Identifier: practiceofobstet00edga (find matches)
Title: The practice of obstetrics, designed for the use of students and practitioners of medicine
Year: 1910 (1910s)
Authors: Edgar, J. Clifton (James Clifton), 1859-1939
Subjects: Obstetrics
Publisher: 3rd ed., rev
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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of the neck; and itis, furthermore, the only part of the fetus which sinks into the maternal pelvisbefore labor. The breech always lies above the excavation of the pelvis untillabor begins. When either fetal pole is found in an iliac fossa, the presentationwill be transverse. 158 PHYSIOLOGICAL PREGNANCY. 4. Palpation of the Upper Fetal Pole.—To accomplish this satisfactorily,the position of the hands is in the opposite direction from that just described, thepalms being placed facing each other on the upper part of the abdomen, withthe fingers toward the patients head (Fig. 196). The head when found in theupper segment of the uterus can be subjected to ballottement, and otherwisehas the characteristics which have been mentioned (Fig. 200). The breechin the upper segment is less mobile, more voluminous, and softer than thehead (Fig. 196). 5. Location of the Cephalic Prominence.—(i) The hand is pressed trans-versely across the maternal abdomen, just above the symphysis, and the head
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Fig. 198.—Deep Pelvic Palpation to Determine the Amount of Engagement opTHE Presenting Part by External Palpation.—(From a photograph taken at theEmergency Hospital.) thus grasped and palpated (Fig. 197). The occipital side is that at whichthe hand sinks deepest into the pelvis; since the occiput itself is the part ofthe head which, as a rule, is deepest in this cavity. The greatest prominenceat the brim is, therefore, the forehead, most marked in the occipito-posteriorposition. (2) The right or left hand, with thumb and fingers separated as faras possible, grasps the fetal head just above the pelvic inlet (Fig. 197). Sincethe head in primigravidae is usually partially engaged in the pelvic inlet, it isadvisable to direct the thumb and finger-tips downward toward the pelviccavity. In multigravidse, by reason of the rather high situation of the headthe thumb and finger-tips are held more horizontally. In the latter case we THE EXAMINATION OF PREGNANCY, 159 can assist in the manoeuv

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