Operative midwifery : a guide to the difficulties and complications of midwifery practice . s a variety>f face presentation, for the same factors influence the occurrence in»oth. When one has said that, however, the resemblance ceases. A•row is an infinitely more unfavourable presentation than a face. 1 Lond. Obst. Trans., 1899, vol. xli., p. 280. 2 Amer. Journ. Obst., 1905, vol. li., p. 615. 1! OPERATIVE MII>\;\ The diagnosis of the presentation is rarely made until the osis sufficiently dilated to permit one feeling such landmarks as theanterior fontanelle, and especially the sup
Operative midwifery : a guide to the difficulties and complications of midwifery practice . s a variety>f face presentation, for the same factors influence the occurrence in»oth. When one has said that, however, the resemblance ceases. A•row is an infinitely more unfavourable presentation than a face. 1 Lond. Obst. Trans., 1899, vol. xli., p. 280. 2 Amer. Journ. Obst., 1905, vol. li., p. 615. 1! OPERATIVE MII>\;\ The diagnosis of the presentation is rarely made until the osis sufficiently dilated to permit one feeling such landmarks as theanterior fontanelle, and especially the supra-orhital ridges. True, ifconditions are very favourable, one may make out by abdominalpalpation the chin and the head less flexed than usual, but the deepdepression between the occiput and the back, which can often beappreciated in face presentations, is not so marked. Even vaginalexamination may leave one in doubt if the membranes have been longruptured and a caput succedaneum has formed. Besides, the head isoften high in the pelvis, for it engages in the occipito-mental diameter,. FlG. 24.—Brow Presentation. the longest cranial diameter, and so finds great difficulty in entering thepelvis. Should there be any doubt about the presentation, the patientshould be anaesthetized and a thorough examination made. In certain cases one may be deceived as regards the extent towhich the head has descended, for the caput and elongated foreheadmay give the impression that the head is lower than it really is. Spontaneous delivery in brow presentations rarely occurs, exceptwhen the child is below and the pelvis above the normal. When itdoes occur, the face in the region of the base of the nose is fixedagainst the pubes, and the anterior fontanelle and rest of the headsweep over the perineum. If the chin remains posterior, spontaneousdeliver}7 is impossible. The moulding of the head is shown in theillustration (Fig. 25). BROW PRESENTATIONS 45 As already stated, the prognosis for both m
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