A manual of practical obstetrics . Bipolar version (second step). 2. The fingers inside can now touch the shoulder, and theypush or lift it in the same direction as the head, while thehand outside still further depresses the breech (Fig. 95). Thehead is now a little higher above the brim than the breech,and the knee is within reach of the fingers. 3. Grasp the knee (the membranes, if unbroken, may beruptured), and pull it down, while the hand outside changes 236 VERSION OR TURNING its position so as to push up the head toward the fundus(Fig. 96). The foot may now be reached and the case man-ag
A manual of practical obstetrics . Bipolar version (second step). 2. The fingers inside can now touch the shoulder, and theypush or lift it in the same direction as the head, while thehand outside still further depresses the breech (Fig. 95). Thehead is now a little higher above the brim than the breech,and the knee is within reach of the fingers. 3. Grasp the knee (the membranes, if unbroken, may beruptured), and pull it down, while the hand outside changes 236 VERSION OR TURNING its position so as to push up the head toward the fundus(Fig. 96). The foot may now be reached and the case man-aged as a breech or footling presentation. In transverse presentations the operation comprises the secondand third steps above given for head cases—that is, push theshoulder after the head, then grasp the knee, etc. Should itbe desired, however, to convert the shoulder (transverse) pres- Fig. Bipolar version (thircTstep). The external hand, as shown in the figure,has not yet changed its position, but is ready to do so. entation into a head presentation instead of a footling, thefingers inside will, of course, push the shoulder in the directionof, and after the breech, while the hand outside depresses thehead. It should be particularly observed that the main purpose ofthis combined or bipolar method, is to supersede the more INTERNAL VERSION. 237 dangerous proceeding of introducing the whole hand and partof the forearm into the uterus, which is the last alternativewhen the external and bipolar methods have been unsuc-cessful. Version by Internal Manipulation. — Like all theversion operations, this is comparatively easy before thewaters have escaped and when the uterus is not rigidly con-tracted round the child, but difficult when opposite conditionsprevail. Additional conditions, however, are necessary beforethe operation should be attempted, viz.: the pelvis must be ofsu
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