Operative midwifery : a guide to the difficulties and complications of midwifery practice . rposely notreferred to the outline ofthe abdominal swelling inthe case of twins, for Ihave not found it of greatservice. Without doubt,especially if the childrenare lying side by side,a sulcus may mark thedivision between the twosacs, but as often as notno such dividing mark ispresent. Very much thesame applies to the foetalheart sounds. It is fre-quently stated that hear-ing these sounds over twoareas, separated by an areain which they cannot beheard, should lead one tosuspect plural shoul
Operative midwifery : a guide to the difficulties and complications of midwifery practice . rposely notreferred to the outline ofthe abdominal swelling inthe case of twins, for Ihave not found it of greatservice. Without doubt,especially if the childrenare lying side by side,a sulcus may mark thedivision between the twosacs, but as often as notno such dividing mark ispresent. Very much thesame applies to the foetalheart sounds. It is fre-quently stated that hear-ing these sounds over twoareas, separated by an areain which they cannot beheard, should lead one tosuspect plural should not, however, domore, for I have severaltimes observed the samewhen there was only onefoetus. To be absolutelycertain that there are twofcetal hearts beating, theaccoucheur must make outthe heart sounds to be ofdifferent rhythms over thetwo areas. They shouldtherefore be counted simul-taneously by two observers,for it is surprising howquickly, and often after theslightest movement, the foetal heart rhythm becomes altered. Lastly, the feeling of two distinct sacs through the os is only. FlG. 65.—Twins lying One in Front of the Other. PRESENCE OF MORE THAN ONE F(ETUS 11/ possible where the os is sufficiently dilated. Although not infre-quently with plural pregnancy the os is dilated for some time beforelabour, I have only been able to make out this feature on twooccasions, and in both the foetuses were lying side by side. It isstated that even when they lie one in front of the other the two sacsmay occasionally be felt; but I fancy that is unusual, for in suchcases the one is invariably higher than the other. The relative frequency of the positions of the foetuses is asfollows I1 Total Cases, 1840 (Leonhard). First child - head ; Second child - head - 38-5 361 cent »> head; n breech - 21-1 ii )> breech; )> head - 14-3 ii >j breech; 11 breech - 10-7 ii >> head ; > transverse - 8-3 ii )> transverse; )) head - 0-8 ii )> breech ; 11 transverse - 4-2 ii
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