Treatment Of Dystocia Dr. S.p.gavit

Recent trends to Relive dystocia in Domestic Animals VOBG-809 Veterinary Obstetrics Submitted ToDr. M.T. Panchal Prof. Dept. of ARGO Submitted ByS.P. Gavit M.V.Sc Gynaecology

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Dystocia in Heifers vs. Cows Heifer s Growing- smaller than a mature cow. Never had a calf before- the tissues of the birth canal have not ever been dilated. Cows The size of their birth canal. the calf is extremely large. the calf is malformed or malpositione. .

Dystocia Scoring SystemAn example of a record keeping dystocia scoring system: 0 - no assistance required 1 - easy pull - typically means a single person pulling 2 - hard pull - typically means 2 people pulling 3 - mechanical pull (calf jack used) 4 - c-section An alternative example: 1 - no assistance required 2 - easy pull 3 - hard pull, mechanical pull, or veterinary procedure required

The approach to an obstetrical case 3. History of the case Full term arrive or premature. Primigravid or multigravida. Previous breeding history. Straining – slight, intermittent or frequent & forceful. Water-bag. Fetus appear in the vulva. Multiparous species. Bitch and cat-vomiting.

2. General Examination Temperature, Respiration & Pulse . If animal is dull, depress & appear to be exhausted, the resuscitation is most important before operation. Protruding parts of fetus, dry or moist may help in assessing the nature of dystocia.

3. Specific Examination Condition of vulva and vagina - dry, moist or swollen. Condition of the fetus- living, dead, emphysemated or monster. Presentation, position and posture of the fetus. Dry fetus -amount of lubricant requires. Torsion of the uterus. Normal Dilatation of cervix

Causes of Dystocia A. Maternal causes 1.

Force/Uterus (Expulsive defects) Uterine inertia Uterine rupture Torsion of uterus

8.

Force/Abdominal Age Pain Debility Rupture diaphragm Hernia of uterus Perforated trachea

3. Birth canal (constriction) c.

Inadequate pelvis Immaturity Fracture Breed Diet Development Disease

b. Insufficient dilatation Uterine torsion Cervix Vagina Vulva

B. Fetal causes of dystocia   3. Fetal over size 5. Faulty disposition g. Presentation, Posterior Transverse k. Position, Ventral Lateral

c. Posture Anterior Limb flexion carpal elbow shoulder Head flexion lateral upward downward Posterior Hock flexion Hip flexion 19.Fetal death.

Dystocia of Mare

Elbow Flexion

Unilateral Carpal Flexion

Bilateral Carpal Flexion

Lateral Deviation of the Head

Anterior Presentation, Dorsal Position, Extended Posture

“Dog Sitting” Position

Ventral Deviation of the Head

Anterior Presentation, Ventral Position

Dorso Transverse Presentation

Ventro Transverse Presentation, Uterine Body Gestation

Vntero Transverse Presentation

Posterior Presentation, Ventral Position, Extended Posture

Bilateral Hip Flexion (Breech)

Bilateral Hock Flexion

Twins

Dystocia of Cow

Anterior presentation— one foreleg retained.

Anterior presentation— downward deviation of head. (From Diseases of Cattle, USDA Special Report, 1942.)

Anterior presentation—forelegs bent at knee.

(From Diseases of Cattle, USDA Special Report, 1942.)

Anterior presentation— forelegs crossed over neck

Anterior presentation— with hind feet in pelvis.

Croup and thigh presentation

(From Diseases of Cattle, USDA Special Report, 1942.)

Posterior presentation— the fetus on its back.

(From Diseases of Cattle, USDA Special Report, 1942.)

Posterior presentation— All feet presented.

Anterior presentation— upward deviation of head. .

(From Diseases of Cattle, USDA Special Report, 1942.)

Anterior presentation— with back down

Croup and hock presentation

Dorsolumbar presentation

(From Diseases of Cattle, USDA Special Report, 1942.)

Head turned sideways

Hiplock

Twist causing obstruction

Breech presentation .

Anterior Presentation

Limb flexion Carpal Elbow Shoulder

Head flexion Lateral Upward Downward

Lateral Head deviation

Posterior Presentation

Hock flexion Hip flexion

Dog sitting Posture

Most common obstetrical operations 3. Forced extraction 5. Traction after correction, which includes Repulsion Rotation Version Extension of the extremities of the fetus.

16. Fetotomy 18. Cesarean section

1. Forced extractionThe withdrawal of the fetus from the dam through the birth canal by means of the application of outside force or traction.

Proper placement of OB chains

Head and shoulders – pull downward at a 45° angle, nearly parallel with the rear legs of the cow. Raise the calf's hips and lessens chance of hip lock. "Hip lock" - push the calf back a short distance and rotate the calf a half a turn and pull downward and forward between the cow's legs. If the cow is lying down, roll her on her back and pull the calf forward over the udder between the hind legs. Make sure the calf begins breathing normally as the umbilical cord will be pinched closed. Posterior presentations (backwards calf) - posterior presentation is a problem because the calf's hind legs and hips do not dilate the cervix as well as the front legs and head. Due to premature rupture of the umbilical cord, early assistance and rapid delivery is needed. A backwards calf in the setting position with feet and legs up under him (breech presentation) must be detected early in labor and corrected. Cows will start labor but nothing will show externally except occasionally the tail of the calf. If not detected, labor will cease and calf is emphysematous three to seven days later.

Cows with torsion of the uterus (posterior uterus and cervix twisted) will act similar to cows with a breech presentation; however, they will usually show much more pain. On examination, the calf is difficult to palpate and the twisted opening can be determined. If detected early, the torsion can be corrected or a caesarean performed to obtain a live calf. A calf puller should be used correctly and only by experienced people. A calf puller can apply traction equivalent to the pull of seven men. First examine the cow, making sure the calf is in the proper presentation and position, lubricate the vagina, then apply gradual traction. If no progress, a caesarean may be needed. Excessive traction may kill the calf, traumatize the cow and both may be lost. Correcting abnormal presentations and positions after extended labor usually requires professional help.

Proper use of OB chains

Proper use of OB chains

CHAINS:-

CHAINS:Anterior presentation - pasterns or above the knee or elbow. The noose of the obstetrical chain above the fetlock and place a half hitch around the pastern. Posterior presentation - pastern or above the hock. The best arrangement is a double half-hitch, where the first loop is placed above the fetlock and the second half-hitch is placed below the dewclaws. Apply traction steadily, alternating the pull from one leg to the other. 1st apply the traction in an downward direction until the calf's shoulders are through the pelvis. Then a downward pull is needed to help move the calf's hips through the wider portion of the cow's pelvis. Always use plenty of lubricant during this procedure.

Improper Use of Force!

Attach the obstetrical handles and pull gently, making sure the chains have not slipped. Although some calves can be delivered by pulling both legs evenly, it's usually best to alternately pull on one leg and then the other a few inches at a time. This is called "walking out the shoulders."

SNARE Anterior presentation- A snare may be applied around the lower jaw and tightened firmly so not slip and fracture the dental plate. A loop of the chain around the neck behind the head when the fetus is dead. For live fetus a loop of obstetrical chain is more commonly used around the poll, under the ear and through the mouth in the manner of “war bridle” for applying traction to the head. Post presentation- snare may be fastened around the hind legs.(Sheep) In dogs and cats snare or gauze around the hind legs or gasping the hocks with sponge forceps will assist traction. Excessive twisting of the fetal pelvis around the by the means of forceps may injure the lumbosacral articulation.

HOOKS Blunt or knobbed Krey’s hook or short obstetrical hooks on loop or cord in the orbit helps in traction of head. Long blunt hook use in the hiplock condition in the anterior presentation. In sheep/goat snare and forceps are applied to the fetus head, around the neck or to the fore legs. Whenever forceps are applied, the wall of the genital tract should be examined before traction is applied, to make sure that it is not caught in the forceps. In dogs and cats forceps may be applied to the head of the fetus after the head is repelled out of the pelvis to the uterus; but great care should be taken to prevent tearing an ear or laceration the skin, fracturing the mandible, or crushing the skull.

Anterior - 2 point traction- One loop over the fetlocks and a second half hitch below the fetlocks.

Anterior - 3 point traction - By placing a head snare behind the calf's head and in the mouth & one loop over the fetlocks and a second half hitch below the fetlocks.

Fetal extractor (calf jack)-  This can be very useful if used correctly but can also be extremely dangerous if misused.

Fetal extractor (calf jack)

2. Traction after correction

Mutation: Mutation is defined as those operations by which a fetus is returned to normal presentation, position, and posture by repulsion, rotation, version and adjustment or extension of the extremities

Repulsion/Retropulsion: It consists of pushing the fetus out of the maternal pelvis or birth canal in to the abdominal cavity and uterus, where space is available for the correction of the position or posture of the fetus and its extremities.

In anterior presentation the crutch or hand of the operator is usually place on the fetus between the shoulder and chest or across the chest beneath the neck. In posterior presentation it is placed in the perineal region or the ischial arch. In sheep, goat and swine repulsion is performed by the arm and hand or by fingers in the bitch and cats.

Rotation Rotation is the turning of the fetus on its long axis to bring the fetus in to a dorso-sacral position. In the cow the presence of the fetus in dorso-iliac or dorso-pubic position frequently is accompanied by900 to 1800 torsion of the uterus.

Version Version is the rotation of fetus on its transverse axis in to an anterior or posterior presentation. Version is usually limited to 900 By repulsion on the cranial or caudal end of the fetus and traction on the other end, the transverse presentation is changed to a longitudinal presentation. If possible the fetus should be turned in to a posterior longitudinal presentation as that prevents the head and neck from complicating the correction of the abnormal presentation or posture.

Extension of the extremities of the fetusExtension and adjustment of the extremities is the correction of abnormal postures usually due to flexion of one or more of the extremities causing dystocia. Repulsion of the proximal portion of the extremity. Lateral rotation of the middle portion of the extremity, carpus, tarsus or neck Traction on the distal portion of the extremity.

FetotomyFetotomy is defined as those operations are performed on the fetus for the purpose of reducing its size by either its division or removal of certain of its parts.

Cesarean section – CS is the delivery of the fetus, usually at parturition, laparohysterotomy.

Operation performed when Mutation Forced extraction Fetotomy are deemed inadequate or difficult to be employed to relive the impending or present dystocia or when it is desired that the fetus be delivered alive.

Cow Sites for cesarean section:Upper right flank, with animal standing. An oblique abdominal incision in the lower left. Right flank region below the fold of the skin in the flank . Parallel the ventral border of the ribs. Operation: Asepsis General anesthesia Skin is incise. Facia Trans.abd. muscle Peritoneum

Knife and scissor.

Inserted arms into the abdominal cavity. Apex of the uterine wall pulled. The uterine horn and fetal membranes are incised longitudinally over the greater curvature. Avoiding the cotyledons. Chains are applied to the limbs of the fetus by exerting traction in the ventral and caudal direction the fetus is removed. If necessary the incision in the abdominal wall and uterus should be enlarge to prevent tearing. If uterine torsion is present the direction of the torsion accurately ascertained before the cow is forced down. The uterine incision is closed with double row of Lembert or Cushing suture of no. 1 or 2 chromic catgut.

Mare Sites for cesarean section:The left flank incision starting at the middle of the last rib and extending caudal and ventrally towards the stifle. The upper left flank or the left paramedian or midline abdominal areas. Lower left flank is the best site.

Operation The incision on greater curvature over a fetal prominence. A complication SC diffuse bleeding . To prevent bleeding, the continuous “whipstitch” suture of catgut be placed through endometrium, submucosa and serosa completely around the uterine incision for a depth 1 cm being careful not to include the placenta. This suture was inverted in to the uterine cavity by a double raw of Lembert or Cushing sutures use to close the uterus after the fetus is removed. The peritoneum, muscle and facia abdominal 4 chromic catgut. Modified Mayo or overlapping mattress suture for closure of the wound on the ventral abdomen. The skin incision was closed with non-absorbable nylon suture.

Bitch Sites f or cesarean section:The flank incision at an oblique angle parallels the last ribs. A left flank incision 3 to 5 inches long parallel to the spine and beginning 1 – 1½ inch behind the costal arch and 1 -1 ½ inch above the mammary gland. Operation: The horn is incised near the bifurcation. The fetus may be removed through the same hysterectomy incision. The uterus is incised longitudinally on the site opposite the attachment of the broad ligament, Care being exercise not to incise through a placental area. Umbilical cord is clamped with forceps The uterine incision closed by the single row of Lembert suture of catgut. The flank incisions are sutured with several rows of catgut, with nylon or silk in the skin.

Hysterectomy: Indicated when trauma, injury and even rupture of the uterus have been produce by unsuccessful Fetotomy, mutation or forced extraction operations or the fetus is emphysematous or uterus is atonic, severely infected and disease.

Uterine torsion:A twisting of uterus on its long axis. Handling/ TreatmentRolling the Dam. Schaffer’s method - A modification in the rolling technique Laparotomy for the intra abdominal correction of Torsion. Rotation if the fetus and uterus through the birth canal. Abdominal ballottement . Detorsion rod.

Laparotomy for the intra abdominal correction of Torsion. Cow right para lumbar fossa. Mare left para lumbar fossa Right side torsion: The right hands and the arms are passed downward between the uterus and abdominal wall until the bottom or ventral surface of the uterus can be felt. Left side torsion: The hand and the arms are passed over the top of the uterus and down between rumen and uterus.

Abdominal ballottementRight side torsionAn assistant on the right side pushes downward and inwards in the upper right flank while an assistant on the left side pushes upward and inward on the lower left flank. Left side torsion The upper left flank and the lower right flank are pushed strongly with the fists.

Application of Detorsion rod

Detorsion rod

Uterine inertia Primary Uterine inertia:Lack of tone or failure of the uterine muscle to contract. Most commonly seen in Dogs & Cow especially in older dairy cows. CausesDiseases of uterine muscle. Due to lack or failure of release of hormones. Lace of exercise, excessive fatness, Debility and senility causes weakness of uterine contraction at parturition. Treatment:Inj. Oxytocine/Pitutrin- Large Animal 20-100 units, Small animal- 1020 units. Inj. should be given with saline by an IV drip. Feathering-(Dog) - Feathering the vagina by inserting finger and stroking the dorsal wall of the vagina to stimulate the production of oxytocine by animal. If no respond after 3-5 hours Cesarean Section recommended.

Secondary inertia:Prolonged by dystocia & it is characterized by exhaustation of uterine muscles. Cattle- Retracting/bandl’/ contracting ring dystocia:- Where the uterine muscle just cranial to the cervix contract tightly, so normal expulsion of the fetus in to birth canal do not take place. In this condition by per vaginal palpation revealed normal PPPPresentation, Position, Posture but uterine muscle contract over fetus. Treatment:Lubrication of birth canal, and removal the fetus by traction if normal PPP. Cesarean indicated at last.

Medicinal Treatment CLOPROSTENOL SODIUM PGF2Alfa Analogue Removal of Mummified Fetus Induction of Parturition Cattle - 2ml IM 1.3 ml IV

TIAPROST – PGF2Alfa Analogue Removal of Mummified Fetus Induction of Parturition Cattle - 3.5 ml IV Horse– 3 ml IV Removal of mummified fetus Cattle – 3.5 ml IV

OXYTOCINE Induction of parturition( Only in case of sufficient cervical dilatation). Cat/Bitch/ Sheep/GoatUseful in expulsion of last fetus in polytochous animals. C/BIn CS as local infiltration. (speed up involution control bleeding after the removal of fetus) Horse- Uterine inertia, Uterine prolaps.

Dose- IM/IV Cow75-100 UNITS Mare- 75-100 UNITS Ewe30-35 UNITS Bitch5-25 UNITS Queen- 5-10 UNITS

VALETHAMATE Anticholinergic Hard cervix in Dystocia Inadequate cervical dilatation in dystocia Cattle/Mare- 40- 50 mg IM Sheep/Goat- 10-20 mg IM Dog/Cat5-10 mg IM DEXAMETHASONEC/S/G – Induction of Parturition. Cattle- 40 mg IV S/G2-5 mg IV

1. 2. 3. 4. 5.

LIGOCAINE KETAMINE DIAZEPAM XYLAZINE PENTAZOCINE

1. LIGOCAINE

2. KETAMINE

3. DIAZEPAM

4. XYLAZINE

5. PENTAZOCINE

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