title: Effectiveness of score card-based antenatal risk selection, care pathways, and multidisciplinary consultation in the Healthy Pregnancy 4 All study (HP4ALL): study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  Promotion of healthy pregnancies has gained high priority in the Netherlands because of relatively unfavorable perinatal outcomes. In response, a nationwide study, 'Healthy Pregnancy 4 All' (HP4ALL), has been initiated. Part of this study involves systematic and broadened antenatal risk assessment (the Risk Assessment substudy). Risk selection in current clinical practice is mainly based on medical risk factors. Despite the increasing evidence for the influence of nonmedical risk factors (social status, lifestyle or ethnicity) on perinatal outcomes, these risk factors remain highly unexposed. Systematic risk selection, combined with customized care pathways to reduce or treat detected risks, and regular and structured consultation between community midwives, gynecologists and other care providers such as social workers, is part of this study.
  
  
  METHODS
  Neighborhoods in 14 municipalities with adverse perinatal outcomes above national and municipal averages are selected for participation. The study concerns a cluster randomized controlled trial. Municipalities are randomly allocated to intervention (n = 3,500 pregnant women) and control groups (n = 3,500 pregnant women). The intervention consists of systematic risk selection with the Rotterdam Reproductive Risk Reduction (R4U) score card in pregnant women at the booking visit, and referral to corresponding care pathways. A risk score, based on weighed risk factors derived from the R4U, above a predefined threshold determines structured multidisciplinary consultation. Primary outcomes of this trial are dysmaturity (birth weight < p10), prematurity (birth <37 weeks), and efficacy of implementation.
  
  
  CONCLUSIONS
  The 'HP4ALL' study introduces a systematic approach in antenatal health care that may improve perinatal outcomes and, thereby, affect future health status of a new generation in the Netherlands.
  
  
  BACKGROUND
  Dutch Trial Registry ( NTR-3367) on 20 March 2012.
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Department of Obstetrics and Gynaecology, P,O, Box 2040, 3000 Rotterdam, CA, The Netherlands. a.a.vos@erasmusmc.nl.
authors.forename: Amber A
authors.initials: AA
authors.lastname: Vos
authors.forename: Sabine F
authors.initials: SF
authors.lastname: van Voorst
authors.forename: Adja J M
authors.initials: AJ
authors.lastname: Waelput
authors.forename: Lieke C
authors.initials: LC
authors.lastname: de Jong-Potjer
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Semiha
authors.initials: S
authors.lastname: Denktaş
mesh_terms: D001724:Birth Weight; D002985:Clinical Protocols; D003299:Cooperative Behavior; D019091:Critical Pathways; D003661:Decision Support Techniques; D005260:Female; D005865:Gestational Age; D006293:Health Promotion; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D033183:Interdisciplinary Communication; D009426:Netherlands; D010348:Patient Care Team; D018743:Perinatal Care / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012017:Referral and Consultation; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome