A textbook of obstetrics . le at the vulvar orifice, and may, in case of doubt, be pulledout and inspected. If the child is alive, the pulsating vessels inthe cord may be felt. I was once called in consultation, how-ever, by a young physician who believed that a coil of intestinehad prolapsed in the vagina. The prognosis for the child is grave. The mortality in gen- 74 THE PATHOLOGY OF LABOR. oral is more than fifty per cent. The child obviously dies ofasphyxia from pressure upon the cord ; hence the danger istwice as great in head presentations (sixty-four per cent.) as inbreech presentations
A textbook of obstetrics . le at the vulvar orifice, and may, in case of doubt, be pulledout and inspected. If the child is alive, the pulsating vessels inthe cord may be felt. I was once called in consultation, how-ever, by a young physician who believed that a coil of intestinehad prolapsed in the vagina. The prognosis for the child is grave. The mortality in gen- 74 THE PATHOLOGY OF LABOR. oral is more than fifty per cent. The child obviously dies ofasphyxia from pressure upon the cord ; hence the danger istwice as great in head presentations (sixty-four per cent.) as inbreech presentations (thirty-two per cent.). The danger to themother lies in the operative procedures which are often requiredfor the reposition of the cord, such as version and rapid extrac-tion. Treatment.—The cord should be replaced by manipulationwith the woman in a knee-chest posture, or, better, the Trendelen-burg posture—over the back of a chair. It is advisable to hooka loop of the cord over an extremity or the chin to prevent its. Fig. 449.—Trendelenburg posture over a chair to guard a prolapsed cord from pres-sure and to facilitate its reposition (Dickinson). prolapsing again, which is extremely likely. The whole handmust be inserted in the vagina, and perhaps within the loweruterine segment; so that anesthesia is usually required. While the anesthetic is administered, and while the physician makes hispreparations for the reposition, the patient should be kept in theTrendelenburg posture, so as to guard the cord from fatal pres-sure. If the cord is satisfactorily replaced so that it will notcome down again, forceps should be applied to the head to f\x itfirmly over the pelvic inlet. If manipulation fails to replace thecord, podalic version should be performed without waste of breech being firmly impacted in the pelvis, the ease is man-aged as one f breech presentation—by delay until the os is well L IBOR COMPLICATED BY ACCIDENTS AND DISEASES. 3/ D and then by rapid extra
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