Inaugural College of Obstetricians & Gynaecologists Lecture: recent developments in obstetric care and maternal fetal medicine in Singapore.

1 Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital, Singapore Address of Correspondence: Dr George Yeo, Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore 229899. Maternal Fetal Medicine Emerged as an Obstetric Subspecialty Has it done any good to pregnancy outcome as promised? Pregnancy outcome is commonly represented by both maternal mortality and neonatal mortality. Maternal mortality is a rare event in Singapore. It is no longer a sensitive indicator of changes in the quality and standards of care because of the strong influence of many confounding factors and the low observed incidence. Our incidence of 12 per 100,000 deliveries is very similar to that reported in the UK. On the other hand, neonatal mortality at a frequency of 100 times the incidence of maternal deaths is a pertinent yardstick. There is strong evidence showing a significant difference between the neonatal mortalities of the restructured hospitals in the last 10 years at any point of time.1 In a small country with homogenous social geopolitical factors across the pregnant population, this reflects the difference in the organisational decisions of the perinatal practices in the hospitals. In KK Women’s and Children’s Hospital (KKH), significance is also demonstrated when neonatal mortality is benchmarked by trending over the last 10 years. Neonatal mortality showed a marked change around 1993 to 1994. In 1993, KKH made a major commitment to subspecialty development and revamped its obstetrics clinical systems and processes. The neonatal mortality of the years before 1993 differs significantly from that of the years 1994 and after.2 This is a strong message that the change in organisational decisions made in maternal fetal medicine (MFM) from 1993 to 1994 has a powerful effect on the improvement of pregnancy outcome (Table 1, Fig. 1). International Benchmarking also showed us up favourably, with a neonatal mortality rate (NNMR) of 2/ 1000 live births. The corresponding figures for Germany (1997) was 3.5/1000 live births and for the United States (1998, Maryland), 4.8/1000 live births.