Improving evaluation of obstetric interventions

In most pregnancies the synergy between mother and her unborn child is adequately balanced, resulting in the birth of the baby at the end of an uncomplicated pregnancy. Unfortunately, not all pregnancies and deliveries remain in such optimal balance. Many new and existing interventions can be offered to pregnant women who face a problem in pregnancy or during labour. In order to guide clinical as well as policy decision making, evaluation research is needed to establish evidence on effectiveness and potential harm of these interventions. A randomized controlled trial (RCT) is worldwide considered as the best instrument to evaluate the effectiveness of medical interventions. Systematic reviews and meta-analyses subsequently aggregate the evidence to give a more balanced answer to a research question. In summary we face the following problems in evaluation research in obstetric interventions: 1) a lack of standardization in the selection and operationalization of outcomes. This may lead to inefficiency in research and waste of resources. 2) a lack of systematic follow-up data of randomized controlled trials, leaving a blind spot in clinical research. 3) a gap between clinical research and its impact in clinical decisions. Patients therefore do not fully benefit from the available evidence. This thesis focuses on improving evaluation research on obstetric interventions. The aims are to: • develop a core outcome set that can be used in obstetrical evaluation studies • measure long-term outcomes of obstetrical evaluation studies • integrate outcomes of obstetrical evaluation studies in order to guide clinical decision making