LECTURE LVI. 

 OBSTETRICS— DIFFICULT PARTURITION. 



Nature's plan. — When the delivery occurs according to na- 

 ture's evident plan, the ligaments of the pelvis relax; the w^ater 

 bag appears through the neck of the uterus and finally outside 

 the vagina ; the neck and vagina gradually dilate to accommodate 

 the foetus, which presents first the apex of a wedge or cone. 



Normal presentations. — We recognize two normal presenta- 

 tions, viz., the anterior in which the two front feet and the nose 

 present, with the foetus resting upon its sternum, and the poste- 

 rior in which the two hind legs and tail present, with the foetus 

 resting the sterum. 



Variations from these produce more or less difficulty in de- 

 livery according as the presentation differs more or less from the 

 normal. 



The cause of difficulty may lie with either the mother or 

 foetus, more commonly with the latter. 



If the fault lies with the mother, it is usually because of pre- 

 mature delivery; of extreme narrowness and closeness of the 

 pelvic outlet; volvulus; deformities of the pelvis (sometimes frac- 

 ture) ; tumors within the pelvis; induration or hardening of the 

 uterine neck. Sometimes there is complete closure, and some- 

 times the trouble is due to excessive accumulations of fat within 

 the pelvis. 



If the fault lies with the foetus, it is because of faulty pre- 

 sentations, excessive size, monstrosities or deformities of the 

 foetus. 



Common faulty presentations. — Faulty anterior may be: 

 head, or head and neck douljlcd liack ; two feet, or feet and legs 

 back; the neck and one front limb; or the neck and both front 

 limbs back. 



Faulty posterior prer.cntation may be: one limb back and 

 doubled at the hock or stifle; both limbs back with one flexed at 



