TV4101 - Bovine - Obstetrics 3

Dystocia due to multiple pregnancies

Can arise due to?

– Uterine inertia – overstretching of myometrium

– Simultaneous presentation of two or more foetuses. Usually one is presented cranially and the other caudally or both may present cranially or caudally

– Malposition of the first or subsequent foetuses

Dystocia due to multiple pregnancies

CX?

• Failure of birth to proceed normally

• Presentation of multiple limbs or heads

• Presentation of fore- and hindfeet in vaginal canal

• Birth or delivery of one foetus with death of 2nd

foetus → dystocia, retained placenta or postparturient ill cow as 2nd foetus decomposes

• With twins both foetuses are often smaller than normal but in some cases they will still be large foetuses

Dystocia due to multiple pregnancies

dx?

• Identify origin of each limb by carefully tracing back to foetal

body.

• Care is needed to differentiate from congenital abnormalities which can result in multiple heads and limbs

Dystocia due to multiple pregnancies

TX?

Foetal manipulation steps?

After deilvery?

Common sequeulae?

1. Repel one and deliver other by traction

2. Deliver most caudal foetus first or any foetus in caudal presentation as only hindlimbs need to be manipulated

Post devliery

• Check for more foetuses

• Oxytocin (20 IU IM) → uterine involution

Retained placenta, post partum metritis & delayed conception

Dystocia due to foetal malformation

Examples?

Head?

Fluid?

Spine flexion?

Hydrocephalus – enlarged cranium

Foetal ascites – abnormal distension of abdomen with fluid, passage of head, neck and thorax through vagina but abdomen will not pass

Foetal anasarca – Subcutaneous oedema (autosomal recessive in Ayrshire cattle)

Schistosoma reflexus – dorsoflexion of foetal spinal column with exposure of foetal viscera, common

Dystocia due to foetal malformation

Examples?

Joints?

Lumbar?

Monsters?

Mulitples?

Dwarves?

• Contortion and rigidity of joints, wry neck (rigidity of neck)

• Perosomus elumbus – agenesis of lumbosacral spine, normal cranial portion of foetus may traverse birth canal, but abnormal hind end with anklylosis of hindlimbs become impacted

• Chondrodystrophia foetalis (dwarf or bulldog calves)

• Acardiac monsters (headed, headless, amorphous – lack any external characteristics of a normal foetus)

• Multiplication/duplication of foetal parts

Dystocia due to foetal malformation - what this?

CX during delivery?

Cause?

Perosomus elumbis

Cranial presentation - appears normal at first but is halted following delivery of thorax

Vaginal exploration may reveal abnormal lumbar and poor hind region, rigid HLs

Genetic cause potentially - agenesis of lumbosacral spine

What this?

CX?

TX?

Control?

Neuropathic hydrocephalus – Angus cattle

• Inherited, homozygous recessive disorder

Severe cranial enlargement from hydrocephalus, with dwarfism

• Affected calves may be aborted before the end of gestation

Collapse of hydrocephalic cranium or caesarean

Control: detection and culling of carriers

What this?

Describe it?

Cause?

Control?

Arthrogryposis multiplex. ‘Curly calf syndrome’

• Congenital limb fixation

• Mild hydrocephalus

Same chromosome affected as neuropathic hydrocephalus

DNA test is now available and carriers are being detected and eliminated

What this?

Achondroplasia (bulldog calf)

What this?

Describe it?

Causes?

TX?

Foetal ascites & anasarca (hydrops foetalis)

Abnormal accumulation of fluid characterized by an accumulation of fluid, in at least two foetal compartments

• e.g. oedema of foetus and placenta, ascites, pleural effusions and/or pericardial effusions

Myriad congenital anomalies can cause this (results in passive venous congestion) eg pulmonary, cardiac, liver anomalies

Draining fluid filled compartment with a palm knife

• Foetotomy

• C-section

What this?

Pulmonary Hypoplasia Anasarca (hydrops foetalis)

What is this?

Describe it

Caused by?

What this?

How does it work?

Amorphus globosus (Classic)

Incomplete twin (with all 3 layers, ectoderm, mesoderm and endoderm) connected vascularly to twin placenta

• May be different sex to normal twin but no freemartin risk as no gonadal tissue

What this?

Describe it

Holoacardius Amorphus aka Anidean monster

An embryonic anideus is a blastoderm in which no embryonic axis develops

What this?

Importance?

General principles for managing foetal monstrosities

DX?

Traction?

Placenta?

Limbs?

Abnormalities may be detected on vaginal examination or progress of foetus fails to occur or is halted during application of traction

Small foetus? Traction no no

Placenta may be abnormal - oedematous

Detection of abnormal limb, head and/or neck postures that cannot be corrected (eg arthrogrypotic limb)

General principles for managing foetal monstrosities

TX

Fluid?

Traction?

Foetotomy?

Draining swollen or oedematous regions with single or multiple incisions with a palm knife eg hydrocephalus, foetal ascites, foetal anasarca

Traction where abnormality still enables passage through the birth canal safely with mild traction or abnormality can be corrected or reduced in size

Foetotomy to reduce size of abnormal part, remove abnormal part(s) or transect foetal body to reduce foetal size

General principles for managing foetal monstrosities

TX

Hydrocephalus?

Anything?

• Hydrocephalus – a transverse cut with wire passed behind the ears and the head of the foetotome positioned in the mouth should remove the dorsal half of the foetal head

• Caesarean section

What this?

Occurs in who?

Twin aspect?

Caused by?

Schistosomus reflexus

Occurs in ruminants, pigs, horses

An affected foetus can be cotwinned with a normal or

freemartin foetus

A genetic cause (autosomal recessive is suspected) - Higher in Holsteins and Jerseys

Schistosomus reflexus

What change happens to foetal body?

Failure of the abdominal muscles to fuse medially → abdominal fissure and the development of a spinal inversion

Head and tail curving dorsally in relation to the long axis of the foetus

The viscera are located externally within the amnion and the limbs and spinal column are usually ankylosed

Schistosoma reflexus – Clinical signs

Dystocia with palpation of foetal viscera within the vaginal canal or visible externally

• Foetal visceral loops of intestine smaller than dam (DDX uterine rupture)

Palpation of multiple limbs within the vaginal canal with ankylosis of limbs and vertebral canal

Schistosoma reflexus

Presentation options

– Visceral (transverse ventral) presentation – most amendable to foetotomy

– Presented by extremities (transverse dorsal) – more difficult

to reduce with foetotomy

Schistosoma reflexus – Treatment

Steps?

1. Foetotomy done first usually as long incision may be needed for c-section

2. Bisection following passage of a wire introducer

   around the foetal trunk can enable sufficient reduction in foetal size to enable delivery by traction

3. Easier for transverse ventral (viscera presented) than transverse dorsal (limbs presented) presentation (C-section easier in latter)

In case of visceral presentation, remove viscera first, if still alive, break umbilical cord first

Frequency of treatments applied to correct dystocias arising from cases involving a schistosomas reflexus

Freq from most to least used

Why wouldn’t you do these?

Most cases foetotomy, then C-section, the simple traction

Case is hopeless as cow is severely exposed to toxic decomposing emphysematous foetus

Equine dystocia – general principles

Foal surviability?

C-section?

Risks?

Look out for?

Most foals presented dead as equine placenta separates from endometrium rapidly during foaling

Caesarean section may be indicated where correction cannot be achieved relatively quickly, atraumatically and foal is alive

Risks of cervical laceration, uterine trauma and perforation are high with manipulation of the foetus and foetotomy

Look out for flexural deformities, contracted tendons, wry neck which can complicate

Equine dystocia – general principles

What can assist delivery?

Straining?

Tail?

Presentation?

General anaesthesia and elevation of mare’s hindlimbs

To control straining – can insert a stomach tube through the glottis into trachea of the mare

Wrap tail

Most delivered in cranial presentation

schistosoma reflexus calf

Foetotomy diagrams

Description?

Equipment for companion animals

What is this?