Improving perinatal outcome: towards individualized care

Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity.
First assessment in antenatal care is to distinguish women who require standard care from those requiring special attention. At the moment, we can make some global risk assessments, but are not able to give a women a risk assessment that is adapted for her. For instance, foetal characteristics and pregnancy specific/environmental factors are often not incorporated in the risk assessment these days, even though they play a role. If we can predict more precisely who is at risk (for preterm birth or any other pregnancy complication) preventive strategies can be used to decrease complications and improving poor perinatal outcomes.
Obviously many different factors are related to poor perinatal outcomes. The objective of this thesis was to identify women at risk in order to improve perinatal outcomes. We focused on three subjects with separate aims:
- study screening options for spontaneous preterm birth at different time points during pregnancy in order to identify risk factors and gain insight in pathophysiologic mechanisms;
- investigate the association between asymptomatic bacteriuria and poor perinatal and maternal outcome to investigate the necessity of a screen and treat program in the Netherlands;
- explore differences in perinatal mortality near term in certain subgroups in order to individualize management of these pregnancies.