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She had booked with a midwife, but was advised to attend Hospital regarding
the advisability of having her confinement at home. Unfortunately she
did not attend Hospital as advised. Labour commenced ten days later
and resulted in the death of both mother and child. Details of the case are
given under maternal mortality.
Of the eleven multiparae, three gave a history of previous premature
births or abortion. One had given birth to five full term children followed
by a six weeks' miscarriage after an interval of five years. The premature
birth (36 weeks) followed two years later. The child died at the age of two
weeks from bronchitis. The second mother was a girl of eighteen years
who was having her second child (born at 34 weeks) when her first (born
at 32 weeks) was only 14 months old. The third patient was a woman who
was very anxious to have a live child. This was the third premature birth
she had had, and none of the children had survived. There was no obvious
cause for the repeated early termination of pregnancy and the case will be
sent to hospital for a fuller investigation. Of the eight remaining multiparae,
one developed pneumonia at eight months and that brought on labour
prematurely. Another had had several attacks of ante-partum haemorrhage
and the pregnancy terminated at 7 months. No obvious abnormality was
found in the other six cases, and only one of the babies died.
(b) Stillbirths (9 cases).
Four of the stillbirths were in primigravidse, and five in multiparae.
Of the four primigravidse only one attended more than once and
even she did not make her first attendance until she was 35 weeks pregnant.
She was found to have a raised blood pressure and slight swelling of the
leg, but no albuminuria ; the presentation was a breech with extended legs.
A second case was known to have a difficult labour. She was an elderly
primigravida (40 years) who had a malpresentation and was admitted to
hospital in labour after her medical attendant had pulled down an arm. A
third case was an unmarried girl who gave a history of an inflammatory
pelvic condition during pregnancy. No details were available regarding
the fourth case.
Of the five multiparae, two gave a history of previous miscarriages.
Of these, one had suffered from salpingitis several years previously, and the
second showed signs of pre-eclampsia when she attended at 8 months—a
week before labour commenced. The latter had been warned two months
previously that the condition of her mouth was a source of danger to her,
her teeth being particularly septic. The third case was a breech presentation
which was sent to hospital for version. Version was performed under
eneral anaesthesia, and a macerated foetus was born ten days later. In
the fourth case no abnormality could be found to account for the stillbirth.
The fifth case was in a woman with an excess of abdominal fat, who attended
once only at six months. She had a large stillborn child.
(c) Instrumental Delivery (6 cases).
Of the six instrumental deliveries, none were in regular attendance
at the ante-natal clinic.