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The last case was that of a woman of 36 who had had two
normal confinements. She miscarried at the 26th week. The
puerperium was normal for a week when signs of cardiac failure
were manifested. The blood pressure rose to 220 and the patient
died suddenly of:— "1 (a) acute dilatation of the heart; (b) high
blood pressure ; (c) recent pregnancy, ten days ago."
Of these nine cases which proved fatal, or 11 when the other
two are included, not one attended the local ante-natal clinics,
nor were the Consultants summoned to any of these difficult cases
of labour. Patients who are shocked or who have severe
haemorrhage do not stand removal well.
Enquiries into local maternal deaths are now carried out by
the Medical Officer of Health.
PUERPERAL INFECTION.
One notification of puerperal fever was received during the
year and 22 of puerperal pyrexia, the rate per thousand total
births (i.e., live and stillbirths) being therefore 0.38 and 8.45,
compared with figures of 3.60 and 9.44 for the country as a whole.
The case of puerperal fever proved fatal. After the patient
had been 8½ hours in labour, forceps were applied and the child
delivered easily. On the fifth day there was some pyrexia and the
lochia became offensive. On the tenth day the patient was
removed to hospital, but died 16 days later from hæmolytic
streptococcal septicæmia.
Sepsis accounted for the deaths in outside hospitals of a
further four women, not one of whom, however, had been notified
as suffering from puerperal infection.
Of the 22 notifications of puerperal pyrexia, five were in respect
of patients who were confined in London hospitals; a further two
patients were confined in local nursing homes, but the remainder
were delivered in their own homes.
Of the 18 cases in respect of which particulars are available
seven appear to have been cases of uterine infection. In two
normal labour was followed by uterine infection with hæmolytic
streptococci. In another two retained clots caused the infection,
the first patient being a case of precipitate labour with a resulting
B.B.A., the other, a twin delivery extending over many hours.
One case followed the birth of a large baby, the first, labour taking
32 hours and causing vaginal damage. The other two cases
followed abortions, one self-induced at the 20th week and the other
a three months miscarriage.
In three cases the infection was apparently localised to the
perineum. In four cases the raised temperature was due to
pyelitis, in two to mastitis, in one to phlebitis in a patient who