LECTURE LVII 

 DIFFICULT PARTURITION (DYSTOKIA) 



Nature's plan. — ^When the delivery occurs according to 

 nature's evident plan, the ligaments of the pelvis relax; the 

 water bag appears through the neck of the uterus and finally 

 outside the vagina; the neck and vagina gradually dilate to 

 accommodate the fetus, which presents first the apex of a wedge 

 or cone. 



Normal presentations. — We recognize two normal presenta- 

 tions, viz., the anterior, in which the two front feet and the nose 

 appear with the fetus resting upon its sternum, and the posterior, 

 in which the two hind legs and tail appear with the fetus resting 

 on the sternum. 



Variations from these cause difficulty in delivery. 



Cause. — The cause of difficult parturition may lie with either 

 the mother or the fetus, though more commonly with the 

 latter. 



If the fault lies with the mother, it is usually because of 

 premature delivery; extreme narrowness and closeness of the 

 pelvic outlet; volvulus; deformities of the pelvis (sometimes 

 fracture); tumors within the pelvis; or induration, hardening, 

 of the uterine neck. Sometimes the trouble is due to excessive 

 accumulations of fat within the pelvis. 



If the difficulty lies with the fetus, it is because of faulty 

 presentations, excessive size, monstrosities, or deformities. 



Common faulty presentations. — Faulty anterior presentations 

 may be : head, or head and neck doubled back ; two feet, or feet 

 and legs back ; or the neck and one front limb back ; or the neck 

 and both front limbs back. 



Faulty posterior presentation may be: one limb back and 

 doubled at the hock or stifle ; or both limbs back with one flexed 

 at each of these points, or both flexed at the same joint, which 

 may be either hock or stifle. Various other false presentations 



may occur. 



274 



