The science and art of obstetrics / by Theophilus Parvin.

  • Parvin, Theophilus, 1829-1898.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of obstetrics / by Theophilus Parvin. Source: Wellcome Collection.

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    has ascended so far iu the womb that a foot can be felt, presents no real advantages and exposes to some daugers both immediate and remote; of course, the more completely the amuial liquor is retained the more readily version is accomplished—it is like turning a body floating in a bucket of water—but if the hand enters the amuial cavity imme- diately after the rupture, it acts as a plug and prevents the escape of any considerable amount of fluid. The search for the feet or for a foot is facilitated by the action of the free hand externally pressing upon the uterus, keeping it iu one position, and especially by pushing toward the internal hand the pelvis of the child. In this search two methods have been proposed, the one known as the German and the other as the French ; iu the former the hand is passed directly to the anterior plane of the foetus and then to the part where the feet and knees are; by the other plan the hand follows the lateral plane of the foetus until the lower limb is found, and then a finger may be hooked behind the knee, and the latter thus drawn to the mouth of the womb when the leg is extended and the foot brought into the vagina. The objections made by Hergott to the German plan, which he admits is the more rapid, is that upon the anterior plane the four members, hands and feet, forearms and legs, arms and thigh, are situated very near each other, and some- times crossed, so that difficulties of distinction may be presented, and the accouch- eur is liable to bring down a hand instead of a foot. He also states, however, that one is often compelled to do as he can, neglecting the rules which seem the best and safest. In regard to the selection of the foot of the foetus—usually only one will be brought down—and means of securing it, the reader is re- ferred to pp. 328-330. When the foot is brought into the vagina a noose of thick muslin may be placed around the ankle so as to have a secure hold by which traction can be exerted, and this traction be outside of the vagiua, the latter being a point of essential importance when, as in some cases of transverse presentation, the head cannot be dislodged, either by external pressure or by pulling upon the foot, and the hand must be introduced into the vagina to push it up. It must be remembered that the movement given to the pelvic end of the foetal ovoid by pulling upon one or both feet is to be assisted by a corresponding movement impressed upon the cephalic end by the hand pressing on it through the abdominal wall. If podalic version be required in shoulder presentation, when the arm has prolapsed, it is not always necessary to begin by returning the arm, but a noose is placed upon the wrist so that it may be drawn down when the chest is delivered, preventing its ascension by the side of the head ; of course, when the prolapsed arm interferes with the introduction of the operator's hand, the former should be pushed up in the anterior portion of the vagina. Turning having been accomplished the delivery of the child is, in most cases, left to uterine action, as in an original pelvic presentation. But if traction upon the limb or limbs be neces- sary, because of inefficiencv of uterine action or the necessity of speedy delivery it must be made simultaneously with the contraction ot the uterus, and assisted by manual pressure upon the abdomen. The rules as to the delivery of the trunk and head, the care of the cord and the treatment of ascension of the arm or arms are found ou pp.