Puerperal infection: an analysis of 283 cases following abortion of labour
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Date
1928Author
Warnock, Alexandra Alice
Metadata
Abstract
During the two year period from April 1st
1926 to March 31st 1928, 725 patients were admitted to
Auckland General Hospital for complications of pregnancy
or the puerperium (exclusive of a number of cases of
threatened abortion), and 43 of them died.
(The General Hospital will admit any case of
any illness from infancy to old age, except, knowingly,
normal confinement. All abnormal confinements,however,
except forceps cases, are admitted to the General, not
to the Maternity Hospital. The population of the
district is about 200,000).
The chief reasons for admission were: -
1. Inevitable or incomplete abortion (1--3 months
pregnant), 378 cases, of whom 154 were febrile
(100 °F. or more) after admission, and of these
9 died.
2. Inevitable or incomplete miscarriage (4 -6 months
pregnant), 94 cases, of whom 47 were febrile after
admission, and of these 7 died.
3. Real or anticipated complication of labour or
puerperal pyrexia (i.e. total puerperal cases)
128, of whom 82 weré febrile after admission, and
of these 19 died.
4. "Chronic renal toxae'Aa" . ore- eclamptic toxaemia,
or eclampsia, 30 cases (included also in above
groups), of whom 3 died (including i from sepsis already
counted in group 3).
5. Ectopie gestation, 47 cases, of whom 2 died.
6. Various other complications, 78 cases, of whom 4
died - 2 from concealed accidental haemorrhage, 1
from malignant endocarditis (at term - undelivered),
and 1 from hyperemesis and haemorrhage.
If a temperature of 100° F. or more, in the
absence of any other cause, is taken as indicative of
sepsis, there were altogether 283 septic cases, of whom
71 were fairly serious, and 31 had an illness lasting
four weeks or more without convalescence, and 35 died.
These cases form the series studied.
There were no deaths from haemorrhage alone,
though no doubt exsanguination would load the scales
against some of the more severe cases. One patient
died from empyema and purulent pericarditis following
a typical attack of taw: left lower lobar,pneumonia ,
starting two days before an easy spontaneous delivery.
At post -mortem the signs were almost confined to the
chest, but culture from the empyema pus gave a growth
of streptococci only. With the possible ex.eption of
this patient, and also that of 1390 K who was ill for
six weeks before delivery, and showed an unusual blood
count, all the deaths appear definitely due to sepsis.
It is interesting to note that the much
higher mortality among the miscarriage cases - 7 out of
94 - than the abortion cases - 9 out of 378 - tends to
justify the greater dislike of these cases common to
House Surgeons at least. The difference is presumably'
due to the formation of the placenta and increasing
size of the uterus. In the remainder of the paper the
distinction between abortion and miscarriage is not
maintained - both groups are included in the term
abortion.
In considering the 35 deaths it is surprising
to find that 16, or nearly half, followed abortion; only
19 following labour, although abortion is generally
regarded as of relatively little importance. In
addition, of the 71 other cases selected as being more
severe, 34 were post- abortion, and of the 31 most prolonged,
16 were post -abortion. In this connection
Allant states that one -third of the septic cases in
Victoria in 1918 -27 were septic abortions. Cassie2
reports 35 in a series of 129, and the report of the
Scottish Board of Health Committee-states that of 1253
cases of sepsis in Glasgow between 1918 and 1922, 217
were associated with abortion. It is of course
impossible to say without further statistics whether
these figures really mean that septic abortion is commoner
in Auckland than in these other places, or merely
that a larger proportion of them than of puerperal cases
reach the Hospital. Its frequency even in these other
reports appears to indicate that septic abortion merits
a little more attention in Text Books than those
available here at least.show.