Bovine abdominal surgery 5

Question 1

cesarean section indications?

Answer 1

o Dystocia, if not resolved by fetal manipulation, manual extraction or fetotomy
o Fetal/pelvic disproportion
> Extremely large fetus
> Pelvic fracture
o Twin pregnancies
o Fetal anomalies
> Fetal monster or hydrops
> Emphysematous fetus
o Uterine abnormality
> Rupture, if fetus not yet delivered
> Torsion, if not resolved by fetal manipulation, detorsion rod or rolling cow

Question 2

surgical approaches for C-section - optoins

Answer 2

 Flank: Paralumbar fossa - *Left or right
 Flank: Mid to low - *Left or right
 Flank: Ventrolateral oblique - Left
 Paramedian: Left or right
 Ventral midline

Question 3

factors for selecting C-section surgical approach?

Answer 3

 Is the fetus alive?
 How sick or weak is the animal? Will she stand for surgery?
 How large is the animal?
 Is a fetal anomaly suspected?
 Does the uterus feel healthy
 The rumen is easier to manipulate than are the intestines!!!

Question 4

Anesthesia & analgesia for c section

Answer 4

• Presurgical NSAID’s, maybe antibiotics
• Local anesthesia
• Epidural with max. 5 mls of lidocaine
• Sedation only if recumbent approach
• Acupuncture?

Question 5

celiotomy incisoin for c section - location and length? considerations for exteriorizing uterus?

Answer 5

• Location & length altered for uterine exposure & exteriorization (better too long than too short)
• For paramedian & ventral midline approaches in dorsal recumbency, rolling the cow slightly toward the surgeon will aid in exteriorizing the uterus

Question 6

how much should we exteriorize uterus for c section? what is our general surgical technique?

Answer 6

• Exteriorize as much as practical for the situation: Size of animal, surgical approach, condition & size of the uterus & fetus (e.g., dead emphysematous fetus)
• Usually with manipulation limbs can be brought to the incision
• If possible, lock a limb in the celiotomy incision (“wedge it in the incision”)
• Long incision in the uterus → easier to close than a short tear → placenta incised, chains around the feet → either assistant to deliver calf while surgeon holds uterus OR Vulsellum forceps can be used to hold the uterus in place
• Check uterus for another calf or tears

Question 7

c section - should we remove placenta?

Answer 7

• Remove placenta only if it separates easily

Question 8

drug to give for c section during closure?

Answer 8

• Oxytocin
  o 20 40 IU, IM or IV, q8h for 24h
  o Start during closure of uterine incision

Question 9

how to close c section

Answer 9

• Closure of uterine incision: Usually 2 layer continuous inverting suture pattern
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• 2 layers:
  > one simple continuous plus Cushings
  > one s. continuous plus Lembert
  > one s. continuous plus Utrecht
  > two inverting patterns

Question 10

Ventrolateral oblique celiotomy for c section - when would we use this?
- length of incision?
- how to position cow?

Answer 10

• Best if fetus decomposed
• Or uterus friable (Clostridium!!!!)
• Length of incision depends of size of uterus
• Tilt cow slightly towards you