PELVIC PRESENTATIONS. 75 



may be detected at a very early period of labour ; it is better than 

 the eye, which may not only be injured, but may mislead ; it is 

 better than the malar bones, for these may be mistaken for the tuber 

 ischii, or even for the shoulder. The nose not only tells the pre- 

 sentation, but also the position. After the face has descended, the 

 chin will confirm it. 



Treatment. — Face presentations require more laborious effort for 

 delivery than others, from the fact that the cephalic extremity is re- 

 moved from the line of direction in which the uterus and accessory 

 powers act. The second stage is also longer, because the bones of 

 the tace are incompressible, and there is not the same adaptation to 

 the parts through which it is to pass. 



In ordinary cases little is required beyond watching the case 

 carefully, cheering and supporting the patient. If called early 

 enough, endeavour to rectify the presentation ; if not, to bring 

 the chin to the pubis by the gentlest assistance. In most cases no 

 interference is required ; the general rules already given are sufficient. 

 The features of a child born under a face presentation are generally 

 much swollen, turgid, and livid. We must be prepared, therefore^ 

 to expect some disfigurement, which, however, will generally dis- 

 appear in a day or two. 



Other deviations from vertex presentations sometimes occur from 

 the operation of the same or similar causes. The head may descend 

 half turned over, so that the occipito-frontal, or occipito-mental diame- 

 ter corresponds to those of the straits. In this case either the anterior 

 fontanelle or forehead will be the presenting part. Sometimes the 

 head is too much flexed, occasioning a part of the nucha to present 

 with the occiput. Again, it frequently happens that one of the pa- 

 rietal bones, or the ear, or the temple, being nearly parallel with the 

 plane of the superior strait, engages first. Such cases may either 

 correct themselves, or become the cause of preternatural labour. 



PELVIC PRESENTATIONS. 



Under the head of pelvic presentations are included those of the 

 knees and feet ; it matters but little, so far as the mother is concerned, 

 which end of the foetal oval presents at the superior strait, since 

 either can be born unassisted. These pelvic presentations are, how- 

 ever, more dangerous to the child than cephalic, either from the fact 

 that the placenta is often detached from the uterine surface before 

 the head is born, or from pressure upon the umbilical cord during 

 the exit of the head, either case being attended by the same result, 

 viz.; asphyxiation of tlie child. All practitioners agree that the 

 child is oftener born dead in pelvic prfesentations, than in those in 

 which the vertex descends first. 



CoMses. — Breech labours occur once in about every forty-five or 

 fifly cases; why they occur this often, or why they happen at all, 



