Obstetrics

Stages of Labour

• Duration

• Process INSIDE cow

• Clinical signs

STAGE ONE:

Duration:

• Cow = 3 - 8hr

• Heifer = 12 - 48hr

Inside:

1. Foetus moves into position for delivery

2. Relaxation of birth canal, pelvic symphysis and soft tissue

3. Cervix softens, thins and dilates

4. Uterine contraction begins

Clinical Signs:

1. Change in behaviour = Restless, isolation, inappetence

2. Raised tail (“sprung” tail head)

3. Swollen udder and engorged milk vein

4. Lengthening and swelling of vulva

5. Clear/pale yellow mucoid discharge from vulva

6. Membranes protruding from vulva

STAGE TWO:

Duration:

• Cow = 30 minutes - 1hr

• Heifer = 1 - 4hr

Inside:

1. Fluid released from around foetus as chorioallantoic membrane ruptures

2. Calf MAY be delivered before chorioallantoic membrane ruptures (RARE)

   • -ve: Calf may suffocate before cow can sufficiently lick membranes away from nostrils (image)

Clinical Signs:

1. Obvious abdominal straining during uterine contraction

2. Shifting between recumbency and standing

3. Slow progressive outward-movement of foetus seen at vulva

   • Head, shoulders and pelvis may take longer due to larger diameter

   • Normal for cow to take short breaks after passing head, shoulders and pelvis

4. Defaecation, vocalisation and milk leaking

5. Finished when calf completely expelled from cow

STAGE THREE:

Duration: 30 minutes - 8hr

Inside:

1. Placenta separates from uterus (cotyledons and maternal caruncles unbutton)

2. Uterus begins to shrink resulting in expulsion of placenta → Helps control haemorrhage within uterus

3. Cervix begins to close

Clinical Signs: Do NOT assume a cow has completed stage 2 of parturition as calf may not have been delivered OR a 2nd calf within

1. Placenta protruding from vulva

2. Small amount of haemorrhage

3. Fluids draining from vulva

4. Finished when entire placenta has been delivered

5 Positive indicators of normal birth

1. Active and productive contractions

2. Calf movement

3. Fluid being expelled from calf’s lungs

4. Pink tongue

5. Visualisation of 2 feet and a nose

Overview of Obstetrics

• 4 Methods of assisted calving

• 4 Major causes of dystocia

• Incidence in NZ (heifers vs. cows)

Methods:

1. Manual traction

2. Foetotomy

3. C-section

4. Euthanasia

Major Causes:

1. Head back

2. Leg back

3. Failure to dilate/uterine inertia

4. Foeto-maternal disproportion #1

Incidence

• Heifer = 6.5%

• Cow = 3.8%

4 Consequences of dystocia

1. Obturator paralysis

2. Trauma, tearing, bruising or contusion of birth canal

3. Rupture of middle uterine artery → Fatal haemorrhage

4. Increased risk of post-calving infection and RFMs → Infertility

Describe 3 ways to prevent dystocia

1. Feeding → Reduced intra-pelvic fat in heifers

   • 1st trimeter → Greatest effect on calf birth weight

   • Cannot easily reduce foetal GR with feed restriction

   • Effects visible only after 6 weeks

2. 30 60 90 rule = Prioritise heifer growth rate monitoring

   • 30% MWT at 6 months

   • 50% MWT at 12 months

   • 60% MWT at mating

   • 90% MWT at calving

3. Choice of bull

   • Jersey bull OR AI to LIC short-gestation length bulls for 1st calving heifers

   • AI beef bulls strongly selected for short gestation length and calving ease

   • Natural service beef bulls increasingly being selected for easy-calving characteristics

   • Genotype cows and match appropriate bulls

Causes of Dystocia

• 3 Maternal causes

• 4 Foetal causes

MATERNAL CAUSES

1. Skeletal

2. Soft tissue

3. Ineffective labour

   1. Uterine inertia

   2. Uterine torsion

FOETAL CAUSES

1. Foetal oversize

2. Multiple foetuses

3. Foetal death

4. Foetal monsters

THREE Maternal Causes of Dystocia

• Mechanism

• Examples

ONE: SKELETAL CAUSES

MoA: Small pelvis → Relative foeto-maternal disproportion

Examples:

1. Poorly grown and under-sized heifers at calving (24 months)

   • Higher risk if mated over sire predisposed to producing large calves → Foeto-pelvic disproportion

2. Previous pelvic trauma (fractures or dislocations) from previous assisted birth or mating injuries

3. Genetically malformed pelvis eg. Holstein-Friesian #1 = Longer and narrower pelvis

   • Rare FM disproportion in beef breeds with purebred calves

   • Jerseys less prone to FM disproportion (despite being smaller than Holstein-Friesians)

TWO: SOFT TISSUE CAUSES

MoA: Small pelvis → Relative foeto-maternal disproportion OR incomplete dilation of cervix

Examples:

1. Ineffective/incomplete cervical dilation

   1. Previous vaginal/rectal prolapse

   2. Uterine torsion

   3. Fibrosis of cervix from previous injury

   4. Neoplasia/abscess → Narrowed vagina

2. Scar tissue in birth canal from previous dystocia or calving trauma → Reduced soft tissue stretching

3. Excess intra-pelvic fat → Reduced space for calf to pass

   • eg. Lifestyle animals and carry-over cows with high BCS

4. Rupture of the pre-pubic tendon (rare)

THREE: INEFFECTIVE LABOUR

1. Uterine Inertia = Absent contractions after stage 1 labour due to:

   1. 1˚ uterine inertia = Over-distended uterus eg. Twins or hydrallantois (hydrops)

   2. 2˚ uterine inertia due to dystocia = Myometrium becomes exhausted

   3. Hypocalcaemia = Reduced contractility of skeletal and smooth muscle

   4. Weak/emaciated

   5. Overfat cow with no exercise

2. Uterine Torsion

What is this?

• Diagnosis

• 3 Treatments

Ruptured Pre-Pubic Tendon (RARE)

Diagnosis: Pendulous abdomen due to herniation

Treatments:

1. Emergency slaughter (unless dam or calf extremely valuable)

2. Attempt to induce parturition (some may manage normal vaginal delivery)

3. ± Caesarean section by ventral approach

What is this?

• 2 Methods of diagnosis

• Treatment

Hydrallantois (Hydrops) = Excess accumulation of allantoic fluid in pregnant cow

Diagnosis:

1. PE = Round cow with no udder development at 6 - 7m gestation and BCS ≤ 3

2. Rectal exam = Massive fluid-filled uterus with no calf palpated

Treatment: Induce labour with prostaglandin and corticosteroid

• Cow does NOT come into milk (salvage situation)

FOUR Foetal Causes of Dystocia

• Mechanism

• Examples/risks

ONE: FOETAL OVERSIZE

MoA: Absolute foetal oversize →

1. Foetus too big to fit through pelvic canal

2. Insufficient room in uterus for calf to get into correct “diving” position to parturition with anterior presentation and extended posture

   • Correct malpresentation → Still difficult to get out

Examples:

1. Paternal effects on calf size (Continental breeds or double muscling eg. Belgian Blue)

2. Long gestation length → Larger calf

   • Late gestational growth favours growth of parts contributing to increased calf diameter (eg. shoulders and pelvis)

   • Exponential increase in foetal weight after 282d of gestation

3. Male calf

TWO: MULTIPLE FOETUSES

MoA:

1. Multiple foetuses approach the pelvic canal simultaneously

2. Multiple foetuses become entangled around each other

THREE: FOETAL DEATH

MoA:

1. Incorrect presentation to pelvic canal (NOT active during birth process) → Delays normal cervix dilation (even smaller aborted foetuses cannot assume normal position)

2. Early rupture of membranes → Loss of natural lubrication required for delivery

3. Decomposition (emphysematous “fizzers”) → Accumulation of SC gas → Calf increases in size significantly → Foetotomy required for delivery

4. Maternal fatigue and uterine atony

FOUR: FOETAL MONSTERS

MoA: Genetic defects → Misshapen and deformed calves which require more intervention than the standard malpresentation (eg. foetotomy or C-section)

Examples:

1. Hydrocephalus

2. Schistosomus reflexus

3. Foetal ascites

4. Conjoined twins

Foeto-Maternal Disproportion

• 2 Types

• When to intervene?

Types:

1. Relative = Calf and pelvis mismatch (eg. small heifer)

2. Absolute = Calf too big irrespective of pelvis size

Intervention:

1. Cow = Amniotic sac broken 3hr with no progress

2. Heifer = Amniotic sac broken 2hr with no progress

5 Ways to determine if the calf is dead

1. Smell

2. Anterior presentation → Gently push finger into eye (elicit blink) or squeeze leg (kick)

3. Posterior presentation → Squeeze leg or push finger into anus to elicit response

4. Head back → Usually dead

5. Umbilicus still attached

Hydrocephalus

• Diagnosis

• 2 Treatments

Diagnosis: Difficult to palpate as head not present normally in birth canal

Treatments: Depends on size of skull

1. Foetotomy (small dome)

2. C-section (large dome)

Schistosomus Reflexus

• Definition

• Aetiology

• 2 Treatments

Definition: Acute angulation of spinal column dorsally and incomplete closure of abdominal wall (“inside-out” calf) → Tail next to head and viscera free-floating in amnion ± ankylosis

Aetiology: Genetic component during embryonic development

Treatment: May present longitudinally OR transversely (visceral OR limb presentation)

• Visceral presentation may loos like intestinal hernia of cow

1. Foetotomy

2. C-section

Foetal Ascites

• Definition

• 2 Causes

• Treatment

Definition: Late-term abortion with ascites and oedematous intestinal walls (1% of calvings)

• Dead calf delivered normally until shoulder engage → No further progression causing the abdomen and intestinal walls to fill with fluid

Causes:

1. Foetal infection

2. Developmental defects

Treatment:

1. Rupture calf abdomen to release fluid (40 - 50L) via thoracic inlet and diaphragm with alkathene pipe

2. Foetotomy to remove front legs and smash through ribs

Describe 3 P’s of Calving (+ normal)

Calves must be positioned properly to be delivered unassisted (unlike lambs and piglets which can be delivered unassisted in several different birth presentations)

ONE: PRESENTATION

Describes the spinal axis of the foetus relative to the long axis of the dam AND which part of the foetus is entering the birth canal first

1. Anterior (longitudinal) = Head and FL first

2. Posterior (longitudinal) (5%)

   1. Rump and HL first

   2. Breech = Sub-category of posterior presentation where both hips are flexed and held under calf’s torso

3. Transverse (RARE)

TWO: POSITION

Describes position of calf’s dorsum relative to the maternal pelvis

1. Dorsosacral

2. Dorsoiliac (L/R)

3. Dorsopubic

THREE: POSTURE

Describes the extremities of the foetus relative to the trunk

1. Extended

2. Flexed (retained at shoulder OR head OR hip)

Normal: Anterior longitudinal and dorsosacral with head and front legs extended into the birth canal

Describe FIVE steps of dystocia intervention

ONE: PREPARATION

Vet Checklist

1. PPE

   1. Calving gown and bib

   2. Gumboots

   3. Warm hat

2. Gloves

   1. Rectal gloves

   2. Short gloves over top

   3. ± Thick rubber gloves for rotten calves

   4. Silicon barrier cream to protect skin

3. Obstetrics Kit

   1. Chain/ropes

   2. Pulley/Vink calving jack

   3. Krey hook and eye hook = Useful tool when no anchor points available to place chains or ropes on. Placed on bone, hide and limb stumps to assist in providing traction

   4. Foetotomy equipment

   5. Halter and casting rope

4. Lube (+ pump)

5. Medications

   1. Epidural kit (clippers, meths, swabs, syringes/needles, lignocaine)

   2. Tocolytic (clenbuterol = Planipart)

   3. Antibiotics

   4. NSAIDs

   5. Oxytocin

   6. Metabolic treatments (ketol, electrolyte sachet, bags, starter drench) AND Agger’s pump

6. Surgical Kit

7. Cleaning Equipment

   1. Antiseptic

   2. Clean scrub brush

   3. Clean bucket

Farm Checklist

1. Warm water in bucket

2. Cow in yards

3. Good facilities

TWO: HISTORY

1. Age of dam and parity

2. Previous problems (eg. calving difficulties last season?)

3. Expected due date

4. Mated to AB or natural service? Issues with sire?

5. Full/slack udder? (eg. late abortion)

6. Calf still alive?

7. Duration of labour and evidence of straining?

8. Any farmer intervention? Attempted delivery and medications/metabolic treatments?

THREE: ASSESS FACILITIES

1. Clean with good lighting

2. Safe for cow, farmer and vet?

3. Understand how to operate head bale and open side gate in event of emergency

   • Make escape plan

4. Place chain/bar in case cows slips out of head bale (or use halter)

   • Tie halter low in case she goes down

FOUR: ASSESS PATIENT

1. Ataxia → Milk fever or nerve damage

2. Dehydration > 5%

3. HR > 100bpm → Toxaemic shock

4. Brick red/cyanotic MM

5. Demeanour (pain = groaning)

6. Significant blood loss?

7. Hindson’s traction ratio (TR)

→ Consider euthanasia if signs above are presented which indicate the cow is suffering

FIVE: SELECT METHOD

If making no progress with a method (10 - 20 minutes) → Select different method OR tool

Planipart

• Active ingredient

• MoA

• Onset of action

• 2 Indications

• Dose rate

• WHP

Active: Clenbuterol

MoA: Tocolytic = Sympathomimetic amine (β-2-agonist) with high degree of selectively for lungs and uterus → Induces relaxation of uterine musculature → Dilation of birth canal

Onset: 20 minutes of IM administration

Indications:

1. C-section to exteriorise uterus

2. Dystocia management to create more space where calf can be more easily manipulated

Dose Rate: 2mL/100kg BWT IM or IV

WHP: 12d meat and 60hr milk (also applied to calf → important if bobby)

Method Selection for Dystocia Intervention

1. Calf oversized AND alive (or fresh dead) → C-section

2. Calf oversized AND dead → Foetotomy

3. Calf appropriate size → Traction

4. Sick cow → Euthanasia

3 Ways to determine if feet presenting at the birth canal are FL or HL

1. Soles of feet

   • Facing UP = HL (or FL in dorsopubic position)

   • Facing DOWN = FL (or HL in dorsopubic position)

2. Palpate joint proximal to fetlock

   • HL = Hocks more angular and bend OPPOSITE planes as fetlock

   • FL = Bend in SAME plane as fetlock

3. Reach further to find tail OR head

Hindson’s Traction Ratio (TR)

Use interischial distance and the diameter of the calf’s digit to assess best method of dystocia treatment

• TR > 2.5 → Traction sufficient

• TR < 2.5 → C-section or foetotomy required

6 Steps of traction

1. Lubricate and thoroughly clean with warm water

2. Administer epidural ± tocolytic

3. Manipulate calf to assume correct presentation/position

4. Place chains on feet ± head (if anterior)

5. Use appropriate force and calving aids

   • Angle downwards to pull calf through natural curve of birth canal

6. Rotate calf as chest emerges to minimise presenting diameter (exploit “box-like” shape of pelvis)

7. Put hand back in to check for “spares and tears”

   • 2nd calf or full-thickness uterine tear

8. Cow and calf aftercare

Placement of calving chains and head rope

CALVING CHAINS

ALWAYS apply a chain to the leg with a loop above the fetlock (first joint) with a half hitch below the fetlock (below dew claws, above bulbs) → Prevent fracture and torn claws by dispersing pressure along limb

HEAD ROPE

Place snare behind BOTH ears and around mouth

• Do NOT place head rope around lower jaw → Risk of breaking bone with forceful traction

• Do NOT place rope around neck → Head becomes out of alignment with spinal column making job more difficult (even if dead)

5 Functions of a GYNstick

1. Correction of uterine torsion

2. Correction of upside down presentation of calf

3. Limb retrieval

4. Repulsion of calf back into uterus

5. Ramrod to assist breakdown of diaphragm and internal structures while debulking the calf (esp. for foetal ascites)

Calving Pulleys vs. Calving Jack

• Advantages

• Disadvantages

CALVING PULLEYS

+ve:

1. Flexible and dynamic → Can be used by single operator

2. With ample anchoring points, it provides more control over angle and tension of pull

3. If tension is rapidly released, there is little risk from pulleys injuring a person

4. Rapid release mechanism which can be reached even when standing directly behind the cow

5. Take up little room in the back of a vehicle

-ve:

1. Become tangled and jammed if set up incorrectly

2. Must place truck/tractor in correct position to be used as an anchoring point for paddock calving

3. Too much force can be applied if multiple people pulling

4. Can smell if not cleaned and dried thoroughly

VINK CALVING JACK

+ve:

1. Does not require additional anchoring points (U-shaped piece braces against back end of cow)

2. Can be used by ONE person to deliver a calf

3. Some models have a double ratchet movement which brings one leg forwards at time to “walk” the calf’s shoulder through the pelvic canal

-ve:

1. Fixed angle of pole can make getting correct angle of pull for a down cow challenging

2. If cow unsettled and swinging hind end → Pole can cause injury to people

3. Tension handle can become stuck if too much tension is applied and handle cannot be replaced all the way to the horizontal position

Hiplock

• Definition

• 2 Treatments

Definition: Complication of anterior presentation where head and thorax is delivered BUT foetal pelvis/greater trochanters jam into the dam’s pelvis

Treatments: Do NOT continue to pull → Damage to cow

1. Rotate calf by twisting FL (50% success)

2. Partial foetotomy

   • Trunk → Evisceration → Split hips

Describe how to manipulate the calf for

• FL back

• Head back

• Posterior presentation

• True breech

• Anterior dorsopubic

FL BACK

Inside: Only ONE of the limbs has successfully extended into the birth canal as the other has become caught behind the brim of the pelvis (retained at the shoulder, carpus or fetlock)

• Occasionally, the limb can be crossed over or entangled with the extended limb or head

Diagnosis:

1. ONE set of toes and head protruding from vulva

2. Only one limb and head within pelvis on vaginal exam → Deeper examination to locate and position the 2nd forelimb

Treatment: Cannot deliver without correcting limb position

1. Slide arm into uterus and ID which forelimb is retained + which joint (eg. shoulder)

2. Slide arm down limb and grasp forelimb at the humerus

3. Pull limb forwards until carpus is retained now

4. Slide arms down and UNDER limb to grasp metacarpal

5. Pull metacarpal up (clear pelvic inlet with foot) until fetlock is retained now

6. Take other hand and slide under your arm so that it is cupping the claws

   • Length of limb to carpus is longer than the birth canal diameter → Attempts to straight limb forcefully results in uterine tearing

7. Repel the carpus back into the uterus to clear space to bring the foot into the birth canal

HEAD BACK

Inside: 2 front limbs extended normally into pelvic canal BUT head is trapped behind the pelvic inlet

• Pressure from uterine contractions can exacerbate malpresentation by causing the head to move further away from the birth canal as shoulder become jammed into the pelvic inlet

Diagnosis:

1. 2 front limbs extended normally outside vulva

2. No palpable nose or head → Deeper palpation reveals shoulder present at the pelvic inlet

   • Palpate in direction which head lies and double check it is not a posterior presentation

Treatment: One of the most difficult types of dystocia to correct (esp. when head is forcefully pushed away from birth canal)

1. Slide arm into uterus and ID head back presentation (may need to pull calf into birth canal to reach head)

2. Hook the bony orbit of the eye OR commissures of the mouth with your fingers → Gives control of head

3. Bring head into normal position by repelling calf into uterus and AWAY from head to replace shoulders of calf with head

4. Can extend hand over face of calf to rotate up and into the birth canal

POSTERIOR PRESENTATION

Inside: Calf presented to birth canal backwards with 2 hindlimbs extended into birth canal

• Cervix may NOT dilate normally due to incorrect pressure applied (no gradual expansion of the cervix with forelimbs and head to shoulders)

Diagnosis:

1. 2 feet extended from vulva with soles facing the sky

   • Anterior presentation with dorsopubic position OR uterine torsion

   • Posterior presentation

2. Palpation reveals opposite flexion of distal joints and no head or neck palpated ± tail identified

Treatment: Can be delivered in posterior presentation BUT difficult

1. Ensure cow is fully dilated at the pelvic inlet to avoid uterine tearing

2. Place calving chains and slowly add traction

3. Pull at a level angle to the cow’s pelvis until the hips have passed through the birth canal → Keeps hindlimbs and pelvis in straight line

   • Downward traction on hindlimbs → Forces pelvis up into the spine of the cow

4. After hips through the vulva, angle the traction lower than the pelvis to assist delivery of shoulders and head

TRUE BREECH

Inside: Calf presenting into pelvic canal backwards with all four hooves pointing towards the head of the cow (i.e. tail coming first)

Diagnosis:

1. Cow not progressing in delivery often only sign

2. ± Calf tail visible outside cow vulva

Treatment:

1. Slide hand in to grasp the tibia of the calf

2. Pull the leg towards the birth canal while flexing the hock

3. Reposition hand and grasp the metatarsal

4. Pull leg towards birth canal while repelling calf back into the uterus with other hand

5. Take other hand and slide under your arm so that it is cupping the claws

   • Significant length between the hock and the distal limb → Longer than diameter of birth canal and risk of uterine tearing

6. Repel metatarsus into the uterus while pulling the foot into the birth canal at a diagonal (widest width of the birth canal)

7. Repeat on the other hindlimb

8. Deliver via posterior presentation after cervix has fully dilated

• Breech = High incidence of twin deliveries → Check for 2nd calf which makes job difficult

  • Twin adds pressure behind calf and limits room to repel calf

ANTERIOR DORSOPUBIC PRESENTATION

Inside: Both forelimbs extended and head in pelvic canal BUT dorsal part of skull is facing the pubic bone of the cow’s pelvis

• May indicate uterine torsion

Diagnosis:

1. Two limbs extended out of vulva with soles facing up

2. Vaginal palpation to determine if limbs are forelimbs vs. hindlimbs (all 3 distal joints bend in the same direction) → Head and neck palpated (may be difficult if head is dropped ventrally)

3. Rectal exam → Rule out uterine torsion

Treatment: Presentation and posture correct, position incorrect (dorsopubic)

1. Repel most the calf back into the uterus

2. Turn calf over to correct position (consider criss-crossing legs until calf’s body is rotated

Overview of Caesarean Section

• Endogenous contamination

• Prognosis

• 7 Causes of mortality

• Long-term effects

Endogenous Contamination: 83% of uterine environments are heavily contaminated → Wound contamination is inevitable

• Aim to avoid contamination of abdominal cavity

Prognosis: Influenced by calf condition

• Live calf prognosis for cow → 86%

• Dead calf prognosis for cow → 79% (33% when emphysematous)

Mortality:

1. Peritonitis

2. Shock

3. Metritis

4. Concurrent disease (eg. milk fever)

5. Acute haemorrhage

6. Increased surgical time

7. Post-op adhesions

Long-Term Effects: No significant effects on lactation

• 71% pregnancy rate in dairy and 91% pregnancy rate in beef

• +18.5d from calving to conception

12 Steps of Caesarean Section

1. Location and Restraint

   • Clean, light and dust-free

   • Ideally perform while standing (exteriorise uterus)

2. Pre-Op Drugs

   • Epidural

   • Clenbuterol IM

3. Local Anaesthesia

   • LEFT laparotomy

   • Options: Line block, inverted L-block, paravertebral block #1

4. Clip and Surgically Prep Site

   • Use clean water and scrub 3x with surgical scrub solution working outwards from intended incision site (≥5 minute contact time) → Rinse between scrubs

   • Wipe off last scrub with tincture and sterile swabs

5. Surgeon Preparation

   • Place sterile surgical pack in clean and safe location

   • Ensure hands and arms (up to armpits) are surgically scrubbed and wear surgical gloves

   • Have clean assistant with scrubbed hands

6. Incision

   • Location: Halfway between tuber coxae and 13th rib

     • Hand width below lumbar vertebrae, leaving ~1/3 of trunk un-incised

     • ~50cm incision

   • Structures: Skin → SC → 3 muscle layers → Peritoneum

     

7. Exteriorise Uterus

   1. Locate part of uterus containing a hind leg

   2. Grasp calf’s metatarsal and steadily pull uterus up into abdominal incision

   3. Place one hand under hock and other on dorsal pastern to lock foot into abdominal incision

   4. → Incise into greater curvature of uterine horn beginning at hock (avoid cotyledons and blood vessels where possible)

   5. Grasp leg and ID 2nd leg to exteriorise

   6. With help of assistant, lift upwards and then pull backwards along the flank to remove the calf

8. Calf Care and Rescrub

9. Uterus Closure = Continuous inverting (Utrecht) in 2 layers

   • Peritonitis comes from inside out → Ensure uterine serosal contact for adhesion formation and minimise exposed suture (wick bacteria)

   • Material: 6M chromic catgut on curved round bodied needle

10. Abdominal Closure = Muscle and peritoneum → SC → Skin (Ford interlocking)

11. Additional Treatments and Aftercare

    • Penicillin IM 5d

    • Meloxicam SC

    • Recheck 3 - 4d for emphysema, peritonitis and metritis

12. Sutures Out 2 - 3w

Overview of Foetotomy

• Definition

• 6 Ways to protect the cow

• 2 Methods

Definition: Dissection of foetus into ≥1 parts while it is still inside the uterus and/or vagina

• Achieved by cutting through skin, muscles, ligaments and bone with braided wire

• If done correctly → No risk of uterus damage

Protect Cow:

1. ALWAYS epidural

2. Consider tocolytic agents to abolish uterine contractions

3. Copious amounts of obstetrical lubricant

4. Use proper equipment (tighter the weave = higher the quality)

5. Careful technique and anatomical considerations of cut location to minimise sharp edges of foetus on uterus

6. Cup hand over sharp points with towel in between when removing parts → Avoid laceration of uterus and vagina

Methods:

1. Malposition → 1 - 2 cuts

   • +ve: Quicker than C-section

2. Complete foetotomy → 3 - 6 cuts which require forethought in cut placement

   • ~2hr if experienced

   • -ve: Prolonged foetotomy → Increased cow and vet exhaustion

TWO Types of Foetotomy Cuts

• Definition

• Indications

• Method

REVERSE CUT

Definition: Head of foetotome further in → Cutting backwards

Indications: Remove head and FL OR HL

Method:

1. Load BOTH channels of foetotome and pass wire around head and FL (OR around HL)

2. Advance foetotome until its head is dorsolateral behind point of scapula and wire is seated in axilla (OR anterior to tuber coxae and wire between tail and opposite tuber ischii)

3. Apply traction to leg and anchor chain into notched base plate

END-ON CUT

Definition: Straight-forwards cut with head of foetotome further out

Indications: Head back and splitting pelvis of hiplock

Method:

1. Thread ONE channel of foetotome and pass wire around part you want to remove with an introducer

2. Thread other channel

3. Advance foetotome until hard up against calf

7 Pieces of equipment required for foetotomy ONLY

1. Foetotome (notched base plate for anchoring chains)

2. Threader (thread wire onto foetotome)

3. Wire handles

4. Krey’s hook

5. Introducer

6. Sharp cutting pliers

7. Embryotomy wire (tight weave = higher quality)

   • Cut 3.5x length of foetotome

10 Steps of general foetotomy

1. Restrain cow and administer epidural and tocolytic

2. Administer generous lube

3. Place calving chains

4. Foetotome set-up

   1. ID end that goes into cow (mushroom-shaped and opposite to handle end)

   2. Embryotomy wire is passed through the fetotome using a threader by pulling from the cow-end to vet-end

   3. Attach handles to vet-end by looping wire around each alligator clip (x2) OR attaching via surgeon’s knot

   4. Wire placed around the anatomy to be removed (may require an introducer)

      • Attach introducer to cow-end of wire and pass round calf

   5. Thread 2nd channel of the fetotome with the threader from cow-end to vet-end

5. Get foetotome into position for end-on or reverse cut

6. Apply traction to calving chains and lock over base plate notch

7. Wire placement checked to ensure correct anatomy is being removed and no maternal anatomy included in cut

8. One person with hand over foetotome head to keep wires in place by keeping head of foetotome still

   • Good communication with person cutting

   • Person pulling wires is prepared to stop immediately if required

9. Initial short strokes to imbed wire → Longer smooth strokes to cut through skin and bone

   • Fell “pop” when through

10. ALWAYS debulk calf

    1. Remove calf’s heart and lungs (may need finger knife)

    2. Burrow through diaphragm to remove all intestines in reach

Lawrence Butt Cut

• Indication

• Method

Indication: Calf in true breech position with both hips flexed

Method:

1. Use extra wire (4x fetotome) and thread both channels

2. Pass loop around rear end of calf just below tuber ischii

3. Advance head of fetotome until dorsal to thoracolumbar junction

4. → Calf sliced in FOUR

   • 2 hind legs cut through proximal femur

   • Pelvis and spine up to ribs

   • Anterior portion of ribs, head and front leg

5. Pull pelvis → legs out with Krey hook

7 Steps of cow aftercare and 6 steps of calf aftercare (alive)

COW

1. ± Antibiotics = 3 - 5d penicillin IM (emphysematous calf or vaginal tear)

2. Oxytocin

3. NSAID

   • Ketoprofen

   • Meloxicam (when AB given due to WHP)

4. PO starter drenches (eg. calcium, molases, propylene glycol)

5. PO fluids

6. Coat and nursing

7. Arrange metricheck 2 - 3w post-calving

CALF

1. Lift HL over rail to drain fluid from chest (esp. posterior-presenting calves as they breathe in fluid)

2. Stimulate breathing with straw or mouth-to-nose resuscitation

3. NSAIDs

4. ± Penicillin 3d

5. Dress navel

6. Tube with 2L fresh colostrum

Overview of Uterine Prolapse

• Aetiology

• Sequelae

• Prevalence

• Predisposing risks

  • Young cow (4)

  • Older cow (5c)

Aetiology: Continual abdominal contractions expel uterus through vagina

Sequelae: EMERGENCY

1. Shock

2. Severe haemorrhage

Prevalence: 0.02% in NZ

Risks:

• Young Cow = Foetal oversize, nerve damage, assisted calving, farm contour

• Older Cow = Milk fever, nerve damage, poor BCS, assisted calving, farm contour

Describe SEVEN steps of uterine prolapse treatment

ONE: PHONE INSTRUCTIONS

1. Need warm water, 2 buckets and shed aprons or clean sheet

2. Where is the cow? Will drive to cow (do NOT bring to shed)

3. Administer SC calcium

4. Need 1 - 2 helpers to retrain cow and replace uterus

5. Do NOT walk excessive distance if cow up and mobile

TWO: HISTORY

1. Age of cow and parity (milk fever?)

2. When did the cow calf?

3. Was the calving assisted? (excess traction → traumatic uterine prolapse)

4. AI or natural mating (oversize?)

5. Any metabolic treatment (no response → other pathology)

6. Cow up since calved? (existing milk fever or nerve damage a potential complication?)

THREE: PATIENT ASSESSMENT

1. Milk fever → Give Ca (not too much to prevent mobilisation of cow)

2. Haemorrhage → ± Transfusion after replacing uterus OR euthanasia ASAP

3. Uterine damage → Amputation OR euthanasia

4. Mastitis → Euthanasia if severe

FOUR: PRE-REPLACEMENT TREATMENT

1. Roll into sternal

2. Administer sedative if fractious (0.1mg/kg xylazine IV)

3. Epidural ± tocolytic

4. Position cow in frog-leg position OR restrain in narrow race if up

   • Frog legged = Ideal position for down cow with prolapse to tilt the pelvis down towards the cow’s head (replace with gravity)

5. Thoroughly clean with warm water and iodine

6. Remove placenta ± trim

7. Use plenty of lube

FIVE: TREATMENT

1. Support weight of uterus with sling or on thighs

2. Do NOT use sugar to shrink uterus by osmosis

3. Use flat hands or firsts and begin at top → Sweep hands around internal rim of vulva (breaststroke action)

4. Use clean lubed bottle to push out tips of uterus

SIX: REFRACTORY

1. Check bladder if retroflexed within uterus → Requires drainage with needle

   • Feels like a firm ball or large swelling inside the uterus

2. Check no haemorrhage/haematoma preventing replacement

3. Uterus not sufficiently elevated → Sedate cow and shackle back legs to fore end loader → Hoist cow rear ~1m above growth and try to replace

4. Uterus not relaxed → Try tocolytic clenbuterol IV

5. Check pushing uterus back into correct hole

SEVEN: AFTERCARE

1. Do NOT stich vulva

2. Aftercare as for dystocia = OT, Ca2+, AB, NSAIDs, propylene glycol, metricheck

Overview of Uterine Torsion

• Timing

• Most common direction of twist

• 4 Methods of diagnosis

• 4 Methods of correction

Timing: 90% at parturition = Late 1st stage of labour

• Does NOT occur in Bos indicus → Different broad ligament anatomy

Twist: 90 - 360˚ and 75% anticlockwise (observe from behind cow)

Diagnosis:

1. History = Failure for delivery to progress beyond 1st stage of labour (farmer may report no cervical dilation)

2. ± Deviated angle of vulva

3. Vaginal palpation = Narrowed and twisted vaginal and cervical lumen

   • DDx: Incomplete cervical dilation

4. Rectal palpation = Broad ligaments spiralling over top of uterine body → Confirms diagnosis ± Oversized calf

→ Determine which direct the twist is occurring via vaginal and/or rectal palpation

• Twist occurs in the SAME direction as the curve across the top of the vagina

• Hand swept to right → Clockwise rotation

• Hand swept to left → Anti-clockwise rotation

Treatments:

1. Create momentum

2. GYNstick/Torsion bar

3. Rolling cow

4. C-section

FOUR Treatments of Uterine Torsion

• Indication

• Disadvantage

• Method

ONE: CREATE MOMENTUM

Indication: Limbs MUST be palpated in birth canal

-ve:

1. Physically impossible in some cases

2. Risk of injury to vet

Method: Use calf to rock uterus back and forth in abdomen → Create sufficient momentum to flip calf AND uterus back to correct the twist

TWO: GYNSTICK/TORSION BAR

Indication: Limbs MUST be palpated in birth canal

Method: Ropes applied to both limbs of calf → Ropes cross through loop in torsion bar → Bar rotated in opposite direction of the twist to use the body of the calf to pull the uterus back into the correct position

THREE: ROLL COW
Indication: Cannot get hand through cervix to reach limbs

• Roll cow so she catches up with her uterus (twist the cow about her uterus which remains stationary)

Equipment:

1. Long rope

2. Long and wide plank

3. ≥3 adult helpers

Method: Roll cow in SAME direct as twist while anchoring uterus stationary (eg. anticlockwise twist to left → left lateral recumbency)

1. Cast cow using long rope and Reuff’s method and tie legs together

2. Place plank over gravid uterus = Between wing of ilium and ribs

3. Someone stands on plank → Surf the cow

   • Plank fixes position of uterus while cow is unrolled around it

4. Have 1 person in charge of hindlimbs, 1 person in charge of forelimbs and 1 person in charge of head

5. Ideally keep hand in vagina to ensure there is no tightening

6. Roll cow through 180˚ and keep her on the ground to check for progress

7. Often need to repeat rolling to fully correct

   • Keep cow rolling in same direction

   • Do NOT allow her to get to her feet

   • → Replace plank and roll again

FOUR: C-SECTION

Method: Depending on type, direction and degree of rotation, the uterus can be corrected first OR calf removed first

+ve:

1. Less space and assistance required

2. Vet can visualise uterus to ensure complete correction

3. Saves time when cervix is not dilated after uterine torsion correction

Uterine Torsion After Treatment

• Indicators of correction

• 5 Additional treatments after torsion is corrected

Correction: Passage of uterine fluids and urine

• Vaginal palpation to assess progress

Additional Treatments: Often not fully dilated cervix

1. Prostaglandin/steroid to continue cervical dilation

2. Ideally place calf legs through cervix to initiate contractions

3. Recheck for delivery in 3 - 4hr

4. ± Veterinary assistance for delivery (oversized calf)

5. ± Caesarean or cut into cervix (may not dilate)

Therapeutic Induction of Calving

• Indication

• Disadvantage

• Method

Indication: Late gestation as a solution for poor bull selection

• Easy when mating date known

-ve: May negatively affect lactation (BUT cow welfare #1 priority)

Method: Inducing heifers/cows of unknown expected calving date

1. Examine udders and select cows that have entered the pre-calving mammary growth spurt

2. Give long-acting corticosteroid

3. Re-examine at 7 - 10 days

4. Give 2nd short-acting corticosteroid if final udder growth has taken place OR more long-acting and wait

5. Check through mob of heifers weekly