H.—3l.

Table IVa. —Maternity Hospitals, 1929-1933.

CASES NOT ATTENDED IN MATERNITY HOSPITALS. Section D of Table IV shows the comparative death-rate of 7,193 confinements conducted either wholly in private houses or partly therein and partly in the general wards of public hospitals, to which a considerable number of complicated cases are transferred. These figures have been made comparable with the death-rate in the maternity hospitals by the exclusion, of cases of abortion and ectopic gestation which are not admitted to the latter. The number of patients attended in the general wards of public hospitals prior to delivery was 193. An analysis of these cases shows that only 7 were admitted for normal labour ; the remaining were admitted suffering from more or less severe complications, and included 43 cases of obstructed labour, 2 failed forceps, and 19 antepartum haemorrhages. The severity of these complications may be measured by the high maternal mortality —namely, 8-28 per cent. This maternai mortality for these complicated cases has been gradually dropping, and is considerably lower than it was last year. Though it would be an advantage to the patients in most cases if they could be admitted to special obstetric hospitals, so far as it has not been found possible to arrange this in all places. The position has been met by the efforts of the Medical Superintendents and Staffs to provide better facilities for dealing with these cases. It is therefore gratifying to be able to record that the death-rate of this group has shown a decline during the past few years, no doubt largely due to the interest taken in this problem by the surgeons and physicians concerned and in some cases to the appointment of obstetrical specialists to the honorary staffs, thus relieving the Medical Superintendent and general staff of a responsibility that should not be imposed upon them. In addition to the 193 cases above mentioned, there were 202 cases admitted to the general wards of public hospitals after delivery of which 4 were for eclampsia, 4 for post-partum haemorrhage, and 79 for puerperal septicaemia, the remainder being for other conditions. All the deaths of patients transferred from maternity hospitals but occurring in the general wards of public hospitals are recorded in Table IV, as though they had actually died in the hospital in which they were originally attended. Table V gives the detailed results of the seven St. Helens Hospitals which was the number under the control of the Department at the beginning of the year. During the year the Gisborne and Wanganui Hospitals were passed over to the Hospital Boards. As, however, they have remained under the same management for this year, I have included the whole of their returns in Tables IV and V. The main difference between the procedure in the conduct of the St. Helens Hospitals is that all uncomplicated labour cases are attended by midwives only, though medical assistance is always obtained for complicated labour cases, and all patients attending the ante-natal clinic and all patients during the puerperium receive adequate medical supervision. It will be noted (Table IV) that the percentage of instrumental deliveries under these conditions in St. Helens Hospitals is 5-85 per cent., as against 9-3 to 10-21 for other hospitals.

B—H.8 —H. 31.

51

Maternal Deaths. Number of Hospitals. Number of Confinements. Class of Hospital. Total Number. Rate per 1,000 Confinements. 1929. 1930. 1931. 1932. 1933. 1929. 1930. 1931. 1932. 1933. 1929.1930.1931. 1932. 1933. 1929. 1930. 1931.1932. 1933. Group I, admitting M00 cases 149 143 146 159 163 6,869 6,453 6,624 6,548 6,551 23 21 15 12 19 3 • 35 3-25 2-26 1 • 83 2-90 per annum (maternity cases only) Group II, admitting over 100 42 44 43 40 41 6,263 6,905 6,714 6,482 6,422 19 14 19 21 15 3• 03 2• 03 2• 83 3• 242• 34 cases per annum (maternity cases only) Group III, St. Helens Hospitals 7 7 7 7 7 2,403 2,472 2,262 2,184 2,238 5 9 6 3 6 2-08 3-64 2-65 1 • 37 2-68 Greoup IV, mixed hospitals— 71 76 73 67 64 2,310 2,770 2,6912,334 2,356 19 12 12 8 7 8-23 4-334-46 3'43 2-98 i.e., hospitals admitting medical and surgical patients as well as maternity cases