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

Question 1

Anaesthesia for any kind of laparotomy

Required (left paralumbar fossa):

Answer 1

• Proximal (preferred) or distal lumbar paravertebral
• Local (line infiltration) block
• Inverted L

Question 2

Anaesthesia for any kind of laparotomy

Optional

Answer 2

Caudal epidural (needed or not ?) to control tenesmus
• Not anesthesize uterus

IV sedation and analgesia if it is indicated:
• Drugs cross the placenta (CS)
• Cow may lie down
First look for behavior and general state of the animal Recumbency !! preferred standing position

Question 3

Incision site for caesarean section

Answer 3

standing restraint

median, paramedian and oblique for CS in recumbency

Median (3) and paramedian (4)

Question 4

Incision technique for any kind of laparotomy

Answer 4

General incision technique: Know the muscle layers -> situate how far you are from abdominal cavity -> to minimize injury

skin and subskin → external oblique muscle → internal oblique muscle → transverse muscle → peritoneum → abdominal cavity

Question 5

Abdominal cavity manipulation

Answer 5

Before anything put sterile saline on gloves -> slippery -> Easier examination

Uterus manipulation
1-Make the uterine incision
2-Deliver the fetus
3-After delivery
4-Suturing the uterus

Question 6

Abdominal cavity manipulation

Uterus manipulation

Answer 6

• Grasp the leg of the fetus within the tip of the uterine horn
• Do not grasp the tip without including the foot of the fetus! -> Rupture
• Bring the tip into the abdominal incision
• Calf in posterior presentation is more difficult to move

Question 7

Abdominal cavity manipulation

Make the uterine incision

Answer 7

• 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 has to be long enough: uterine tears!
o Size of uterus depends on size of foetus
o Risk of rupture of uterine horn if too big -> Leakage in abd cavity -> Peritonitis
o Rupture tissues are really hard to suture
• If the fetus is extremely large →
o Possible to grab HL in uterine wall
o Impossible to bring it in the abdominal incision because too large and heavy
o In such cases : Allow to do Uteral wall cut inside the abd cavity (not external ) with special knife
• Blind incision on the greater curvature as near the tip as possible
o Can’t avoid uteral fluid contamination (Sterile usually)
o If uterus intact = No bacteria infection inside

Question 8

Abdominal cavity manipulation

Deliver the fetus

Answer 8

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 fetus) extend the uterine incision and/or skin incision ventrally

Question 9

Abdominal cavity manipulation

After delivery

Answer 9

Remove the placenta if it is loose (don’t need to remove the all placenta ) -> not the cotilodons

If it is tight, trim the tags and place the placenta back in the uterus

Uterine antibiotics in bolus (tablet) form before closing uterus

Question 10

Abdominal cavity manipulation

Suturing the uterus

Answer 10

• USP 2 or 3 synthetic absorbable suture material
• Inverting sero-muscular suture pattern (Cushing, Lembert or Utrecht)
o Avoid formation of canal bw abd and uterine cavity
o That’s why we need to avoid any infection of the uterus after C-section
o Notmucousmembrane
• One efficient row of sutures is adequate if uterine involution is rapid (good quality of uterine horn.
• A double row of sutures is preferred
• The objective is to seal the uterine incision completely

Once finished suture of uterus -> Then flushing of serosa, external surface of uterus

• Minimize intraperitoneal spillage of uterine fluids
• Remove all blood clots → to minimize adhesion bw uterus and abd organs -> If it’s clear, place back the uterus at its normal position
• Uterus back in its normal position
• Intraperitoneal medication ?
o Optional, before suturing abd. Wall : IV Omerctin 8 mL Inj. In abd wall -> Avoid peritonitis

Question 11

Abdominal wall suturing for any kind of laparotomy

Layer 1

Answer 11

• Peritoneum and transverse and internal oblique abdominal muscles together
• Simple continuous pattern
• Monofilament absorbable No. 2 or 3

Question 12

Abdominal wall suturing for any kind of laparotomy

Layer 2

Answer 12

• External oblique abdominal muscle and subcutaneous tissue -> Suture the 2nd layer to the 1st
o If not : Maximize the risk of fluid accumulation of the abd. wall = Seroma (Infected, abcess formation)
• Bite into the internal oblique muscle to close dead space
• Simple continuous pattern
• Monofilament absorbable No. 2 or 3

Question 13

Abdominal wall suturing for any kind of laparotomy

Layer 3

Answer 13

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

Question 14

Postoperative Care for any kind laparotomy

General

Answer 14

• Long Acting antibiotic for a week
• Other medications: intravenous fluids or NSAID (Flunixin )minimize the pain )
• Remove skin sutures in 12 to 14 days
• Provide supportive nutritional care

Question 15

Postoperative Care for any kind laparotomy

Speciality for CS

Answer 15

• Oxytocin (stimulates further uterine contractions and milk letdown)
o The placenta is generally passed within 24 hours
o Retained placenta
• Calcium therapy if needed