. The science and art of midwifery. rve of the parturient canal. If, in purebreech cases, obstetrical aid becomes necessary, the operator is em-barrassed by the absence of a natural handle by means of which extrac-tion can be effected. Theoretically, cephalic version by external manipulations, performedduring the latter part of pregnancy, or in the early stages of labor,most completely fulfills the required indications, viz.: the saving of the EXTRACTION IN FOOT AND BREECH PRESENTATIONS. 37 child with the least possible risk to the mother. That, in cases wherethe breech is not engaged in the p
. The science and art of midwifery. rve of the parturient canal. If, in purebreech cases, obstetrical aid becomes necessary, the operator is em-barrassed by the absence of a natural handle by means of which extrac-tion can be effected. Theoretically, cephalic version by external manipulations, performedduring the latter part of pregnancy, or in the early stages of labor,most completely fulfills the required indications, viz.: the saving of the EXTRACTION IN FOOT AND BREECH PRESENTATIONS. 37 child with the least possible risk to the mother. That, in cases wherethe breech is not engaged in the pelvic cavity and the membranes areintact, external version may be successfully accomplished, has beenshown by Mattei, Hegar, and Pinard. Tarnier at first opposed themeasure on the ground of its impracticability and the risk of rupturingthe membranes before the version was completed, thus converting abreech into a shoulder presentation, but more recently has practicedthe procedure in many cases without inconvenience to the mother or. Fig. 171.—Method of seizing both feet. child.* Its successful performance presupposes a relatively consider-able quantity of amniotic fluid, the absence of reflex irritability in thepatient, and experience on the part of the operator in mapping outthe foetus through the abdominal wall. Ahlfeld f advises that in pri-miparae the hand be introduced immediately after the rupture of themembranes, or at least while the introduction is still practicable, andthat the anterior extremity be brought down as a prophylactic measure, * Ollivier, De la conduite a tenir dans la presentation de rextremite pelvienne, Mode des fesses, p. 103, Paris, 1883. f Ahlfeld, Arch. f. Gynaek., vol. v, p. 174, Berlin, 1873. 378 OBSTETRIC SURGERY. leaving the child to be expelled subsequently by the natural hand should be passed over the anterior surface of the child tothe knee ; the thumb should then be placed in the popliteal space,while four fingers grasp the leg,
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Keywords: ., bookcentury1800, bookdecade1890, bookidsci, booksubjectobstetrics
