E X T E R N M A T E R N I T Y

DR. ROSEMARY JORDAN

CALLS . . . . . . . . . . . . 2,157 TOTAL NUMBER OF CASES ATTENDED 1,015 DELIVERIES A I ~ E E 2 8 t h W~EIC

(B.B.A. 46) . . . . . . . . . 636 MISCARRIAGBS . . . . . . . . . 96

Comple te . . . . . . 21 I n c o m p l e t e . . . . . . 75 f

ABOR~OHS . . . . . . . . . . . . 283 omp ete " ::: 21 } Incomplete . . .

PmMIPAP~E . . . . . . . . . 38 U ~ o o r ~ v . . . . . . . . . . . . 22

BREECH DELIVERIES : Tota l cases . . . . . . . . . 18

St i l lb i r ths . . . . . . 4 , . ~ . . ~

A n e n c e p h a l u s .. . 2 Mul t ip le abnormal i t ies ' " 1 P r e m a t u r i t y (28 weeks) 1

N . N . D . . . . 2 H y d r o c e p h a l u s " a n d " s p i n a " "

bif ida 1 ~ematu~ty (~'weelgi 1

COMPLICATED B ~ E C S DZI~V~R~S : To t a l cases 1 ~ 1 7 6 o . o . . ~

2nd twin , p ro lapsed a r m , in t e rna l vers ion, b reech ex t rac t ion~ deadborn .

MULTIPLE PaeONASCY : Tota l cases (all twins) .. . 5

St i l lborn . . . . . . . . . . . . 1 N . N . D . . . . . . . . . . . . . Nil. U n d i a g n o s e d . . . . . . . . . . 3 G r a n d - m u l t i p a r a - - p r e v i o u s

L.S.S. 1 V e r t e x - - n o r m a l " d o l i v e ~ ( b o ~

twins) . . . . . . . . . 4 Ass i s t ed b reech de l ive ry (l 'st

twin) . . . . . . . . . . . . 1 P ro l apsed a rm, in te rna l vers ion,

b reech ex t r ac t i on (2n, l twin) . . . 1 5 i n f an t s we igh ing 5 t lb. or less were a d m / ~ e d to t h e Paed ia t r i c Uni t .

FORCEPS DELIVERIES : Tota l cases . . . . . . . . . 11

Ind i ca t i ons : P . O . P . . . . 3 2nd s t age de lay" ... 4 M a t e r n a l d i s t ress .. . 2 Foe t a l d i s t ress . . . . . . 2

No m a t e r n a l or foetal mor t a l i t y .

MANUAL I~MOVAL OF PLACENTA, T o t a l ~ 13

Ind i ca t i ons : R e t a i n e d . . . . . . 12 P o s t p a r t u m h a e m o r r h a g e . . . 1 Assoc ia ted P . P . H . . . . . . . 5 Requ i r i ng blood t r an s fu s i on (2

pints) . . . . . . . . . . . . I Morb id i ty . . . . . . . . . . . . 5

POSTPARTUM HARMORRHAGE : T o t a l = S 0

Prim,~-y . . . . . . . . . I s S econda ry . . . . . . . . . 7 R equ i r i ng t r an s fu s ions :

P r i m a r y . . . . . . . . . 4 Seconda ry . . . . . . . . . . . . 0

R equ i r i ng b lood t r an s fu s ions . . . B (1) 2 p in t s c r o s s - m a t c h e d blood. (2) 1 p i n t 0 n e g a t i v e blood +

I p i n t D e x t r a u . Assoc ia ted f ac to r s - - -p r imary P . P . H . :

R e t a i n e d p l a c e n t a . . . . . . 5 B .B .A . . . . . . . . . . . . . 2 P r ev ious P . P . H . . . . ... 1 Acc iden ta l h a e m o r r h a g e . . . I Nil .. . 4[

SecoH~; "b.P.d; . . . .

R e t a i n e d p r o d u c t s of con- cep t ion . . . . . . . . . 7

ANTEPAETUM HARMORRHAGE NOT PLACENTA PRAEV~ :

Total---- 1

Smal l c o m b i n e d acc iden ta l h a e m o r r h a g r d u r i n g labour . N o t r a n s f u s i o n requi red . L i ve chi ld de l ivered b y forceps. P o s t - p a r t u m h a e m o r r h a g e 30 oz.

STILLBIRTHS :

T o t a l ~ 11

Anencephaf i r . . . . . . . . . 4 Hydrocepha l i c . . . . . . . . . 1 Mul t ip le abnormal ! t i e s . . . . . . I P r e m a t u r e (28 weeks) .. . 1 Second twin , (breech ex t rac t ion) I Macera ted , (cord a r o u n d neck, 39

weeks) .. . 1 I n t r a p a r t u m a s p h y x i a 137 w e e ~ i 1

A n t c p a r t u m a s p h y x i a (I .U.D.) , b i la te ra l ta l ipes (37 weeks) " smal l , " B . B . A . . . . . . . 1

NBOHATAL DEATHS : Tota l = 11

1 N .N .D. on d i s t r i c t - - u n b o o k e d , B .B.A. m e m b r a n e s ove r face, F .H . 50. 10 N . N . D . ' s in Paed ia t r i c Uni t .

P r e m a t u r l t y (28 weeks) .. . 1 Ate lec tas i s . . . I P r e m a t u r i t y a n d ' a ' t c l e c t ~ i s .. . 2 H y d r o c e p h a l u s a n d s p i n a bif ida 1 R h e s u s i ncompa t ib i l i t y . . . 2 B r o n c h o - p n e u m o n i a . . . . . . 1 Mul t ip le abnorma l i t i e s a n d

infec t ion ... 1 H y p o t h e r m i a ( w t . ? lb.): i : . . . 1

P r e m a t u r e L a b o u r ~ 32

T h e r e h a s a g a i n b e e n a d e c r e a s e i n t h e n u m b e r o f c a s e s a t t e n d e d o n d i s t r i c t , a l t h o u g h t h i s h a s b e e n l e s s m a r k e d t h a n i n p r e v i o u s y e a r s . S i m i l a r l y

4

the number of operative deliveries has decreased, par t ly because of the present tendency to admit a patient if any complication arises during labour and par t ly perhaps, because of better selection of cases suitable for home confinement.

There was no maternal mortality. The perinatal mortal i ty was 20 {31.411,000). Eight of these infants had gross abnormalities and 4 were very premature. Twenty-nine infants were admitted to the Paediatric Unit, of these 10 died in the neonatal period. The cause of death is shown in the summary table. There was 1 neonatal death on district. The patient, a grande multipara was not booked. The hospital was not contacted until after the birth of the infant. When the group arrived the child was found asphyxiated with the membranes over the face. Despite efforts at resuscitation the child was dead on arrival in the Paediatric Unit .

Three mature infants were stillborn. Each was delivered normally, 1 was macerated with the cord round the neck. One was stillborn at 37 weeks without apparent cause but it had bilateral talipes which may have been associated with other congenital abnormalities. No post-mortem examination was made. In the third case the foetal heart disappeared during the second stage of labourwthe length of this is not recorded but it is possible tha t earlier delivery would have prevented this stillbirth.

The other potentially preventable stillbirth was a 2nd twin. The multiple pregnancy was not diagnosed. After the assisted breech delivery of the first in fan t - -a live female weighing 4 lb. 12 oz. the 2nd infant was palpated and the Clinical Clerk called. The head was presenting and the second sac of membranes was punctured, however an arm prolapsed. The Registrar and Phlebotomist were called. An internal version and breech extraction was performed under general anaesthesia but the 2nd infant was stillborn.

Only one of the cases of postpartum haemorrhage required admission to hospital. This was a multipara who was delivered spontaneously and on arrival of the group was found shocked. I t was estimated she had lost 40 oz. blood. Despite transfusion of 2 pints plasma and 1 pint Dextran her condition was not satisfactory so she was admitted to hospital 2 hours after delivery. One patient who had previously had a postpartum haemorrhage was obviously unsuitable for home confinement.

INTERN MATERNITY SUMMARY

TOTAL DELIVERIES . . . . . . 5 , 0 1 2

PRIMIGRAVIDAE . . . . . . . . . 1 , 4 7 3

UNBOOK]~D ( t h i s f i g u r e i n c l u d e s 179 c a s e s b e f o r e 2 8 w e e k s m a t u r i t y ) 6 1 2

PATIENTS DIED UND]~LIV~ERED . . . l~Til

Deliveries before 28th week : H y d a t i d i f o r m m o l e . . . . . . 4 E c t o p i c p r e g n a n c y . . . . . . 7 A b o r t i o n s . . . 157 M i s c a r r i a g e s (21 born alive) ... 107

Mul t ip le Pregnancy : T w i n s . . . . . . . . . . . . 9 5

Haemorrhages : A n t e p a r t u m . . . . . . . . . 1 7 0 Placenta p r a e v i a . . . . . . 63 P o s t p a r t u m . . . . . . . . . 66

Toxaemia : E c l a m p s i a . . . . . . . . . 6 H y p e r t e n s i o n . . . . . . . . . 71 T o x a e m i a . . . . . . . . . 149

Other Abnormal ObsMria Conditions : D i s p r o p o r t i o n . . . . . . . . . 144 D i s o r d e r e d u t e r i n e a c t i o n (160

86 h o u r s a n d o v e r ) . . . . . . 2 0 6 Prolapse/presentation of c o r d . . . 3 6 R u p t u r e o f u t e r u s . . . . . . 8 Hydranmios . . . . . . . . . 87 Hourglass contraction/contrac-

tion r i n g . . . . . . . . . 17 C a r d i a c d i s e a s e . . . . - . . 4 4

tuberou osis'(aotive/ 4 Breast a b s c e s s 77 A n a e m i a (29 m c g f i o b l a s t i c ) :i~ 1 ,S59 Venereal disease . . . . . . 24 Epilepsy . . . . . . . . . . . . 20 Diabetes . . . . . . . . . . . . 14