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GYNECOLOGY ANI) OBSTETRICS 291 a movement termed "anterior lateral flexion/' the head descends forward into the axis of the fore pelvis and onto the perineum. (See Plate III.) "Anterior lateral flexion is the movement imparted to the head by the cephalic application of forceps, even before any traction is attempted, as the posterior blade of the forceps cannot avoid angulating the long axis of the head away from the low posterior pelvis into the fore pelvis." 16 Actually, when the caput is bulging the perineum at the height of a contraction, the head may recede upward to the low mid pelvis between Fig. 23.—Diagrammatic representation of the axis of descent as revealed by this investigation. A line joining similar points on the series of fetal heads reveals general character of the curved axis. Note the angular relationship between the fetal axis and the perpendicular axis of the pelvis, and the difficulty of anatomically associating the relation of head to pelvis at any given level. The fetal piston moves upward and downward in a straight line with each contraction. Note relationship of its position to the static pelvis at the following levels: (1) During engagement from a posterior parietal position at the inlet. (2) At low level in « posterior pelvis (see Fig. 24, C. D. (3) Shift forward with descent along inclined plane of out et. (4) On perineum to distend it by straight drives downward in axis of fore pelvis. Plate III-20. (Courtesy of the Authors) contractions. Hodge and others have noticed that the head descends until the biparietal diameter is opposite the intertuberous diameter of the pelvis before extension occurs—coincident with this the occiput has partially passed through the subpubic arch. Understanding of this mechanism explains the principle well known to every obstetrician, of elevating the handle of the forceps only after the caput is well showing. In other words, traction must be made in the axis of the fore pelvis to cause the head to descend downward and forward, even partially through the subpubic arch, before the act of extension is encouraged.
Object Description
Rating | |
Fixed Title * | NCHH-16: Transactions of the Medical Society of the State of North Carolina [1891-1939] |
Document Title | Transactions of the Medical Society of the State of North Carolina [1891-1939] |
Subject Topical | Medicine -- North Carolina -- Societies, etc. |
Subject Topical Other | Societies, Medical -- North Carolina. |
Description | After 1939 transactions published in the North Carolina Medical Journal |
Creator | Medical Society of the State of North Carolina. Annual Session. |
Publisher | Raleigh, N.C. : Medical Society of the State of North Carolina, 1891-1939. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1938 |
Identifier | NCHH-16-085 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 85 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-16/nchh-16-085.pdf |
Document Sort | all; group-d; nchh-16 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-16-085 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-16 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2983307 |
Description
Fixed Title * | Page 291 (image) |
Document Title | Transactions of the Medical Society of the State of North Carolina [1891-1939] |
Subject Topical | Medicine -- North Carolina -- Societies, etc. |
Subject Topical Other | Societies, Medical -- North Carolina. |
Description | After 1939 transactions published in the North Carolina Medical Journal |
Creator | Medical Society of the State of North Carolina. Annual Session. |
Publisher | Raleigh, N.C. : Medical Society of the State of North Carolina, 1891-1939. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1938 |
Identifier | NCHH-16-085-0329 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | transactions851938medi_0329.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 85 |
Page Number | 291 |
Health Discipline | Medicine |
Full Text | GYNECOLOGY ANI) OBSTETRICS 291 a movement termed "anterior lateral flexion/' the head descends forward into the axis of the fore pelvis and onto the perineum. (See Plate III.) "Anterior lateral flexion is the movement imparted to the head by the cephalic application of forceps, even before any traction is attempted, as the posterior blade of the forceps cannot avoid angulating the long axis of the head away from the low posterior pelvis into the fore pelvis." 16 Actually, when the caput is bulging the perineum at the height of a contraction, the head may recede upward to the low mid pelvis between Fig. 23.—Diagrammatic representation of the axis of descent as revealed by this investigation. A line joining similar points on the series of fetal heads reveals general character of the curved axis. Note the angular relationship between the fetal axis and the perpendicular axis of the pelvis, and the difficulty of anatomically associating the relation of head to pelvis at any given level. The fetal piston moves upward and downward in a straight line with each contraction. Note relationship of its position to the static pelvis at the following levels: (1) During engagement from a posterior parietal position at the inlet. (2) At low level in « posterior pelvis (see Fig. 24, C. D. (3) Shift forward with descent along inclined plane of out et. (4) On perineum to distend it by straight drives downward in axis of fore pelvis. Plate III-20. (Courtesy of the Authors) contractions. Hodge and others have noticed that the head descends until the biparietal diameter is opposite the intertuberous diameter of the pelvis before extension occurs—coincident with this the occiput has partially passed through the subpubic arch. Understanding of this mechanism explains the principle well known to every obstetrician, of elevating the handle of the forceps only after the caput is well showing. In other words, traction must be made in the axis of the fore pelvis to cause the head to descend downward and forward, even partially through the subpubic arch, before the act of extension is encouraged. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-16/nchh-16-085.pdf |
Document Sort | all; group-d; nchh-16 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-16-085 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-16 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2983307 |
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