438 FOETAL DYSTOKIA. 



Version can only be effected in the uterine cavity, when the uterus is 

 entirely in the abdomen ; so if any portion of the foetus has entered the 

 inlet, retropulsion must be resorted to. Then the operation can be com- 

 menced. It is divided by Saint Cyr into two principal movements : 

 Repulsion and Evolution. 



In these manoeuvres, the veterinary obstetrist, as in so many other in- 

 stances, has not the advantages which the accoucheur of woman possesses 

 with regard to manipulation, and especially that which can be practised 

 outside the abdominal walls in conjunction with the version movements 

 in the uterus. 



Repulsion. — The hand — usually the right — being introduced into the 

 uterus, reaches the presenting^ part of the foetus, and by a succession of 

 forcible pushes, moves it away from the inlet — in fact propels it ; though 

 this retropropulsion should not be made directly forward, but obliquely, so 

 as to press the region we desire to get rid of upward, downward, or to 

 either side, according to circumstances. In this way, the opposite parts 

 -glide over the uterine walls — previously lubricated : they move round 

 towards the hand, and are more easily reached. 



Evolution. — When the parts which are sought for reach the hand, they 

 are firmly seized by the operator and drawn towards him. The uterine 

 contractions assist in this operation, the version movement is continued, 

 the foetus becomes lengthened, as it were, and unfolded, and when its 

 larger diameter is brought into the axis of the pelvis the manoeuvre is 

 completed. 



Version is not always successful when first attempted ; indeed, it has 

 often to be relinquished and again tried, until successful — notwithstand- 

 ing the fatigue and demands on patience these repeated efforts entail. 



Complete version is required in the transverse position of the foetus, 

 and is generally difficult ; it, and indeed all degrees of turning, and all 

 vicious positions of the foetus, demand that the first thing to be done is to 

 secure the most useful parts which present, as the limbs or head, by cords 

 or other appliances, so as to be able to find and utilize them again if cir- 

 cumstances require that they should be used to assist in delivery. Very 

 frequently traction on one or more of these cords, and the manipulations 

 of a hand in the uterus, will greatly facilitate turning. 



As in so many other obstetrical operations, undue haste and violence 

 are to be guarded against in these mutations, and gentleness, patience, 

 and perseverance observed. We not unfrequently find that, when the 

 presentation is anterior or posterior, and the limbs are in a favorable 

 direction, though the body of the foetus may be somewhat inclined to the 

 right or left, the uterine contractions are sufficient to effect adjustment, 

 gradual and well-directed traction being alone required from the operator. 



Independently of the general mutatio7is which have for their object the 

 movement of the whole mass di the foetus in the uterus, it is sometimes 

 only required to resort X.o partial mutations — as in the adjustment of one 

 or more of the limbs, head, neck, etc., these consisting of exte?ision — as 

 when the arm is extended on the shoulder, the fore-arm on the. arm, the 

 head on the neck, the latter on the trunk, etc., Tiudjlexion, in bending the 

 various articulations — as those of the limbs, in order to place them or the 

 body in a better direction ; and rotation. In all these manoeuvres, a 

 rudimentary knowledge of mechanics will be of great advantage, and 

 particularly that pertaining to levers, which is particularly applicable 

 to manipulations of the limbs, that so frequently prove of the greatest 

 service in obstetrical operations. 



