374 F(ETAL DYSTOKIA. 



The dangers of strangulation are also much less when the foetus 

 presents anteriorly ; when the presentation is posterior, there is risk of 

 suffocation, because it is difficult to ascertain the situation of the cord 

 in order to divide it ; and the uterine contractions, as well as the arti- 

 ficial traction, tend to tighten the funis around the neck. 



In the human species, it has often been remarked that children are 

 sometimes born with their limbs deficient, and the spontaneous amputa- 

 tion has been attributed to the constriction produced by this coiling or 

 twisting of the umbilical cord around the part, during the development 

 of the foetus. Vrolig, Hillairet, and Goubaux have recorded similar 

 mutilations in animals. 



Diagnosis. 



There are so many causes of dystokia, that it is often a puzzhng 

 matter to ascertain that which is really in operation in some instances, 

 and this is one of them. When nothing can be discovered as likely 

 to hinder birth — neither narrowness of the passages, excessive size 

 of the foetus, malpresentation, or other obstacle — a careful examination 

 should be made of the umbilical cord, in order to ascertain whether 

 it is relaxed or tight, or encircling any part of the body. If it is 

 relaxed, then the obstacle must be sought in something else ; but if it 

 is in a state of tension, and especially if round the neck or limbs, then 

 to it may be ascribed the dystokia. 



Indications. 



When coiling of the funis is ascertained to be the cause of difficult 

 parturition, the indications are to uncoil it ; or if this cannot be effected, 

 then it must be divided either by the fingers, scissors, or a probe- 

 pointed bistoury — hastening delivery as much as possible afterwards. 

 There is not much to be feared from haemorrhage after section of the 

 vessels, as they seldom bleed. 



But to avert danger from haemorrhage or asphyxia, delivery must be 

 delayed as little as possible. A ligature around the cord before birth will 

 certainly produce asphyxia very promptly. In order to prevent both of 

 these occurrences — asphyxia and haemorrhage — Saint-Cyr proposes to 

 pass a string around the umbilical cord, leaving its two ends outside the 

 vulva ; these are passed through the two holes at the end of a porte-cord, 

 one of them being fastened with a knot there, while the other is carried 

 through the ring at the handle. When the umbilical cord is about to be 

 cut, this instrument is pushed into the uterus close to the body of the 

 foetus, and the line being pulled tight, the vessel is divided on the 

 placental side. This checks haemorrhage, and delivery can be effected 

 without much, if any, hindrance from the porte-cord, which can be 

 held by an assistant, the string being tied firmly round the handle, if 

 need be. 



Excess in Volume of the Fcetus. 



Excess in volume of the foetus, due to normal or abnormal development 

 of either the whole or only part of its body, is far from constituting an 

 unfrequent cause of dystokia in the domestic animals — rendering 

 spontaneous birth more or less difficult or altogether impossible, not- 

 withstanding the healthy condition of the maternal organs, the regu- 



