MINISTER OF HEALTH, DAGFINN HØYBRÅTEN

OPENING SPEECH

XVIII EUROPEAN CONGRESS OF PERINATAL MEDICINE

19 ^TH JUNE 2002 – KONSERTHUSET, OSLO

Your Majesty

President of EAPM; Gian Carlo Di Renzo

Members of the Executive Board of EAPM

Distinguished Guests

Dear Participants

It is a great pleasure for me to open the 18 ^th> European Congress of Perinatal Medicine. Heartily welcome to Oslo. We are glad and proud you have chosen Norway and its capital to host this important event. The fact that almost 1300 participants from 66 countries have found their way to this congress indicates perhaps the importance and significance of such a congress. For what is more important than trying to decrease the morbidity and mortality of the pregnant woman, her fetus and newborn infant?

Perinatal and neonatal mortality

In fact, in Norway as the rest of this part of Europe, there has been a dramatic reduction of both perinatal and neonatal mortality the last decades. Perinatal mortality has been reduced by more than 50% during twenty years. Today perinatal mortality and neonatal mortality in Norway are approximately 6 and 4 per 1000 respectively. However, a couple of decades ago, Norway was one of the countries of this part of the world with highest perinatal mortality. More focus and resources on the pregnancy care involving both midwives and general practitioners, better follow-up of the pregnant woman and her fetus, improved obstetrical as well as neonatal care, are some of the reasons for this progress.

In other parts of our continent as in southern Europe there has also been a remarkably impressive and fast reduction in mortality in fetal and newborn life during the last 20 years.

The prognosis of the most premature babies has also recently been significantly improved. In only 10-15 years time the mortality has been reduced by two- thirds in infants with a birth weight between 500 and 999 grams and by even more for birth weights between 1000 and 1499 grams. We know that with relatively small means and improved organization of the care significant results in perinatal medicine are achieved within a reasonable time frame.

Unfortunately perinatal morbidity and mortality in several countries and regions of Europe are still too high. A 6-7-fold variation in for instance perinatal mortality between those with best and poorest outcome is too high and definetely not acceptable. Of the approximately 7 million births in Europe 44,000 die every year. Although neonatal mortality in several regions of Europe is as low as 3 pr 1000 in some areas it is 9 per 1000. A fall in neonatal mortality in Europe for instance from 6 to 4 per 1000 would save 14,000 lives. The global contrasts are, however, even bigger and of course even less acceptable. By reducing the global neonatal mortality from its present 30 per 1000 live births to 5 per 1000, 3 million newborn deaths could be avoided each year. The suggested Oslo declaration states that these variations not longer should be tolerated.

Ethics

The fetus and newborn infant are among the most vulnerable among us. They therefore need and deserve special protection. Very often one may get the impression that modern technology is refined and used with the main purpose of detecting diseases and anomalies in the fetus for eventually aborting them. The fetus and newborn needs respect and protection. I am therefore glad that one of the main themes of this congress is "the world of the fetus" in which fetal life and well being will be focussed on. It is an exciting possibility indeed that the fetus can remember sensory inputs and perhaps also learn from its experiences in the womb.

Ultrasound in pregnancy is a wonderful tool to detect conditions which can help the obstetrician to make right treatment choices and thus improve the outcome of the newborn. I am, however, more skeptical to the use of ultrasound in the early part of the pregnancy for the purpose of terminating the pregnancy if anomalies and diseases are detected. I notice that the congress is bringing up several of the difficult ethical issues related to modern technology. An open discussion on these themes is indeed needed and highly important. It is my hope that the ethical implications and aspects of modern medical technology and development always are kept in mind and considered also in your daily work, granting the fetus the respect it deserves as a human being.

Collaboration between professional groups

In perinatal medicine a close and smooth collaboration between the different professional groups involved in the care is of utmost importance. The Norwegian Perinatal Society has extremely good experience during 15 years by organizing scientific perinatal meetings integrating all categories of perinatal health workers as midwives, neonatal nurses, neonatologists and obstetricians. This integrated model is used also in this congress. The presence of almost 300 midwives and nurses indicates there is interest for this model at the European level as well. I believe close scientific relations also promote the daily collaboration between all the groups taking part in the care of the mother and child. Such integration between the groups probably is one important factor that has lead to the good results in Norway.

Better care and access to necessary therapy and medication for the pregnant woman, her fetus and newborn infant, all over the world, wherever at this globe the delivery finds place should be a goal for all of us. We have all of us a responsibility for the children of the world - all of them are our children. I therefore want to extend my thanks to all of you who are working in the important field of perinatal medicine. You have a big responsibility to keep up with the latest news in your field, and to improve the care via research and improved organization. The way we treat the smallest and most vulnerable among us is a measure of the human standards of our society. I therefore wish you all the best during the four days of this European Congress of Perinatal Medicine hoping these days will stimulate your own practice when you have returned to your home countries.

I hereby declare the 18 ^th> European Congress of Perinatal Medicine for opened.

Ordliste og definisjoner:

Morbidity: Sykelighet

Mortality: Dødelighet

Perinatal: Tiden rundt fødselen (per definisjon fra 22. svangerskapsuke til og med 1. Leveuke)

Neonatal: Nyfødt (første 4 uker etter fødselen)