2. LMCC REVIEW LECTURE OBSTETRICS Dr L. W. Oppenheimer In the style of Woody Allen

3. LMCC REVIEW Obstetric performance Teratogens Early pregnancy Antenatal care Ultrasound / fetal assessment Twins / breech Medical conditions etc. PIH Labour

4. RISK SPECTRUM IN PREGNANCY LOW RISK - NORMAL OBSTETRICS 75% MEDIUM RISK - PRE-POST MATURE 20% BREECH - TWINS MATERNAL AGE, ETC.. HIGH RISK - GENETIC DISEASE 5% - SERIOUS OBSTETRIC OR MATERNAL COMPLICATIONS

5. RISK IN PREGNANCY Definition of Outcome Measures Perinatal mortality rate - all stillbirths (intrauterine deaths) > 500 grams plus all neonatal deaths per 1,000 total births Neonatal death - is death of a live-born infant less than 7 days after birth (early) or less than 28 days (late) LIve birth - an infant weighing 500 grams and more exhibiting any sign of life after full expulsion, whether or not the cord has been cut and whether or not the placenta is still in place

6. PERINATAL MORTALITY Prematurity Congenital anomaly Sepsis Abruption Placental insuffienciency Unexplained stillbirth Birth asphyxia Cord accident Other eg isoimmunization

7. PERINATAL MORTALITY RATE ONTARIO 5 / 1000 THIORD WORLD100 / 1000

8. MATERNAL MORTALITY Hypertensive Disorders Pulmonary embolism Anesthesia Ectopic pregnancy Amniotic fluid embolus Hemorrhage Sepsis Direct Deaths. (Indirect deaths) < 42 days from delivery

10. MATERNAL MORTALITY RATE ONTARIO 5 / 100,000 HAITI1000 / 100,000