Caesarean section : The Caesarean section : The cowcow

IndicationIndication– physical immaturity of the mother physical immaturity of the mother – Failure of the uterine cervix fully to Failure of the uterine cervix fully to

dilatedilate– Irreducible uterine torsion Irreducible uterine torsion – Preparturient recumbency Preparturient recumbency – acute reticuloperitonitis oracute reticuloperitonitis or pericarditis pericarditis – Shistosoma reflexusShistosoma reflexus – gross oversize of the fetus gross oversize of the fetus – Pregnancy toxaemia Pregnancy toxaemia – gross swelling of the vagina and vulva gross swelling of the vagina and vulva – Irreducible mal-presentation Irreducible mal-presentation – hydroallantois , hydrammnios hydroallantois , hydrammnios – mummified foetus mummified foetus – Others diseases and complicationOthers diseases and complication

Position of the cow and Position of the cow and operative siteoperative site

Left paralumbar or Upper Left paralumbar or Upper left flank approachesleft flank approaches

Upper right flank laparotomy Upper right flank laparotomy Ventral midline approach or Ventral midline approach or

paramedian approach paramedian approach Ventrolateral oblique Ventrolateral oblique

approach approach

Caesarean sectionCaesarean section

Left flank Left flank – StandingStanding– No omentum, intestineNo omentum, intestine– Reduce shockReduce shock– Good healingGood healing

Disadvantage Disadvantage More assistantsMore assistants Recumbency Recumbency Fetal DeliveryFetal Delivery

Caesarean sectionCaesarean section

Right flank Right flank – Oversize fatalOversize fatal– StandingStanding– Small incisionSmall incision– One assitantOne assitant

– DisadvantageDisadvantage Omentum & intestinalOmentum & intestinal Restraint & infectionRestraint & infection

Caesarean sectionCaesarean section

Ventral midline or paramedianVentral midline or paramedian– Emphysema fetalEmphysema fetal– Easy to find uterine hornEasy to find uterine horn– Abnormally uterine content Abnormally uterine content

– DisadvantageDisadvantage IntestineIntestine Lateral recumbencyLateral recumbency

Caesarean sectionCaesarean section

Ventrolateral oblique approachVentrolateral oblique approach– lateral recumbency lateral recumbency – Vessels Vessels

DisadvantageDisadvantage Long incisionLong incision Hernia Hernia

FetotomyFetotomy

Fetotomy Fetotomy

EmbryotomyEmbryotomy Dividing foetus into small piecesDividing foetus into small pieces Dead feotusDead feotus Common in cattleCommon in cattle TechniquesTechniques

– PercutaneousPercutaneous– Subcutaneoues Subcutaneoues

IndicationsIndications

Fetal maldispositionFetal maldisposition Fetopelvic disproportion Fetopelvic disproportion Obstruction by hip-lockObstruction by hip-lock Caesarean section Caesarean section

– Fetotomny only in feotal Fetotomny only in feotal deaddead

– Caesarean section in Caesarean section in foetal alivefoetal alive

Fetotomy equipmentFetotomy equipment

Tubular embryotomeTubular embryotome Fetotomy wireFetotomy wire Handles for wireHandles for wire Handle for embryotomeHandle for embryotome Screw to tighten handleScrew to tighten handle Introducer Introducer ThreaderThreader Cleaning brush Cleaning brush

FetotomyFetotomy

Partial or completePartial or complete AssistantAssistant Restraint Restraint SkillsSkills TechniqueTechnique

– Anterior presentationAnterior presentationHead-> forelegs-> thorax-> pelvis-Head-> forelegs-> thorax-> pelvis-

>>– Posterior presentationPosterior presentation

Hind limbs -> body -> forelegsHind limbs -> body -> forelegs

Partial fetotomyPartial fetotomy

Deviation of the neckDeviation of the neck Shoulder flexionShoulder flexion Bilateral hip flexion (Breech Bilateral hip flexion (Breech

presentation)presentation) Hock flexionHock flexion Fetal monstersFetal monsters

Hip flexion

Hock flexion

Dystocia in the mareDystocia in the mare

Incidence less than cattleIncidence less than cattle 4 % in Thoroughbred 4 % in Thoroughbred Common in Shetland poniesCommon in Shetland ponies

Causes of dystociaCauses of dystocia- Anterior presentation- Anterior presentation- Posterior presentation- Posterior presentation- Transverse presentation- Transverse presentation

Specific causes of equine Specific causes of equine dyctociadyctocia

Uterine inertiaUterine inertia Bony tissue obstructionBony tissue obstruction Soft tissue obstruction Soft tissue obstruction Uterine torsionUterine torsion Downward deviation of the uterusDownward deviation of the uterus Fetal monsterFetal monster MalpresentationMalpresentation MalpositionMalposition MalpostureMalposture

Dorsotransverse position

Dystocia in the sowDystocia in the sow

Incidence 0.25-1.0 %Incidence 0.25-1.0 % Gilts or old sowsGilts or old sows Welsh gilts -> small pelvisWelsh gilts -> small pelvis Large white -> uterine inertiaLarge white -> uterine inertia

Causes of dystociaCauses of dystocia

Uterine inertia Uterine inertia 37 %37 % Obstruction of the birth canalObstruction of the birth canal 13 %13 % Deviation of the uterusDeviation of the uterus

9.5 %9.5 % Maternal excitementMaternal excitement 3 %3 % Fetal maldispositionFetal maldisposition 33.5 33.5

%% Fetopelvic disproportionFetopelvic disproportion 4 %4 %

Uterine inertiaUterine inertia

Primary uterine inertiaPrimary uterine inertia 20 %20 %– stillbornstillborn

Secondary uterine inertiaSecondary uterine inertia 49 %49 %

Idiopathic uterine inertiaIdiopathic uterine inertia 31 %31 %– Fat sowsFat sows– Calcium Calcium

Treatments : oxytocinTreatments : oxytocin

Obstruction of the birth Obstruction of the birth canalcanal

Bony tissue abnormalityBony tissue abnormality Soft tissue abnormalitySoft tissue abnormality

– Distension of the urinary bladderDistension of the urinary bladder– Vulval abnormalitiesVulval abnormalities– Persistent hymenPersistent hymen– Non-dilation of the cervixNon-dilation of the cervix– Obstruction of the uterine lumenObstruction of the uterine lumen– Downward deviation of the uterusDownward deviation of the uterus

Maternal excitementMaternal excitement

Gilts Gilts Delay or inhibit the farrowing processDelay or inhibit the farrowing process Late movementLate movement Innate nervousnessInnate nervousness

Treatments : azaperone IM 2 mg/kgTreatments : azaperone IM 2 mg/kg

oxytocin 20 IUoxytocin 20 IU

Signs of dyctociaSigns of dyctocia

Discharge and placenta at the vulvaDischarge and placenta at the vulva Signs of imminent but no farrowingSigns of imminent but no farrowing Straining but no pigletsStraining but no piglets Premature cessation of labourPremature cessation of labour Prolonged farrowing >½-4 hrs. (2.5 Prolonged farrowing >½-4 hrs. (2.5

hrs.)hrs.) Placenta Placenta

Dystocia in the dog and catDystocia in the dog and cat

Incidence cat lower than dog Incidence cat lower than dog Exotic breedExotic breed Causes Causes

Uterine inertiaUterine inertia 36 %36 % Fetopelvic disproportionFetopelvic disproportion 22 %22 % Fetal maldispositionFetal maldisposition 11 %11 % Abnormalities of birth canalAbnormalities of birth canal 9 %9 % Other causesOther causes 22 % 22 %

Failure of the expulsive Failure of the expulsive forcesforces

Primary uterine inertia Primary uterine inertia – Scottish terrierScottish terrier– Single pup syndrome and single kitten Single pup syndrome and single kitten – Hysteria Hysteria Cocker spaniels Cocker spaniels

Secondary uterine inertia Secondary uterine inertia – Abdominal muscle tone -> old or fat Abdominal muscle tone -> old or fat

animalsanimals

Obstruction of the birth Obstruction of the birth canalcanal

Bony abnormalitiesBony abnormalities

- pelvic fracture -> accidents- pelvic fracture -> accidents

- Scottish terrier- Scottish terrier

- Brachycephalic toy breeds- Brachycephalic toy breeds Soft tissue abnormalitiesSoft tissue abnormalities

– Deviation of uterus Deviation of uterus Boxer Boxer– Torsion of uterusTorsion of uterus

Fetal maldispositionFetal maldisposition

Posterior presentationPosterior presentation– normal whelping 40 %normal whelping 40 %– Bilateral hip flexion Bilateral hip flexion

Deviation of the headDeviation of the head– Long neck Long neck Collies Collies– Long head Long head Sealyham and Scottish Sealyham and Scottish

terrierterrier

Fetopelvic disproportionFetopelvic disproportion

Small breedSmall breed Low litter sizeLow litter size Yorkshire terrierYorkshire terrier

Fetal monsterFetal monster- hydrocephalus- hydrocephalus- Anasarca- Anasarca- Conjoined twins- Conjoined twins

DiagnosisDiagnosis

Examination of genital systemExamination of genital system– Inspection of vulvaInspection of vulva– Vaginal examinationVaginal examination– Abdominal palpationAbdominal palpation– Abdominal auscultation/ UltrasoundAbdominal auscultation/ Ultrasound– X-raysX-rays

Treatment of dystociaTreatment of dystocia

Ecbolic therapy Ecbolic therapy oxytocin 2-5 IU IMoxytocin 2-5 IU IM 20-30 minutes 20-30 minutes Calcium borogluconate 10% 5-15 ml slow IVCalcium borogluconate 10% 5-15 ml slow IV

Assisted delivery of the fetus Assisted delivery of the fetus – EpisiotomyEpisiotomy

Manual deliveryManual delivery Forceps delivery Forceps delivery