A manual of obstetrics . e first blade. is applied. One of the blades, depending upon the pelvic diameter inwhich the head is resting, must be rotated upward and theinstrument locked. Compression to the desired amount 442 A MANUAL OF OBSTETRICS. may be slowly made and the head delivered (Figs. 11 i-i 13).Very often the operator will find that after evacuation ofthe cranial contents the head will collapse to such an extentthat it may be delivered by the craniotractor, crushing beingrendered unnecessary. The eighth step of the operation,then, is extraction of tJic head by the craniotractor. One
A manual of obstetrics . e first blade. is applied. One of the blades, depending upon the pelvic diameter inwhich the head is resting, must be rotated upward and theinstrument locked. Compression to the desired amount 442 A MANUAL OF OBSTETRICS. may be slowly made and the head delivered (Figs. 11 i-i 13).Very often the operator will find that after evacuation ofthe cranial contents the head will collapse to such an extentthat it may be delivered by the craniotractor, crushing beingrendered unnecessary. The eighth step of the operation,then, is extraction of tJic head by the craniotractor. One bladeof this instrument is introduced through the cranial perfora-tion and passed upward until it grasp the base of the skull;the outer blade is then applied directly over the ear or theface, and steady traction exerted, the vagina being guardedfrom injury by the fingers of the left hand. In some cases ofgreat difficulty comminution of the skull becomes necessary,portions of the cranial bones being broken off by the cra-. FiG. 114.—Craniotomy on the after-coming head : one method of perforating (Dickinson). niotractor. When this is done the utmost care is requiredto avoid laceration of the maternal soft parts by the sharpspiculae of bone. 9. Extraction of the trunk, either manuallyor by the craniotractor. Perforation of the After-conwig Head.—Occasionally, inbreech presentations complicated by hydrocephalus or in PRESENTATION OF THE FACE. 443 those cases of contracted pelvis in which an unwarranted ver-sion has been performed, with ultimate inability to deliverthe after-coming head, it becomes necessary to resort to cra-niotomy (Fig. 114). The operation in such a case is generallyunattended with difficulty, the steps being as follows : i. Anassistant grasps the fetal body and carries it upward andover the maternal abdomen. 2. Perforation.—This may beaccomplished in one of two ways according to the positionof the occiput. When the latter is anterior under the sym-physis pu
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
