482 FCETAL BY ST OKI A. 



Should the fore-limbs be most advanced, anterior version must be 

 attempted — this will bring the fcetus into the dorso-sacral position ; 

 but it is a troublesome operation, and necessitates retropulsion of the 

 hind-limbs, or their removal wholly or partially, as well as straighten- 

 ing the head and neck. If neither of these measures appears advisable, 

 the fore-limbs may be entirely removed or amputated at the elbow- 

 joints, and posterior version adopted ; evisceration of the foetus, by 

 diminishing its volume, will facilitate delivery. 



A cephalo-ahdominal position — vertical sterno-abdominal presentation 

 — has been described, but it must be exceedingly rare, and the remarks 

 that have been made with regard to the cephalo-sacral position are 

 equally applicable to this. 



A lateral or costal presentation has also been noticed by several 

 writers. In this the foetus, having the limbs doubled under the body, 

 presents at the inlet by one of its sides, as it lies horizontally on its 

 chest and abdomen. The limbs are more or less accessible to the 

 operator, and therefore the mode of extraction is obvious after what 

 has been said of the other presentations. 



■Jt. 



