[Prevention of late abortion and high risk premature labor--measures suited for routine practice].

Ascending infection is likely to be the main cause of late abortion and early delivery. In a retrospective evaluation performed at our hospital, evidence of infection was encountered in 76% of 195 pregnancies with premature infants having birth weights less than 2000 g. It may be assumed that the processes responsible for this development take place at the lower pole. It was against this background that we developed a programme designed to contribute to an effective prevention of late abortion and early delivery. The essential requirement is that measurements of vaginal pH enter into routine use during prenatal care. This simple procedure allows for the identification of many (not all) vaginal disorders that might occur in patients at risk. In the presence of other serious anamnestic or diagnostic evidence of imminent late abortion or early delivery, specific bacteriologic examinations including a check-up for chlamydia, vaginal ultrasonography of the cervix and testing for CRP should be carried out. Lower pole lavage, a procedure recently developed by the authors, facilitates the identification of pathogens in the upper part of the infected area, as compared to conventional vaginal and cervical smear. Following are the most important therapeutic measures: An early total blockage of the os uteri is desirable in patients with a clinical history of late abortion or premature infants with little chance of surviving. Acidifying local treatment with Lactobacillus acidophilus is recommended in the presence of abnormally high vaginal pH values (over 4.2). If pathogenic or potentially pathogenic micro-organisms are identified in the upper part of the infected area, local antibiotic therapy should be resorted to, if useful; otherwise systemic antibiotics should be given. If the patient shows definite symptoms of imminent late abortion or early delivery (e.g. critical cervical findings and/or premature labour and/or positive CRP values), systemic wide-spectrum antibiotics should be administered, even if no pathogens have been encountered. The first assessments of the effectiveness of this programme have shown that since its institution in 1989 and 1990, the incidence of underweight infants (birth weight below 1500 g) was significantly reduced at this hospital (by 30%) as compared to the years 1987 and 1988. On the other hand, the incidence of larger underweight infants having a birth weight of 1500 g and more was shown to rise slightly by 9%, while the total number of underweight infants remained unchanged (8.7%).(ABSTRACT TRUNCATED AT 400 WORDS)