#52’s Case of a Uterine

TorsionA TWIST OF FATE

By: Amy Sanders Advised by Dr. Jenna Bayne

March 28 th, 20147 years oldCharolais Approximately 1000 lbsBCS 5/9Full term Owner rectally palpated:

Uterus felt twisted Fetus still was presumptively alive

CASE PRESENTATION OF #52

Usually occurs at the termination of gestation (Gestation length 280 days)

Prolonged Stage I ParturitionNo clear age or season predisposition Multiparous > PrimiparousCommonly Reported Breeds: Brown Swiss, Holstein,

and Charolais is a high-risk breed. Can be twisted CLOCKWISE or COUNTERCLOCKWISECan range from 180-720

WHAT IS A “TWISTED UTERUS”?

Instability of the gravid uterus Small non-gravid horn

Excessive fetal weight Broad ligament: Body vs. HornsWhen a cow lies down gravid uterus is

suspended in abdominal cavity. a sudden slip or fall could cause the gravid uterus to twist

Increased fetal movements during 1 st-stage labor

Decreased amounts of uterine fluidFlaccid uterine wallConfinement in stables for long periods can

contributeFUN FACT: TWINS can PREVENT torsion

WHAT IS A “TWISTED UTERUS”?

Normal Presentation

Clockwise (twisted to the RIGHT)

Counter Clockwise (twisted to the LEFT) MORE COMMON

DO THE TWIST

FeverTachycardiaTachypneaAnorexiaStrainingVaginal Discharge

CLINICAL SIGNS OF UTERINE TORSION

HOW TO DIAGNOSE WHAT WAS FOUND WITH #52

VAGINAL EXAM Twist will be caudal to cervix CORKSCREW EFFECT Torsion <360 may be possible to reach

the cervix #52 had a 180 twist Fetal limb could be felt through the

cervix: Upon stimulation of the limb there was no

reaction from the fetus

RECTAL EXAM Feel Broad Ligaments

The Right Broad Ligament was stretched= COUNTER CLOCKWISE TWIST

Manual Detorsion via VaginaRolling the cowDetorsion RodCesarean Section

HOW TO UNTWIST

COUNTERCLOCKWISE TORSION Lay in LEFT lateral and roll LEFT 360

CLOCKWISE TORSION Lay in RIGHT lateral and roll RIGHT 360

NON-SURGICAL CORRECTION:“PLANK IN DA FLANK”

Roberts, Stephen J and Hillman, Robert B. An Improved Technique for the Relief of Bovine Uterine Torsion.

Place chains as far up the limbs you can reach as possible

Place chains through one eye on the barPush into cow between calf limbs and start to hand

twist until tightPlace a bar in the outside eye and rotate.

NON-SURGICAL CORRECTION:DETORSION ROD

Uterus cannot be corrected by rollingCervix does not dilate to suffi ciently deliver the fetusFetal proportion or anomalies prevent delivery of the

fetus

APPROACHS: RECUMBANT LEFT FLANK VENTRAL MIDLINE OBLIQUE PARAMEDIAN STANDING LEFT FLANK

SURGICAL OPTIONS:CESAREAN SECTION

PROS The cow is standing so more comfortable for the surgeon Closure Simplified

CONS Less exposure Cow can go down Peritoneal contamination

PROS AND CONS OF STANDING LEFT FLANK

Pre-Op Treatment: Epinephrine 10 mL IM injection Flunixin Meglumine (1.1 mg/kg) 15 mL IV injection Florfenicol (6 ml/100lbs) 90 mL Subcutaneous injection

Inverted “L” block with 250 mL 2% Lidocaine Incision midway between last rib and the wing of the

ilium ending approximately ten inches vertically, individually incising through: Skin External Abdominal Oblique Internal Abdominal Oblique Transversus Abdominus Peritoneum

LEFT FLANK C-SECTION STEPS

Palpate the uterus, pull limb If forelimb:

Carpus to toe pulled out of incision site

If hindlimb: Hock to toe pulled out of

incision site

Make vertical incision through uterus and placenta

Remove calf and uterine fluid

LEFT FLANK C-SECTION STEPS

Uterus Utrect Pattern

Want an INVERTING pattern for luminal seal

Chromic Gut #2 Cleansed with Sterile Saline

solution around the incision site to reduce the chance of infection and reduce uterine fluid in the abdominal cavity

IMPORTANT Place uterus back into

CORRECT position The uterus was pulled to the

left so then the uterus was pushed back into the abdominal cavity placing the right horn into the right abdominal space

CLOSURE

Peritoneum, Transversus Abdominus, Internal Abdominal Oblique Simple Continuous

Chromic Gut #2

External Abdominal Oblique Simple Continuous

Chromic Gut #2

Skin Fords Interlocking Pattern

Appositional Nylon 3 ply

CLOSURE

DeadMaleWeighed approximately 100 lbsFetal-maternal mismatch

UNEXPECTED “TWIST”

Can be good- worsens with timeDepends on:

Severity of torsion Systemic compromise

Complications of the C-section can include: Retained Placenta Metritis Incisional edema Peritonitis Infertility Adhesions

THE FATE OF THE COW

FATE OF #52

Pearson H. Uterine Torsion in Cattle: A review of 168 cases. Veterinary Record 1971:597-603.

Noakes DE. Ferti l i ty and Obstetr ics in Cattle . 2 ed. Cambridge, MA: Blackwell Science, 1997.

Schonfelder AMaS, Axel. Cesarean Section and Ovariohysterectomy After Severe Uterine Torsion in Four Cows. Veterinary Surgery 2006;35:206-210.

Roberts, Stephen J and Hi l lman, Robert B. An Improved Technique for the Rel ief of Bovine Uterine Torsion. Cornel l Vet . 1973, 63:111-116

Youngquist RS. Current Therapy in Large Animal Theriogenology . Phi ladelphia, PA, 1997.

Zaborski Review Factors aff ecting dysotcia in cattle http:/ /

www.vin.com/members/proceedings/proceedings.plx?CID=WVC2002&PID=1051&O=VIN

http:/ /www.vet.uga.edu/lam/teaching/mueller/FemaleBovUrogen.swf http:/ /www.ncbi.nlm.nih.gov/pmc/artic les/PMC2275340/#!po=60.9375 http:/ /www.ncbi.nlm.nih.gov/pmc/artic les/PMC1687017/?page=1 http:/ /

books.google.com/books?id=DYGUFOLiGWkC&pg=PA50&dq=uterine+torsion+in+cow&hl=en&sa=X&ei=cVxHU4eMMYnu2QWU2IHoCw&ved=0CCsQ6AEwAA#v=onepage&q=uterine%20torsion%20in%20cow&f=false

REFERENCES

GodMy Amazing FamilyFriends all over the countryDr. Jenna Bayne All the Large Animal CliniciansFood Animal Block Crew “You pick me up when I fall”Radiology Rotation Trimac FarmSebastian and Colby

A GREAT BIG “WAR EAGLE” THANKS