230 



NORMAL PARTURITION. 



with as secondary positions after the reduction of a mal-presentation — 

 chiefly the dorsal or ventral. 



B. Posterior Presentation. — In this the cioup or breech first pre- 

 sents at the pelvic inlet. The lumbar region of the foetus, which is the 

 determinate point, may be directed towards the sacrum, the pubis, or the 

 right or left branch of the ilium of the female. Hence we have four 

 positions, as in the preceding presentation. These are : — 



I. Lumbosacral Positioti. — The foetus is in what some authorities have 

 called a '' natural " position, but which is asserted by others to be unnatu- 

 ral. The loins are towards the sacrum of the mother, the right coxo- 

 femoral articulation towards the right ilium, and the left articulation 

 towards the left ilium. This is sometimes named the first posterior posi- 

 tion. 



Fig. 59. 



LUM BO-SACRAL POSITION. 



2. Lumbo-puhic Position. — Some practitioners designate this the poste- 

 rior reversed position. The foetus, in fact, is lying on its back, its croup 

 and loins corresponding to the pubis of the mother, while the limbs are 

 towards the sacrum, against which they are more or less pressed. This 

 is sometimes termed the second posterior position. 



3. Left Lumbo-ilial Position. — The fcetus is lying' on its left flank, its 

 croup and loins opposite the ascending branch of the left ilium of the 

 female, and the limbs towards the right flank, where they must be sought 

 for if they do not present in the pelvis. 



4. Right Lumbo-ilial Position. — This is exactly the reverse of the pre- 

 ceding position. 



C. Dorso-lumbar Presentation. — Here the foetus is presented 

 across or transverse^ and it may lie on one or other of its sides, its head 

 towards one of the maternal flanks, and the body curved like that of a 



