46. Caesarean section in cows: anaesthesia of the abdominal wall, incision, abdominal manipulation, closure of the abdominal wall

Question 1

Anaesthetia?

Answer 1

Anaesthesia

• Required (left paralumbar fossa):
• Proximal (preferred) or distal lumbar paravertebral
• Local (line infiltration) block
• Inverted L

Question 2

Optional anaesthetia?

Answer 2

Optional:

• Caudal epidural to control tenesmus
• usually not indicated as the volume of lidocaine used is only 4ml and this volume anaesthetises the caudal

part of cows including labia, vagina and cervix- so this is not enough to anaesthetise the uterus. You could

inject more but it will cause recumbency which is not preferred

• In all cases we want to only give analgesia postoperatively as these are dangerous to the foetus. Immediately

give NSAIDs once calf is out

• IV sedation and analgesia if it is indicated:
• Drugs cross the placenta (CS)
• Cow may lie down

Question 3

Abdominal cavity manipulation for caesarian section?

Answer 3

Abdominal Cavity Manipulation for Caesarean Section

• Put saline on gloves as it makes manipulation easier.
• Uterus Manipulation
• Grasp the leg of the foetus within the tip of the uterine horn
• Do not grasp the tip without including the foot of the foetus, if in anterior position it will be the metatarsus

that you grab (HL)! We grab the legs as the wall of the uterine is stretch and the leg can easily rupture it

• Bring the tip into the abdominal incision
• Calf in posterior presentation is more difficult to move- will be the carpus that you grab

Question 4

Uterine incision?

Answer 4

Uterine Incision

• Uterine incision is placed in the greater curvature of the pregnant horn
• Start the incision at the tip of the horn and extend it toward the cervix
• Incision must be long enough; this depends on the foetus size= uterine tears
• Blind incision on the greater curvature as near the tip as possible
• These tears are very difficult to suture, and healing will lead to leaking in abdominal cavity afterwards

resulting in general peritonitis, which eventually leads to death.

Question 5

Deliver the foetus?

Answer 5

Deliver the Foetus

• Obstetric chains to the legs (double loop is preferred: one above and one below the fetlock)
• Dorsal and lateral traction until the calf is delivered.
• If indicated (too large foetus) extend the uterine incision and/or skin incision ventrally (not dorsally) as it is

easier to suture.

Question 6

After delivery?

Answer 6

After Delivery

• Remove the placenta if it is loose
• If it is tight, trim the tags and place the placenta back in the uterus
• Uterine antibiotics in bolus (tablet) form before closure.

Question 7

Sutring?

Answer 7

Suturing

• USP 2 or 3 synthetic absorbable suture material
• Inverting sero-muscular suture pattern (Cushing, Lembert or Utrecht (his favourite it can be done in one

layer)

• only suture the serosa and muscle never mucosa as it is the inside wall of the uterus, this avoids formation of

canal between abdominal cavity and uterine cavity.

• One efficient row of sutures is adequate if uterine involution is rapid (2 is preferred)
• A double row of sutures is preferred - over your own sutures in the same direction but a different pattern
• The objective is to seal the uterine incision completely
• Minimize intraperitoneal spillage of uterine fluids
• Remove all blood clots via flushing to avoid adhesions between uterus and abdominal cavity
• Place uterus back in its normal position
• Intraperitoneal antibiotics are optional, can inject LA antibiotics in abdominal wall to minimise risk of

peritonitis

Question 8

Abdominal wall suturing?

Answer 8

Abdominal Wall Suturing

• Three-layers:
• Layer 1:
• Peritoneum and transverse and internal oblique abdominal muscles together
• Simple continuous pattern
• Monofilament absorbable No. 2 or 3

• Layer 2:

• External oblique abdominal muscle and subcutaneous tissue
• Bite into the internal oblique musclose dead space (suture second layer into first layer)
• If you have too large a dead space it leads to seroma which is fluid accumulation under the surface

of the skin it can become infected and pathological leading to abscess formation

• Simple continuous pattern
• Monofilament absorbable No. 2 or 3

• Layer 3:

• Skin
• Continuous interlocking or interrupted suture pattern
• Synthetic nonabsorbable suture material No. 3

Question 9

Speciality for CS?

Answer 9

Speciality for CS:

o Oxytocin (stimulates further uterine contractions and milk let down)

§ The placenta is generally passed within 24 hours

§ Retained placenta is more common in c-section then after normal delivery

o Calcium therapy