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76
Maternal Mortality.
There were 14 deaths due to pregnancy, of which 6 were due to
sepsis, giving a maternal mortality rate for sepsis of 3.12, and for
other accidents and diseases of pregnancy and parturition a rate of
4.15, being a total rate of 7.27. Per 1,000 live births the rates for
England and Wales were 1.61, 2.63 and 4.24.
Of the fatal cases of septicaemia, two followed abortions. In
one case the patient, after miscarriage, was three weeks without
obtaining medical attention. The other patient was admitted to
hospital on account of abortion, suffering at the time from heart
disease and bronchitis ; manual removal of the placenta was
performed, but the patient developed broncho-pneumonia of which
she died one month after admission. She was, however, a notified
case of pulmonary tuberculosis. Three of the other cases followed
a straight forward confinement. In one, a woman of 38, pregnant
for the first time, a raised temperature was noticed at the 7th day,
for which she was immediately admitted to hospital. No gross
lesions were found post-mortem, but a haemolytic streptococcus
was grown from the cervix. Another case was, before labour,
admitted to hospital on account of domestic circumstances; she
was in good condition at the onset of labour and had a normal
confinement ; the source of the trouble was apparently an infected
perineal tear. The third ease, after a straightforward confinement
at home, developed mental symptoms for which she was subsequently
admitted to a mental hospital where she died one month
after confinement. The remaining case of sepsis was one in which
difficult labour was followed by the development of pelvic
thrombosis.
Of the remaining fatal cases, one followed an incomplete
miscarriage, the patient having aborted at 20 weeks, obtained no
medical attention for one month and then summoned a doctor on
account of haemorrhage ; she was immediately admitted to hospital
where the placenta was removed, but she died a few hours
later. Two fatal cases were due to damage to the kidneys, In
one of these the patient had chronic interstital nephritis and cystic
tumours of both kidneys, and in the other, a patient who had even
ante-natal care, an acute pyelonephritis developed rapidly. This
patient, who gave no past history of renal trouble, showed for the
first time at her fifth attendance on 13/7/32, a cloud of albumin
for which she was advised rest in bed and diet. On the 16th. on
account of haemorrhage, she was admitted to hospital, where she
was delivered shortly after admission, but died in a few hourspost-mortem
examination showing extensive pyelonephritis. In
two cases, on failure to deliver, the patients were sent in to hospitone
dying of obstetric shock and the other following peritonitis
subsequent to hysterectomy. One patient died from "acidosis,