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28
Placental changes which adversely affect the foetus in prolonged
pregnancy were investigated in a Survey of Perinatal
Mortality sponsored by the National Birthday Trust Fund. It was
confirmed that postmaturity was a serious cause of perinatal
mortality which was lowest at 39/41 weeks, doubled at 43, trebled
at 44 and quintupled at 45. It was also established that the
multiparous did not escape the effects of prolonged pregnancy. In
this survey the importance of improving the maternity services
was stressed; proper antenatal care would tend to avoid toxaemia,
uterine haemorrhage and conditions leading to foetal anoxia or
neonatal jaundice and extra special care exercised in the selection
of cases for hospital treatment would duly make its contribution
to the reduction of perinatal mortality.
There are grounds for believing that a ' risk register" as has
been suggested by some authoritative bodies would serve a very
useful purpose. This register would record all infants who, for
various reasons, such as exposure to radiation before birth—those
who have special inheritance risks—those likely to develop handicapping
conditions, etc., which might require special attention and.
in this way, the preventive services could be concentrated where
they would be most likely to prove effective.
However, it is essential to remember that the more successful
are the efforts to reduce infantile mortality, the greater the future
problems for public health services in general, for it is inevitable
that a rise in standards of obstetrics and neonatal care will result
in an increase in the number of immature, malformed, birth-injured
and weakly infants who, later on, will require special attention. As
a prerequisite to efficiency, it is very proper that in these cases the
health services be given as accurate and as early a diagnosis as
possible.
The Infantile Mortality Rate for Greenwich, measured by the
deaths of children under one year of age to the number of live
births registered was 32.66 per thousand live births as compared
with 23.11 for last year and 18.84, the average for the previous
ten yeais. For the County of London the rate was 21.1 in comparison
with 21.6, the figure returned for England and Wales.
The present Borough figure of 32.66 shows an increase of
9.55 over that of the previous year and is 13.82 higher than the
average for the last 10 years.
A table showing the causes of and ages at death is included
in the Appendix to the Report.
The following table shows the comparative Infantile Mortality
Rates for the quinquennial periods since 1931, together with the
Rate for 1962:—