The practice of obstetrics, designed for the use of students and practitioners of medicine . Fig. 193.—Opened Vulva in a Primigravida;Thirty-eighth Week; Shallow VulvalCanal.— {From a photograph at the New YorkMaternity.) 154 PHYSIOLOGICAL PREGNANCY. should be estimated two weeks before labor is expected, in order to detect anyovergrowth of the fetus. (See Cephalometry.) The examination of pregnancycan conveniently be divided into (i) external or abdominal, and (2) internal orvaginal. EXTERNAL OR ABDOMINAL EXAMINATION. DIAGNOSIS OF FETALPRESENTATION, POSITION, AND ENGAGEMENT OF PRE-SENTING PAR
The practice of obstetrics, designed for the use of students and practitioners of medicine . Fig. 193.—Opened Vulva in a Primigravida;Thirty-eighth Week; Shallow VulvalCanal.— {From a photograph at the New YorkMaternity.) 154 PHYSIOLOGICAL PREGNANCY. should be estimated two weeks before labor is expected, in order to detect anyovergrowth of the fetus. (See Cephalometry.) The examination of pregnancycan conveniently be divided into (i) external or abdominal, and (2) internal orvaginal. EXTERNAL OR ABDOMINAL EXAMINATION. DIAGNOSIS OF FETALPRESENTATION, POSITION, AND ENGAGEMENT OF PRE-SENTING PART. EXTERNAL PELVIMETRY. The patient should lie upon her back upon the side of the bed or couch,with the clothing loosened and the abdomen bare, or covered only with onethickness of a bed-sheet, through which it is possible to make a satisfactoryexamination. The examiner should see that his hands are warm, since the. Fig. 194.—Location of the Fetal Back and Small Parts by External left hand displaces the fetus to the left for locating the dorsal plane.—{Froma photograph taken at the Emergency Hospital.) contact of a cold hand with the abdominal wall is apt to excite reflex contractionsof the abdominal muscles, and even in the uterus. Moderate flexion of thethighs will often assist in relaxing the abdominal muscles, and this positioncan often be used to advantage. The bladder and rectum should have beenemptied recently. We should ascertain as much as possible at the first exam-ination, and, in order that nothing be overlooked, we ought to follow somedefinite routine order of examination, as in the case of the internal examination THE EXAMINATION OF PREGNANCY. 155 of pregnancy (see page 167) and labor (see Labor). We should also accustomourselves to palpate with the left as well as the right hand. The order ofexamination here recommended is: (i) Determination of general conditions.
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectobstetrics, bookyear1
