Fig. 67.—Shoulder presentation. Left-scapulo-anterior position. (Lenoir and Tarnier.)
Forceps are not recommended for application to the breech as they do not fit and are liable to slip off and injure both child and mother. The fingers are best.
Forceps are not recommended for the after-coming head unless the child is dead. If the child lives, the Smellie-Veit is more-successful; and if the child dies, the cranioclast, if possible, will save the mother much suffering and avoid some injury to the tissues.
Transverse or Shoulder Presentations.—These are cases in which the long axis of the child lies directly across or obliquely across the long axis of the uterus.
The shoulder (scapula) is the bony landmark, and the part which most frequently impends over the inlet. This presentation probably occurs once in two hundred labors.
It is due to the same conditions that were given for breech cases; namely, weak abdominal or uterine muscles, pelvic contraction, placenta previa, hydramnios, and twins.
It is easily recognized in pregnancy, and must not be neglected, for it is impossible of delivery without first changing it into a longitudinal presentation. If this correction is not done, rupture of the uterus is liable to occur, with the consequent death of both mother and child.
The treatment is invariably version.
Face and Brow Presentations.—The face presents once in about three hundred labors. In this case, the head is completely extended so that the occiput rests against the back of the neck. The trunk and spine are straightened out while the legs and arms remain in the normal attitude of flexion.
The causes of these anomalies must be sought in those conditions which bring about the deflexion of the chin. The most common are pelvic contraction, large child, placenta previa, hydramnios, goiter, anencephalus and multiparity.