant patients have
participated or are still participating, and about 3000 returned
the questionnaire to us. Of the 1715 women whose data have been
evaluated so far, 595 were pregnant for the first time and 1120
had been pregnant before. The anamnestic information given by the
group of women with previous pregnancies was particularly
interesting (see figure 2). A high number of these women, namely
46.4%, had had miscarriages and about 18.3% had had underweight
infants (< 2500 g) during the immediate previous pregnancies.
To date, we are able to draw the conclusion that the
participating women belong to a higher-risk group rather than to
a lower-risk group. According to the returned records, 60.8% of
the patients reported ‘disturbed courses’ in their present
pregnancy.
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Fig. 2: Rates of low birthweight
infants before and after prenatal care self-examination
Please click on the miniature picture.
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Our evaluations have shown, that the rate of
underweight infants, in particular the very small ones (birth
weight < 1500 g) in all pregnant patients who took part in
this program, is clearly lower at 1.3% than in previous
pregnancies, when the rate was 7.8%. The rate of extremely small
infants (< 1000 g) is 0.9% when the women participated in our
program, compared with 3.9% in previous pregnancies.
Another evaluation shows comparisons between the
results of the immediate previous pregnancies and the present
pregnancies only of those women who had suffered a premature
birth in the immediate previous pregnancy. Of the 111 women, only
20 (18%) again gave birth to a premature baby (< 37+0 weeks of
gestation). Of the 38 women who had given birth to a very early
premature (< 32+0 weeks) in the immediate previous
pregnancy, only 3 (8%) suffered the same misfortune again, and,
of the 22 who had given birth to an extremely early premature
(< 28+0 weeks of gestation), no recurrence happened.
Results of the Erfurt and of the Thuringian
prevention project 2000
The effectiveness of our self-care program was
also proved by two prospective campaigns [Hoyme et al. 1998, Hoyme et al. 2002,
Hoyme &
Saling 2004]. 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 versus 12.3%
in the control group. 0.3% versus 3.3% of the neonates belonged
to the group of very early prematures with a gestational age of
< 32+0. PROM was registered in 22.8% versus 30.8%,
respectively.
Encouraged by these results, in 2000 a similar pH
screening campaign was initiated in the whole state of Thuringia,
in order to reduce prematurity. The goal was to compare data from
babies who were born in the first half-year of 2000 (where no
participation in prenatal care self-examination was offered to
the pregnant women) with data from babies who were born in the
second half-year of 2000 (where participation in prenatal care
self-examination was recommernded to the pregnant women).
The figures in the state Thuringia were obtained
from the official Thuringia Perinatal Inquiry and included data
of about 16.000 women. In the half year with the program a
significant reduction of early prematurity from 1.58% to 0.99%
(see figure 3), and regarding low birth weights a significant
reduction of cases in all groups was achieved (see figure 4).
Concerning pregnancies with twins and triplets, which are at
especially high risk, there was also a considerable reduction of
prematurity (see figure 5).
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Fig. 3: Thuringian prematurity prevention
project 2000
Rates of very early prematures and of all prematures
Hoyme et
al. (2002).
Please click on the miniature picture.
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Fig. 4: Thuringian prematurity
prevention project 2000
Rates of children with extreme low and
very low birthweight
Hoyme et
al. (2002).
Please click on the miniature picture.
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Fig. 5: Thuringian prematurity prevention
project 2000
Birth weights of prematurely born twins and triplets
Hoyme et
al. (2005).
Please click on the miniature picture.
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When interpreting the figures, it should be
considered that only about 50% of the women who were pregnant in
Thuringia in the second half-year of 2000 had participated in the
prenatal care self-examination. That means, if all Thuringian
pregnant women would have participated, the results very probably
had been even better.
After the campaign in Thuringia 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 a
new Thuringia prematurity prevention campaign 2004/2005 started
on September 1st 2004.
Some German health insurance companies offer our
prenatal-care self-examination program as a pilot project to
their pregnant members at no charge. This is especially
important, because prematurity is most frequent in women with low
social status. The companies started this project in December
2003, and after first internal evaluations, they have already
saved a high amount of expenses.
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