A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter.
- Karl Schroeder
- Date:
- 1873
Licence: Public Domain Mark
Credit: A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
99/444 (page 81)
![bone the nose, forehead, and the whole head sweep oyer the peri- naemn. When the head is born the face Looks forwards and to the right. The shoulders enter the pelvis in the firsl oblique diameter, the right shoulder is fixed againsl the Lefi descending ramus of the pubic bone, and the left shoulder sweeps over the perinseum. In the second face presentation the delivery takes place in th< same way, mutatis mutandis. A swelling is formed on the presenting fare, for the same reasons that in head presentations a caput succedaneum is met with. It is situated close to the mouth at thai angle which is directed forwards —in first face presentations the right angle of the mouth. If the swelling is more considerable it extends over the whole cheek, the nasal region, and sometimes also to the other side, so that the face is frightfully disfigured, and bluish-black from suffused blood. The disfiguration disappears in a few days after delivery. In face presentation the shape of the foetal head is usually altered by passing through the pelvis. The change consists in a compres- sion of the head in the vertical diameter. The upper surface of the head is flattened; in the region of the large fontanelle there is si mi, times a kind of saddle-shaped depression; the occiput is drawn out and the longitudinal diameter of the head is lengthened. This change of shape also disappears a few days after birth. In treat- ing of the etiology, it will be mentioned that a hereditary develop- ment of the occipital bone predisposes to face presentations, so that a greatly prominent occiput may be still more lengthened by labour. According to the statistics of Winkel, face presentations occur as frequently in primiparse as in pluriparse; they are more frequent in a narrow pelvis than in the normal. The causes of face presentation are essentially those which result from the contractions of the uterus. These, by diminishing its transverse diameter, tend to change oblique positions of the foetus into longitudinal. The longitudinal positions are obtained by the ] »art which is situated high up being pushed into the fundus, i. e. the breech in most cases, whilst the part situated below—the head— is pushed into the brim. In large children this is often attended by great difficulties. If the child is so situated that its back is directed downwards to the pelvis, the breech having been forced into the fundus by the uterine contractions, the pressure of the other lateral wall of the uterus must chiefly act upon the forehead, whereby the curvature of the child is increased and the chin is closely pressed against the thorax. But if the child is situated with the back directed to the fundus and the abdominal surface to the pelvic inlet, the breech having again been pushed into the fundus, the pressure of the outer lateral wall of the uterus chiefly acts upon the occiput and forces it tightly against the nape of the neck. At the same time the contracting uterus forces the head downwards. The occiput is pressed against the uterine wall, whilst the forehead does not meet with any resistance. Under these conditions, although the expelling force is nearer to the occipui than to the forehead, yet the forehead descends lower, because the greater resistance, acting through the short arm of the lever (the occiput), prepon- derates over the slight resistance acting on the Long arm of the](https://iiif.wellcomecollection.org/image/b21004705_0099.jp2/full/800%2C/0/default.jpg)
