DVSTOKIA Fli'i'M THE STEKXO-ABDOMJXAL I'llESEXTATIVX. IM 



very often in the lurabo-ilial position, when it can now be changed 

 into the lumbo-sacral. In order to prevent the hind-quarters jamming 

 against the maternal ihum, the traction on the hind-hmbs should he 

 oblique — from right to left or left to right, according to the position of 

 the fa^tus — when bringing it into the inlet. 



When the liind-quarters are too distant to he brought first iiuo the 

 inlet, then anterior version should be tried. The hind-legs are pushed 

 into the uterus — though the fojtus may be delivered witla one, or even 

 both of these, Hexed under the body — but it is well to have them 

 corded before retropulsion is attempted. The head and fore-limbs 

 should also be corded, and knots ought to be made on all the cords 

 used in order to distinguish the parts to which they are attached. 

 Then, while traction is made on the head and fore-limbs, the croup 

 should be pushed forwards into the uterus ; if the head cannot be got 

 into a proper direction it, or one of the hind-legs on the side opposite 

 to it, must be amputated. If the foetus cannot be extracted from the 

 uterus without risk of bringing that organ with it, then — provided the 

 chest and abdomen can be reached — evisceration should be resorted to. 

 In those not infrequent cases in which the foetus has the limbs 

 doubled against the body, and can only be touched with the tips of the 

 fingers, the hind quarters of the mother should be lowered by placing 

 her on a sloping Hoor — on the back if necessary ; an assistant then 

 manipulates the ftt>tus through the abdominal wall, so as to move it 

 towards the inlet, where one or more of its limbs may be secured, and 

 •one or two repellers — or a repeller and crotchet — might now be utilized 

 to effect either anterior or posterior version. 



It must not be forgotten that, in some instances, the uterus itself 

 in this presentation offers a serious obstacle to delivery, when its 

 mucous membrane forms folds or bands towards the os, which prevent 

 access to its interior, and imprison the limbs of the fcetus. Through 

 these the hand must pass, and in trying to smooth or lay them down 

 the legs must be freed. 



CEPn.\LO-SACR.\L Position. 



In the sterno-abdominal presentation, this position is said to be less 

 frequently noted than the last, and of the cases reported the greater 

 number occurred in Mares. The fa'tus is more or less in a sitting 

 posture, the breech being towards the floor of the abdomen, and the 

 withers and head in the direction of the sacrum, or to one of its sides. 

 All the limbs are usually in the genital canal, and they may extend to 

 or beyond the vulva, the soles of the hoofs being inclined downwarels, 

 though it may happen that only two or three are visible. When all 

 protrude eciually, it is evident that the position of the fcetus is vertical; 

 but should the two fore or the two hind limbs project most, then the 

 position is oblique. 



It has been found that the foetus nearly always succumbs in this 

 position, though the mother may be saved. 



Indications. — Here again version must be resorted to, and this should 

 be posterior when all the limbs, or only the hind ones, protrude ; 

 the fore-limbs must be entirely, or tto a great extent, pushed forward 

 into the uterus, or, if that cannot be done, amputated at the knees or 

 elbow-joints — if possible at the shoulders — then traction on the hind- 

 limbs will complete deliver}-. 



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