Bovine C-section

Question 1

Kit list

Answer 1

Surgical pack
o Scalpel handle
o Rat tooth forceps
o Plain forceps
o Curved forceps
o Large scissors
o Needle holders
o Circle cutting needles
o Circle round bodied needles
o Swabs
o (Embryotomy knife)

Other materials
o Size 21 & 22 scalpel blades
o Suture material – absorbable – cat gut or vicryl – for the peritoneum, uterus and muscle
– Catgut promotes quite strong inflammatory response - can end up with lots of adhesions within the abdomen, so reduces her chance of getting pregnant again
o Suture material – non-absorbable – supramid – for the skin
– Nylon (non-absorbable used to skin) -> can decide when to take out, can re-examine cow at the same time, monofilament so less likely to wick bacteria
o Sterile drapes
o Iodine or hibi
o Nail brush
o Surgical spirit
o Swabs
o Head torch
o Surgical gown
o Gloves
o Doxapram hydrochloride to assist reviving the calf
o Antibiotic aerosol spray
o Clippers
o Halter
o Ropes for casting a cow o Bucket
o Drugs
o Needles and syringes
o Stomach tube - if needed to tube colostrum into calf afterwards

Question 2

Restraint and anaesthesia protocol

Answer 2

• Location for restraint: well light and clean straw bed underneath (for if she becomes recumbent).
• To relax the uterus tocolyticum (clenbuterol-hydrochloride 0.15mg) is injected into the tail vein.
• If not done in a crush: tie the cows head to the left to prevent her from falling onto the wound side during the procedure. Stand with its right side against a wall.
• Can use a crush or c-section box.
• Left hind limb can be fastened with a rope to prevent the cow from kicking
• Sedation with alpha-2 agonists can be used for agitated cows, however they can cause
  rumen atony and uterine contractions as well as reducing oxygen supply to the foetus
• Could use detomidine for sedation
• Epidural anaesthesia
  o Procaine (contraindicated for epidurals, can still use but tell farmer, or use lidocaine)
  o epidural is useful to reduce abdominal contractions (in combination with clenbuterol to stop uterine contractions), but doesn’t block the flank
• Line block anaesthesia
  o 5ml behind from the most caudal part of the last rib or 5cm caudal from previous c- section incision
  o 80-120ml of LA (procaine)
  o Part SC, part IM
  o Quick and easy, doesn’t need much local, but then making incision through the line block which could impair wound healing
• Can also use paravertebral or inverted L block for LA
  o Paravertebral good -> blocks whole flank, don’t have to use lots of local, but fiddly and doesn’t always work
  o Inverted L -> easier than paravertebral, not cutting through local, need lots of local, local hurst so more likely to get kicked during this stage

Question 3

Surgical procedure (up to point of calf removal)

Answer 3

Scrubbed prior to putting in line block
* Rescrub once line block placed
* Can put a drape over the bars of crushes
* Make incision – middle/caudal 1/3rd of paralumbar fossa
* Use blunt dissection to retract skin and dissect fascia
* Dissect through the 3 muscle layers- external abdominal oblique, internal abdominal
oblique, transversus abdominus
* Can see the muscle fibres going in different directions as go through them - so know when getting close to the peritoneum
* Retract peritoneum laterally with forceps, to prevent incision of the rumen
* Hear a rush of air as go into the abdomen
* Insert hand into abdomen, feel for uterus
* Determine foetal position and uterine condition (is it friable?)
* If in anterior position then will be looking for a back leg
* Bring gravid horn to the abdominal incision
* Exteriorise a limb within the uterus
* Always check for a 2nd calf

Question 4

Surgical procedure from removal of the calf

Answer 4

Make incision over limb (~9 inches)
* Try to avoid cutting through blood vessels and caruncles
* Remove foetal membranes from the limb and attach calving rope to it
* Retrieve 2nd limb and attach ropes to it
* Remove calf upwards and caudally (with assistant)
* Get someone else to revive the calf if possible
Closing:
* Try to remove as much placental material as possible
* Ensure no 2nd foetus
* Close uterus with uterus inverted suture, using absorbable material – start proximally
* Ideally apply a 2nd layer of sutures
* Suture the peritoneum and muscle layers using simple continuous, absorbable suture
material, usually do peritoneum + transverse abdominal muscle, and then the internal +
external abdominus
* Can do SC layer if you want
* Close the skin with preferred pattern (something appositional)
* If continuous used for skin, finish with 1 or 2 single sutures to allow drainage if required
* Spray wound with topical spray
* Can give oxytocin after surgery
* Do not put antibiotics into them abdomen

Question 5

Post-op drugs

Answer 5

• Parenteral antibiotics for minimum 4d
  o Broad spec
  o 3 1st line options should go for: amoxicillin, oxytet, TMPS
• NSAIDs the following day and for longer if required
  o Flunixin
  o Meloxicam
  o Ketoprofen
  o Carprofen
  o NOT FINIDINE - associated with stillbirth and retained foetal membranes

Question 6

Aftercare

Answer 6

• Repeat analgesia
• 3-5d antibiotics
• Put her in separate pen - freshly calved cow pen or on her own - not with too many other cows
• Dipping navel of calf
• Check she’s eating and drinking
• Monitor temperature
• Monitor navel
• Monitor cows wound
• Check for signs of peritonitis - shorter the length of time abdo open the less risk of peritonitis

Question 7

Common problems that might be encountered during this procedure

Answer 7

• malposition of the car
• haemorrhage
• perforation of the uterine wall
• uterine torsion
  – uterus twists at cervix
  – sometimes can be untwisted
  – untwist before making incision into uterus as when calf removed it will untwist itself (and then incision will be on the wrong side)
  – Can be v friable so care with handling and suturing

Question 8

Twins

Answer 8

• rare for c-section
• would take both out of the same incision