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68
MATERNAL MORTALITY.
Thirteen deaths were registered as due to or associated with
pregnancy, giving a maternal mortality rate of 4.19 per 1,000 live
births. Of these seven were due to sepsis, being a mortality rate
from this cause of 2.26 and six to other accidents and diseases of
pregnancy, a rate of 1.93. The corresponding rates for England
and Wales were 3.23, 0.97 and 2.26, and for this district in 1936:
4.02, 0.67 and 3.35. The rates per 1,000 total births were 4.07, 2.19
and 1.88, compared with figures of 3.11,0.94 and 2.17 for the country
as a whole.
Of the deaths due to sepsis, only three occurred in women
delivered at full term. The particulars of these cases are:
(1) Following impaction of a persistent occipito-posterior presentation
the patient was admitted to hospital where craniotomy was performed.
Death was due to infection following trauma of the birth
canal. (2) Pyrexia occurred in a patient who, after a normal labour
had stitches inserted. On admission of the patient to hospital on
the fourth day there was delayed involution and an unhealed
perineal laceration. Hsemolytic streptococci were grown from
vaginal culture. (3) The patient was delivered by forceps in a
nursing home. Blood cultures later gave non-haemolytic streptococci
and the death was ascribed to a low grade puerperal infection
by a non-haemolytic streptococcus which resulted in bacterial
endocarditis of an already damaged mitral valve. Three deaths
were due to neglect of abortions: (1) Following an abortion at
12 weeks of her sixth pregnancy the patient was admitted to hospital
on account of pyrexia due to strep, aureus which was found in the
vaginal swab and on blood culture. (2) One month after delivery
of a 30 weeks still birth at home the patient was admitted to hospital
as an "acute abdomen." A mass of retained products was removed
from the uterus. (3) On seeking advice regarding vaginal bleeding
of six weeks' duration following an abortion in the second month
of her fourth pregnancy, a patient was admitted to hospital but
died a few hours after admission from septicaemia due to gasproducing
organisms. The remaining death from sepsis occurred
in a patient who, in her fourth month of pregnancy was admitted
to hospital for treatment of a severely damaged heart. After 14
days' rest she was discharged but was re-admitted 10 days later
with a 7 days' history of threatened abortion. Drug induction
resulted, 14 days' later, in a 20 weeks' abortion. The retained
products were removed under general anaesthesia, but the patient
developed septicaemia—apparently a low grade infection on an
already damaged heart valve. In the classification of the so-called
"preventable" causes of maternal mortality the Departmental
Committee grouped the primary avoidable factor under four main
headings: —(1) Omission or inadequacy of ante-natal examination;
(2) Error of judgment in management of the case; (3) Lack of
reasonable facilities; (4) Negligence of the patient or of her friends.
In three of these seven deaths the primary avoidable factor would