Although the symptoms of malposition of the child during the last few days before, or at the commencement of labour, are far from being distinct, still, however, when taken collectively, they will be sufficient to excite our suspicion. The abdomen is irregularly distended, and marked with unequal prominences; anteriorly, it is more or less pointed. It is usually much increased in breadth, and this is generally in an oblique direction, forming a globular protuberance at the upper part on one side, and at the lower part on the other: the former is the pelvic extremity of the child; the other, from its size, form, and hardness, may easily be recognised as the head. "The movements of the child feel differently to what they did before; they are no longer exclusively confined either to one side or the other. Sometimes, as before-mentioned, cramp-like pains are felt in the abdomen, during which it is more or less distorted with violent movements, apparently of the child, as if it were trying to force its way through the abdominal parietes at this spot." (Naegelé, _Lehrbuch_, p. 223.) Upon examination _per vaginam_, either no presentation is to be reached at all, or only small parts can be indistinctly felt, such as the hand, the arm, or the shoulder. The not being able to feel a presenting part in a primipara shortly before or at the commencement of labour, is an unfavourable symptom; for the head at this time ought to be deep in the cavity of the pelvis; still, however, it does not necessarily prove that the child is presenting wrong, for it may be a presentation of the nates, which, as we have before shown, do not descend so low into the pelvis just before labour, as the head does; or it may arise from the unusual size of the child's head, especially in cases of congenital hydrocephalus. It may arise from a large quantity of liquor amnii, and where the head is nevertheless presenting; it may be a case of twins, or lastly of dystocia pelvica, where the head is presenting, but unable to pass through the contracted brim. In women who have had several children, it is frequently impossible to reach the presentation during the early part of the labour: this arises either from the abdomen in these cases being generally more or less pendulous, or from the circumstance of the uterus having been distended in so many previous pregnancies: its lower part does not become so fully developed as before, but continues more or less funnel-shaped, a considerable portion of the cervix still remaining. Where this is the case, the head will not descend so low as usual at first, but remains out of reach, or nearly so, until the os uteri is fully dilated and the membranes have given way.