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59
Of the three deaths from sepsis, one was that of a patient who
was advised at the consultant clinic because of suspected moderate
disproportion to be attended at her confinement by a doctor. At
labour the shoulders were impacted, and the patient was removed
to hospital where embryotomy was performed. Signs of general
infection appeared on the following day, the patient dying on the
fourth day from "toxic myocarditis, puerperal fever, childbirth."
The second patient, because of toxaemia, was treated as an in-patient
for a period during the ante-natal stage and was admitted shortly
before term because of raised blood pressure and oedema. Labour
was complicated by uterine inertia, and forceps delivery was
followed by post-partum hæmorrhage for which blood transfusion
was given. The patient did well for three weeks when pyrexia
developed, and death occurred from pyaemia following parametritis.
The third patient was one who died six weeks after confinement
from sub-acute bacterial endocarditis which was associated with
some degree of puerperal infection.
Nine deaths were due to conditions other than sepsis. (1)
A normal confinement attended by one of the Council's midwives
was followed by post-partum haemorrhage. The patient was
removed to hospital but died 15 minutes after admission. It was
her seventh pregnancy and she had refused ante-natal supervision.
(2) A normal confinement was, except for a slight rise of temperature
on the eighth day, followed by a normal puerperium. On getting
up on the fourteenth day the patient died suddenly from pulmonary
embolism. (3) A normal delivery of a patient who had systematic
ante-natal supervision at the hospital at which she was confined
was followed by acute uterine inversion with a partially adherent
placenta. (4) A patient whose condition was normal on the eight
occasions she attended the hospital for ante-natal supervision
(including the day before confinement) died of post-partum
eclampsia. (5) A large baby was delivered by forceps. Subsequent
haemorrhage was controlled, but because of the shocked
condition of the patient the placenta was left in. Six hours later
the patient suddenly collapsed. (6) This patient was advised at
the clinic to be attended at her confinement by a doctor. After
some hours of labour she was admitted to hospital for observation.
Trial of labour was permitted, but because the head remained
high a lower segment Caesarian Section was performed. The
patient collapsed and died just after the baby was delivered.
(7) This patient was admitted to hospital at 36 weeks because of
pregnancy toxaemia. Drug induction was performed at term.
Because of ante-partum haemorrhage an anaesthetic was given and
the child delivered by forceps. Haemorrhage and collapse followed
manual removal of the placenta. (8) This patient died from
post-partum eclampsia after a Caesarian section followed by moderate
hæmorrhage. (9) This patient was recommended at the ante-natal
clinic to have her confinement in hospital because she suffered
from some degree of contraction of the pelvis. After forceps