480 



FCETAL DYSTOKIA. 



legs in the passage make the case more difficult, and. one only yet 

 more so ; while it is less embarrassing if all four limbs come together, 

 or two hind ones and a fore one. This statement is made on the 

 understanding that the presentation is either altogether transverse, or, 

 if oblique, that the hind-quarters of the foetus are nearest the inlet ; 

 but if the anterior part of the body is nearest, and if the head is 

 engaged, or can be easily brought into the passage, the fore-legs there 

 are an advantage to the operator, while the hind ones present at the 

 same time would be baffling. 



When the limbs cannot be laid hold of, the skill of the obstetrist is 

 most severely taxed, and all the more if much time has elapsed since 

 parturition commenced and amateurs have been at work. 



Indications. — It has just been remarked that posterior version is most 



Fig. 149. 



Sterno-Abdominal Peesentation, Hind Limbs most advanced, Head ketained: 



Calf. 



favourable for delivery in this presentation, and with this object in view, 

 the hind-limbs should be secured and corded at the pasterns — even one 

 limb is often sufficient if the other is not attainable. Should the head be 

 engaged, it must be pushed as far into the uterus as possible, and if 

 the fore-limbs are likewise present they must also be repelled. This 

 retropulsion is comparatively easy when there is plenty of room and 

 the straining is not very severe ; but in the Mare it is often the 

 opposite, and some authorities assert that it is impossible or very 

 dangerous to push the fore-limbs into the uterus, while others declare 

 that it can be done if the repeller be employed. If they cannot be 

 pushed into the uterus, then they must be amputated at the knee, 

 elbow, or shoulder, and the fore-part of the foetus thrust forward while 

 traction is made on the hind limbs ; gradually these approach the 

 vulva and pass through it, the hind-quarters follow — the body being 



