120 5 CHAPTER 5 12 | GOODARZI et al. from a time period in which the IOL rate has increased, which may have impacted the outcomes of this study. 4.5 | Conclusions This nationwide longitudinal retrospective cohort study in a healthy Dutch pregnant population showed that the probability of TM differed among subgroups of women depending on which determinants were considered and the number of determinants included. These results indicate that a routine approach using single determinants may result in underestimation or overestimation of probabilities of TM, leading to overuse or underuse of IOL. A VBHC strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality. ETHICAL APPROVAL Ethical approval was requested from the Medical Ethics Review Committee of VU University Medical Centre. 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