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(b) Other causes.
(1) Cerebral Haemorrhage.
Embolism (miscarriage 28 weeks)
Malignant Endocarditis
(2) Bronchitis
Cardiac dilatation (5 days after
normal confinement
(3) Shock of post partum Haemorrhage
Obstructed labour
(4) Pulmonary Oedema
Cardiac Failure
Pregnancy
(5) Cerebral Haemorrhage.
Hyperpiesis
Toxaemia of Pregnancy.
Detailed investigation of the Maternal deaths reveals that of
the four cases of puerperal sepsis, three had received ante-natal
care; the other case was that of an early miscarriage. The cause
of the miscarriage was probably due to the extra work done by the
woman as a machinist; she did not send for medical help until two
days after the onset of haemorrhage.
Ante-natal supervision in the other three cases was regular;
two patients attended clinics and were referred during pregnancy
for the advice of a gynaecological specialist; the third case was
examined by a private doctor at frequent intervals. Difficult
labour occurred with two of these patients, the third case, though
a normal full-time delivery in hospital, yet developed all the signs
of virulent puerperal infection 48 hours later; the cause of which
was untraceable.
Of the five cases who died from causes other than sepsis, there
is a history of previous ill-health in two, viz., bronchitis and
chronic heart disease. Death in these cases was in no way attributable
to any abnormality of pregnancy but to conditions which,
though aggravated by pregnancy, might well have occurred otherwise.
There were two deaths due to difficult prolonged labour, requiring
much operative interference—each had attended an antenatal
clinic; the third fatality was due to cerebral haemorrhage
as a result of toxaemia of pregnancy which had been suitably
treated.
Ante-natal care undoubtedly helps towards the reduction of
the maternal death-rate, but it must be thorough. There is a great
need for more ante-natal beds. The Maternity Hospitals tend to
over-book," practically all available accommodation being used
for the lying-in women; it is extremely difficult, therefore, to obtain
admission for cases of slight toxaemia or slight antepartum
haemorrhage requiring observation, or for the necessary in-patient
treatment to be accorded to pregnant women suffering from intercurrent
diseases such as, e.g., the two fatal cases mentioned
above. 64