During pregnancy and around birth, complications can arise that affect the health of both mother and child. In perinatal care, four major complications are often grouped together as the so-called “Big 4”: congenital abnormalities, placental problems that restrict fetal growth, preterm birth, and oxygen deprivation during birth. Together, these complications occur in approximately 18% of pregnancies. When babies die after birth or develop serious health problems, this can often be traced back to one of these well-known causes.

At the same time, new technology is now available that can provide far more detailed measurements of fetal condition. “With the new equipment, we don’t just measure the heart rate of the mother and child and uterine activity, but we can also see how contractions spread through the uterus,” explains TU/e researcher Ivar de Vries. However, this additional information remains unused in current clinical practice, because doctors are not yet sure how to interpret the data.

That is exactly the focus of Ivar de Vries’ PhD research. He is developing practical tools for medical professionals: how can these new measurements be used to detect complications earlier and more accurately? 

During his PhD, he carried out dozens of measurements at Máxima MC and worked on algorithms that extract meaningful information from the data. The goal is to improve diagnostics for all four main causes, enabling doctors to intervene earlier and give babies a better chance.

Improving survival rates

“Right now, the problem is that doctors still don’t have a clear enough picture of who needs treatment,” De Vries explains. Risk factors are known, but they do not always lead to accurate assessments. As a result, pregnant women are sometimes treated or admitted to hospital unnecessarily—in cases of threatened preterm birth, this applies to about half of all cases.

At the same time, patients who are actually at risk sometimes go unnoticed. “When things go wrong, it is not always recognized in time, even though early intervention can significantly improve a baby’s chances of survival,” De Vries emphasizes.

“For the first time, we are able to collect this type of data, so it’s a unique opportunity to extract something valuable from it,” he says. “By comparing data from healthy and high-risk pregnancies, we can translate new medical technology into something that is truly useful in clinical practice.”

“You speak with people who have experienced things going wrong during pregnancy. The questions and uncertainties they had show what they actually need help with. That gives direction to your research. Those conversations are also very motivating, because you really see the human behind all the data and understand what you are doing it for.”

He also values working side by side with doctors. “At the beginning, I was missing that medical background, so it was very helpful to sit at the same desk and work together,” De Vries says. The collaboration between medical and technical expertise worked extremely well, he adds. “Quite a few research ideas were born at the coffee machine.”

Preterm birth

In nearly half of babies who die after birth, preterm birth is the cause. Medication can be given to help the baby’s lungs mature, but it must be administered 48 hours in advance and only works for about seven days. “This medication also has side effects, so you only want to give it when it is truly necessary—and not more than twice,” De Vries explains.

With one of the algorithms he developed, it is now possible not only to predict preterm birth, but also to estimate when delivery will occur. This allows medication to be given in time, and only to women who truly need it. At the same time, women without elevated risk can stay at home, avoiding the stress of unnecessary hospital admission.

A heart tracing without noise

Another complication De Vries focuses on is congenital abnormalities. These occur when organs or structures in the fetus do not develop properly. When the heart is affected—the most critical organ—this can be life-threatening. In the Netherlands, early ultrasounds are already performed, yet around 40 percent of heart defects are still missed.

“With the new equipment, we can create a heart tracing of the baby,” De Vries explains. “But because the baby is in the uterus, behind the mother’s abdominal muscles, there is a lot of noise. With a specially developed algorithm, we can largely remove that noise, giving us a much clearer signal.”

Another algorithm can then determine, based on the heart tracing, whether a congenital heart defect is present. “Otherwise, you would have to train all gynecologists to interpret this data—they are not cardiologists, after all.” The system can automatically flag high-risk cases, which can then be sent to an expert center for further evaluation.

Acting quickly

With the new technology, it may become possible to detect more abnormalities early on. Not all babies can be saved, but with early detection, pregnant women still have time to consider terminating the pregnancy. For many, this is less traumatic than continuing a pregnancy knowing the child will likely die shortly after birth.

In some cases, a newborn can be operated on immediately after delivery. In those situations, it is essential that the condition is known in advance, so the medical team can prepare and act quickly.

Placenta

Problems with the placenta can lead to preeclampsia, a condition that can also be dangerous for the mother. It causes high blood pressure, which in severe cases can lead to kidney or heart failure, and even death. “At the moment, we cannot predict preeclampsia. And once kidney failure has occurred, you are essentially too late,” De Vries explains.

From new measurements, however, De Vries has been able to identify important biomarkers that can predict preeclampsia early in pregnancy—weeks before the condition develops. This allows doctors to monitor pregnant women at increased risk more closely.

Practical applications

“The diagnostic methods still need to be validated, but in principle the technology is almost ready to be used in hospitals,” the PhD candidate says hopefully. The fact that the research has so many practical applications is directly linked to its starting point: it was driven by the questions and needs of gynecologists. “We’ve created something they can actually use—and that works.”

That need is also urgent. “Gynecologists are sometimes still left empty-handed, so anything they can use is seized with both hands.” The goal is for the methods to quickly find their way into clinical practice, so that both unborn and born babies have better chances.

This article was translated using AI-assisted tools and reviewed by an editor