Cranial presentations and cranial positions : suggestions, practical and critical / by R.U. West.

  • West, Robert Uvedale, 1810-1870.
Date:
1857
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Licence: Public Domain Mark

Credit: Cranial presentations and cranial positions : suggestions, practical and critical / by R.U. West. Source: Wellcome Collection.

    61/78 page 47
    I cannot find notes of any other occipito-pubic cases, unless the following very remarkable one may be regarded as belonging to that class:— “ No. 2107.— Sept. 9, 1853.—I am quite clear that in this case, 1, for a full hour, felt the head in the first position, the posterior fontanelle directed, as usual, to the left side. When the os uteri was nearly fully dilated, the head began to roll about, and I plainly felt the postoiior fontanelle pass to the symphysis pubis, the head being still very high in the pelvis—too high to descend in such a posi- tion. I assisted it back again to the left side. But during a pain, and while 1 had my finger applied to it, the posterior fontanelle rolled again to the sym- physis, and thence to the right side ! when 1 felt the left lambdoidal suture point- ing to the symphysis, with the left parietal protuberance presenting. In this position, the head passed into the pelvis, cleared the os uteri, and was expelled in the usual way. Before the posterior fontanelle passed to the symphysis, 1 had felt the right parietal protuberance as the presenting part.—N.B. I felt both fontanelles in both positions, and the head being a well-ossified one, with nothing unusual about the fontanelles, I could not he deceived, the anterior being very wide, and the posterior nearly closed. A veiy wide pelvis.”—Note in JRegister. In accordance with my own arrangement, I registered this case as one of second position. It was, perhaps, as much a case of unusual deviation from the normal progress of labour as one of unusual position; as was, perhaps, the following, which may be regarded also as a doubtful example of_/ronto-pubic position:— “ No. 2134.— Od. 14, 1853.—Strange ca.se I I first felt anterior fontanelle to left side of pubis, the left branch of the coronal suture running to symphysis. Quite satisfied it was the anterior fontanelle, as I felt the four radiating sutures over and over again, and the fontanelle was large. As the os dilated, it ap- proached nearer the symphysis, until I felt it distinctly in the position repre- sented in Plate IV., fig. 1. Now the head was very loose, and rolled about, the pelvis wide, and the pains, though effective in dilating the os uteri, very slack, weak, and infrequent. To my surprise, having omitted taking a pain, I found, when I examined again, that the fontanelle had passed to the right side of the pubes, as shown in Plate IV., fig. 2; and the posterior fontanelle became perceptible to the touch—more easily felt now vnth the right hand, than when it was lying on the right side, as just before. The anterior fontanelle then gra- dually came round more to the side, and the labour proceeded as bregmato- anterior cases of first position usually do, the occiput coming to the arch by the left side. The posterior fontanelle proved to be well ossified, and not at all likely to be mistaken for the anterior, even if I had not fairly traced the latter from the left side to the symphysis, and thence to the right side. Besides, how much more unlikely, even than what 1 have described, would it have been, if the posterior fontanelle had first advanced close to the symphysis, and then gone quite back?”—Note in Register. This case, therefore, I registered as one of first position.^ breg- mato-cotgloid variety. I need not say anytliing hero on the subject of transverse posi- tions of tlie cranium, having already {ante, pages 23, 24) sug- gested an explanation of the supposed occasional occurrence of such positions. Presentations of the ear are not alluded to by Niigele. They afe occasionally met with, and are surely varieties of cranial position. They are very rare. I have myself only met witli two
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