32

during the present Mastership with the loss of the baby. I t is known tha t there were several near misses also, where the baby survived. I t should be a cast iroI~ rule that active management of the 3rd stage by oxytotic sub- stances can orfly be justified where the midwife or doctor attertding the patieltt can assure him or herself tha t the uterus does not contain an ult- suspected twin. This responsibility must be accepted, and it is to be hoped that no further losses for this reason will occur. See case No. 79684 under Uterine Rupture Letterpress, p. 57.

VAGINAL D E L I V E R Y FOLLOWING PREVIOUS

SECTION, (R.C.O.G. TABLE 21)

DR. ANTHONY RICHARDSON

CAESAREAN

Summary:

119 f B o o k e d ---- 118 (a) T o t a l n u m b e r o f c a s e s . . . . . . . . . . . . ~. U n b o o k e d = 1

I n c i d e n c e a g a i n s t t o t a l d e l i v e r i e s 28 w e e k s m a t u r i t y a n d o v e r (5 ,273) . . . . . . . . . 2-2 p e r c e n t .

(b) M a t e r n a l m o r t a l i t y . . . . . . . . . . . . N i l f D e a d b o r n = 2

(c) G r o s s f o e t a l loss . . . . . . . . . . . . . . . 4 ~ 1s t w e e k N N D ' s = 1 [ . L a t e N N D ' s = 1

P e r i n a t a l m o r t a l i t y r a t e . . . . . . . . . 2 4 . 7

(d) M u l t i p l e p r e g n a n c i e s . . . . . . . . . . . . 2 s e t s o f t w i n s

Indications for previous Caesarean sections:

P l a c e n t a p r a e v i a . . . . . . . . . . . . . . . F o e t a l d i s t r e s s i n 1 s t s t a g e . . . . . . . . . . . . T o x a e m i a . . . . . . Disproport ion/~ai ledV- t r ' ia l o f ' i a b o u r ' " . . . . . . F a i l e d i n d u c t i o n . . . P r o l o n g e d l a b o u r / i n e r t i a B r e e c h p r e s e n t a t i o n / b o r d e r l i n e d i s p r o p o r t i o n . . . A n t e p a r t u m h a e m o r r h a g e u n c l a s s i f i e d . . . . . . T r a n s v e r s e lie i n l a b o u r . . . . . . . . . . . . P r o l a p s e d c o r d . . . . . . . . . . . . . . . A c c i d e n t a l h a e m o r r h a g e . . . . . . . . . . . . B a d o b s t e t r i c a l h i s t o r y . . . . . . . . . . . . F a i l e d f o r c e p s . . . . . . . . . . . . . . . O v a r i a n c y s t / o b s t r u c t e d l a b o u r . . . . . . . . . C e r v i c a l f i b r o i d / o b s t r u c t e d l a b o u r . . . . . . . . . P r o l a p s e d a r m . . . . . . . . . . . . . . . M a t e r n a l d i s t r e s s . . . . . . . . . . . . . . .

. . °

. . o

. . o

. , .

2 5 18 16 14 10

7 6 5 4 3 3 2 2 1 1 1 1

Methods of delivery:

S p o n t a n e o u s v e r t e x . . . . . . . . . . . . . . . F o r c e p s . . . . . . . . . . . . . . . . . . A s s i s t e d b r e e c h . . . . . . . . . . . . . . . V a c u u m e x t r a c t i o n . . . . . . . . . . . . . . . B r e e c h e x t r a c t i o n . . . . . . . . . . . . . . .

Total

8 8 2 4

4 3 1

D[B 1

1

NND

2

33

Causes of foetal loss associated with Table 21:

DEADBORN = 2

Defective foetal growth--dysmaturity. Macerated . . . . . . 1 Placental insufficiency. No F]H. on admission. Macerated ... 1

NEONATAL DEATHS ='---- 2 1st week NND's (1):

Hydrops foetalis . . . . . . . . . . . . . . . . . . . . . l

Late NND's (1): Cardiac failure due to congenital heart disease . . . . . . . . . 1

COMMENT

T h e r e was one case of r u t p u r e of t h e p r ev ious s ec t i on sca r in a t o t a l of 119 cases; t h i s d e l i v e r y be ing e f fec ted b y t h e v a c u u m e x t r a c t o r . U n d e r U t e r i n e R u p t u r e L e t t e r p r e s s p. 57 see Case No. 77835.

T h e foe ta l loss was cons ide r ed t o be u n a v o i d a b l e a a d n o t r e l a t e d t o t h e m o d e of de l ive ry .

T h e r e were 67 1st full t e r m de l iver ies fo l lowing sect ion. 30 2 n d . . . . . . . . . . 10 3 rd . . . . . . . . . .

3 4 t h . . . . . . . . . . 5 5 t h . . . . . . . . . . 2 6 t h . . . . . . . . . . 1 8 th . . . . . . . . . .

T h e r e was one case h a v i n g 4 ful l t e r m de l ive r ies a f t e r t h e 1st sectiolx alxd 1 ful l t e r m d e l i v e r y a f t e r t h e 2 n d sec t ion . T h e i n d i c a t i o n fo r t h e 1st sectioI~ b e i n g t o x a e m i a arid for t h e 2 n d p r o l a p s e d cord. T h i s case i l l u s t r a t e s t h e pos s ib i l i t y of a n t i c i p a t i n g v a g i n a l d e l i v e r y fo l lowing t w o p r e v i o u s sec t ions for a n o n - r e c u r r e l l t cause .

DISPROPORTION, (R.C.O.G. TABLE 22)

MASTER

Summary:

(a) Total number of cases . . . . . . . . . . . .

Incidence against total deliveries o8 weeks maturity and over (5,273) . . . . . . . . .

(b) Maternal mortality . . . . . . . . . . . .

(c) Gross foetal loss . . . . . . . . . . . . . . .

Perinatal mortality rate . . . . . . . . .

(d) Multiple pregnancies . . . . . . . . . . . .

(e) Total clinical assessments . . . . . . . . .

(f) Total new x-ray pelvimetry films . . . . . .

(g) Symphysiotomy . . . . . . . . . . . . . . .

(h) Ruptured uterus . . . . . . . . . . . . . . .

1 2 8 f Booked ~. Unbooked

2.4 per cent.

Nil

1 (Early NND)

7.8

Nil

48

39

8 cases

Nil

----117 11