. The science and art of midwifery. six last-born, two survived. Reimann, in commentingon these figures, remarks, The child whose head first enters the pel-vis is in great danger, because, not only is its neck squeezed by thehead of the second child, thereby producing cerebral hyperemia, butits umbilical cord is exceedingly liable to be compressed by the bodyof the second child. 2. When one child presents by the breech, the other by the vertex,the former, because of its smaller size, is apt to descend first into thepelvis. No difficulty is then experienced until the neck is born. Jncase, howev
. The science and art of midwifery. six last-born, two survived. Reimann, in commentingon these figures, remarks, The child whose head first enters the pel-vis is in great danger, because, not only is its neck squeezed by thehead of the second child, thereby producing cerebral hyperemia, butits umbilical cord is exceedingly liable to be compressed by the bodyof the second child. 2. When one child presents by the breech, the other by the vertex,the former, because of its smaller size, is apt to descend first into thepelvis. No difficulty is then experienced until the neck is born. Jncase, however, meantime the head of the second child has entered thepelvis, further progress may be rendered impossible, a lock resultingeither from the overlapping of the chins, or of the occipital portionsof the two heads, or from the pressure of the face of one child intothe neck beneath the occiput of the other. By lifting the body of the * Reimann, Am. Jour, of Obstet., 1877, vol. i, p. 58. MULTIPLE PREGNANCIES AND THEIR MANAGEMENT. 237. Fig. 141.—Twin pregnancy, head and breech presenting. (Tarnier et Chantrcuil.) child, and introducing the half-hand into the vagina, the diagnosis isrendered easy. In a large, roomy pelvis, if the pains are good and the childrensmall, spontaneous delivery may take place. In a number of cases ofthis kind which have been reported, the head of the second child wasborn first. In a few instances, it has been found possible to push upthe second head. Operative measures consist in applying the forcepsand extracting the second head, and afterward, if necessary, the case of failure, craniotomy remains as an ultimate resort. The firstchild is rarely born living. Of twenty-six children, the fate of whichwas ascertained by Eeimann, only three survived. The prognosis ofthe second child is more favorable. Of twenty-nine cases, Eeimannreports nineteen survivals. Naturally, therefore, the perforation ofthe first head would be preferred, were the matter on
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