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These notes give only a brief summary of the full enquiry that has been
made into each of these unfortunate cases. The maternal mortality rate
of 8.4 per thousand, as compared with 0.9 per thousand in the previous
year, is a very high one, and one must consider carefully in each case
whether there are any circumstances which indicate failure in the provision
of suitable prenatal or midwifery care.
In two cases of abortion, and in a third where concealed pregnancy
was followed by death from pulmonary embolism, there was undoubtedly
failure on the part of the patient to take advantage of the available services.
Two of the cases present a curiously similar history. In each case the
relatively uncommon condition of pregnancy outside the uterus occurred
and operative treatment became essential. In each case the operation
was followed by fatal paralysis of the bowel. This again is a relatively
uncommon condition, although it may follow any operation involving the
peritoneum.
In two cases death was caused by septicaemia. In such cases one
must always consider the possibility of some failure in technique. In these
two cases, however, skilled medical and nursing care appears to have been
available during labour and for some months preceding it. Both were
cases of abnormal labour, where the danger of sepsis is always greater.
In one of these cases, and in the two remaining, the patient was in
bad health during pregnancy and was perhaps unsuited to stand the strain
of motherhood, even with the help of full pre-natal care.
Thus three cases must be excluded as having failed to take advantage
of facilities which are available. The remainder appear to have had
skilled treatment and every possible care, and must be considered as an
unfortunate series of those deaths which appear to be unavoidable even
when the best services are provided and used. This is all the more
a cause for concern when it is remembered that in Westminster facilities
for ante-natal care and skilled attention in confinement are readily
available for every mother. Last year and the year before, only one
woman died from conditions associated with pregnancy. This year with
midwifery services even more developed it is most disquieting to record
nine deaths, the highest for five years. Five of the nine had skilled antenatal
care; four of them were in hospital before labour had begun ; one
came into labour at home and was removed to hospital because of complications
and subsequent illness. Maternal mortality is not a community
problem to be considered in terms of preventive measures such as may be
applied to epidemic disease. It is definitely, in London at any rate, of