DIFFICULT PARTURITION. 237 



accident that must be carefully guarded against on account of 

 probable blood poisoning. 



When one part presents, and others are to be secured or when 

 one has been secured and it is desirable to return it into the uterus 

 to secure another part, always make sure of the progress gained 

 by attaching one of the ropes to the part secured. If the patient 

 cannot be made to stand, always have her on the side opposite the 

 missing part which thus comes on top. Work between labor pains, 

 and when all is clear and ready to pull, the assistance should be 

 given moderately and while the mother is straining. 



Dropsies. — Sometimes the retarded delivery is due to large 

 accumulations of fluid in the brain cavity (hydrocephalus) of the 

 foetus, or within the abdominal cavity (ascites) or to a general 

 accumulation of fluids beneath the skin in the connective tissue 

 and also in the abdominal cavity (general dropsy). In these 

 cases the difficulty may be overcome by removing the fluid by 

 tapping the brain and squeezing the soft bones together, or tap- 

 ping the abdominal cavity and allowing the fluid to escape from 

 these. A large trocar is very convenient for this operation. 



Gaseous distention. — The difficulty may be clue to an ex- 

 cessive accumulation of gases within the body of a dead and de- 

 caying foetus and the obvious treatment is to tap with trocar or 

 knife and allow gas to escape. 



Embryotomy. — If it becomes necessary to open the foetal 

 body or remove one or more of the foetal limbs, the operator must 

 observe certain general precautions. 



Beware of injuring the maternal parts ; be patient and don't 

 be in a hurry. 



In case of twins with both presenting at the same time, try 

 to force one back into the uterus and deliver one at a time before 

 attempting dissection which is usually very tedious and very ex- 

 hausting to the operator and mother, as well. 



Always save the skin and leave plenty to cover the bones and 

 rough parts of the foetus, and to pull on. 



Removing a fore limb. — Take the one that is presenting, draw 

 out, as far as possible, cut around the ankle, and then cut the skin 

 on the inside of the limb up to the body and dissect the skin loose 

 from the limb, largely by fingers. Then cut the muscles between 

 the limb and the sterum. By twisting and pulling at the same 

 time the limb can then be removed entire, leaving the skin attached 



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