Alberta Perinatal Health Program 2007-2008 Annual Report

APHP ANNUAL REPORTALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORTAR0708

PrinciplesComprehensive ScopeThe APHP focuses on the perinatal health of infants and their mothers, healthy or at risk, in the context oftheir families and communities. The program scope is from preconception through the first year of life.The APHP is concerned with the range of services delivered in Alberta across the continuum of care,including prevention, early identification, intervention and harm reduction.Proactive, Multi-faceted StrategyThe program will use a multi-faceted approach that addresses individual and population perinatalhealth issues. The program strives proactively to identify, prioritize and address these issues, withan emphasis on quality improvement, advocacy, evidence-based optimal practice, education andinformation. The program is guided by a population health approach, and is planned and evaluatedat the individual, aggregated and population levels.CollaborativeThe program undertakes its mandate in partnership with stakeholders. Recognizing that the APHPdoes not provide direct patient services, program staff value and strive for positive relationships withtheir key partners --- regional health authorities, health professionals and others.Ethical ConductThe program is guided by ethical principles, which form the basis for decisions. Issues with an ethicalimplication are referred for ethical direction.Evidence-basedThe program is guided by the best available evidence and promising practices, informed by evaluation.Program staff will look for evidence and will incorporate it in program planning and decision-making.Outcomes-orientedThe program uses an outcomes-oriented approach to measure success.QualityContentsMessage from the Minister 1Message from the Chair 2Message from the Director 3Governance and Accountability 4Organizational Structure 4Executive Summary 5Health Care Facility Births 62007-2008 Report and Outlook• Leadership and Coordination 7• Education and Consultation 8• Quality and Innovation 9• Information Management and Research 10Summary of Financial Results 11Acronyms and Terms 12Committee Members 13The program fosters the highest possible quality of care in the delivery of perinatal services for womenand infants, provided at a level of care required for optimal practice and patient safety, and as close tohome as possible.The program incorporates the following quality dimensions: accessibility, acceptability,appropriateness, effectiveness, efficiency and safety. [As defined by Alberta Health and Wellness andadopted by the Health Quality Council of Alberta].VisionOptimal health for expectant mothers and the infantsthat are born each year in Alberta.MissionTo promote maternal health, positive birth outcomes andhealthy infancy by providing provincial leadership andprovincial support to health regions, health professionals,Alberta Health and Wellness and other stakeholders.

Message from the MinisterI commend the Alberta Perinatal Health Program on another successful yearin supporting the best possible outcomes for expectant mothers and infantsborn in Alberta.The Alberta Perinatal Health Program provided leadership in thedevelopment of the Healthy Mothers Healthy Babies: How to PreventLow Birth Weight Consensus Conference in May 2007. The conferencebrought together key partners in perinatal and resulted in the productionof a Consensus Statement with 27 recommendations to addressing theissue of low birth weight.The Alberta Perinatal Health Program continues to provide outreacheducation and consultation to nurses, physicians, midwives and otherhealth professionals. By working with the Alberta Perinatal Health Program,health regions and providers of perinatal services across the province havebeen able to achieve the milestones of the Managing Obstetrical Risk Efficiently(MORE OB ) program, a patient safety program that focuses on clinical skills drills,rehearsals for emergencies, multidisciplinary teams communicating effectively,and creating cultures of safety.I am very pleased that the Alberta Perinatal Health Program creates synergy bybuilding on regional resources. The impressive STORC Manual (Strategies forTeaching Obstetrics to Rural and Urban Caregivers) is one example of a tangibleproduct which can be achieved when health regions and the Alberta PerinatalHealth Program work together. The Alberta Perinatal Health Program hasdemonstrated an understanding of the need for accessible, available educationby taking the next step to create an electronic platform. I am optimistic that thiseducational strategy will be of use to new nurses and clinicians, and to all of theinternationally educated recruits that we hope to welcome to Alberta over thecoming year.Another significant achievement this year was the development of a consolidatedprovincial data repository. I am appreciative of the technical work that wasneeded to make provincial, perinatal health information available for analysis andinterpretation. With improved access to perinatal data, researchers, administratorsand clinicians will be better able to reflect on their practices, to set realistic goalsand to plan programs efficiently.I wish the Alberta Perinatal Health Program continued success and thank theprogram staff and their diverse partners for contributing to the health of infantsand families in Alberta. Healthy mothers and babies contribute to the capacityof every community and to the health of all Albertans.Sincerely,Ron LiepertMinister of Healthand WellnessRon LiepertMinister of Health and WellnessGovernment of AlbertaALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Message from the ChairSelikke Janes-KelleyChairI am pleased to present this year’s annual report for the Alberta Perinatal HealthProgram and to highlight the progress that together we have made towardsimproving the health of women, babies and families across Alberta. The2007-2008 year started with the Consensus Conference on HealthyMothers Healthy Babies: How to Prevent Low Birth Weight that was heldMay 23 to 25, 2007 in Calgary. The planning for this conferenceinvolved key partners, the APHP staff, and clinicians from around theprovince and culminated in one of the most successful conferences.The production of a literature review and a Consensus Statementdistinguished this conference, and now a subcommittee of the AlbertaPerinatal Health Advisory Committee will develop an action plan basedon the recommendations to present to the Minister of Health.One of the most significant accomplishments to date has been the creationof a provincial, perinatal data repository. These data will be available for reportsthat will be useful for staff and clinicians to reflect upon their practices, forprogram planning and evaluation. The Partnership Accord membership has beeninstrumental in guiding and supporting the work of the APHP and continues todemonstrate outstanding commitment to improving birth outcomes for womenand infants across the province.I’m sure that each of you have been challenged over the last year to recruit andorient new staff and I’m sure that you will be looking forward to having accessto the STORC e-Learning platform. We anticipate that the STORC programwill “go live” before the end of the year and we will advise you accordingly.I invite you to review our annual report and to consider opportunities that youwould like the APHP to address in the coming year. In conclusion, I would liketo thank each of you at the bedside and in the community for working withus, our Program Director, each of the staff, and other partners. The programachievements are a direct result of individual dedication and an outstandingteam commitment to perinatal health.Sincerely,Selikke Janes-KelleyChairAlberta Perinatal Health ProgramCoordinating CommiteeALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Message from the DirectorI am delighted to present to you the third annual report from the AlbertaPerinatal Health Program (APHP). The APHP has had another busy yearand I would like to highlight a few of the Program’s many achievements.The APHP worked together with key partners to plan and host a ConsensusConference to address Healthy Mothers Healthy Babies: How to PreventLow Birth Weight. A literature review was commissioned, internationallyrespected researchers were invited to present their findings, and adiverse panel of experts was drawn from across the province. The panelfunctioned much like a jury. They reviewed the literature, listened tothe speakers, asked poignant questions, and worked very hard to developa consensus statement with 27 recommendations. The work from thisconference continues through a subcommittee of the Alberta PerinatalHealth Advisory Committee. The subcommittee has been charged with theresponsibility for making recommendations for action to the Minister.The APHP continues to provide outreach education and consultation for nurses,physicians, midwives and other health professionals. We acknowledge and applaudthe milestones achieved by staff and clinicians from each of the health regions asthey have worked through the modules of the Managing Obstetrical Risk Efficiently(MORE OB ) program. Maternity patients and their families can be assured thatstaff and clinicians have been actively engaged in this patient safety program thatfocuses on clinical skills drills, rehearsals for emergencies, multidisciplinary teamscommunicating effectively, and the creation of cultures of safety.To build upon the computer based learning skills and team work acquiredthrough the MORE OB program, I am pleased that the APHP has worked inpartnership with educators from across the province to create the STORCManual (Strategies for Teaching Obstetrics to Rural and urban Caregivers).The APHP has listened and heard the needs of frontline staff for accessible,available education and has taken the next step to create an electronic learningplatform. With this platform, the 32 STORC modules will be continuallyavailable to caregivers across the province. I am hopeful that this educationalstrategy will be useful to nurses, clinicians, and to the new graduates and recruitscoming to work in Alberta.Another significant achievement this year was the implementation of aconsolidated provincial data repository. Provincial perinatal health informationwill be available for analysis and interpretation, for reflection on clinical practices,for program planning and for evaluation.All of these achievements are possible only through the dedication and work ofour staff and through your interest and participation. Thank you for partneringin the initiatives offered by the Alberta Perinatal Health Program. Together we areable to optimize the health of mothers, infants and families in Alberta.Yours truly,Corine FrickDirectorCorine Frick, R.N., M.N.DirectorAlberta Perinatal Health ProgramALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Governance and AccountabilityThe APHP is accountable to the Minister of Alberta Health and Wellness(AHW) through the tripartite partnership (AMA, Calgary Health Regionand Capital Health). The tripartite executive is comprised of the ExecutiveDirector, AMA; Vice President, Calgary Health Region; and Chief OperatingOfficer, Royal Alexandra Hospital, Capital Health. A governance committeecomprised of one staff representative from each of the three partnerorganizations provides the overall direction to the program.In addition to the direct line accountability, the Minister of AHW establisheda perinatal health advisory committee comprised of stakeholders with aninterest and expertise in perinatal health. Members were selected because oftheir expertise and come from regional health authorities (RHAs), academicinstitutions, medical specialties and government.APHP Organizational Structure 2007-2008AlbertaHealth & WellnessMinisterDeputy MinisterAssistant Deputy Minister,Public Health DivisionAlbertaPerinatalHealthAdvisoryCommitteeTripartitePartnership(Executive Level)Alberta Medical AssociationCalgary Health RegionCapital HealthTripartitePartnership(Operational Level)Alberta Medical AssociationCalgary Health RegionCapital HealthPartnershipAccordAll nine (9)Regional HealthAuthoritiesAlberta Perinaltal Health Program - Core FunctionsLeadershipandCoordinationEducationandConsultationInformationManagementand ResearchQualityandInnovationAd hoc Committees• New TechnologiesPrioritization Committee• Low BirthWeight ConferenceCommitteesEducationStandingCommitteeInformationManagement andResearch StandingCommitteeAMACommitteeon Reproductive Care(Quality AssuranceStandingCommittee)QualityImprovementStandingCommitteeDataProcess Mgmt.WorkingGroupProvincialReportingWorkingGroupDataElementsWorkingGroupALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Executive SummaryThe fiscal year 2007-2008 marks the third full year of operations for theAlberta Perinatal Health Program. Maturation of the program has resultedin the achievement of significant milestones, all of which contribute tothe health of expectant mothers and the infants that are born each yearin Alberta.One outstanding achievement was the full implementation and “go live” ofPeriLink AB , the new provincial perinatal data repository. PeriLink AB providesa collation of provincial perinatal data which is used for analysis, reportingand research.In the past year, the Alberta Perinatal Health Program has made asignificant contribution toward the reduction of preterm birth and thereduction of infants born small for gestational age. The Alberta PerinatalHealth Program partnered with other organizations and individuals to planand host a Consensus Conference on low birth weight. The results of thisconference contributed to the knowledge and understanding about lowbirth weight and will result in actions toward reducing the provinciallow birth weight rate.In addition to the larger, more publicly visible achievements, the AlbertaPerinatal Health Program Director, staff and partners work every day onpromoting maternal health, positive birth outcomes, and healthy infancy.The key achievements in the activities of leadership, coordination, education,consultation, quality, innovation, information management and research arecaptured in this report.The achievements, large and small, would not occur without fundingand support from Alberta Health and Wellness, and collaborationwith the Alberta health regions, health professionals, and otherorganizations who strive toward the same vision of optimalhealth for Albertans.ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Alberta Births in 2006There were a total of 45,973 babies born in Alberta in 2006. This maprepresents the number of live born and still born infants delivered inAlberta health care facilities and includes babies born before admissionto hospital. Midwife-attended, out-of-hospital births are not representedon this map.ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Leadership and CoordinationProvincial leadership and coordination for perinatal health includingimplementation of relevant strategies and activities.Key Achievements• Together with partners, planned and hosted a Consensus Conference on“Healthy Mothers Healthy Babies: How to Prevent Low Birth Weight”which was held in Calgary May 23 to 25, 2007.• A subcommittee of the Alberta Perinatal Health Advisory Committee wasformed to address the recommendations of the Consensus Conferenceand to submit a report to the Minister of Health and Wellness. The firstmeeting was held on February 26, 2008.• Provincial midwifery education plan is being developed. Leadership isprovided by Mount Royal College, Calgary. A steering committee hasbeen formed.Mean Maternal Age atDelivery in AlbertaYear Age2000 28.22001 28.32002 28.32003 28.52004 28.52005 28.52006 28.5• Work within the program is in progress to consolidate the educationand consultation work with the quality improvement work through theformation of a practice support team. The core functions will be addressedmore efficiently and effectively through working groups rather thanthrough Standing Committees.• There were site visits to Aspen, East Central, David Thompson, PeaceCountry and Northern Lights health regions to explore opportunities toenhance regional capacity through APHP support.• Enhanced communication between APHP and stakeholders thoughpublication of a provincial perinatal newsletter called AlbertaPerinatal Connections.• Program evaluation has focused on the development of logic models tosupport the strategic plan.• Preconcception Health Framework printed and disseminated to key partners.ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Education and ConsultationProvides learning opportunities and resources for health professionals,health regions, Alberta Health and Wellness (AHW) and otherstakeholders to achieve best perinatal practice.Total Live Birthsin Alberta 2000 to 2006(in thousands)504030201002000200120022003200420052006’00 ’01’02 ’03’04 ’05’06Through the APHP, Alberta health professionals can access up-to-dateknowledge and skills in neonatal resuscitation, stabilization and support ofacutely ill infants, implementation of a new test to screen for preterm labour,care for the mother and baby in the antepartum, intrapartum and postpartumperiods and patient safety in obstetrical care.Key Achievements• Established a process for the APHP to be responsive to requests forinformation and education.• Planned, developed and implemented the Acute Care of at-Risk Newborns(ACoRN) Program for Alberta health professionals made available fromthe ACoRN Neonatal Society.• Developed and distributed educational materials for the Introductionof Fetal Fibronectin (fFN) Testing.• Updated Alberta health professionals’ knowledge and skills onnewborn resuscitation by implementing an updated NeonatalResuscitation Program (NRP) curriculum made available from theCanadian Pediatric Society (CPS).• Working actively with the Canadian Perinatal Programs Coalition (CPPC)to develop a new education program and materials for intermittent fetalheart auscultation and electronic fetal monitoring based on the new FetalHealth Surveillance (FHS) guidelines issued by the Society of Obstetriciansand Gynaecologists of Canada (SOGC).• Developed Strategies for Teaching Obstetrics to Rural and UrbanCaregivers (STORC) program manual as well as an e-Learning platform.• There are 2200 health professionals working in 62 Alberta hospitals whoare participating in the Managing Obstetrical Risk Program (MORE OBProgram). The MORE OB Program is designed to enhance patient safety,professional development, and quality improvement.ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Quality and InnovationFacilitates and enhances capacity of health regions, healthprofessionals, Alberta Health and Wellness, and other stakeholdersto achieve optimal perinatal practice.Key Achievements• Completed revisions to Alberta Prenatal Record (APR) and developedelectronic specifications.• Developed and distributed APR and documentation guidelines forthe APR and Healthy Mother, Healthy Baby Questionnaire andresource directory.• Conducted independent external evaluation of revised APR andHealthy Mother, Healthy Baby Questionnaire. Evaluation results arebeing considered.• Completed development of Health-Related Maternity Leave ReferenceGuide for Health Care Providers.• Completed development of practice resource on Intrauterine GrowthRestriction: Diagnosis and Management.• Developed recommendations in response to issues identified through studyof perinatal mortality.• Raised awareness of First Nations and Inuit Health Branch (FNIHB)representatives and Quality Improvement Standing Committee of gapsin prenatal and specialist care to aboriginal women living on reservewith pregnancy complication of diabetes, as observed in the study ofperinatal mortality.ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Information Management and ResearchCollaborating with health regions, health professionals, AHW andother stakeholders on activities to monitor and assess the health statusof mothers and infants in Alberta.Total Live Birthsin AlbertaYear Number2000 37,5312001 38,1602002 39,2082003 40,8132004 41,3212005 42,6312006 45,640Caesarean Sectionsto Women GivingBirth in AlbertaYear %2000 19.92001 22.12002 22.92003 23.82004 25.22005 25.72006 26.3Key Achievements• Production of the first provincial perinatal hospital comparativereport – May 2007.• Preparation of provincial perinatal report using 2006 data for presentationat a meeting with key Alberta stakeholders – May 2008.• Migration of historical data completed from the three legacy databases tothe new provincial data repository – December 2007.• APHP baseline privacy impact assessment submitted to the Office of theInformation and Privacy Commissioner – January 2008.• Full implementation and “go live” of PeriLink, new provincial datarepository – March 2008.• Data standards for postpartum depression and breastfeeding have beenaccepted in draft by the Health Information Standards Committee ofAlberta (HISCA) and incorporated into Phase I of the development ofthe public health electronic medical record through the Regional SharedHealth Information Project (RSHIP).10ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Summary of Financial ResultsApril 1, 2007 to March 31, 2008APHP Grants Actual Budget VarianceGeneral Operating Grant 1,436,754.41 1,552,540.00 115,785.59Retained Grant from 2006/07* (16,290.32) (16,290.32) -Other Revenue* (14,818.21) - 14,818.21Salary and Benefits 993,161.32 992,962.29 (199.03)Office Expenses 301,973.60 313,072.23 11,098.63Consultation 141,719.45 195,830.48 54,111.03Committees 14,792.32 48,888.32 34,096.00Program Evaluation 16,216.25 18,077.00 1,860.75Information Management Special Purpose Grant 509,956.82 520,000.00 10,043.18Project Leader 61,808.62 60,000.00 (1,808.62)Data Architect 127,590.00 123,000.00 (4,590.00)IT Development Services through Calgary Health Region 286,817.50 300,000.00 13,182.50Support Services – Electronic Prenatal Record 23,769.43 27,000.00 3,230.57Other Expenses 9,971.27 10,000.00 28.73STORC e-Learning Grant 40,000.00 40,000.00 -Office Expenses - - -Consultation 40,000.00 40,000.00 -Managing Obstetrical Risk Grant 1,566,716.75 1,714,915.52 148,198.77Interest Income* (47,601.94) - 47,601.94Tuition 877,370.00 877,370.00 -Administrative Costs 77,837.44 94,372.21 16,534.77Coordinator Costs 116,952.47 118,166.40 1,213.93Implement a Rural Strategy 155,074.16 190,840.91 35,766.75MORE OB Provincial Core Team Training 157,916.00 234,166.00 76,250.00e-Learning 89,534.45 100,000.00 10,465.55Evaluation 99,912.17 100,000.00 87.83Minor Equipment 39,722.00 - (39,722.00)Total $3,553,427.98 $3,827,455.52 $274,027.54* Revenue other than Grant Funding includes interest earned, NRP fees, and research fees for access to dataALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT11

Acronyms and TermsACoRNAcute Care of at-Risk NewbornsNeonatalNewborn less than 28 days of ageAHFMRAMAAHWAPRAPHPAlberta Heritage Foundation forMedical ResearchAlberta Medical AssociationAlberta Health and Wellness,the provincial ministry whosemandate includes perinatal healthAlberta Prenatal RecordAlberta Perinatal Health ProgramNRPPANeonatal Resuscitation ProgramPartnership AccordPeriLink AB The Alberta PerinatalHealth Program’s provincialdata repositoryPerinatalHealthHealth of mothers and infantsduring the period frompreconception up to the firstyear of lifeCHRCHfFNCalgary Health RegionCapital HealthFetal FibronectinQASCQISCQuality AssuranceStanding CommitteeQuality ImprovementStanding CommitteeFHSHISCAFetal Health SurveillanceHealth Information StandardsCouncil of AlbertaRHARegional Health Authorities(used interchangeably withhealth regions)(iCARE)Integrated Centre for CareAdvancement Through ResearchSOGCSociety of Obstetricians andGynaecologists of CanadaIHEInstitute of Health Economics,Alberta, CanadaSTORCStrategies for Teaching Obstetricsto Rural and urban CaregiversIMLBWMORMORE OBInformation ManagementLow birth weightManaging Obstetrical RiskManaging Obstetrical RiskEfficiently – a copyrighted patientsafety program offered throughSalus Global CorporationTOPToward Optimized Practice– a group formed by a trilateralagreement to support evidencebasedpractice among physiciansand the teams with whomthey work12ALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT

Alberta Perinatal Advisory Committee2007-2008Co-chairsNeil MacDonald, Executive Director, Healthy Living Branch,Alberta Health and WellnessDr. Reg Sauve, Professor, Department of Community Health Sciences,University of CalgaryMembersDr. Karen Benzies, Associate Professor, Faculty of Nursing, University of CalgaryDr. Mike Caffaro, Family Physician, HintonDr. Radha Chari, Perinatologist, Capital HealthDr. Virginia Clark, Family Physician, CalgaryDr. Albert De Villiers, Medical Officer of Health, Peace Country HealthDr. Charlotte Foulston, Pediatrician, Medicine HatJoanna Greenhalgh, Registered Midwife, Capital HealthDr. Shoo Lee, Scientific Director, Integrated Centre for Care AdvancementThrough Research (iCARE), University of Alberta, Capital HealthDr. Brian Muir, Obstetrician, Grande PrairieDelmarie Sadoway, Senior Operating Officer, Community Health Services,Primary Care Division, Capital HealthDr. Don Schopflocher, Biostatistician, Faculty of Nursing, University of AlbertaDr. David Strong, Deputy Medical Office of Health, Calgary Health RegionDr. John Van Aerde, Regional Director for Newborn Services, Northern AlbertaNeonatal Intensive Care Program, Clinical Professor, University of AlbertaHeather Young, Director of Nursing Services, Health Canada, Alberta Region,First Nations and Inuit Health BranchEx Officio MembersJoan Berezanski, Director, Medical Care Consultant Office, Alberta Health and WellnessLaurie Blahitka, Executive Director, Women’s Health, Calgary Health RegionCorine Frick, Director, Alberta Perinatal Health ProgramDr. William Hnydyk, Assistant Executive Director, Professional Affairs,Alberta Medical AssociationSelikke Janes-Kelley, Patient Care Director, Women’s Health Program,Royal Alexandra Hospital, Capital HealthDr. Gloria Keays, Provincial Health Officer, Alberta Health and WellnessMichael Sanderson, Sub-Population Health Unit, Surveillance andEnvironmental Health Branch, Alberta Health and WellnessSherri Wilson, Project Manager, Healthy Living Branch,Alberta Health and Wellness, Healthy Living BranchTripartiteExecutiveMike Gormley, Executive Director, AlbertaMedical AssociationJoanna Pawlyshyn, Chief Operating Officer,Royal Alexandra Hospital, Capital HealthPaula Tyler, Vice President, Child andWomen’s Health and Specialized ClinicalServices, Calgary Health RegionCoordinatingCommitteeSelikke Janes-Kelley, Patient Care Director,Women’s Health Program, Royal AlexandraHospital, Capital Health (Chair)Laurie Blahitka, Executive Director,Women’s Health, Calgary Health RegionDr. William Hnydyk, Assistant ExecutiveDirector, Professional Affairs, AlbertaMedical AssociationCorine Frick, Director, Alberta PerinatalHealth ProgramALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT13

DirectorCorine Frick, R.N., M.N.North OfficeSuite 101 Kingsway Professional Centre10611 Kingsway AvenueEdmonton, Alberta T5G 3C8Tel: (780) 735-1000Fax: (780) 735-1024South OfficeSuite 310 South TowerFoothills Medical Centre1403 - 29 Street NWCalgary, Alberta T2N 2T9Tel: (403) 944-1242Fax: (403) 944-124314Website: www.aphp.caALBERTA PERINATAL HEALTH PROGRAM 2007-2008 ANNUAL REPORT