. The science and art of midwifery. Two cases reportedby Hecker, J in which thelength of the occiput wascomparable to that foundin face presentations,show, however, that theoriginal shape of the heac1counts for something inthe appearances presentedafter delivery. Prognosis.—As regardsthe mother, the prognosisin uncomplicated casesdoes not differ materiallyfrom that of vertex manual extractionbecomes necessary, thereis always, however, increased danger of lacerating—1. The cervix ; perinaeum. Lacerations are apt to follow attempts to drag the after-cominghead through an imperf
. The science and art of midwifery. Two cases reportedby Hecker, J in which thelength of the occiput wascomparable to that foundin face presentations,show, however, that theoriginal shape of the heac1counts for something inthe appearances presentedafter delivery. Prognosis.—As regardsthe mother, the prognosisin uncomplicated casesdoes not differ materiallyfrom that of vertex manual extractionbecomes necessary, thereis always, however, increased danger of lacerating—1. The cervix ; perinaeum. Lacerations are apt to follow attempts to drag the after-cominghead through an imperfectly dilated cervix. The prognosis ismore favorable, therefore, in cases where the membranes do notrupture until after dilatation is completed. It is also better in pel-vic presentations, where the bulk of the breech is increased by theaddition of the extremities. In footling cases, when the membranes * Vide Kustner, Die Stciss- und Fusslagen, p. 21. f Spiegelberg, loc. cit., p. 176. % Hecker, Arch. f. Gynaek., Bd. xi, p. Fig. 134.—Showing shape of head in breech presentations. (Budin.) MECHANISM OF LABOU. 209 rupture prematurely, the smaller size of the pelvis and its rapid de-scent through the cervix imperfectly prepare the way for the subse-quent passage of the head. A stricture is, therefore, liable to formabout the neck of the child, and, as the spasm does not yield to force,the result of violent tractions is to sacrifice the integrity of the cervix,the extent of the laceration being proportioned to the power exerted. Lacerations of the perinaeum occur where with rigidity of the tis-sues it becomes necessary to introduce the hand to release the arms,or the interest of the child demands the speedy delivery of the head. The prognosis for the child is, on the other hand, extremely unfavor-able. According to the statistics of Dubois,* the mortality in full-term children is as one to eleven, while in vertex presentations theproportion is as one to fifty. The chief
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