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Ante-Natal Care relating to Toxaemia of Pregnancy
In my annual report for 1956 brief reference was made to the meetings then being held
between the professional representatives of the three parts of the national health service
on the Memorandum from the Standing Maternity and Midwifery Advisory Committee
on ante-natal care relating to toxaemia of pregnancy. It was clear at these
meetings that co-operation between hospitals, general practitioners and the local health
authority was developing but needed strengthening and the discussions at professional
level were verv helpful in promoting: better liaison between the services.
Routine medical examination takes place on booking and at the 30th and 36th
weeks of pregnancy. All measures are taken for the early recognition of toxaemia,
including keeping of weight records and midwives in the Council's domiciliary service
are required to summon medical aid from a general practitioner obstetrician or the
patient's own doctor if there is a rise in blood pressure or if the diastolic pressure at any
time reaches 90 mm. of mercury.
Obstetric
examinations
The Council's ante-natal clinics provide for the full range of blood tests and offer
a chest X-ray examination to every pregnant mother. The Rhesus factor is always
determined and tests for antibodies are carried out in appropriate cases : these tests are
done either by the Blood Transfusion Service or the laboratories of the hospitals. In
most areas of the County cord blood is taken for Coomb's test from all babies bom of
Rhesus-negative mothers, whether antibodies were present at 34-36 weeks or not. Among
Rhesus-negative mothers delivered at home who had no antibodies at 34-36 weeks,
several pregnancies had ended in still-birth in utero.
General practitioners giving maternity medical services are able to use the facilities
for all these tests whether the mother has her intermediate ante-natal care at the Council's
clinic or not. Midwives referred all mothers with a haemoglobin level below 11.8 grm.
per 100 ml. to the clinic doctor and called medical aid for all mothers with a
haemoglobin level below 8.9 grm. per 100 ml. (100 per cent. of haemoglobin equals
14.8 grm. per 100 ml.).
Although the need is recognised to expand the maternity and child welfare dental
service, under present circumstances this can be done only at the expense of the school
dental service, although a modest improvement has been possible in some areas by
arranging additional evening dental sessions reserved for maternity and child welfare
priority cases. The Council's midwives follow-up all expectant mothers recommended
by the clinic doctor for dental treatment to see that the mother obtains early treatment
either at the Council's dental clinics or elsewhere.
Blood testing
etc.
The most striking deficiency in co-operation brought to light as a result of the
discussions with hospitals and general practitioners was the absence of any efficient
system by which any one of the three branches of the national health service, who might
at any time during pregnancy, labour or puerperium become concerned with the
mother, would have available full information of the mother's medical and obstetric
history. Under the existing arrangements for domiciliary cases there was interchange
of records between the general practitioner and midwife on booking and at the 36th
week of pregnancy and midwives sent all their records to hospital with any patient who
had to be transferred there in labour. It was clear, however, that these arrangements did
not meet all contingencies which might arise and that what was required was a personal
ante-natal record card to be carried by the patient herself. Preliminary trials have been
carried out to test the reliability of mothers in keeping the record card intact and in
bringing it to the centre and these have proved encouraging. A card suitable for use in
all cases is now being devised and it is hoped to introduce it early in 1958.
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Ante-natal
records