. The science and art of midwifery. erfere with the fixationof the foetus. Thus, the production of breech presentations is favored * Schatz, Die Umwandlung von Gesichtslage zu Hinterhauptshge, etc., Arch, fGynaek., Bd. v, p. 328. \ Tarnier et Chantreuil, Traite de Part des ac, p. 454. 204 LABOR. by an excess of amniotic fluid, by lax uterine walls, and by contrac-tions of the pelvis. They are more common in multipara? than inprimipara?. Of the 3,301 cases collected by Pinard, there were 1,347primiparae and 1,954 multipara?, though the entire number was nearlyequally divided between the two cla
. The science and art of midwifery. erfere with the fixationof the foetus. Thus, the production of breech presentations is favored * Schatz, Die Umwandlung von Gesichtslage zu Hinterhauptshge, etc., Arch, fGynaek., Bd. v, p. 328. \ Tarnier et Chantreuil, Traite de Part des ac, p. 454. 204 LABOR. by an excess of amniotic fluid, by lax uterine walls, and by contrac-tions of the pelvis. They are more common in multipara? than inprimipara?. Of the 3,301 cases collected by Pinard, there were 1,347primiparae and 1,954 multipara?, though the entire number was nearlyequally divided between the two classes.* Finally, they occur withgreatest frequency of all in twin pregnancies, and during the expul-sion of premature and dead children. Of 32,264 children from thestatistics of Hegar and Spiegelberg,f 910 were the product of multiplepregnancies, and 659 were premature. Of the former, 227, or 25 percent., and of the latter 148, or 22*4 per cent., were delivered by thebreech, though we have seen that the ratio of breech presentations. Fig. 132.—Presentation of the breech. Left dorso-anterior position. (Pinard.) to the entire number of births does not exceed the proportion of oneto thirty. Diagnosis.—By external palpation the recognition of the head atthe fundus uteri furnishes the chief diagnostic sign. Upon vaginalexamination, the presenting part, as in face presentations, is usuallyhigh up, and reached with difficulty. The bag of membranes is aptto be of large size, owing to the imperfect closure of the lower uterinesegment by the small breech, often descending through the canal,where the cervix is rigid, in the form of an elongated pouch. Throughthe membranes, upon pressing the foetus downward during the inter- * Vide Tarnier et Chantreuil, p. 455. f SriEGELBERG, IOC. tit., p. 171. MECHANISM OF LABOR. 205 val between the pains, the breech is felt as a soft, irregular body, andwith care it is possible to recognize the coccyx, the sacrum, the ilia,and sometimes to feel tappi
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