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It is perhaps worthy of special mention that antenatal treatment
had been sought by no fewer than eight of the thirteen cases
ending fatally, i.e. in 61.5 per cent. In view of all the claims
made for antenatal supervision this seems a big percentage of the
total deaths. It must be remembered, however, that it is frequently
due to some abnormality or feeling of distress or illness
that the woman first seeks advice. The aim of antenatal care as
a preventive rather than a cure of abnormal conditions, has still
to be learnt by many. A visit to or by a doctor or midwife in
regard to the pregnancy does not constitute antenatal care, nor
does an isolated examination at the early or late stages of pregnancy,
more often than not without any examination whatever
of the urine. If the undoubted advantages of adequate antenatal
treatment are not to be minimised, it is highly important that only
cases which have received continued and thorough antenatal
supervision should be so categorised.
Deaths from Puerperal Sepsis.
Of the six deaths due to this cause, three (cases 1, 3, 4) had
received antenatal care of some description ; in two cases pregnancy
was normal, but in the third (No. 1) there was a history
of slight ante-partum haemorrhage at the eighth month. Possible
difficult labour was anticipated in Case No. 4, owing to contracted
pelors; this resulted in an instrumental confinement with
much interference and probable infection at the time of delivery.
The remaining two had normal confinements in which it is difficult
to trace the source of infection. More adequate antenatal
care might have produced a different result in Case No. 2: as
stated above, home visiting only by a midwife is insufficient antenatal
supervision. In the case of death from septicaemia after
abortion (No. 5) the patient did not report her condition till the
onset of haemorrhage. This emphasises the need for impressing
on women the importance of early examination and advice in
pregnancy.
From Haemorrhage.
Four deaths from haemorrhage out of a total of thirteen is a
very high percentage, and is a distressing factor. Many cases of
accidental ante-partum haemorrhage being toxic in origin, care
during pregnancy to eliminate source of toxaemia is a great safeguard.
Placenta praevia seems to be an unavoidable complication
in the present state of knowledge as to its causation, but
active treatment immediately the condition is diagnosed should be
adopted. Had all these women been in a Maternity Hospital or
Home where skilled treatment and necessary appliances were immediately
available at the onset of haemorrhage, it is almost
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