Obstetrics : the science and the art . nal point is the sacrum of the foetus. For the shoulder presentation,the cardinal point is the whole head of the child. As to the head presentation—it may deviate, and allow a shoulderto come to the os uteri: but this is a mere accident of a cephalic pre-sentation : an accident that has arisen from the impinging of the headupon the margin or brim of the pelvis, whence it has glanced upwardsto the iliac fossa, permitting the shoulder to take its place. This is to be seen by inspecting the cut, in whichthe childs head, which originally pre-sented, has devia
Obstetrics : the science and the art . nal point is the sacrum of the foetus. For the shoulder presentation,the cardinal point is the whole head of the child. As to the head presentation—it may deviate, and allow a shoulderto come to the os uteri: but this is a mere accident of a cephalic pre-sentation : an accident that has arisen from the impinging of the headupon the margin or brim of the pelvis, whence it has glanced upwardsto the iliac fossa, permitting the shoulder to take its place. This is to be seen by inspecting the cut, in whichthe childs head, which originally pre-sented, has deviated, and gone abovethe plane of the superior strait, lodgingitself in the left iliac fossa, while theshoulder has come to the strait, andallowed the arm to prolapse. The cut may serve to show how thehand and arm have merely prolapsed;making what is commonly denominatedan arm presentation: but is it not clear,the head having gone up, that the shoul-der still really presents, and that thearm has only fallen down or prolapsed? Fig. PRESENTATIONS AND POSITIONS, 89 Fig. 33. From the above, it appears that we have— 1st. Cephalic presentations; 2d. Cephalic presentations deviated, with descent of the shoulder;and, lastly, 3d. Cephalic presentations deviated, with descent of the shoulder,and prolapse of the arm. Here is a drawing representing a breech presentation, or presentationof the pelvic extremity of the foetal oval. This is the second normalpresentation of the child, the cephalicbeing the first. In this case, an acci-dental deviation might cause the buttockto glance upwards on the brim of thepelvis, to take its lodgment in the leftiliac fossa. Such an accident wouldgive rise to a footling labor, or to a pre-sentation of the knees. A footling presentation, then, is onlyan accident happening in the course ofa pelvic presentation—and the samemay be said of the knee cases, whichare very rarely met with. I recommend these views of presen-tations to the Medical Student, who
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Keywords: ., boo, bookcentury1800, booksubjectmidwifery, booksubjectobstetrics
