A treatise on the science and practice of midwifery . rnal and internal manipulation, without passing the handinto the uterus, and subsequently that which involves the introduc-tion of the hand. Turning by Combined External and Internal Manipulation.—Toeffect podalic version by the combined method it is an essential pre-liminary to ascertain the situation of the foetus as accurately as pos-sible. It will generally be easy, in transverse presentation, to makeout the breech and the head by palpation; while, in head presenta-tions, the fontanel!es will show to which side of the pelvis the faceis
A treatise on the science and practice of midwifery . rnal and internal manipulation, without passing the handinto the uterus, and subsequently that which involves the introduc-tion of the hand. Turning by Combined External and Internal Manipulation.—Toeffect podalic version by the combined method it is an essential pre-liminary to ascertain the situation of the foetus as accurately as pos-sible. It will generally be easy, in transverse presentation, to makeout the breech and the head by palpation; while, in head presenta-tions, the fontanel!es will show to which side of the pelvis the faceis turned. The left hand is then to be passed carefully into the TURNING 449 vagina, in the axis of the canal, to a sufficient extent to admit of thefingers passing freely into the cervix. To effect this, it is not alwaysnecessary to insert the whole hand, three or four fingers being gen-erally sufficient. If the head lie in the first or fourth position, push it upwards andto the left; while the other hand, placed externally on the abdomen, Fig. First Stage of Bi-polar Version.—Elevation of the Head and Depression of the Breech. (After Barnes.) depresses the breech towards the right (Fig. 143). By this meanswe act simultaneously on both extremities of the childs body, andeasily alter its position. The breech is pushed down gently butfirmly, by gliding the hand over the abdominal wall. The head willnow pass oat of reach, and the shoulder will arrive at the os, andwill lie on the tips of the fingers. This is similarly pushed upwardsin the same direction as the head (Fig. 143), the breech at the sametime being still further depressed, until the knee comes within reachof the fingers, when (the membranes being now ruptured, if stillunbroken) it is seized and pulled down through the os (Fig. 144).Occasionally the foot comes immediately over the os, when it can beseized instead of the knee. Version may be facilitated by changingthe position of the external hand, and pushing the
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Keywords: ., bookcentury1800, bookdecade1870, bookidtre, booksubjectobstetrics
