We have been more fortunate. True enough the affection was slight, but we delivered by the forceps an infant which lived 5,1 months.
Presentations of the pelvic extremity render the prognosis still more unfavorable.
In case of the mother the prognosis depends purely on the conduct of the accoucheur. Early diagnosis and intervention are in her favor.
The mother usually dies from rupture of the uterus, or from trauma tism during efforts at delivery.
Trectiment.—This varies according as the presentation is of the vertex or the pelvic extremity.
In case of the vertex, as we have before-stated, if the affection is slight, spontaneous labor is possible. If the affection is more pronounced, the forceps may be tried, but if after a number of prolonged tractions the head does not come down, we should at once perforate. Certain authors, in the hope of giving the infant a chance, have counselled puncture with a fine trocar. This hope is a vain one. The head must be extracted by the cephalotribe or the bone forceps. We prefer the former. Certain
authorities have recommended version. This should never be attempted before diminution of the head, and afterwards we do not see what advan tage it offers over the cephalotribe.
In case of presentation of tho pelvic extremity traction will sometimes deliver, but also sometimes result in separation of the trunk. Perforation, after one or another fashion, should be the rule. Lacroix and Van Huevel have advocated evacuation of the fluid through the vertebral canal. Tar flier has done this a number of times. He makes an incision with a bis touri down to the vertebra, and then pushes a catheter through the rachidian canal into the cranial cavity. In 1878, Maggioli succeeded by this method. Indeed, it is so simple that it should be resorted to in every case of pelvic presentation with hydrocephalus. (Fig. 170.) In certain rare cases, finally, the infants have presented transversely. Tarnier, Koscia, Gripat (1873) have recorded cases. After version, evacu ate the fluid as indicated above.