If the head at this early stage of labour be high up in the pelvis, viz.
has scarcely entered the brim, as is frequently the case in multiparæ, the
sagittal suture approaches in its direction to that of the transverse
diameter, or to one between the transverse and oblique diameters, the
posterior fontanelle corresponding to about the left acetabulum. The
higher the head is in the pelvis, the nearer does its greater diameter
correspond to the transverse one of the pelvis: the more oblique also is
its perpendicular diameter, from which reason the right ear at this time
can usually be felt without difficulty behind the pubic bones. Sometimes
both fontanelles can be reached with equal ease; most frequently the
posterior one is lowest, but occasionally the reverse is the case, and it
is the anterior fontanelle, without, however, at all influencing the
progress of the labour.
As the head advances through the brim and begins to enter the cavity of
the pelvis, the sagittal suture corresponds more closely with the right
oblique diameter, so that now the posterior fontanelle is turned towards
the left foramen ovale, and as it approaches the outlet of the pelvis, the
occiput advances still more forwards, although the head entirely quits its
oblique position. At this stage of the labour, the fontanelles can usually
be again reached with equal facility, and we find the anterior one
corresponding to the right sacro-iliac synchondrosis, the occiput is
completely behind the left descending ramus of the pubes, the right
lambdoidal suture running parallel with it. Owing to this slight change in
the position of the head, the occiput having advanced somewhat forwards,
we no longer feel the right parietal protuberance to be lowest and in the
centre of the pelvis, but the finger now touches upon the posterior and
superior quarter of the right parietal bone, for this is the part of the
head which first comes under the pubic arch, and first enters the external
passages.
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