H.—3l.

PART lI,— MATERNAL MORBIDITY AND MORTALITY (EUROPEAN). The graph showing maternal mortality rates from different puerperal causes, together with Tables IVa and IVb, giving the number of deaths and rates per 1,000 live births, divided into groups in accordance with the system of international classification is indicative of the medical and nursing professions' and the Health Department's successes and failures in attempts to increase the safety of child-bearing. It also shows the extreme danger of sepsis following attempts to avoid child-bearing by the termination of pregnancy by induced abortion. In speaking of " maternal deaths " I do not include deaths from septic abortion in that term. This is dealt with separately. The true maternal death-rate is 3-25, if septic abortion is added an untrue " maternal death " rate of 4-21 is obtained, and the issues are hopelessly confused.

Table IVa.—Showing the Number of Puerperal Deaths and the Death Rate per 1,000 Live Births, 1927-1935.

Table IVb. —Puerperal Mortality, 1935, showing the Number of Deaths and their relation to Live Births.

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1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. Puerperal sepsis following childbirth .. No. 56 42 30 27 18 13 14 17 8 Rate 2-01 1-54 1-12 1-01 0-68 0-52 0-58 0-70 0-33 Haemorrhages, accidents of labour, thrombosis No. 35 30 39 36 31 30 29 19 24 phlegmasia, and following childbirth not Rate 1'26 1-10 1-46 1-34 1 16 1-21 1 -19 0-78 1-00 otherwise defined Toxaemia, albuminuria, and eclampsia .. No. 27 40 34 36 38 23 29 30 34 Rate 0-97 1-47 1-27 1-34 1-43 0-92 1-19 1-24 1-42 Accidents of pregnancy, non-septic abortion, No. 5 8 7 7 11 9 10 10 12 and ectopic gestation Rate 0-18 0-29 0-26 0-26 0-41 0-36 0-41 0*41 0*50 Total maternal deaths (excluding septic No. 123 120 110 106 98 75 82 76 78 abortion) Rate 4-41 4-42 4-11 3-96 3-68 3-02 3-37 3-12 3-25 Septic abortion— Married women .. .. .. No. \fi 4 iq\ 26 26 24 16 29 17 Single women .. .. .. No. /V ) 4 3 2 10 13 6 Totals .. .. .. 14 14 19 30 29 26 26 42 23 Rate .. .. .. 0-50 0-51 0-71 1-12 1-09 1-04 1-07 1-73 0-96

Number Death Rate of per 1,000 Deaths. Live Births. Puerperal sepsis following childbirth . . .. .. .. .. 8 0-33 Haemorrhages, accidents of labour, thrombosis, phlegmasia, and other accidents of childbirth— (a) Placenta prsevia .. . . . . .. 6 0-25 (b) Other puerperal haemorrhages . . . . . . 9 0-38 (c) Puerperal embolism (non-septic) .. .. 3 0-12 (d) Other accidents of childbirth — (1) Following Caesarean section for obstructed labour or contracted pelvis .. 3 | (2) Ruptured uterus .. . . 1 [ n • 95 (3) Post-partum shock . . . . 1 (4) Dystochia (hydrocephalic foetus) with anaemia of pregnancy .. .. 1 j 24 1-00 Toxaemias of pregnancy — (а) Puerperal albuminuria and eclampsia .. .. 21 0-88 (б) Other toxaemias of pregnancy .. .. .. 13 0-54 34 1-42 Accidents of pregnancy — (a) Abortion (non-septic) .. .. .. .. 8 0-33 (b) Ectopic gestation .. .. .. .. 4 0-17 12 0-50 Total maternal deaths (excluding septic abortion). .. .. .. 78 3-25 Septic abortion — (a) Married women .. . . .. .. .. . . 17 (b) Single women .. .. .. .. .. .. 6 23 0-96