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83
Puerperal Fever, Puerperal Pyrexia and Mortality in Childbirth.—
There were eight deaths of women from causes attributable to childbirth,
giving a maternal mortality rate of 5.7 per 1,000 births. The causes
were as follows(a) Puerperal Fever, 1; (b) and (c) Ruptured ectopic
gestation, 2; (d) Rupture of uterus due to malformation of foetus, 1;
(e) Haemorrhage during obstructed childbirth, 1; (/) Inflammation of
womb, followed by septicaemia, 1; (g) Foetal toxaemia with Caesarean
section, 1; (h) Pneumonia following miscarriage, 1. The results of
inquiries are given as follows:—
(а) Aged 30, third pregnancy, normal labour, sepsis arose from retained decidua
which were removed. (In hospital.)
(b) Aged 38. History of miscarriage at third month, removed to hospital
next day, acute abdominal symptoms, operation, evidence of ruptured
tubal pregnancy which had become gangrenous before admission. (In
hospital.)
(c) Aged 37. Haemorrhage from womb, due to ruptured extra uterine pregnancy.
(In hospital.)
(d) Aged 40. Admitted in labour after two attempts to deliver at home, child
dead, removal by craniotomy—womb found ruptured and removed by
abdominal operation. (In hospital.)
(e) Aged 28. Shock following hemorrhage during obstructed childbirth.
(In hospital.)
First confinement instrumental; second and third normal. No
evidence of foetal life after 33rd week. Labour began before admission.
Prolapsed hand and cord, with offensive discharge. Removal by decapitation
and cleidotomy under anaesthetic. Foetus in advanced state
of maceration. Severe haemorrhage followed with collapse and death
one hour after delivery.
(/) Aged 29. Natural labour, but history of septic condition previously which
appeared to come from a chronic endometritis. Blood culture showed
streptococcus haemolyticus. Symptoms were those of septicaemia.
(At home.)
(g) Aged 29. Foetal toxaemia with Caesarean section. (In Nursing Home.)
(h) Aged 33. Admitted with threatened miscarriage, fibroid of uterus present.
Symptoms of lobar pneumonia developed with death on the fourth day.
(In hospital.)
As previously mentioned in this report, six cases of puerperal fever
occurred, with one death, and it may be of interest to make a short
analysis of the causes attributed to this disease, so far as it concerns
these cases.
Aged 29. High temperature and fever, from which patient recovered after a
few days.