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54
Maternal Mortality.
The following observations and figures have been furnished by Dr. Pritchard, Deputy
Medical Officer of Health.
This subject has recently received considerable publicity and attention. Unfortunately
the term Maternal Mortality has never been definitely defined. Various authorities—the
Registrar.General, the Ministry of Health and the local Public Health Authorities—use it to
mean markedly different groups of deaths. This is an unfortunate state of affairs, because the
use of the term without a definition can be very misleading. An example will explain the
position : —A woman died and the death certificate given was—" Acute Pulmonary (Edema,
Asthma, Recent Puerperium." This death counts as a Maternal Death and so increases the
figure of Maternal Mortality. This figure, therefore, includes deaths which are merely
associated with pregnancy, cases which one cannot include with the figure, which should
represent the common risk run by the average woman who becomes pregnant. There would
be no difficulty if Maternal Mortality always meant this wide group of deaths. Some
authorities, however, use it to mean only those deaths directly due to pregnancy. When a
figure is quoted without a definition it is impossible to know whether the small, select, true
group or the large indefinite group is indicated. Some authorities use the same term to
indicate either the one or the other, and this occurs in the Departmental Report on Maternal
Mortality and Morbidity issued by the Ministry of Health.
The clearest classification divides all these deaths into two groups.—Those deaths
occurring during pregnancy or childbirth, where the death is directly due to the puerperal
state are grouped as Puerperal Maternal Mortality. This group is sub.divided into the deaths
which have been due to Puerperal Sepsis and those due to Non.Septic Puerperal causes.
Such a group would indicate the average risk of pregnancy very accurately if we could
eliminate those cases of abortion which have been artificially induced, but leave insufficient
evidence to return a verdict of criminal interference.
The second group is reserved for those deaths which are only associated with pregnancy
or childbirth, such as the case of Asthma already quoted. They are all classified primarily
to their particular cause of death, and then re.grouped as Non.Puerperal Maternal Deaths.
They do not include cases following criminal abortion.
The Puerperal and Non.Puerperal groups are added together to form the total
Maternal Mortality. The qualification, Puerperal or Non.Puerperal, is the important
indication to the true meaning of any given term when discussing this subject.
Enquiries are made into all these deaths. Reports are made and forwarded to the
Special Maternal Mortality Committee appointed by the Ministry of Health.
In 1934 there were 10 Puerperal Maternal Deaths, 3 due to Sepsis (including one
following abortion, where the circumstances were suspicious of some criminal interference)
and 7 due to other causes (including one where the woman was not in labour, but eight
months pregnant, one after abortion, two with "stillborn " deliveries, two following toxajmias,
and one following " operation shock " when sewing up a vaginal tear).
There was one Non.Puerperal Maternal Death due to Acute Broncho.Pneumonia.
The coroner returned another death as " injection of scalding fluid into uterus for
purposes of procuring abortion, circumstances unknown." This has not been included in any
of the forcging figures.
The Puerperal Maternal Mortality rate was 4.0 per 1000 births (live and still).