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This is the first year in which there was not a single death from sepsis following
child-birth. All the fourteen deaths from maternal sepsis followed abortion.
Puerperal fever is now no longer notifiable as such in the County of London as
the term is covered by Puerperal pyrexia, thus bringing the county into line with the
rest of the country. There has been no significant change in the notification rate
between 1948 and 1949.
The trend of maternal death rate in the Administrative County of London from
1891 is shown by the figures in Table 3. It will be observed from the table that
maternal mortality fell very slowly until the introduction of the sulphonamides
in the middle thirties, resulting in a substantial decline in the mortality from
puerperal infection. Indeed, but for the war-time increase in abortions with their
relatively higher risk of infection, the sepsis mortality in 1941-45 would be an
even smaller proportion of the total than is indicated by the table. In
recent years puerperal sepsis has lost its position as the most serious mortality
risk of pregnancy and has been displaced by toxaemia, haemorrhage and other
accidents (trauma of pelvic organs, etc.) which now contribute the greater part of
the total mortality, though the risk of death from these causes has also been falling
rapidly. The effect of war conditions in arresting temporarily the decline in maternal
mortality in London is shown by the following diagram, which indicates the movement
of the rates in both London and over the country as a whole. The sharp rise in London
in 1941 was not shared by the country as a whole, and can be attributed to the effect
of the bombardment, which reached its peak intensity in that year, and the consequent
evacuation. These factors rendered it difficult to maintain the normal high
standards of maternal care.
MATERNAL MORTALITY
MORTALITY PER 1,000 TOTAL BIRTHS
ENGLAND&WALES LONDON
B