. The science and art of midwifery . ereby producing cerebral hyperemia, bul it- umbilical cord is exceedingly liable to be compressed by the bodyof the second child. 1. When one child presents by the breech, the other by the vertex,the former, because of its smaller size, is apt to descend first into thepelvis. No difficulty is then experienced until the neck is born. Incase, however, meantime the head of the second child has entered the * Reimann, Am. Jour, I Obstet., 1^7?. eol. i. p. 58. MULTIPLE PREGNANCIES AND THEIR MANAGEMENT. 235 pelvis, further progress may be rendered impossible, a lo
. The science and art of midwifery . ereby producing cerebral hyperemia, bul it- umbilical cord is exceedingly liable to be compressed by the bodyof the second child. 1. When one child presents by the breech, the other by the vertex,the former, because of its smaller size, is apt to descend first into thepelvis. No difficulty is then experienced until the neck is born. Incase, however, meantime the head of the second child has entered the * Reimann, Am. Jour, I Obstet., 1^7?. eol. i. p. 58. MULTIPLE PREGNANCIES AND THEIR MANAGEMENT. 235 pelvis, further progress may be rendered impossible, a lock resulting either from the overlapping of the chins, or of the occipital portionsof the two heads, or from the pressure of the face of one child intothe neck beneath the occiput of the other. By lifting the body of thechild, and introducing the half-hand into the vagina, the diagnosis isrendered easy. In a large, roomy pelvis, if the pains are good and the childrensmall, spontaneous delivery may take place. In a number of cases of. Fig. 128— Twin pregnancy, head and breech presenting. (Tarnier et this kind which have been reported, the head of the second child washorn first In a few instances it has been found possible to push upthe second head. Operative measures consist in applying the forcepsand extracting the Becond head, and afterward, if necessary, the case of failure, craniotomy remains as an ultimate resort. The firstchild is rarely born living. Of twenty-six children, the fate of whichwas ascertained by Reimann, nly three survived. The prognosis ofthe Becond child is more favorable. Of twenty-nine cases, Reimannreports nineteen survivals. Naturally, therefore, the perforation of 236 LABOR. the first head would be preferred, were the matter one purely of elec-tion, but the operation is very difficult, and does not remove the ob-stacle, for even the diminished head can not pass the one alreadyoccupying the pelvis.* In the cases so far reported,
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