Perinatal outcome in preterm birth

Abstract

Preterm birth (<37 weeks of gestation) is a major cause of perinatal morbidity and mortality and remains the most important problem in obstetrics. The current thesis aims to 1) provide insight in the nature of the relation between placenta pathology, brain development and outcome in preterm birth, and 2) evaluate the effectiveness and safety of intervention to prevent preterm birth. The first part of this thesis describes studies that found that perinatal infections, mainly postnatal infections, are associated with poorer mental and motor development in very preterm infants. Histological placental abnormalities in very preterm infants relate to long term neurodevelopmental outcome, but not to cerebral MRI abnormalities at term equivalent age. The second part of the thesis describes that in threathened preterm birth, tocolysis with atosiban or nifedipine is preferred based on the largest effectivness found in the current literature. The use of nifedipine and atosiban result in similar rates of adverse perinatal outcome. Tocolysis for more than 48 hours does not improve neonatal outcome or long term neurodevelopmental outcome. To lower the risk of spontaneous preterm birth, the use of aspirin might be a valuable and safe intervention in early pregnancy.