Operative midwifery : a guide to the difficulties and complications of midwifery practice . rtex where, from some cause, such as con-racted pelvis, obliquity of the uterus, dolichocephalic shape of head,umours of the neck, etc., the head, instead of remaining flexed,)ecomes extended. This change of attitude in the head occurs, as 1 Lond. Obst. Trans., vol. xli., p. 142. 2 Zeit. Gel. u. Gnjn., Bd. lxv., Heft 2. 36 OPK1IATIYE MIDWIFE!^ a rule, at the commencement of labour, and the presentation resultingis often spoken of as secondary presentation of the face,to distinguishit from the primary, w
Operative midwifery : a guide to the difficulties and complications of midwifery practice . rtex where, from some cause, such as con-racted pelvis, obliquity of the uterus, dolichocephalic shape of head,umours of the neck, etc., the head, instead of remaining flexed,)ecomes extended. This change of attitude in the head occurs, as 1 Lond. Obst. Trans., vol. xli., p. 142. 2 Zeit. Gel. u. Gnjn., Bd. lxv., Heft 2. 36 OPK1IATIYE MIDWIFE!^ a rule, at the commencement of labour, and the presentation resultingis often spoken of as secondary presentation of the face,to distinguishit from the primary, which may exist for some time before interesting are the cases described by Croom,1 Ahlfeld,2 andothers, in which the presentation has varied before labour, beingsometimes vertex and sometimes face. The diagnosis of a facial presentation is not always easy. Bycareful palpation one searches for and locates the head, the back, thelimbs, and the breech, just as in positions of the vertex. But while invertex presentations this, as a rule, is a simple matter, in presentations. Fir;. 20.—Third Position of tin- Face of the face considerable difficulty may be experienced, owing to thefact that the abdominal and uterine walls are often more vertex presentations we saw that the back and occiput formeda curved surface with only a slight depression at the neck : in facialpresentations, on the other hand, there is a marked depression betweenthe back and the neck, and in conditions favourable for diagnosis,as where the child is lying dorso-anterior, this depression can bereadily distinguished. Not infrequently, however, the child lies withits dorsum posterior (Fig. 20), when it is difficult to reach the depressionmentioned. Some have referred to the inferior border of the chinforming a horseshoe-like rim, which dips into the cavity (McLennan),and I quite agree that this sometimes may be felt, but it is only when 1 Clinical Papers, 1901. 2 Lchrbuch der Geburtshi
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