London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1950

[Report of the Medical Officer of Health for London County Council]

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10 years earlier and the other 13 years earlier and neither, therefore, has any bearing
on maternal risks in the year under review. The true maternal death-rate was 0-50.
While the downward trend of the total maternal mortality rate in recent years is
unmistakable it should be noted that owing to the small number of deaths the laws
of chance applicable to small numbers operate and the rates for component causes
and individual years are liable to considerable fluctuation without any significance
necessarily being attached thereto.

The analysis of maternal deaths has therefore been made on the basis of numbers, not rates, and is as follows :—

Cause of deathPostabortionOther pregnancy and childbirthTotal
Sepsis77
Other causes22931
Total maternal deaths92938

This is the second successive year in which there was not a single death from
sepsis following childbirth. All the seven deaths from 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. The notification rate in 1950 was 6.83 per 1,000 total births,
compared with 7.51 in 1949.
The trend of the 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. 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. Since the war further considerable progress
has been made.
MATERNAL MORTALITY ( EXCLUDING ABORTION)
MORTALITY PER 1,000 TOTAL BIRTHS