478 FCETAL DYSTOKIA. 



course, to bring the foetus into the posterior lumbo-sacral position, with 

 the Hmbs forward and completely retained ; or into the anterior dorso- 

 pubic presentation, with the head and limbs retained. It can then be 

 dealt with as has been described for these presentations. 



No mention appears to be made in the literature of veterinary- 

 obstetrics of the cephalo-abdominal position (vertical dorso-lumbar pre- 

 sentation), though such is possible. The head of the foetus would be 

 towards the floor of the abdomen — though lack of space would prevent 

 the body being directly vertical, and either forward or backward. 



The measures necessary to remedy the position should be similar to 

 those recommended for the cephalo-sacral position, except that the 

 external manipulation would be exercised on the head of the fcetus, 

 instead of its hind-quarters. 



SECTION II.— DYSTOKIA FROM THE STERNO-ABDOMINAL 

 PRESENTATION. 



The sterno-abdominal presentation is a rather common one, particu- 

 larly in the Mare. The foetus is lying on its side, with the sterno- 

 abdominal region and crossed limbs — either flexed or extended — 

 presenting at the inlet or engaged in the passage, while the dorsal 

 region is towards the fundus of the uterus. 



There is no difficulty in discovei'ing this malpresentation, the hand 

 encountering the feet — usually all four — in the uterus, and generally 

 two or more of them in the genital canal. Nevertheless, as there are 

 two positions in the presentation, it is necessary to distinguish which 

 of them we may have to deal with. The situation of the head, of 

 course, defines the position ; so that we may have a right cephalo-ilial, 

 in which the foetus is lying on its left side, the head directed towards 

 the right flank of the mother ; and a left ceplialo-ilial , the reverse of the 

 preceding. If the foetus is vertically placed, with the head upwards, 

 then the position is cephalo-sacral ; when the head is downwards it is 

 cephalo-abdominal. 



Cephalo-Ilial Positions. 



In these positions the foetus is placed horizontally across the uterus, 

 with the body curved^ — the back convex in the majority of cases — so 

 that the abdomen is farther from the inlet than the back was in the 

 dorso-lumbar presentation. The left cephalo-ilial position (Fig. 148) is, 

 according to Saint-Cyr, much more frequent than the right. 



Usually, one or more of the limbs enter the genital canal, and even 

 protrude from the vulva ; but occasionally they are doubled against the 

 body and remain in the uterus, where they cannot be detected by the 

 hand. The head may also enter the canal or be retained in the uterus, 

 which is most frequently the case, and then it is either turned back- 

 wards, or placed above or below the body ; when the latter, then it is 

 either deformed or the neck is contracted. 



When the limbs appear at the vulva, if they are the hind and fore, 

 t-^o — a hind and fore — are at the right side and two at the left, though 

 they are sometimes crossed. "When they project equally, then it is an 

 indication that the transverse presentation is direct ; but if they are 

 unequally protruded it may be inferred that the foetus is lying obliquely 

 more in the vertebro-ilial position. In some instances only one limb 



