Final report of Departmental Committee on Maternal Mortality & Morbidity.

  • Great Britain. Committee on Maternal Mortality & Morbidity.
Date:
1932
Catalogue details

Licence: Public Domain Mark

Credit: Final report of Departmental Committee on Maternal Mortality & Morbidity. Source: Wellcome Collection.

    130/160 (page 128)
    contra-indication. Another pregnancy should be avoided until the patient has been clinically well, with a normal temperature and absence of tubercle bacilli from the sputum, for at least two years. The Committee desire to draw attention to the difficulty which not infrequently arises in obtaining suitable accommodation for tuberculous women both during pregnancy and for delivery. The allocation of a few special beds in voluntary or municipal hospitals would be of undoubted value. The Committee is informed that at one sanatorium, conducted by a voluntary committee, a proposal is under consideration to provide a small number of beds to be reserved for pregnant and parturient women. Heart Disease in Pregnancy. . It is well known that all forms of organic heart disease tend to be adversely affected by pregnancy, so that the patient’s expecta- tion of life is to a greater or less extent diminished. Numerous statistics could be quoted to prove the high immediate mortality attending this condition in pregnancy and labour, but in this section we are concerned only with the aggravation of disablement in those who survive. Even after pregnancy and labour are safely passed, it is frequently found that a -certain amount of permanent heart weakness is left, which is shown by diminished exercise-tolerance as compared with that present before pregnancy. Of six cases of auricular fibrillation during pregnancy observed by Mackenzie,* all with mitral stenosis following rheumatic fever, though all sur- vived the confinement, none ever recovered the same degree of health as was present before pregnancy, and five gradually became worse after delivery and died within two years. Crighton Bramwellt and Mary Regan, in a study of 82 cases of heart disease of all grades of severity at St. Mary’s Hospital, Manchester, found that out of 66 who survived labour, and were followed up afterwards, in at least three the condition was aggravated by pregnancy. Three thou- sand women attending the ante-natal clinic during 18 months were examined for heart disease, and amongst them were found 79 cases of organic heart disease. If we assume that the women attending the ante-natal clinic at this hospital represent a fair sample of the population of the country as a whole, the incidence of heart disease in pregnant women in England and Wales is about 4 per cent.— that is, 28,000 cases yearly. Assuming that 4 per cent. of these are aggravated by pregnancy, we arrive at the conclusion that 1,120 cases yearly represent the disablement resulting in cardiac cases from childbearing. Such figures, coupled with the high immediate mortality, emphasise the risk of pregnancy in these patients. It is not the purpose of the Committee to enter into details of management, which are given sufficiently well in text-books of obstetrics, but they consider it necessary to emphasise that careful supervision is needed in the ante-natal period and during labour, and the amount of * Ref. Sir James Mackenzie. Heart Disease in Pregnancy. Oxford Med. Pub., 1921. + Crighton Bramwell. Lancet, 1931, Jany. 31.