Operative midwifery : a guide to the difficulties and complications of midwifery practice . s at the child, usuallypuny and ill-nourished, and sometimes with a spina bifida or othermalformation. Besides, the uterine swelling above the pubes is stillof large dimensions. The mischief is done just at this stage ; the accoucheur pulls, andwhoever is assisting presses on the uterus above, with the result thatthe uterus ruptures. He has again made the fatal mistake of tryingto deliver by force. His first failure to effect delivery should haveraised in his mind the possibility of the condition of hyd
Operative midwifery : a guide to the difficulties and complications of midwifery practice . s at the child, usuallypuny and ill-nourished, and sometimes with a spina bifida or othermalformation. Besides, the uterine swelling above the pubes is stillof large dimensions. The mischief is done just at this stage ; the accoucheur pulls, andwhoever is assisting presses on the uterus above, with the result thatthe uterus ruptures. He has again made the fatal mistake of tryingto deliver by force. His first failure to effect delivery should haveraised in his mind the possibility of the condition of hydro-cephalus being the cause of the difficulty. The only cases in whichthere is any excuse for the mistake are those where, in addition tothe enlarged head, there is pelvic deformity, to which he attributes allthe difficulty. With such he will be guided to the correct nature ofthe condition by appreciating the large swelling present above thepelvic brim. When the foetus affected by hydrocephalus presents by ///<? head,the recognition of the condition is easier. Abdominal palpation,.. 4l\fl. FlG. >ti.—Hydrocephalus, showing how the After coming Head is caught at thePelvic Brim. (After Bunini.) 102 OPERATIVE MIDWIFERY even with this presentation, does not always ^rive as much informa-tion as one might expect. The lower part of the uterus i.~ undulydistended, and the large head is freely movable: bnt, owing to the facti hat the uterus so tensely grasps the head, the latter cannot be , the condition is overlooked often, not because of its obscurity, butbecause the examination is made hurriedly. The presenting part, being high, is difficult to reach from thevagina, although I once saw a case where, the child being dead, aportion of the lax head projected down into the cavity, and feltexactly like a large caput succedaneum. Others have mistaken asimilar condition for the bag of membranes. In most cases one canfeel the gaping sutures and fontanelles, and although a
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Keywords: ., bookcentury1900, bookdecade1910, bookpubli, booksubjectobstetrics
