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60
MATERNAL MORTALITY.
There were 12 deaths registered as due to or associated with
pregnancy, of which two were due to sepsis giving a maternal
mortality rate from this cause of 0.67 and for other accidents and
diseases of pregnancy and parturition a rate of 3.35, being a total
rate of 4.02 per 1,000 live births. The corresponding rates for
England and Wales were 1.34, 2.31 and 3.65, and for this district
for the year 1935, 1.92, 1.54 and 3.46.
Both patients who died of sepsis had abnormal confinements
in their own homes and were removed to hospital for treatment.
Of the ten deaths from other accidents or diseases of pregnancy
or parturition, a number might have been prevented by the exercise
of more care or co-operation on the part of the patient. One
patient started bleeding when about two months pregnant. It was
not until after three weeks' loss, however, that she decided to obtain
medical advice. Another patient who had a poor obstetrical
history was advised to have her confinement in an institution but
refused. A difficult labour ensued over a brow presentation. She
was delivered in hospital. The following day she had signs of infarction,
more about a fortnight later, and followed by thrombosis
of the leg. From these conditions there was a gradual improvement
but four weeks after confinement she died from pulmonary
embolism. Another patient had been under regular medical supervision,
the urine and blood pressure being normal up to the 36th
week. At the last examination the urine was free though there
was slight oedema of the legs. Five days after this examination
the patient suffered from vomiting and intense headache. In spite
of the significance of these symptoms she did not call in her medical
attendant for many hours. She was removed to hospital where,
after she had been confined of a macerated foetus, she became increasingly
oedematous, dying finally of pulmonary oedema.
In some cases little enough can apparently be done to prevent
an untoward happening. Such was the case of a woman who, when
three months pregnant, was admitted to hospital on account of
vomiting, and in spite of treatment she died within 48 hours of
acute hepatitis. Another woman, after regular ante-natal supervision,
was admitted to hospital in labour and developed intrapartum
eclamptic fits to which she succumbed. Another patient
was satisfactorily under the ante-natal supervision of the hospital at
which she was to be confined. Because of signs of toxaemia during
the 37th week she was admitted for medical induction which, however,
was unsuccessful. At the spontaneous labour which occurred
a week later, primary uterine inertia ensued so the patient was
delivered by forceps. Seven hours later the placenta was manually
removed but two and a half hours afterwards the patient suddenly
collapsed and died from 1 (a) obstetric shock, (b) abnormal labour,
and 2 pregnancy toxaemia. Another patient who was receiving