Bovine C-section & Dystocia (Practical) Flashcards
What does an epidural do to relfex pushing and abominal contractions?
Epidural desensitises pelvic area, stops reflex pushing as she can’t feel pressure. Doesn’t stop innervation of nerves that cause abdominal contraction.
Explain how to anaesthetise and perform a cesarean section?
- Clip and scrub entire left paralumbar fossa.
- Line block or inverted L block- 80-200ml procaine 19G needle. Put 10ml X3 in different directions from one site.
- Clenbuterol IV to relax smooth muscle of body wall and uterus which makes uterus easier to lift out. NSAIDs ketoprofen or Flunixine.
- Bold incision through skin where LA is.
- 30-45cm 5cm caudal to last rib.
- Muscle layers one by one. 3 layers in 3 directions - External oblique, internal oblique, transverse.
- Peritoneum lifted with forceps so don’t cut rumen.
- Cut with blunt tissue scissors.
- Locate uterine horn.
- Grasp forelimb through uterine wall and pull to incision site.
- Approx 9inch incision it uterine wall, avoid caruncles. Make incision towards calf hoof. Pull calf out one leg first then head and rest of calf. Ropes will be needed to pull calf out as it will be very slippery.
- **would like to incise greater curvature of uterus as hardly any vascularisation and no cotyledons. As this calf is posterior presentation in this case it will be difficult to exteriorise. May have to cut uterus still in abdomen which makes it difficult to work out where to cut.
- Check for 2nd calf!
- Examine uterine wall for bleeding.
- Tie off any vessels
- Close uterus with synthetic absorbable Monofilament suture material and round needle. Pattern we just did to avoid adhesions – suture material hidden.
- Close muscle and peritoneum with simple continuous, absorbable suture material.
- Close skin with continuous interlocking pattern. Cruciate at bottom.
- Clean site and spray with topical silver spray.
What can you use to relax smooth-muscle of body wall and uterus, making it easier to life out?
Clenbuterol IV to relax smooth muscle of body wall and uterus which makes uterus easier to lift out. NSAIDs ketoprofen or Flunixine.
Where do we make the C-section incision?
Bold incision through skin where LA is.
30-45cm 5cm caudal to last rib.
What do we close the uterus with?
Close uterus with synthetic absorbable Monofilament suture material and round needle. Pattern we just did to avoid adhesions – suture material hidden.
What do we close muscle and peritoneum with?
Close muscle and peritoneum with simple continuous, absorbable suture material.
What do we close the skin with?
Close skin with continuous interlocking pattern. Cruciate at bottom.
What antibiotics are required after a C-section and for how long?
Antibiotics - pen and strep for at least 4 days.
With a dystocia case, when do we give a sedative?
Which sedative is most commonly used?
Sedative – only use if lunatic cow. Alpha 2 - xylazine most commonly.
If a cow has uterine inertia, what do we give?
Oxytocin useful in species with lots of fetuses. Not useful in cows at all! If cow has uterine inertia then give it calcium!!
If you have a head back position dystocia - what should you do? How can you fix this malpresentation?
Head back presentation. Grab and shake ear. Grab eye socket, wiggle and pull. Get finger in corner of mouth. Put a head rope on once it’s the right way! High risk of head going back again. Make sure you fold ears back over rope to hold rope in place. Tighten so rope in mouth and make sure tongue is under rope! Often cervix not fully dilated. Lots of lube needed.
What is a subcutaneous fetotomy? When is it used?
Subcutaneous fetotomy - cuts through skin only. Used for fetal oversize, if can remove skin and then a leg you remove widest point and it will come out.
What is percutaneous fetotomy?
Percutaneous fetotomy you cut through everything – bone, skin, muscle, the lot. Used for malpresentation e.g. Deviated head or flexed carpus.
Don’t worry about losing bits of fetus in uterus, you will be able to get them out. Uterus will shrink so you will be able to reach. Use lots of lube or wire will break!
What pattern do we use to close the uterus and why?
Continuous non-perforating inverting pattern
‘Utrecht’ or ‘adapted Cushing’ method: minimises exposed suture material to decrease post operative adhesions
What are some complications of suturing the uterus?
How can we reduce complications?
- Friable uterus
- Adhesions
- Breakage suture material
- Leakage of uterus
Prevention
- Double layer
- Pull each suture tightly
- Use adequate suture material
