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12
In five there was premature separation of the placenta with haemorrhage.
Maternal toxaemia was present in two instances. Two suffered from
developmental abnormalities.
A number of stillbirths were of infants who were born full-time and
who were alive just before the onset of labour. In four of these there was
no obvious reason for the death. In another ten the labour was difficult,
in two of these labour being overdue. Maternal toxaemia caused death
before delivery in three instances.
Peri-Natal Mortality
Very much the same conditions are responsible for many of the
stillbirths and for the deaths of infants in their first week, the early neonatal
period. So much is this the case that it is almost a matter of chance
as to whether the loss has to be recorded to one or the other group. For
some years now these losses have been classed under the term of perinatal
mortality, a rate which is calculated as the number of stillbirths
and deaths under one week combined per thousand total live and stillbirths.
The rate for this district for last year was 25.2, comprised of 10.8
the early neo-natal rate and 14.4 due to stillbirths. So many of these
losses are bound-up with the obstetrical care of the mother that it has been
suggested that they should become the yardstick of such care rather than
the crude maternal mortality rate. The rate in this country has fallen
with the increasing proportion of deliveries which take place in institutions.
This need not point necessarily to the desirability that all confinements
should take place in institutions, but does stress the necessity of facilities
being available for dealing with emergencies. Many of these losses occur
in the premature; much even yet has to be learned as to the reason for
the premature onset of labour. Many of the losses too are the result of
developmental abnormalities; something is being learned about the reasons
for some of these.
Death of Infants 1 to 5 years of age
A child who survives the first year of life enters a period when the
probability of dying is very small. Some survive their first birthday in
spite of suffering from congenital abnormalities which later become
responsible for, or contribute to death. Weaker children, especially in
the earlier years, might succumb to infections which older children can
throw off.
Nine survived their first but did not reach their fifth birthdays. Of
these, five were in their second, two in their third and two in their fourth
years. Seven of the deaths were due to congenital abnormalities, and two
to disease. No deaths were due to accidents.
Maternal Mortality
In the earlier years of the life of this Council, maternal deaths were
all too common. The average number for the 1930's was 11.5. The average
for the next six years, mostly war years, was 5.0 and in the succeeding