b 



DYSTOKIA DEPEND lAG ON ANTERIOR PRESENTATION, 443 



in the pelvis, cords should be fixed to the pasterns, and the trunk pushed 

 into the uterus ; assistants then pull moderately at the cords, and in such 

 a manner as to bring each limb to its own side, if the hand of the operator 

 cannot effect this in the uterine cavity. In this way a kind of rotation 

 of the limbs is effected, and they are brought each to its proper side, and 

 a little beneath the head. 



When the fcetus is firmly fixed in the pelvis, and retropulsion is impos- 

 sible, the limbs must be amputated, one after the other. Such an opera' 

 tion must, however, be very exceptionally required in this complication. 



3. Fore-limbs Flexed at the Knees. 



The fore-limbs flexed at the knees, and fixed under the neck and chest, 

 are a very frequent and often troublesome complication. It is generally 

 found in the Mare and Cow ; when it occurs in the Sheep and Goat it is 

 rarely of any importance, as delivery can usually take place without 

 assistance ; in the young of Carnivora, the metacarpal bones are too 

 short to offer any obstacle when the knee is flexed. 



This misdirection of the fore-limbs may occur in all the positions of 

 the anterior presentation, but chiefly in the vertebro-sacral position — the 

 most frequent. One or both limbs may be flexed, and the complication 

 is not unusually accompanied by a misdirection of the head ; hence, there 

 are several varieties of the complication, the most important being those 

 due to the general position of the foetus. We will follow Saint-Cyr in 

 studying it in three positions — the vertekro-sacral, vertebro-pubic, and vcrte- 

 bro-ilial. 



I. Vertebro-Sacral Position of the Fcetus. — If, at the moment 

 when the limbs of the fcetus enter the pelvic inlet, they are not quite 

 extended, and the feet are slightly below the level of the anterior border 

 of the pubis, the uterine contractions push them against that bone, and 

 there they remain ; at the same time the head enters the inlet, and as it 

 proceeds the limbs become flexed, the knees are bent and advance with 

 the head, but the metacarpals and phalanges are directed backwards 

 beneath the fore-arms, and the limbs thus doubled are applied against the 

 neck. We have, therefore, the head, fore-arms, and metacarpals in one 

 mass entering or being propelled into the limited space afforded by the 

 inextensible pelvic circle, and, according to circumstances, the hand of 

 the obstetrist will meet with these parts in varying relative positions, de- 

 pending on the stage of labor. When parturition has only recently com- 

 menced, the head has entered, or is about to enter, the inlet, and the 

 limbs placed beneath it are still somewhat free in the uterine cavity, 

 while the fcetus itself is not immovably fixed if the waters have not long 

 escaped. But when labor has been progressing for some time, the head 

 is well advanced in the passage — sometimes as far as the vulva ; but far 

 behind it are the limbs imbedded on each side of the neck — the knees 

 towards the head, the feet at the elbows. 



With the smaller ruminants, as already remarked, birth may take place 

 spontaneously even now, as they often have more than the one foetus, 

 and this is comparatively small, with regard to the pelvic diameter ; 

 while its bones are elastic and yielding. But with such animals as the 

 Cow and Mare the foetus is nearly always single and voluminous, and its 

 skeleton is rigid and unaccommodating, and can only undergo a very 

 sm ill reduction in size during its passage through the pelvis. 



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