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77
A week before the confinement was expected a woman of 25
went into the labour of her first pregnancy. After 15 hours, with
low forceps, she was delivered of her first baby. The second
twin lay transverse and after unsuccessful attempts at delivery
the patient was taken to hospital where the baby was removed
after a difficult embryotomy. The patient was in poor condition,
and four days later a blood culture gave a growth of staphylococcus
aureus, the patient dying some three weeks later. Incidentally
this organism was cultured from a swab of the cervix taken on the
patient's admission to hospital.
The third case was one of septicaemia following an abortion
at 14 weeks which was neglected for three weeks. The other two
patients were both hospital cases, booked for admission before
labour. The first died of 1 (a) acute suppurative nephritis; (b)
septicaemia following full term delivery. The other, an unmarried
girl of 20, had been treated ante-natally for venereal disease, but,
after her confinement in hospital, died of 1 (a) peritonitis; (b)
parturition ; (c) gonococcal cervicitis.
The first of the non-septic fatal cases was due to eclampsia.
A woman of 32 was pregnant for the second time, the first being a
miscarriage. She was under the care of her doctor ante-natally
and was seen on the 26th November and 14th February, on both
occasions being quite well and her urine containing no albumen.
On the 18th February, at the 26th week of pregnancy, she had
headache all day and there was a heavy load of albumen in her
urine. Within half-an-hour of being seen she had an eclamptic
seizure and was removed to hospital. The blood pressure, which
had not been previously taken, was 204/118 on admission. Active
treatment was carried out but she died 3½ hours after admission.
There were degenerative changes in the kidneys, and still more so
in the liver.
The second case, a woman of 32, who had had one previous
normal confinement and had received ante-natal supervision from
her medical attendant, at term sent for her doctor because of severe
haemorrhage which had occurred without preceding labour pains.
After plugging she was immediately removed to hospital. A leg
was brought down which controlled the haemorrhage but the
condition of the patient was very low and she died undelivered.
The third patient, a woman of 28, died of "Severe reactionary
haemorrhage following pregnancy." She was recognised antenatally
to have some degree of contraction of the pelvis. After
12 hours' labour, low forceps were applied. There was a severe
perineal tear and post-partum haemorrhage which was successfully
controlled. Six hours later she was apparently comfortable, but
after the lapse of another three hours the practitioner was summoned
on account of symptoms which were attributable to a very severe
haemorrhage from which the patient died in a few minutes.