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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stead of this physiological repose, however, prolongedinertia may develop. In such cases the second child may be in a transverseposition, and in any case the second membranous sac should be ruptured atthe expiration of half an hour. The cervix being fully dilated and the cordof the first fetus still connected with the placenta, the chances for intrauterineinfection are considerable. The fetal presentations run as follows in twin labors:the commonest form is the double vertex (Fig. 762); next, the fetus to bebom first presents by the head, the other by the breech (Fig. 764); third, thefirst fetus presents by the breech, the second by the head; fourth, a head and ashoulder presentation are associated, the first child usually presenting by the head.Two shoulder presentations occur infrequently (Fig. 761), while two pelvic pre-sentations are very exceptional. Averaging a large number of presenting parts inmultiple births it is found that about 54 per cent, are cephalic, about 32 per cent.
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Figs 758 to 764.—PresentationsIN Twin Deliveries. — (AfterDickinson.) Fig. 764. 5.55 556 PATHOLOGICAL LABOR. pelvic, while the remainder are shoulder. About three-fifths of the heads are inthe first, the remainder in the second cranial positions. It very seldom occursthat both heads are in the same positions. As a rule, the fetuses are face to face,and the one on the left side is bom first, the right coming after in the secondcranial position. If the fetuses are placed one behind the other, the headsshould be in the same position. In regard to abnormal presentation in twinpregnancy, bregma, brow, and face positions occur more frequently than withsingle births, comprising not less than lo per cent, of cephalic births. Bregmapresentation is probably increased because of the diminished prominence of thefrontal region in twins, which reduces the resistance encountered at the pelvicinlet. As a rule, brow and face presentations run a more favorable course thanin single labors. (For diag

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