Hoyme U B, Grosch A, Roemer V M, Saling E
Frauenklinik Erfurt.
Z Geburtshilfe Neonatol. 1998 Nov-Dec;202(6):247-50.
Genital infection particularly bacterial vaginosis (BV) increases the relative risk of prematurity. Detection of disturbances of vaginal milieu at an early stage and the use of suitable countermeasures such as intervention with antimicrobial substances, e.g. clindamycin, can reduce the preterm birth rate, provided the diagnosis is made early enough.
Since October 1996 pregnant women being given prenatal care in 16 of the 29 outpatient offices in Erfurt, have been informed about the Prematurity Prevention Programme and 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 vaginal milieu. Special CarePlan-VpH gloves (Selfcare, Oberhaching) were used to identify patients a risk (pH > 4.7). The pregnant women taking part in the programme were instructed to see their physician immediately, if abnormal values were present, in order to get them confirmed and to start lactobacillus acidophilus therapy (Gynoflor, Nourypharma, Oberschleissheim) or, in case of BV, to treat with clindamycin cream (Sobelin, Upjohn, Erlangen) i.vag. Patients being given prenatal care in the 13 outpatient offices not participating and other pregnant women in Erfurt who were not interested in the programme served as control group.
Up to now 59 out of 314 women in the intervention group have been identified as risk cases (p > or = 4.7). 52 of them were treated with a lactobacillus preparation, and 19 additionally with clindamycin cream, 3 patients refused to have any therapy. In this ongoing study the prematurity rate was 8.3% in the self-measurement/intervention group vs. 13.0% in the control group (n = 1,842); 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 22.3% vs. 32.1% (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. Earliest possible intervention by the obstetrician appears to result in reducing the rate of prematures and in particular of very early prematures (< 32 + 0 weeks).
生殖器感染尤其是细菌性阴道病（BV）会增加早产的相对风险。早期检测阴道微环境的紊乱并采取适当的应对措施，如使用抗菌物质（如克林霉素）进行干预，若诊断足够早，可降低早产率。
自1996年10月起，爱尔福特29个门诊中的16个为接受产前护理的孕妇介绍了早产预防计划，并邀请她们参与，每周自行测量两次阴道pH值，以筛查阴道微环境的任何紊乱情况。使用特殊的CarePlan-VpH手套（Selfcare，奥伯哈兴）来识别有风险的患者（pH>4.7）。参与该计划的孕妇若出现异常值，需立即就医，以便确诊并开始嗜酸乳杆菌治疗（Gynoflor，Nourypharma，上施莱斯海姆），若为BV，则用克林霉素乳膏（Sobelin，优普强，埃尔朗根）经阴道治疗。在未参与的13个门诊接受产前护理的患者以及爱尔福特其他对该计划不感兴趣的孕妇作为对照组。
截至目前，干预组的314名女性中有59人被确定为风险病例（p≥4.7）。其中52人接受了乳酸杆菌制剂治疗，19人还额外接受了克林霉素乳膏治疗，3名患者拒绝接受任何治疗。在这项正在进行的研究中，自我测量/干预组的早产率为8.3%，而对照组为13.0%（n = 1842）；孕周<32 + 0周的极早早产儿在两组中的比例分别为0.3%和3.3%（p<0.01）。胎膜早破的发生率分别为22.3%和32.1%（p<0.001）。
按照萨林的建议，定期自行测量阴道pH值可早期识别有早产风险的女性。产科医生尽早进行干预似乎可降低早产率，尤其是极早早产（<32 + 0周）的发生率。
