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LAS - RUSS > Cervicovaginal Prolapse and C-Section > Flashcards

Cervicovaginal Prolapse and C-Section Flashcards

1
Q

Pathogenesis for

Uterine Prolapse:
1.
2.

Cervicovaginal Prolapse:
3.
4.

A
  1. Postpartum
  2. Uterine atony
  3. Late pregnancy
  4. Pelvic diaphragm
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2
Q

Cervicovaginal Prolapse:

  1. Happens in (early/late) pregnancy?
Risk factors:
2.
3.
4.
5.
A
  1. Late
  2. Fat
  3. Breed (hereford, Brahman, Romney)
  4. Estrogenic feed
  5. Chronic use as embryo donor
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3
Q

Specific pathogenesis for Cervicovaginal Prolapse:

  1. Initially?
  2. Always starts at ______
A
  1. initial tissue irritation –> cycle of straining/irritation
  2. Always starts at caudoventral vagina, just cranial to urethra / vestibulovaginal junction
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4
Q

3 main steps of treatment for Cervicovaginal Prolapse:

1.
2.
3.

A
  1. Administer epidural
  2. Replace
  3. Keep in place (temporary or permanent)
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5
Q

Replacement of Cervicovaginal Prolapse:

  1. Can reduce swelling via admin of ____
  2. Can _____ if needed. Describe how.
  3. Replace by _____ and hold in place until…
A
  1. Glycerol
  2. Empty bladder. Lift up prolapsed mass to straighten urethra, or drain via needle puncture
  3. Gentle manipulation. Until circulation is re-established
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6
Q

Retention of cervicovaginal prolapse after it’s been replaced:

  1. ____ suture. Describe it.
  2. Goals of this suture?
  3. Ideally should be ____ and ____
A
  1. Buhner suture. Buried purse string suture
  2. Support vestibulovaginal junction and support constrictor vestibule muscle (where prolapse begins)
  3. Deep, and grab enough perivestibular tissue to prevent suture cutting through vestibular mucosa
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7
Q

Buhner Suture for Cervicovaginal Prolapse:

  1. Describe the incisions before suturing?
A
  1. dorsal and ventral to vulva in midline, through skin and subq, deep enough to allow completed suture to migrate cranially
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8
Q

Buhner Suture for Cervicovaginal Prolapse:

When inserting needle:
1. Hand should be where?

  1. You want the needle to pass as far ___ and ___ as possible.
  2. Aiming for ____
A
  1. inside vestibulum
  2. cranially and laterally
  3. opposite incision
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9
Q

Buhner Suture for Cervicovaginal Prolapse:

  1. Knot should be tied (ventrally/dorsally)?
  2. Allow how large a space for urination?
A
  1. ventrally

2. two fingers width

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10
Q

Buhner Suture for Cervicovaginal Prolapse:

  1. Suture must be removed if…
  2. umbilical tape can lose it’s strength if…
A
  1. if prolapse occurs within 6 weeks of parturition. This is why you want to leave the ends long enough to find suture and cut it
  2. left longer than 2 months to parturition
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11
Q

Cervicovaginal Prolapse:

Prevention methods:

1.
2.
3.

A
  1. Permanent surgery
  2. Risk factors
  3. Recurrence
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12
Q

Permanent Pexy for Cervicovaginal Prolapse:

  1. When to perform?
  2. Two techniques?
A
  1. Chronic embryo donor (ie, not genetic)
  2. Vaginopexy aka Minchev = tack cranial dorsal vaginal wall to sacrosciatic ligament
    OR
    Cervicopexy aka Winkler
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13
Q

What tool can you use for sheep vaginal prolapse that you cannot use in cows?

A

Vaginal Prolapse Retainer

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14
Q

Two BROAD indications for c-section:

1.
2.

A
  1. To relieve dystocia

2. Elective c-section

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15
Q

Causes of Dystocia that would require C-section:

1.
2.
3.
4.
5.
6.
etc
A
  1. Relative oversize of fetus
  2. Inadequate cervical dilation
  3. Pelvic abnormality
  4. Prepubic tendon / abdominal muscle rupture
  5. Fetal malposture that cannot be reduced
  6. Fetal monsters
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16
Q

Possible approaches for C-section:

1.
2.
3.
4.
5.
A
  1. left/right Standing paralumbar fossa celiotomy
  2. Ventral midline celiotomy
  3. Paramedian celiotomy
  4. Ventrolateral celiotomy
17
Q

Routine approach for c-section?

A

Standing paralumbar celiotomy

18
Q

Standing paralumbar celiotomy:

  1. Specific area to target?
  2. incision should be (small/large)?
  3. What layers are you cutting for?
A
  1. Caudal third of paralumbar fossa
  2. large, 40 cm
  3. skin, subq, external oblique, internal oblique, transversus abdominus, peritoneum.
19
Q

Standing paralumbar celiotomy:

  1. Sweep abdomen for ____ before extending initial incision.
  2. Describe closure technique:
A
  1. adhesions
  2. simple continous absorbable sutures for peritoneum and muscle layers,
    non-absorbable interlocking pattern for skin (a few interrupted sutures ventrally for drainage if needed)
20
Q

Ventral Midline approach for C-section:

Reasons it is challenging?
1.
2.
3.

A
  1. Labor intensive
  2. Risk of cardiovascular and respiratory compromise
  3. Udder is in the way
21
Q

Ventral Midline approach for C-section:

  1. Tip for facilitating exteriorization of the uterus?
A
  1. make incision, than tip cow.
22
Q

Ventrolateral celiotomy for C-section:

  1. Cow in what position?
  2. Skin incision should parallel ____
  3. Layers you are cutting through?
A
  1. lateral recumbancy with elevated upper hind leg
  2. superficial mammary vein
  3. Skin, Subq, abdominal obliques, transversus abdominus
23
Q

Ventrolateral celiotomy for C-section:

  1. (easy/difficult) incision to make.
  2. Recommended for what scenario?
A
  1. difficult. It’s a prolonged procedure, kneeling surgeon, risk of contamination
  2. emphysematous fetus
24
Q

Left Oblique celiotomy for c-section:

  1. An alternative for ____
  2. Start incision where?
  3. Extend incision at what angle?
  4. End incision where?
A
  1. standing c-section
  2. 10 cm cranial and ventral to tubor coxae.
  3. 45 degree
  4. 5 cm from last rib
25
Q

Left Oblique celiotomy for c-section:

Advantages:
1.

Disadvantages:
2.
3.

A
  1. Possibly easier to exteriorize uterus
  2. High risk of incisional complication
  3. High risk of persistent anesthesia of ventral body wall
26
Q

Delivering the calf during C-section:

  1. You want to ideally lock what part of limb in the incision?
  2. If you need to rotate the uterus, what way do you normally rotate it? How?
A
  1. hock - fetlock (carpus fetlock)

2. clockwise. Bring right uterine horn along ventral body wall toward incision on left

27
Q

Delivering the calf during C-section:

Steps after securing calf position:
1.
2.
3.

A
  1. Incision into uterus and through fetal membranes
  2. Apply sterile chains
  3. Stabilize uterus and allow external drainage of uterine fluid
28
Q

Closure of the uterus after c-section:

  1. ____ pattern using ____ suture
  2. Key point?
A
  1. Inverting pattern (utrecht, cushing, lambert) using no 2 absorbable suture
  2. avoid exposed suture material
29
Q

What suture pattern completely buries the inverting pattern and is associated with improved reproductive outcome

A

Utrecht suture pattern

30
Q

Prognosis after C-section in cows:

  1. What percent survive?
  2. What percent carry another calf to term?
A
  1. > 80%

2. 60%

31
Q

Prognosis after C-section in cows:

Factors associated with mortality:

1.
2.
3.

A
  1. Exteriorization of uterus
  2. Removing abdominal blood clots during surgery
  3. Retained fetal membranes
32
Q

Nerve Blocks used during C-section:

  2. 3.
A
  1. Paravertebral nerve block
  2. Inverted L block
  3. Line block
33
Q

C-section in small ruminants:

  1. Additional indication?
  2. Different approaches?
A
  1. Pregnancy ketosis
  2. Paralumbar fossa or ventrolateral approach in lateral recumbency,
    Ventral midline
34
Q

C-section in Pigs:

  1. Anesthesia?
  2. What position should they be in?
  3. Two approaches?
A
  1. epidural (lumbosacral) or local
  2. lateral recumbency
  3. Paralumbar fossa or ventrolateral
35
Q

Equine C-section

  1. Mare survival = __%
  2. Mare survival when combined with colic sx = __%
A
  1. 85-90%

2. 40%

36
Q

Equine C-section

  1. Retained fetal membranes = ___%
  2. Foal survival in referral dystocia = __%
A
  1. 66%

2. 5%

37
Q

Equine C-section

  1. Avoid ____ in season of surgery.
  2. Success in subsequent years = ___%
A
  1. rebreeding

2. 50%

LAS - RUSS (32 decks)

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