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23
Maternal Deaths.
In last year's annual report of the County Medical Officer,
Volume III (Part I) appear some criticisms regarding the unreliability
of maternal mortality figures for comparative purposes
as well as suggestions for improvement. Deaths due to live births
should, it is indicated, be differentiated from deaths due to stillbirths
on the one hand, and deaths due to abortion and miscarriages on
the other.
The difficulties of arriving at any reliable mortality rate are,
however, far greater than are likely to receive even a partial
correction from such suggestions as are made. In so far as the
Lambeth maternal mortality rate is concerned, the figure this
year has little relation to the truth, as the following will indicate.
Since no evidence regarding what may be termed the pregnancy
rate is available, the number exposed to the risks of death from
pregnancy is unknown. Where any desire exists for the concealment
of pregnancy, even if made compulsorily notifiable, that desire
would indubitably conceal the pregnancy at any cost, even that of
life, as at present. Consequently, the number at risk, the prime
factor needed for a true maternal mortality rate to be calculated,
is definitely unattainable. The rate must therefore be based upon
some known figure, and the number of live births is chosen as the
most certain.
It might at first sight appear that the number of maternal deaths
was comparatively easy to ascertain, but, in fact, this is by no
means the case. The following particulars of the thirteen deaths
registered in 1934, in which the state of pregnancy was directly
or indirectly the cause, will indicate the impossibility of providing
a maternal mortality rate comparable with that of any other district
or even with Lambeth rates of other years.
(1) Puerperal septicaemia, concealed pregnancy, still birth.
(2) Parametritis following upon caesarean section for obstruction,
live birth.
(3) Shock due to haemorrhage following forceps delivery, live
birth.
(4) Ruptured ectopic gestation, operation.