Dystocia: All in a Day’s Work Shelby Hayden Jen Sullivan Meredyth Jones Sarah Burkindine Stage 1: initiation of myometrial contractions Stage 1: Visible signs Seeks out isolation Thick clear mucoid vaginal discharge Signs of abdominal colic Restlessness Can last 2-6 hours Stage 2: expulsion of the fetus Entrance of the fetus into the birth canal Stimulation of oxytocin release Rupture of amniotic and allantoic sacs Stage 2: expulsion of the fetus Increasing uterine and abdominal contractions Stage 2 should last no longer than 1 hour Stage 2: Visible signs Rupture of the “water sacs” Amniotic sac and feet are visible at the vulva Increasing frequency of abdominal contractions Expulsion of the fetus Stage 3: expulsion of the placenta Detachment of chorionic villi from the crypts on the maternal side of the placenta Due to vasoconstriction Usually occurs within 3-8 hours of parturition Fetal positioning Presentation Position Posture Fetal Presentation Anterior, longitudinal Posterior, longitudinal Transverse ventral Transverse dorsal Fetal Position Dorso-sacral Dorso-pubic Right and left dorso-ilial Fetal Posture Relation of the calf’s head, neck and limbs to the body of the cow Normal fetal positioning Transverse Position Causes of dystocia Basic Immediate Causes of Dystocia Hereditary Nutritional (fat heifers, excessive fat in pelvis) Management (breeding large bulls to small cows, breeding too soon after partrition) Causes of Dystocia Infectious (Brucella, Campylobacter, BVD, Bluetongue, leptospirosis, corynebacterium, Trichomonas, Listeria, IBR) Traumatic (rupture of prepubic tendon, uterine torsion) Miscellaneous (hydrops, uterine inertia) Immediate causes of dystocia Fetal causes Maternal causes Fetal Causes Size: breed, age of the dam, sire, sex Abnormal: presentation, position, posture Fetal Monsters: schistosomas reflexus, perosomus elumbis Schistosomus reflexus Maternal Causes Pelvic fractures Breeding heifers too young Hereditary or congenital hypoplasia of the birth canal Parturition Intervention Guidelines Stage I of labor > 6 hours and cow/heifer has not begun to abdominally press. Stage 2 of labor > 2-3 hours and progress is very slow or absent Amniotic sac has been visible for 2 hours and the calf has not hit the ground Dystocia Watch Intervals < 3 hours intervals is required to determine length of duration of the stages of parturition. Equipment required for obstetrical exam Twine or robe Novasan or betadine scrub Bucket or bottle of warm water Sterile lube Palpation sleeves Obstetrical Equipment for Pulling a Calf Same equipment required for obstetrical exam plus: Calf Jack (Puller) Cont. of obstetrical equipment for calf pulling Head snare Epidural Equipment – 2 % lidocaine – 6 cc syringe – 18 gauge 1.5 inch needle Obstetrical Exam 1. Fill clean bucket with betadine or novasan solution diluted with warm water to either a “weak tea” solution or a light blue solution respectively. 2. Place obstetrical chains and handles, tube of sterile lube and head snare into the bucket. Clean the perineal region with a betadine or novasan scrub followed by a clean warm water rinse. 3. • Minimum of 2- 3 separate scrub/rinse cycles 4. Put on 2 clean plastic OB sleeves. 5. Lubricate both arms with sterile OB lube Examine the birth canal for dilation and size of the pelvic opening. 6) • Manually dilate the birth canal if needed 7. Examine cervical dilation and structures in the birth canal 8. Examine uterus and birth canal for prior damage. 9. Evaluate position, presentation and posture of the calf and/or calves. Evaluate calf or calves viability 10. • • • • • Withdrawal reflex Corneal/palpebral reflex Suckle and tongue withdrawal reflexes Anal sphincter reflex Heartbeat felt through chest wall or umbilical artery pulse Methods of Correcting Dystocia Live Fetus Options: Dead Fetus Options: – Mutation – Mutation – Forced Extraction – Forced Extraction – Cesarean Section – Fetotomy – Cesarean Section Mutation Repulsion: Rotation: – Moving from dorso-pubic or dorso-ilial to dorso-sacral position Version: – Turning the fetus end-for end (i.e. on a transverse axis) Reposition of Extremities Minimum Goal of Mutation Reposition the calf into a dorso-sacral position Calf’s front legs extended cranially and hind legs extended caudally in perspective to the calf’s body. Guidelines for Mutation 1. Abnormalities in presentation, position, posture should be diagnosed and corrected prior to attempting traction. When the fetus is dead and repositioning is difficult or dangerous, other options should be considered 2. • • Partial or complete fetotomy Cesarean Section 3. Maximum of 30 minutes of mutation without progress warrants c-section or fetotomy. Types of Mutation Dystocias Retention of Front Limb Retention of Rear Limb Retention of the Head Irregular Presentation or Position – “Dog-sitter” – Uterine Torsion – Transverse Presentations Types of Limb Mutation Dystocias Front limb Hind Limb – Flexed shoulder – Hock flexion posture – Flexed carpal posture – Elbow lock posture – Foot-nape posture posture – Hip flexion posture Flexed Carpus manipulation 1. Convert flexed leg to flexed carpus posture by traction on the upper foreleg if the shoulder is flexed. 2. Apply simultaneous repulsion to the carpus in an anterior-dorsolateral direction and traction on the hoof in a medial and posterior direction Elbow Lock Posture Occur when forelimbs are not fully extended as they come into the pelvic inlet Presentation: – Tips of toes are even with the end of the calf’s nose Correction: – Repulsion on the fetal trunk and simultaneous alternating traction on the limbs Flexed Hock Manipulation 1. Convert the flexed hip to a flexed hock posture Apply hand traction high on the leg working your way distally until the hock is reached 2. Place 1 hand on the hock while simultaneously placing a second hand over the hoof. 3. Move the hoof posteriorly and medially into the birth canal as repulsion is applied in an anterior-lateral direction on the hock. Lateral view Caudal view Dystocia due to Retention of the Head Lateral deviation – Most common Ventral deviation Dorsal deviation Vertex posture – bride of nose is impacted against the brim of the pelvis causing the poll to be presented – Fetus is often dead Head-Breast Posture Correction of ventral deviation of the head Procedure 1. Repel 1 forelimb to the flexed shoulder posture 2. Bring the head up from beneath the body of the fetus 3. Flexed shoulder is converted to normal posture using the flexed carpal manipulation Lateral Deviation of the Head Correction of Lateral Deviation of the Head Repulsion of the shoulder, thorax, or brisket with concurrent traction on the head Sources for Traction on the Head: – 2nd hand – Jaw snare: beware of jaw fractures – -head, jaw or orbital hooks Irregular Presentation or Position “Dog-Sitter” Uterine Torsion Transverse Presentations “Dog-Sitter” Rear legs are extended along the abdomen of the otherwise normally presented fetus Correction of the “Dog-Sitter” Only attempt mutation if the fetus is small enough to allow palpation both hind limbs during extraction. – Allows for the hind legs to be repelled and allows the uterus to be protected from the hooves as the rear legs straighten out during delivery. – Otherwise, rear hooves may tear the uterus as they extend behind the fetus. Cont. Correction of “Dog-Sitter” 180 degree version to posterior presentation and rotation to dorso-sacral position Cesarean section – Especially with oversized fetus Fetotomy – Impacted fetus in the birth canal Uterine Torsion Always examine uterus for torsion if fetus appears to be presented in a dorso-ilial OR dorso-pubic position. Uterine Torsion Findings Spiral folding of the birth canal – Simulates incomplete dilatation of the cervix Broad ligaments of the uterus are rotated and stretches across the birth canal – 1 on the upper and 1 on the lower surface – Felt via Rectal Palpation. Methods to Correct Uterine Torsion Shaffer method (plank in the flank) Rotate fetus in utero Cesarean Section Transverse Presentations Correction of Transverse Presentations Mutation is usually not attempted especially if presenting transverse dorsal. – Rear legs sometimes perforate the uterus as they straighten if delivery is attempted by anterior presentation Convert to posterior presentation, dorsosacral position Cesarean Section Monster Fetus DO NOT ATTEMPT TO MUTATE OR PULL CESAREAN SECTION IS REQUIRED Forced Extraction of a Fetus Which one has already prepared for prior to the initial obstetrical examination – i.e. obstetrical chains and hooks should already be in the bucket of dilute betadine or novasan solution. Do not give an epidural anesthetic unless it is absolutely necessary. – Prevents dam from assisting delivery of the calf Forced Extraction in Anterior Presentation Placement of obstetrical chains 1) • Eyelets on the dorsal surface of the forefeet 2) Traction on Fetus Traction Procedure especially if fetus is oversized Unilateral traction is applied to the bottom (most anteriorly located) forelimb until its shoulder and elbow are past the pelvic inlet – It can usually be felt when the shoulder passes the ilium. – Otherwise, assume that when the fetlock is ~10 cm (15 cm in larger breeds) outside of the vulva, the shoulder has passed through the pelvic inlet. Cont. Traction of oversized fetus (anterior presentation) Full-force unilateral traction is than applied to the top forelimb (hopefully by a 2nd person) – Extraction is usually is possible if the 2nd shoulder also passes the ilium into the birth canal – If not, C-SECTION IS PROBABLY REQUIRED. Traction can be attempted with a calf jack but do not exceed force of 2-3 strong men. 3) Rotation of the Fetus How to rotate the calf to avoid hiplock Completion of Rotation •Rotation of the fetus takes advantage of the widest diameter of the pelvic inlet If Hiplock occurs . . . 1. 2. 3. Discontinue traction Clean the mucus and membranes from the calf’s nostrils Stimulate breathing – – Tickle the nostrils Pour cold water over the head of the calf 4. With hiplock apply traction only when the cow presses Continuous traction is generally unproductive Pelvic inlet becomes functionally larger 5. Apply traction caudally and somewhat dorsally This direction of pull is more perpendicular to the pelvic inlet 6. Maintain rotation of the calf’s pelvis in a dorso-ilial position. •Palpation along the back of the calf is required to ensure that the calf’s pelvis is rotated 60 to 90 degrees. Forced Extraction in Posterior Presentation Rotate the calf into the dorso-ilial position Apply OB chains to the hind legs in a similar manner as the front legs Apply traction in a caudal, slightly dorsal direction to bring the calf’s hips through the pelvic inlet. Cont. Forced Extraction in Posterior Presentation Rotate the calf back into a dorso-sacral position once the rear quarters have passed the pelvic inlet Apply slightly caudal, ventral traction Calf Jack Can be used with either posterior or anterior presentation NEVER APPLY MORE FORCE THAN WHAT 2-3 STRONG MEN CAN APPLY Cesarean Section Approaches: – High left flank – Low left flank – Left paramedian – High right flank – Low right flank – Right paramedian – Ventral Midline Fetotomy Should only be performed in the dead fetus Fetotomy Equipment Fetotome Wire Threader Wire saw handles Wire introducer Krey Hook OB chain Lubicant Epidural equipment Injury to the Calf Asphyxiation and Anoxia Rupture or impaction of the umbilicus during manipulation necessitates rapid extraction to prevent anoxia and potential brain damage Complications more frequently associated with posterior presentation Femoral Nerve Paralysis Often associated with prolonged hiplock during extraction Nerve Damage Fractures Fracture of the mandible due to inappropriate use of obstetrical chains Fractures Placement of obstetrical chains with one loop over the fetlock and a half-hitch around the pastern will better distribute traction and prevent injury to fetal limbs Fractures Excessive traction may also result in fractures of the pelvis or ribs, as well as injury to the joints and spine Complications Associated with Posterior Presentation Pulmonary hemorrhage, diaphragmatic hernia, and liver rupture may be caused by excessive traction on the fetus in posterior presentation Injury to the Dam Calving Paralysis Paresis or paralysis of the cow Damage to peroneal and obturator nerves May be caused by prolonged hiplock or excessive force used in its resolve Retained Placenta Direct association with abortion, twinning, dystocia, cesarean-section, and fetotomy. Uterine Prolapse Associated with dystocia and irritation of the external birth canal Complicated by environmental insult— freezing, drying, severe laceration Trauma to the Birth Canal Tears and lacerations: – Vulvar, vaginal and cervical tears, recto-vaginal fistula or perineal laceration – Forelimbs may be forced through the dorsum of the birth canal Hematoma Vaginal necrosis Uterine Ruptures or Tears Associated with prolonged dystocia, uterine torsion, and excessive repulsion or rough manipulation Tears most commonly occur in the ventral uterine wall @#$*%&!! Dam number 1025 Saturday, April 6: calf presents breech, calving difficulty 5 and 8, calf does not survive extraction Monday, April 8: dam found dead, presented for necropsy Peritonitis Examination of the abdominal cavity reveals a considerable volume of bloody fluid and fibrin Petechiation of the Heart Indicative of an acute/agonal incident or a septic insult Dorsal Uterine Tear Full thickness, approximately six inches long Ventral Uterine Tear Partial thickness, approximately three inches long with associate mucosal/ sub-mucosal hemorrhage Fetal Lungs Appearance of the lungs indicated the calf had taken a breath @#$*%&!! Economic Implications of Dystocia Things to consider: -Dam Value -Live Calf Value -Cost of Veterinary Intervention Dam Value Dairy cows (Holstein) - Replacement of Mature Milking Cow: $1200-1500 - Replacement of Springing Heifer: $1800-2500 - Lactation and Genetic Potential Dam Value Beef Cows Purchase of Replacement Heifer: $850-900 Rearing of Replacement Heifer: $750-800 Seedstock Genetics Live Calf Value •Dairy Calves - 1 day old heifer calf: $500-700 - 1 day old bull calf: $100-150 Live Calf Value •Beef Calves - Feeder Futures for January, 2003 - $79/cwt x 700# = $553 Even if you can’t save baby… •Dairy Cow value post-calving - Lactation: 18,000# x $0.87/# = $15,666 - This does not include cost of lactation - Salvage: $54.00/cwt x 1000# = $540 - Rebreed Even if you can’t save baby… •Beef cow value post-calving: - Raise orphaned or twin calf; Rebreed - Salvage: $60/cwt x 900# = $540 Producer Cost for Caesarean Section •Survey of veterinarians - Average charge for on-farm dystocia ending in Caesarean section - $258.92 What is the bottom line? •Dairy Producer: -Heifer + Calf Alive = $2300 Plus Lactation ($15,000) and Genetics -Heifer Alive = $1800 Plus Lactation ($15,000) and Genetics -Cost of Caesarean: $260 11% of value of both at that time What is the bottom line? •Commercial Beef Producer: - Heifer and Calf Alive: $1403 - Heifer Alive: $850 - Cost of Caesarean: $260 -18% value of both Conclusion •Producers should make dystocia management decisions before breeding occurs •When a dystocia presents itself , make your decisions based on what is best for the herd’s production goals •If you need to intervene, do so with caution and think ahead about the effects of your actions on the pair’s future production Thank you to all the faculty and staff of GPVEC for contributing to our education. The End Any questions?