Transactions of the American Association of Obstetricians and Gynecologists for the year ... . red this will prove easy,but if the water has been drained away for some time, and spasticcontraction is present, it is often difficult to introduce the handfar enough to seize the leg. Pinards maneuver for this conditionis as follows (Farabuef and Varnier): Introduce the hand whose palm corresponds to the fetalabdomen; pass the fingers along the belly of the fetus, whilethe thumb ascends behind the sacrum. Penetrate with the index-and middle fingers along the anterior thigh until the poplitealspace
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . red this will prove easy,but if the water has been drained away for some time, and spasticcontraction is present, it is often difficult to introduce the handfar enough to seize the leg. Pinards maneuver for this conditionis as follows (Farabuef and Varnier): Introduce the hand whose palm corresponds to the fetalabdomen; pass the fingers along the belly of the fetus, whilethe thumb ascends behind the sacrum. Penetrate with the index-and middle fingers along the anterior thigh until the poplitealspace is reached. Now press with the index-finger in this spacethus overflexing the thigh, at the same time making pressure DELI\ERY BY THE BREECH. 517 on the ham-string muscles. The authors assure us that the footwill fall against the back of the hand. My own experience is that when the uterus is so tightly con-tracted as to make the maneuver necessary, the hand cannotpenetrate high enough to pass the knee and flex directly, andoften space does not permit the leg to fall to the back of Fig. I. When the Pinard maneuver fails I have several times succeededby an additional maneuver which has the merit of simplicityonce the Pinard grasp has been attained. The hand is alreadygrasping the fetal pelvis, thumb behind, palm in front, withthe index-finger pressing the anterior thigh. If pressure in thepopliteal space fails to bring the foot within reach, withoutchanging the grasp, rotate the fetal body on its long axis, towardthe side of the leg desired. 518 A. J. S K E E L, For Example: Pos. Sacro Left Ant.: The left thigh is to theright and anterior—rotate the anterior trochanter from theright toward the mothers left. (See diagram.) If it were desired to flex the other leg, popliteal pressure withrotation in the opposite direction would effect the desired result. The anterior thigh being brought down with the foot outsidethe vulva, traction posteriorly on it will aid in engaging
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