Cyclopædia of obstetrics and gynecology . FiG. 13.—Extraction of the Breech. ward. If this rotation does not occur spontaneously, it must be madeartificially. In order to effect this, while downward traction is beingmade, the foetus is turned in the desired direction, and this is ordinarilyan easy matter. But if the body resists, rather than use force we hadbest desist. Where version is easy and contractions good, the arms remain flexedon the chest; but if the uterus retracts more, the arms extend along the 30 A TREATISE OX OHSTETRICS. head, and must be disengaged. The posterior arm sliould be


Cyclopædia of obstetrics and gynecology . FiG. 13.—Extraction of the Breech. ward. If this rotation does not occur spontaneously, it must be madeartificially. In order to effect this, while downward traction is beingmade, the foetus is turned in the desired direction, and this is ordinarilyan easy matter. But if the body resists, rather than use force we hadbest desist. Where version is easy and contractions good, the arms remain flexedon the chest; but if the uterus retracts more, the arms extend along the 30 A TREATISE OX OHSTETRICS. head, and must be disengaged. The posterior arm sliould be first ex-tracted, and then the anterior, and there remain^- only the head. The liead may be flexed or extended, the occiput anterior or the uterine contractions are not sufficient, we must extract it rapidly,lest the infant emleaA^or to breathe, and asphyxiate. Since the extractionof the arms and head offers difficulties, we will describe this later Fig. 14.—Loosening of the Cord. The child born, the cord is to be cut as usual, and the same care isgiven to infant and mother as is customary after normal labor. Version, as we have described it, is simple version. It is not always soeasy, and, as we will see, the operation may become one of the most deli-cate and difficult the accoucheur is called upon to perform. We willpass the difficulties successively in review. VERSioJsr. 31 Obstacles axd DiFFicrLTiES to Introduction of the Hand, The causes of difficulty may lie in tlie vulva or vagina, (edema, nar-rowness, rigidity), or be due to obstacles in the canal, (prolapse of the armor the cord), in the cervix (resistance, rigidity, placenta praevia), in theuterus itself (retraction, tumors, etc.) a. jSTirrowness, rigidity, of the vulva or vagina, are rarely so pronouncedas to constitute genuine obstacles. Edema and traumatic swelling of thevulva and the external parts are the most frequent obstacles. Edema of the vulva may


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