. Obstetrics for nurses. s and the head, so that normal engagement is interferedwith. The diagnosis can be made upon abdominal palpation when theback and the cephalic prominence are detected upon the same vaginal examination, the mouth, nose and eyes can be palpated if the cervix is suffi-ciently dilated. Descent occurs asusual, but flexion isreplaced by extension,which tends to becomemore pronounced asthe head descends andmeets greater resist-ance. Internal rotationserves to bring thechin under the sym-physis, for only in thisway can spontaneousdelivery take movement is
. Obstetrics for nurses. s and the head, so that normal engagement is interferedwith. The diagnosis can be made upon abdominal palpation when theback and the cephalic prominence are detected upon the same vaginal examination, the mouth, nose and eyes can be palpated if the cervix is suffi-ciently dilated. Descent occurs asusual, but flexion isreplaced by extension,which tends to becomemore pronounced asthe head descends andmeets greater resist-ance. Internal rotationserves to bring thechin under the sym-physis, for only in thisway can spontaneousdelivery take movement is in-stituted by the same factors as in vertex presentations, and maynot occur until the face is distending the vulva. If the chin remainsobliquely posterior, or rotates directly into the hollow of the sacrum,spontaneous delivery is impossible, imless the child is very small. FortlK! (bill to v\vx\v the anterior margin of the perineum, under thesecoiiditioiis. furtlier extension would be necessary, but this is impossible,. Fir. 68.—Face presentation with anterior rotation ofthe chin. (Williams.) THE MECHANISM OF LABOR 123 since it is already complete, with the occiput closely applied to theback. The successful treatment of this complication depends upon themanual rotation of the head, so that the chin is anterior, after whichforceps may be applied. Failing this, a major operation is necessary. Flexion.—In the usual case, after the chin has rotated anteriorly,it becomes stemmed against the symphysis and flexion occurs as a resultof the descent being opposed by the perineum, and, when further prog-ress occurs, the nose, eyes, brow and finally the occiput, come overthe perineum. External rotation and expulsion occur in the usual manner. Spontaneous delivery is the rule in face presentations, but operativeinterference is more frequently necessary than in vertex duration of labor, and especially of the second stage, is increasedand results in a slightly higher f
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectobstetrics, bookyear1
