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25
A case which may be saved by skilful emergency aid may subsequently succumb
to sepsis; on the other hand, in the absence of such emergency aid, death may occur
earlier and before septic conditions could develop. There is therefore some tendency,
though it may be small, for skilled emergency aid to increase relatively the deaths
due to sepsis, since in all cases of maternal deaths in which the word sepsis is mentioned
on the death certificate the death is assigned to that condition, equally whether
sepsis was an inevitable terminal condition or the sole cause of death. On the other
hand in years in which the epidemiological factor which governs the incidence of
sepsis is relatively high, some of the cases which without the supervention of sepsis
would have been assigned to other accidents of childbirth, such as those in which
death occurs more than five days after delivery, would be transferred to the heading
of sepsis. It is, therefore, necessary to bear in mind the probability that there is some
interchange between the heading of sepsis and other causes of death respectively.
Abortion.
The figures relating to deaths from abortion, of which the majority are due to
sepsis, are given for single and married women, separately, for England and Wales
as a whole since 1927 in the text volumes of the annual reports of the RegistrarGeneral.
In the following table the percentage of septic abortions to total deaths
from sepsis among single and married women respectively are added:—

The increase in the proportion of septic abortions, especially among single
women, is independent of the movement of the total sepsis rate, which indeed was
lower in 1931 and 1932 than in 1929 and 1930. The maternal mortality-rate has, as
the figures show, been increasingly loaded by deaths attributed to septic abortion;
but it remains to be seen whether the increased pro-portion of septic abortions is an
increase resulting, as would be supposed, from increased interference, or whether
it is merely a "statistical" increase resulting from closer inquiries into the causes
of deaths associated with pregnancy. In any case, however, the effect is to mask to
some extent the results of the increased provision for ante-natal care during the period
to which the figures relate as will be seen below.
The influence of economic conditions upon the birth-rate and maternal mortalityrate
has been referred to in previous reports, notably in that for 1928, page 25. In
addition to the increase in septic abortions referred to above, the Registrar-General's
returns show that with a decreasing birth-rate, the deaths from criminal abortion
are increasing. In view of these tendencies it becomes of special importance to collect
any evidence available of interference among the cases which come into the hospitals
for post-abortive treatment, for sooner or later it will be recognised that the problem
of abortion can no longer be left to settle itself.
Effect of
improved
ante-natal
care.
In order to assess fairly the value of the improved and extended ante-natal
service, it is necessary to consider more particularly the cases which are likely to
profit most, i.e., those cases in which pregnancy has been carried to labour.
The following table contrasts the maternal mortality-rates of married women in
England and Wales, excluding abortion, with the maternal mortality-rates as
commonly calculated.