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uterine sepsis followed and caused the thrombosis of neighbouring veins,
which resulted in fatal embolism. The patient was admitted to hospital
in labour as an emergency case. There was no evidence of effort to
secure ante-natal attention and in hospital the patient admitted attempts
to produce abortion. She was in hospital for a short period at the 30th
week on account of uterine sepsis and discharged herself against advice.
7. M.J.F. (married). Died from paralysis of the bowel and toxæmia
due to puerperal sepsis following difficult labour. Under hospital
supervision throughout pregnancy.
These notes give a brief summary of the full enquiry that has been
made into each of these unfortunate cases.
The maternal mortality rate of 6.5 per thousand is a very high one
and should therefore be carefully considered, especially from the point
of view of finding out if there were any circumstances which indicate
failure in the provision of suitable pre-natal or midwifery care.
In the first six cases there was undoubtedly intentional failure on
the part of the patient to take advantage of the available services,
because the pregnancy was unwanted. The list clearly indicates the
terrible dangers of attempts to get rid of an unwanted pregnancy by
unskilled persons.
The last case is in a totally different category. The patient took full
advantage of the ante-natal care and skilled attention in confinement,
which are readily available to every mother in Westminster. She was
admitted to hospital at the onset of labour and later showed a condition
of feebleness of contraction of the uterine muscle, known as "uterine
inertia," which sometimes, though rarely, occurs in first pregnancies.
As a result, this factor, associated with a very slight degree of disproportion
between the size of the mother's pelvis and the baby's head,
which had been noted at ante-natal examinations, though it was insufficient
in degree to indicate Caesarian section or some such operative
procedure, made forceps delivery and a minor operation for enlarging the
diameter of the birth canal necessary. Puerperal infection followed the
delivery of a dead child, which was found at post-mortem to have certain
congenital abnormalities which would have rendered its life precarious
even if it had lived. The origin of the infection was almost certainly
from the intestinal tract of the mother and not from the instruments or
the persons attending the patient. These persons are regularly examined