A manual of obstetrics . eechand the other by the head; after the delivery of the thoraxof the first child further progress may be arrested, whendigital examination will show that the head of the secondchild has descended into the hollow of the sacrum, whilethe head of the first is detained above the pelvic brim, thechins of both fetuses being in contact and a face directed toeach thorax (Fig. 139). Treatment.—(i) The chins must be disengaged, if pos-sible : this may beaccomplished bypushing up thehead of the breechpresentation and atthe same time push-ing aside the headof the second child:if
A manual of obstetrics . eechand the other by the head; after the delivery of the thoraxof the first child further progress may be arrested, whendigital examination will show that the head of the secondchild has descended into the hollow of the sacrum, whilethe head of the first is detained above the pelvic brim, thechins of both fetuses being in contact and a face directed toeach thorax (Fig. 139). Treatment.—(i) The chins must be disengaged, if pos-sible : this may beaccomplished bypushing up thehead of the breechpresentation and atthe same time push-ing aside the headof the second child:if this maneuversucceed, the firstchild must be drag-ged down to pre-vent a recurrenceof the condition. Rigid contraction of the uterus contra-indicates such a proceeding. (2) If the first fetus still beliving, forceps must be applied to the head of the secondchild and an effort made to drag it down past the thoraxof the breech presentation. (3) This failing, if the firstfetus be dead it must be decapitated and the second. Fig. 139.—Locking of heads in twin labor FETAL DYSTOCIA. 491 child delivered by forceps: if life still exist, it is yetpreferable to destroy the first child, since its chancesof living through the obstetric performances that will benecessitated are much less than those of the secondchild. (<^) Interlocking of the Occiputs.—In this conditionthe occiput of each fetus is jammed into the nape of theneck of its fellow. The treatment of such a complicationis the same as for the preceding. Other varieties of lockingare when the chin of one fetus fits into the nape of the neckof the other, or the head of the one is pressed against thelateral cervical region of the other. These cases must bedealt with according to the judgment of the operator.{e) Placenta Prcevia.—This is an exceedingly rare compli-cation of twin pregnancy. The reason that has beenadvanced for this rarity (Herman) is that the conditionof the endometrium, preventing the ovum from becomingimbedd
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
