DYSTOKIA FROM THE DORSO-LUMBAR PRESENTATION. 



477 



Cephalo-Sacral Position. 



As has been mentioned, in this position the anterior portion of the 

 body is higher than the posterior, and the head may be either turned 

 to one side or bent downwards. This accident is more rare than the 

 preceding. On exploration the back is discovered to be more or less 

 vertical, instead of horizontal, as in the cephalo-ilial positions ; though 

 it is seldom directly in front of the inlet, for one end or other of the 

 body is generally nearest it — sometimes it is the posterior, when the 

 presentation somewhat resembles the lumbo-sacral (Fig. 147) ; at other 

 times it is the anterior, when it is like the dorso-pubic. It therefore 

 happens that the hand will meet with the anterior part of the croup 

 and may feel the base of the tail in the first case, and in the other it 

 encounters the back, withers, and base of the neck. 



Fig. 147. 

 Transverse Pre.sent.\tion : Verticvl or Ceimialo-Sacrai, Position. 



This position is not so diflicult to deal with as the horizontal lumbo- 

 sacral, as it approaches the longitudinal presentations. 



Indications. — An endeavour must be made to bring one of the ends of 

 the body of the foetus to the inlet — that which is nearest this opening. 

 Ketropulsion is therefore necessary, pressure being made on tlie end 

 farthest from the inlet. If the mother is placed in the dorsal position 

 and the posterior parts of the fa^tus manipulated through the abdominal 

 walls, the task of the operator will be facilitated. When tlie posterior 

 parts of the fcetus are nearest the inlet, an assistant should push against 

 its lumbar region, so as to bring the buttocks and thighs in front of the 

 opening, while the operator with his hand on the repeller pushes the 

 dorsal region forwards. 



When the anterior part of the body is nearest the inlet — the mother 

 being in the dorsal position — the assistant pushes the hind-quarters 

 forwards and downwards, while the operator endeavours to bring the 

 neck towards him, using the crotchet if need be. The object is, of 



