A system of obstetrics . y be kept there, and thus, often,gradually, complete flexion may be secured ; or, a lever may be slippedover the occiput, and the back of the head be well brought down; orboth of these manoeuvres may be employed simultaneously. In occip-ito-posterior positions of anterior fontanel presentations the indicationsare to secure anterior rotation of the occiput, and, at the same time, causethe head to flex. When the forceps is demanded, it is highly import-ant that the head should, if possible, be completely flexed before trac-tions are made. Inclined Presentations of the Ve
A system of obstetrics . y be kept there, and thus, often,gradually, complete flexion may be secured ; or, a lever may be slippedover the occiput, and the back of the head be well brought down; orboth of these manoeuvres may be employed simultaneously. In occip-ito-posterior positions of anterior fontanel presentations the indicationsare to secure anterior rotation of the occiput, and, at the same time, causethe head to flex. When the forceps is demanded, it is highly import-ant that the head should, if possible, be completely flexed before trac-tions are made. Inclined Presentations of the Vertex.—Presentations of theSides of the Head.—Sometimes, in rare instances, the child offers by PEESEXTATIOXS OF THE VERTEX. 591 the side of its head. An ear or one parietal protuberance is found atthe centre of the superior strait instead of the vertex. Such cases havebeen described as distinct presentations; but, for reasons already givenin discussing presentations of the anterior fontanel, I think it more Fig. Presentation of the Lett Ear (Rarnsbotham). advantageous to describe them as deviations from a vertex presenta-tion. Presentations of the side of the head undoubtedly are caused byobliquities of the uterus. Either side of the head may offer. If thepresentation should persist, the difficulty is that the occipito-mental cir-cumference, with its five-inch diameter, offers at the superior strait, andthe head is arrested. Luckily, the occiput may slip into the cavity ofthe pelvis, the head flex, and a fair vertex presentation terminate thelabor. Should this favorable spontaneous termination not happen, thehead remains arrested and labor becomes impossible. The indication for treatment of labor in a presentation of the sideof the head is not to trust to Naturen or to wait for a spontaneoustermination. Assistance should be immediately given, since all assist-ance is more easily rendered early in labor, but becomes more difficult 592 MECHANISM AND TREATMENT OF LABOR.
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectobstetrics, bookyear1
