103 once. The uterus was felt to be well contracted, but low in the abdomen." A t 13.40 t h e second pint of blood was running-in. The blood pressure was 80/60. Vaginal examination showed a second degree inversion, the vagina being distended b y t h e inverted fundus and body of the uterus. The cervix was " fully dilated " and quite flaccid. General anaesthesia was administered a t 14.15, but a t t e m p t s at digital hydrostatic replacement by two senior assistants failed. By now, the patient was again in severe shock. Noradrenaline was administered. The third pint of blood was flowing. Consultation was summoned. At 15.00 hours the pulse was barely perceptible and the systolic pressure about 60. The shock and collapse present represented the cumulative effect of haemorrhage, the t r a u m a of a t t e m p t e d expression of the placenta and rep l a c e m e n t of the uterus, traction on the infundibulo-pelvic and broad ligaments and pressure of the inversion ring upon its contents. There was no bleeding now, presumably because of the lowered blood pressure and compression upon the extruded uterus. General anaesthesia was again administered. Whilst the hand of the operator was in the vagina and grasping the uterus, 6 ml. of 50 per cent. magnesium sulphate were injected intravenously by the anaesthetist. The constriction at the neck of the inversion appeared to relax almost immediately and replacement of the uterus proved easy. Transfusion was continued. Cortisone, 200 mg., penicillin, 500,000 units, streptomycin , 0.5 g., and omnopon, gr. }, were administered. After replacement of the uterus, the general condition of the patient slowly improved, but she remained pale and somewhat cold and restless for some hours. She received 4 pints of blood in all. The systolic blood pressure did not reach 100 until 10 hours after delivery. Cortisone 100 rag. twice daily and the antibiotics were continued for the first 5 days of the puerperium. The fasting blood sugar did not fall below 100 mg. per cent. and the insulin sensitivity test showed normal response on two occasions during the puerperium. The puerperal haemoglobin ranged between 60 and 70 per cent. The kidneys functioned satisfactorily. Lactation commenced on the 2nd day, but the patient did not breast-feed. The puerperium was afebrile. There was no puerperal asthenia. The patient took her discharge on the 9th day. She is followed-up on account of the possibility of chronic pituitary insufficiency. Seven months after delivery she was in good health. 10. 1296/'54. Multipara. History of unsuccessful pregnancies, then s y m p a t h e c t o m y for hypertension, then living infant, l~ecurrence hypertension this pregnancy with concealed accidental haemorrhage in middle months. Macerated miscarriage. B.P. normal on discharge. 11 and 12. 1372/'54 and 1424/1954. Severe cases of hypofibrinogenaemia. See Accidental Haemorrhage, Cases Nos. 9 and 10. 13. 1439/'54. Multipara near t e r m a d m i t t e d with urinary infection, vomiting a n d jaundice. Spontaneous. Hypocalcaemia with carpopedal spasms, etc. during labour. Good recovery. 14 and 15. 1583/'54 and 1824/'54. Primigravidae with vertical vaginal septa obstructing labour. Low forceps deliveries after division and excision of septa. 16. 2122/'54. Second pregnancy. Previous L.S. Caesarean Section for disproportion with s y m p h y s i o t o m y " on the way out " with a view to vaginal delivery n e x t time. Although the pelvis was still fiat (9.2 cm.), division of the symphysis had resulted in a wide brim transverse of 13.6 cm. and a roomy subpubic arch. On this occasion, low forceps delivery of living 6½ lb. foetus after 7½ hours' labour. Abdominal pain, tenderness and distension and vomiting suggested rupture 18 hours after delivery. Careful observation. Spontaneous recovery. 17. 2202/'54. Troublesome case of bleeding from the early months. See Accidental Haemorrhage, Case No. 7. 18. 2239/'54. Exemplifies the ravages of severe familial hypertension in a young woman. See P r i m a r y Caesarean Section, Case No. 81. 19. 2301A/'54. Eclamptiform convulsion following the injection of ergometrine after the delivery of a first twin. See Eclampsia, Case No. 8. "
NEONATAL DEATHS As in former Reports, I include here the deaths of all babies who were born alive within the Hospital ; but who died within 30 days of birth in the labour or puerperal wards, in the baby unit, in their own homes after discharge, in a n y other institution or in the baby unit after re-admission. I do not include deaths of babies over 30 days of age ; babies born outside our service but admitted to the unit at the urgent request of a doctor or nurse ; miscarriage foetuses of 24-28 weeks' gestation ; babies born in the district. See District Maternity Service for the last mentioned.
104 There were 64 such deaths in 2,136 babies born alive, a neonatal mortality oI just under 3 per cent. The corresponding figures for 1950, 1951, 1952 and 1953 were 3.4, 4-9, 3-0 and 2-8. The figure 2,136 is arrived at in this way : 2,400 deliveries at all stages of gestation; add 44 extra living twin and triplet foetuses; subtract 218 abortions, miscarriages and moles, together with 90 stillbirths. Thus 2 , 4 ~ less 308----2,136. The weight distribution in these intern neonatal deaths was as follows : 2 l b . - - 2 / 1 5 oz . . . . 3 lb.--3/15 . . 4 lb.---4/15 . . 5 l b . - - 5 / 8 incl . . . .
. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
. . . . . . . .
. . . .
. . . .
. . . .
10 12 8 6
5/9--5/15
..................
6/0--6/15
. . . . . . . . . . . . . . . . . .
7/0--7/15 8/0--8/15
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 7
. . . . . . . . . . . . . . . . . .
0
. . . . . . . . . . . . . . . . . .
1
9/0--9/15
10/0 lb. a n d o v e r
"~ 36
1 7 13
28
Thirty-six (56~o) died within 48 hours of birth. The causes of the neonatal deaths were : " Atelectasis " / " Failure of e x p a n s i o n of l u n g s " ...... Major Congenital D e f o r m i t y . . . . . . . . . . . . . . Intracranial Haemorrhage . . . . . . . . . . . . . . Asphyxia/Placental Insufliciency/Intra-uterine Asphyxia Pneumonia . . . . . . . . . . . . . . . 6 Neonatal Infection . . . . . . . . . . . . 4~ " Infective E n t e r i t i s " .. . . . . . . . . . . lJ Cause u n c e r t a i n o n clinical a n d p o s t - m o r t e m e x a m i n a t i o n H y d r o p s Foetalis . . . . . . . . . . . . . . . . . . . . P u r p u r a I-Iaemorrhagica . . . . . . . . . . . . . . . . . Suprarenal and Intracranial Haemorrhage .........
...
17 11 9 8
...
11
...
4 2 1 1
. .
. .
64 A u t o p s y was p e r f o r m e d b y t h e P a t h o l o g i s t in 21 cases. Including all e x t r a t w i n foetuses, 2,136 babies were b o r n alive w i t h i n t h e h o s p i t a l a n d 1,158 in t h e district in 1954. This is a t o t a l of 3,294 f o e t u s e s b o r n alive a t a n d p a s t 28 w e e k s ' gestation. Of t h i s n u m b e r , 64 of t h e b a b i e s b o r n w i t h i n t h e h o s p i t a l died w i t h i n 30 d a y s of b i r t h and 22 of t h o s e b o r n o n t h e district. T h u s 86 in 3,294 is 2.6%. T h e c o r r e s p o n d i n g p e r c e n t a g e for 1953 w a s 2.4%.
Reg. No.
3O
167
187
249
269
298
307
311
352
392
Case No.
1
2
3
4
5
6
7
8
9
10
9
1
1
3
2
2
1
3
1
1
No. of Pregnancy
8
6
0
8
0
0
0
6
6
2
4
4 10
7
6
4
3
8
6
3
lb. oz.
Birth Weight
Yes
No No
properly
Medicinal induction Sudden d e a t h
Respirations never established.
Hydrocephaly and spina bifida
Moderate toxaemia
Spontaneous
Spontaneous Spontaneous
2 days 36 hours
36 hours
15 hours 2½ hours
Intracranial haemorrhage. of
Congestion lungs ; asphyxia.
Failure of expansion of lungs.
Asphyxia
Congenital deformity.
Spontaneous
Spontaneous
Colitis
No
Premature rupture branes.
Hydramnios with slight a n t e p a r t u m h aemorrhage.
Spontaneous
2 days
Atelectasis
of mem-
Bougie induction at 36 weeks
Severe toxaemia
Spontaneous
7 minutes
Placental insufficiency ; asphyxia.
Yes
No
No
No
Hydrocephaly and spina bifida
Spontaneous
Congenital deformity.
19 days
13 days
Congenital • deformity.
No
Spontaneous
Few minutes.
Placental insufficiency. Asphyxia.
Spina bifida and o t h e r lesser deformities.
Autopsy
Spontaneous
REMARKS
No
Accidental haemorrhage.
Age a t D e a t h Mode of Delivery ! Associated Maternal Conditions, etc.
Mother apparently n o r m a l up to onset of haemorrhage.
Cause of D e a t h
(includes all babies a t or past 28 weeks' gestation who were born alive within t h e Hospital, b u t who died within 30 days of b i r t h in the labour or puerperal wards, in the b a b y unit, in t h e i r own homes, after discharge, in a n y other i n s t i t u t i o n or in the b a b y unit after re-admission)
N E O N A T A L D E A T H S (1954)
~=~ o ¢n
(1954)--co~ltinued.
7 14
6 12
3
2
4
2 10
8
6
8
3
420
421
435
440
542
642
690
921
12
13
14
15
16
17
18
0
4
8
lb. oz.
11
Birth ~vVeight
Reg. No.
Case No.
No. of Pregnancy
7minutes
Congenital deformity.
Congenital deformity.
Failure of expansion of lungs.
Congenital deformity,
Intracranial haemorrhage.
Suprarenal haemorrhage ; intracranial lmemorrhage. Failure of expansion of lungs.
Yes
Second twin. Easy delivery, First twin was stillborn. Membranes had been ruptured for three days.
Caesarean section Spontaneous Spontaneous
12 hours
4 days 2 hours
Hydramnios
Placenta praevia ; n~itralstenosis.
Anencephaly
multiple deformities.
I Hydrocephaly, spina bifida and
No
No
No
No Anencephaly, recurrent Hydramnios
Spontaneous
l:~ew
minutes
Yes Spontaneous onset of labour at 28 weeks.
Mild antepartum bleeding.
Spontaneous
Assisted breech
Yes
Congenital haemolytic disease verified on autopsy.
Hydramnios ; megaloblastic anaemia ; P.P.H. ; manual removal.
Spontaneous
2 days
Few minutes
Yes
Autopsy
Congenital haemolytic disease verified on autopsy.
REMARKS
Presentation of cord
Associated Maternal Conditions, etc.
Caesarean section.
Age at Death Mode of Delivery
Hydrops foetalis Few minutes.
Hydrops foetalis
Cause of Death
(includes all babies a t or past 28 weeks' gestation who were born alive within the Hospital, but who died within 30 days of birth in the labour or puerperal wards, in the baby unit, in their own homes after discharge, in any other institution or in the baby unit after re-admission}
NEONATAL DEATHS
g
13
4
1
3
1
1
4
924
937
971
977
984
991
1019
1034
1143
80
19
2O
21
22
23
24
25
26
27
28
3
13
1
No. of Pregnancy
Reg. No.
Case No.
8
2
5
4
2
2
2
8
8 14
4
7
3
0
2
5
3
5
lb. oz. 5 8
Birth Weight
Spontaneous
5 minutes
12 hours
Atelectasis
Pneumonia
Intracranial haemorrhage, 18 hours
Few hours
Spontaneous
Spontaneous
Spontaneous
Caesarean
36 hours
Congenital deformity.
Few hours
Spontaneous
21 days
Placental insufficiency. Asphyxia. Prematurity.
Intracranial haemorrhage.
Spontaneous
Few
Internal version and breech extraction.
Spontaneous
10 minutes
hours
SpontaneOus
3 days
Age at Death VLode of Delivery
Intra-uterine asphyxia.
Congenital deformity.
Congenital deformity.
Atelectasis
Cause of Death
I
Accidental haemorrhage.
--
Severe hypertensive toxaemia.
Accidental haemorrhage.
Hydramnios. Vomiting.
P.P.H.
Antepartum haemorrhage associated with clotting defect.
Associated Maternal Conditions, etc.
Easy labour --
Large meningocele
Note duration of survival
Admitted in labour with transverse lie.
Anencephaly
Anencephaly
REMARKS
Yes
No
No
No
No
Yes
No
No
No
Yes
Autopsy
(includes all babies a t or past 28 weeks' gestation who were born alive within the Hospital, but who died within 30 days of birth in the labour or puerperal wards, in the baby unit, in their own homes, after discharge, in any other institution or in the baby unit after re-admission)
NEONATAL DEATHS (1954)---continued.
(1954)--continued.
3
9
6
5 .
1
2
8
4
2
4
6
165
223
315
368
385
491
528
725
766
L073
105
787
1152
29
3O
32
33
34
35
36
37
38
39
4d
~1
7
8
No. of Pregnancy
Reg. No.
Case No.
4
6
0
4
6
8
0
0
2 12
4 13
2 l0
5
4 12
8
10
8
6
6
7
3
lb. oz. 6 9
Birth Weight
Atelectasis
Atelectasis
Asphyxia
Atelectasis
Pneumonia
Neonatal sepsis
Pneumonia
Infective enteritis.
Pneumonia
Purpura haemorrhagica.
Neonatal sepsis
Atelectasis
Pneumonia
Cause of Death
~pontaneous ~pontaneous
24 hours 21 days
Some hours
~ome hours
Spontaneous
Caesarean section.
Spontaneous
10 minutes
--
Antepartum haemorrhage.
m
rwin Twin
~pontaneous rupture of membranes and bleeding a t 28 weeks.
No
No
No
No Respirations never properly established.
~pontaneous
Yes
Re-admitted from district
~egaloblastic anaemia.
3pontaneous
7 days
25 days
No Baby died in own home
;low labour
~pontaneous
~res Re-admitted from district
~pontaneous
23 days 21 days
~o Re-admitted from district
~pontaneous
~o
Re-admitted from district
18 days
Mild accidental haemorrIlage.
fes
Re-admitted from district
No
No
twin
~pontaneous J 3pontaneous
12 hours .4 days
~To
~.utopsy
Re-admitted from district
REMARKS
~pontaneous
Clinically postmature.
kssociated Maternal Conditions, etc.
.I days
Age at Death ~Iode of Delivery
'includes all babies a t or past 28 weeks' gestation who were born alive within the Hospital, but who died within 30 days of birth in the a b o u t or puerperal wards, in the baby unit, in their own homes, after discharge, in any other institution or in the baby unit after re-admission)
NEONATAL D E A T H S
O 00
(1954)---vontinued.
1
1
1227
1245
1275
1273
1449
1452
1572
1661
1703
1748
1757
43
44
45
46
47
48
49
50
51
52
53
1
1
6
6
3
4
3
12
1
2
1166
42
No. of Pregnancy
Reg. No.
Case No,
I
0
0
9
0
3
0
6
5
3
8
8
5
2 10
4
5 12
8
5
3
4
6
lb. oz. 7 0
Birth Weight
Doubtful
Intracranial haemorrbage
Asphyxia
Intracranial haemorrhage.
Intracranial haemorrhage.
Failure of expansion of lungs.
Intracranial haemorrhage.
Hydrocephaly
Doubtful
Atelectasis
Pneumonia
Doubtful
Cause of D e a t h
4 days
4 days
Some hours
3-4 days
7 days
6 days
4 days
21 days
9 days
1-2 days
15 days
10 days
Low forceps
Low forceps
Spontaneous
Caesarean section.
Spontaneous
Easy breech
Symphysiotomy
Caesarean section.
Easy breech
Spontaneous
Assisted breech
Spontaneous
Age a t Death Mode of Delivery
Hypertension ; A.P.H.
Accidental haemorrhage.
Contracted pelvis
Disproportion
Disproportion
Associated Maternal Conditions, etc.
I
Autopsy
No cause of d e a t h c o u l d b e estabhshed.
1V~edicinal induction
--
Repeated unsuccessful pregnancies.
Re-admitted from home
Twin
Re-admitted from home
Yes
Yes
No
Yes
No
Yes
No
No
No
Yes
No
Autopsy showed congestion Yes and enlargement of the liver, otherwise negative.
REMARKS
(includes all babies a t or past 28 weeks' gestation who were born alive within the Hospital, b u t who died within 30 days of b i r t h in the labour or puerperal wards, in the b a b y unit, in t h e i r own homes, after discharge, in a n y other institution or in the b a b y unit after re-admission)
NEONATAL DEATHS
DEATHS
(1954)--continued.
No. of Pregnancy
5
3
6
1
2
4
1
1
6
2
7
Reg. No.
1840
1880
1921
2053
2117
2115
1885
2239
2250
2124
2201
Case No.
54
55
56
57
58
59
00
61
62
63
64
0
1
0
8
4
6
7
2
0
2
3 11
2 10
6
2
2
3
8
3
lb. oz. 3 6
Birth Weight
Doubtful
Atelectasis
Atelectasis
Failure of expansion of lungs.
Neonatal sepsis.
Atelectasis
Atelectasis
Neonatal infection.
Congenital defect in Diaphragm. Asphyxia.
Intracranial haemorrhage. Atelectasis.
Atelectasis
Cause of Death
No No Yes
No
No No
Maturity 28-30 weeks Maturity 28-30 weeks Scalp abscess ; cavernous sinus thrombosis. Minor congenital deformities. Gross placental insufficiency
Maturity 29-30 weeks Twin Died in own home after discharge.
Easy breech Spontaneous Spontaneous
Caesarean section. Easy breech Spontaneous Spontaneous
Some hours 21 days
5 days
Some hours 20 minutes 16 days
Some hours
Severe hypertensive toxaemla.
Long ruptured membranes.
No
Low forceps
7 days
Twin
Spontaneous
3 hours
Yes
Yes
Accidental haemorrhage.
Easy breech
12 hours
Induction for postmaturity.
No
Autopsy
Placenta praevia
~EMARKS
Caesarean section.
Associated Maternal Conditions, etc.
1-2 days
Age at Death Mode of Delivery
(includes all babies at or past 28 weeks' gestation who were born alive within the Hospital, but who died within 30 days of b i r t h in the labour or puerperal wards, in the baby unit, in their own homes, after discharge, in any other institution or in the baby unit after re-admission)
NEONATAL
l.a
