DYSTOKIA FROM TRANSVERSE PRESENTATIONS. 495 



us as to the situation of the head, this being always of course in the direction 

 ■of the anterior limbs. In order to be able to do this, retropulsion has 

 often to be employed. 



We have mentioned that the limbs are always the first to appear at the 

 inlet in this presentation, and that four, three, or only two may be 

 engaged — the others being flexed and retained beneath the body of the 

 foetus. When only two limbs are at the inlet, they are necessarily a hind 

 and fore. The head may or may not accompany the presenting limbs, 

 or lie so deep in the uterus as to be inaccessible to the hand of the 

 obstetrist. 



From this circumstance, there are eight varieties in this presentation, all 

 of which are, nevertheless, fundamentally the same. They are as fol- 

 lows : (i) Hind and fore-limb presenting, with or (2) without the head ; 

 (3) Two fore and a hind-limb, with or (4) without the head ; (5) A fore 

 and two hind-limbs, with or (6) without the head ; (7) All the limbs, 

 with or (8) without the head. 



Fig. 142. 

 Sterno-abdominal Presentation, Head retained : Calf. 



A verj^ careful examination will lead to the discovery of the fore and 

 hind limbs, should the head not be within reach. We have already 

 pointed out how they may be distinguished by the hand. But in this 

 presentation it has to be remembered that, when they are engaged in the 

 genital canal, they cross — the hind crossing the fore-limbs in such a way 

 that the latter are directed towards the hinder part of the body of the 

 foetus, and the former towards the anterior region. The hind and fore- 

 feet, when engaged, may also be some distance forward, should one end 

 of the body be nearer the inlet than the other. 



Indications. 



In the ooinion of some obstetrists, this is one of the most serious 



