Final report of Departmental Committee on Maternal Mortality & Morbidity.

  • Great Britain. Committee on Maternal Mortality & Morbidity.
Date:
1932
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Licence: Public Domain Mark

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

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    physical strain regulated, so that it is well within the patient’s capacity. Should congestive failure set in, it is important that whenever possible the patient should be transferred to hospital, so that she may be free from household worries, may have the benefit of skilled nursing and be under the immediate supervision of a cardiolo- gist who can collaborate in treatment with the obstetrician. No hard-and-fast rules can be laid down regarding treatment. Hach case is a problem in itself and requires special study, but the Com- mittee would emphasise the absolute need for close co-operation between the physician and the obstetrician if the best results are to be obtained. The management of labour may call for the exercise of all the obstetrician’s powers of judgment, and the claims of Caesarean section, with or without sterilisation, should receive full consideration. , Diabetes. Before the proper dietetic management of diabetes was under- stood the effect of pregnancy on the disease was almost always disas- trous. Since the introduction of insulin the outlook for mother and child has been transformed. Arnold Walker* has collected 18 insulin-treated cases from literature and reports one of hisown. In 13 of them the diabetes was known to exist before pregnancy, in three it was first discovered during pregnancy, and in the three others the information was not available. In only one case did a patient die in or immediately after labour. In addition to diabetes she had severe toxaemia of pregnancy and probably eclampsia. One other died from broncho-pneumonia some weeks after delivery. There was no case of death from diabetic coma. Walker, from this review, con- cludes (1) that insulin has entirely altered the outlook on diabetes in pregnancy ; (2) there now seems to be no reason to terminate preg- nancy, and no reason why a diabetic should not give birth toa a | child; (3) there is no special incidence of puerperal infection; an (4) neither does pregnancy seem to have any ill effect on the diabetic condition. There is as much need as in pre-insulin days for general care, especially rest, freedom from worry, avoidance of chills and exposure to infection. From the beginning of pregnancy the patient should be under the care of a physician who will co-operate with the obstetrician. Chronic Nephritis. The available evidence proves conclusively that the occurrence of pregnancy in a patient who is already the subject of chronic nephritis is a most serious event for the mother, the nephritis being invariably aggravated and the expectation of life shortened. The most recent and striking figures published are those of H. J. Stander and C. H. Peckham from Johns Hopkins Hospital.t These workers traced 135 of 263 patients admitted with 260 pregnancies between the Ist January, 1919, and 3lst December, 1928. Of these 260 preg- * Ref. Walker, A. Proc. Soc. Med., vol. xxi., part 1, 1927-28, 378. + Amer. Jnl. Obst. and Gyn., 1931, 626. 5012 =