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89
At the Council's clinics the major problem is avoidance of congestion, for the
decision to take Wassermann tests of all women attending for the first time, and the
greatly increased number of blood pressures recorded, has naturally resulted in
larger attendances. The differential death-rate suggests, however, that these
precautions are well worth while.
Ante-natal care.
Total
cases.
Total
deaths.
Rate per
1,000.
Deaths
due to
pregnancy
or confinement.
Rate per
1,000.
Rate per
1,000.
L.C.C. clinic 11,436 31 2.71 24 2 .10 7 0.61
Other sources, nil or not stated. 1,630 35 21.47 23 14.11 12 7.36
Total 13,066* 66 5.05 47 3.60 19 1.45
* Includes four cases where the third stage only was conducted in a Council's hospital, and one case
where death from toxaemia of pregnancy occurred before the 28th week.
A careful investigation is made of the circumstances attending every maternal
death in the Council's hospitals. The autopsy, which is obtained whenever possible,
is now performed by, or under the personal supervision of, Dr. Barnard, of the
histological laboratory, or his assistant. The results are of the greatest interest
and suggest that surveys of maternal mortality without this check on clinical reports
may easily go astray.
Maternal
deaths.
The subjoined tables show that puerperal sepsis remains the commonest single
cause of death in the Council's wards, as it is elsewhere. The rates are as follows
(deaths from sepsis following abortion are excluded):—
1931 2 per 1,000 births. 1933 1 .54 per 1,000 births.
1932 1.05 per 1.000 births. 1934 1 .18 per 1.000 births.
Puerperal
sepsis.
These figures cover all maternal deaths after the 28th week from sepsis, whatever
the associated condition or original cause. They include five deaths supervening
after operations for Cæsarean section (q.v.), and two from septicaemia due to mastitis,
which are not always included in returns of puerperal sepsis. Deaths from true
uterine sepsis numbered eight only (.61 per 1,000 births), and of these five only
occurred in patients whose labours had been conducted entirely in the Council's
hospitals (.43 per 1,000 births). The remaining three had had prolonged interference
or frequent vaginal examinations before admission, e.g., a woman of 42, weighing
22 stone, who had been in labour six days with ruptured membranes before admission.
Another patient, a 2-para of 38, with a persistent occipito-posterior presentation,
was sent in to hospital as a "failed forceps." Part of the cervix had been torn
away, and the uterus ruptured. The child was delivered with great difficulty after
craniotomy, and a hysterectomy was performed a few hours later. The patient
rallied, but developed peritoneal sepsis.