Midwifery opératoire : un guide des difficultés et des complications de la pratique midwifery . sans très grande difficulté; mais s'il y a une malformation anypelvic, peu importe la légère, le travail peut être bothdifficile et dangereux, et l'une des principales opérations peut nécessiter une exécution. Comme je l'ai mentionné ailleurs, le rasage maternel rachitique souvent des enfants relativement grands. La tête de l'enfant cause, en règle générale, le plus de difficulté, car, parataltogether de sa taille, les os sont souvent indûment ossifiés, et sothe tête ne moule pas bien. Cependant, peu souvent, la ceinture de roches est l'ap

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Operative midwifery : a guide to the difficulties and complications of midwifery practice . without very great difficulty; but if there is anypelvic malformation, no matter how slight, the labour may be bothdifficult and dangerous, and any of the major operations may requireto be performed. As I have mentioned elsewhere, rachitic mothershave often relatively large children. The head of the child causes, as a rule, the most trouble, for, apartaltogether from its size, the bones are often unduly ossified, and sothe head does not mould well. Not infrequently, however, theshoulder girdle is the part of the foetus which has the greatestdifficulty in passing through the pelvis. 1 Archiv f. Gijn., Bd. lxxiv., Heft 3., p. 556. 2 Dub. Journ. Med. Sciences, July, 1905. 97 7 98 OPERATIVE MIDWIFERY General Foetal Dropsy (Fig. 55) occasionally may cause con-siderable dystocia. Some time ago in the Maternity Hospital I hada case under my care, and although the delivery was not extremelydifficult, it was somewhat trouhlesome, for the limhs tore off whenever any traction was made upon them.. Fig. 55.—General Fcetal Dropsy.(From a photograph of a case in the practice of Dr. -lames Dmil]>.) A case of this kind was recently reported by Walther where therewas considerable difficulty in getting the second twin away, as thelimbs came off with the slightest traction, and, even although thetissues were torn, little fluid escaped. Ballantyne, -summing up the histories of the labours in such cases, 1 Frommelfl Jahresbericht iiber Geb. u. ti.yn., 1904, p. 887.8 Antenatal Pathology and Hygiene, p. 290. MALFORMATION OP THE FGETUS 99 writes : The birth of a dropsical infant was, if near the full term, atedious and often an instrumental matter. Abnormal presentationswere unusually common. The delay in labour was sometimesovercome by the natural efforts and sometimes by manual orinstrumental traction ; but in certain instances the procedureswhich were finally adopted before birth (in fragments)

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