Approach to Complicated Calvings and Post-Partum Conditions

Describe key features of a Twisted Uterus.

Twisted Uterus Occurs in 1st stage labour generally before cervix has fully opened (can occur before labour too)

• Normally anti-clockwise (60% pregnancy in right horn)

• Usually involves vagina too so can detect on vaginal exam

• Occasionally pre-cervical - can’t feel on vaginal exam
  

• 90^o > 180^o > 280^o > 360^o Varying degrees of severity

• Feels like a tight band (90^o) or completely closed, unable to reach calf and palpable vaginal folds (360^o)

How is a twisted uterus diagnosed?

Diagnosis:

Classic history (calf doesn’t get into pelvis)

= ‘calving long time’ or ‘not getting on with it’ ‘Doesn’t feel right’ ‘Can’t feel calf’

• Distinctive vaginal and rectal exam findings

• If occurs months before calving, present as ‘sick cow’ in mid-late pregnancy – normally very healthy at this point

If you CAN feel the calf, how do you correct a twisted uterus?

Twisted Uterus Correction – if CAN feel calf (90^o – 280^o)

• Roll the calf to untwist the uterus

• Depends on your stature

• Not easy if dry/dead calf

1. Hold onto calf and rock calf back and forward to start momentum then, flip it over in OPPOSITE DIRECTION of twist

2. Gyn stick Cast and roll cow

If you can’t feel the calf, how do you correct a twisted uterus?

Twisted Uterus Correction – CAN’T feel calf (>180o) Cast/roll cow IN DIRECTION of twist

• i.e. cast onto let lateral, roll cow anticlockwise

• Needs momentum and 3 people

• Sometimes calf upside down after

• Cervix needs time to dilate If doesn’t work or cervix doesn’t dilate, need C section, don’t bother untwisting

What are main risk factors for twisted uteruses?

What does the progosis usually look like?

Twisted Uterus Risk Factors

• Cows more prone than heifers

• Big calves

• Male calves

• Hypocalcaemia

• Excessive foetal movement

Prognosis

• Early diagnosis + rapid correction = good outcome

• Prognosis declines with time, degree of torsion, and systemic illness

• Cow survival is generally better than calf survival

What are the man features of cervical stenosis?

Cervical Stenosis (ring womb) = tightness of the cervix

• Could be interfering too quickly

• Historically wait ‘2 feet 2 hours’ - evidence that intervening earlier is not always a bad thing

Can attempt to manually dilate OR

• Prostaglandin

• Oxytocin

• Denaverine hydrochloride

• Consider C-section

• Common after twisted uterus

• More common in sheep than cattle

What are the main features of vulval stenosis?

Vulval stenosis - tightness of the vulva

More common than cervical stenosis esp in heifers

• Easy to diagnose on vaginal exam

• Some need time Tx - Lube and manual stretching for up to 20mins or episiotomy

If faced with a dead, emphysemaous calf, how should you proceed?

Dead, emphysematous (airfilled), rotten calving

• Calf dead so can use considerable traction but don’t damage cow LOTS of lube

• Really rotten = falls apart easily but can be tricky to make sure you have got all the bits

• Embryotomy an option

When traction occurs during birth, what does this mean?

IF TRACTION = NO PROGRESS

Malpresentation not corrected

OR

Calf too big, cow too small – section

OR

Deformed

What are the main features of Schistosma reflexus?

Schistosoma reflexus

• Rare, fatal congenital condition

• Spinal inversion, abdominal organs exposed, limb ankylosis and limbs adjacent to skull

• Embryotomy or c section

What are the main features of ascites in newborn calves?

Ascites - often due to infection in utero

• Everything feels ok at the front, apply traction but no progress

• Prognosis for calf very poor

• Use guarded knife and cut open abdomen to release fluid

What are the main features of polymelia?

Polymelia = Extra limbs Developmental error, twin

• Feels like twins Depends on what/where

• Might be able to deliver or C-section

What are the main indictions for an Embryotomy?

Embryotomy Indications

• Dead calf

• Unable to calve with manipulation and traction

• Most commonly carried out for hip lock/stuck at the hips

• Variable levels

  • Head only

  • Body/hips

  • Full

How do you perform an embryotomy?

Embryotomy – Post op Cow NURSING Down cow management Continued NSAID Broad spectrum antibiotics Fluids Often nerve damage Regular moving/lifting

Epidural & NSAID

First, try rotation or sharp turn of calf to cow’s flank, might just get it out

1. Traction - as much as possible to get calf out

2. 1st cut: cut soft tissue with knife behind ribs then embryotomy wire through spine

Embryotomy - post op cow

• Nursing

• Down cow management

• Continued NSAID

What are some general tips for calving?

Calving in general –

• Use drugs appropriately

• Get 2 hands inside cow

• Powder lube via stomach pump not if c-Section, good for dry or dead calves

• If small: Stand on a bucket

• Delegate to farmer

• Keep calm

• Stay determined but change tactic

• Know your limitations

• Phone for help

• COMMUNICATE WITH THE FARMER

What are the main features of calf resuscitation?

First step check umbilicus for haemorrhage

• Check for respiration, if not breathng then resuscitation

• Methods oftn anecdotal:

• Ensure airway open and clear fluid

• Water in ear, straw up nose

• Sternal recumbency and extend neck

• Rubbing chest, bring front and hind limb together

• Hang briefly if fluid in lungs ONLY for 10 secs

Best way to ge rid of fluid it for calf to breath

• Doxapram (Dopram)

• Oral stimulants - energy, minerals, caffeine

• Endotracheal tube 7-9.5mm with larygngoscope

• Mouth to mouth does not work

Why do all calves have some degree of respiratory acidosis at irth?

Calf acidosis All calves have respiratory acidosis at birth + C-section takes longer to breath

• If respiration delayed = metabolic acidosis due to low oxygen and high lactic acid production

• So if hard calving (Restricted blood supply to calf) and breathing delayed = ACIDOSIS

Consequences Reduced respiratory function Reduced cardiac function Reduced calf vigour Reduced suck reflex Reduced IgG absorption

What are the main signs of calf acidosis?

Signs

• No respiration

• No suck reflex

• Time Sternal Recumbency > 3 mins (9 mins is risk of death)

• Time to standing > 15-30 mins

• Dull

• Hyperreflex

Treatment 50-100ml 8.4% Bicarb IV

What are the main features of general calf care?

• COLOSTRUM 4l in 4 hours

• Treat navel

  • strong Iodine (10%) dip preferred to spray

• Clean environment

• NSAID

  • Underutilized but not currently licensed

What are some other post-calving complications that may occur?

Post calving – Other calf problems

• Fractures - jaw, leg, ribs

  • Tx - cast depending where

• Femoral nerve paralysis

  • Tx - NSAID and time

• Glossal oedema

  • Tx - NSAID and time

• Umbilical haemorrhage

  • Tx - clip, clamp and surgically close

• Umbilical hernia

Why should you always perform a vaginal exam after caving?

• Look for another calf, tear, bleeding, brusing

• Also check udder for mastitis / colostrum

Possible medical therapy:

What are some common complications that may affect the cow post calving?

Post Calving – Cow Haemorrhage Vaginal or pudendal artery Die quickly

Uterine haemorrhage Pack uterus Oxytocin Blood transfusion

What is this term?

Post Calving – Uterine Prolapse Common, emergency Hypocalcaemia Excessive traction Prolonged recumbency

Occurs minutes to hours after calving

Why does uterine prolapse occur post calving?

Post calving – Uterine Prolapse Assess haemorrhage Assess viability Check for tears Check for GI tract

What questions should you ask before replacing the uterus in the case of a bovine prolaps?

Post calving – Uterine Prolapse Epidural Clean uterus Remove placenta Replace uterus LUBE

How should you go about replacing the uterus in the case of a prolapse?

Post calving – Uterine Prolapse Ensure fully everted Stitch Antibiotics NSAID Calcium

How does nerve damage often occur post calving?

Post Calving – Nerve damage Result of prolonged calving Obturator – splits Peroneal – knuckle Sciatic – unable to rise

Tx NSAID Hobbles NURSING

How do most down cows end up dying?

DOWN COW DDX Hypomagnesaemia Hypophosphataemia Milk fever Lameness Fracture Botulism Nerve damage

What are some other post-calving conditions?

Post calving – Covered Elsewhere Retained foetal membranes Metritis Endometritis

What are the main factors that contribute to dystocia in cattle?

Factors Affecting Dystocia in Cattle Malpresentation Twins Calf mortality Cow body weight Uterine torsion Calf birth weight Breed Pelvic area BCS Gestation length Age at calving Calf sex Nutrition Sea