Operative midwifery : a guide to the difficulties and complications of midwifery practice . hose of theface, brow, and occipito-posterior positions of the vertex, may be men-tioned in connexion with the f(etus. The arm, of course, prolapses much more readily than the foot,and generally it is the anterior arm. Some extraordinary cases havebeen recorded where both arms and legs have presented. Broom2has related a very interesting one where the head and two feet becamearrested at the brim. Yon Zumph describes one where there was pro-lapse of both feet and arms and the cord in a facial presentatio
Operative midwifery : a guide to the difficulties and complications of midwifery practice . hose of theface, brow, and occipito-posterior positions of the vertex, may be men-tioned in connexion with the f(etus. The arm, of course, prolapses much more readily than the foot,and generally it is the anterior arm. Some extraordinary cases havebeen recorded where both arms and legs have presented. Broom2has related a very interesting one where the head and two feet becamearrested at the brim. Yon Zumph describes one where there was pro-lapse of both feet and arms and the cord in a facial presentation. Hall3describes a very complicated condition where the head was impacted 1 Winckels Handbuch, Bd. ii., Teil iii., 1905, p. 1582. 2 Lancet, 1890, p. 1298. 3 Archiv f. Qyr *H lxiii., 1901. PROLAPSE OF LIMBS 47 between the legs of the child, and many odd and interesting cases are to be found scattered throughout the literature relative to the subject. When the foot or feet come down, the child is invariably premature or macerated, and the uterus is firmly retracted over the childs Fig. 26.—Prolapse of Ann in Vertex Presentations. (Bumm.) I have only once experienced difficulty in diagnosing the condition—when a foot came down beside the head and the tips of the toes feltexactly like the prolapsed cord. A careful examination under an anaesthetic should always be madein doubtful cases, when it will invariably clear matters up. 48 0PERAT1\ i: Ipon three occasions I have found the hand preventing the childshead engaging at the brim, but the arm was easily displaced, and tin-head immediately entered and descended. Naturally, considerable difficulty may be experienced in deliveringthe child if the prolapsed limb is not recognized, especially if thepelvis is deformed, and that accounts for the fact that not infrequentlythe mother and child have been seriously injured. The fu-tal mor-tality, however, is also increased by the fact that the children areoften prematu
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