Cervicovaginal Prolapse and C-Section

Question 1

Pathogenesis for

Uterine Prolapse:
1.
2.

Cervicovaginal Prolapse:
3.
4.

Answer 1

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

Question 2

Cervicovaginal Prolapse:

1. Happens in (early/late) pregnancy?

Risk factors:
2.
3.
4.
5.

Answer 2

1. Late
2. Fat
3. Breed (hereford, Brahman, Romney)
4. Estrogenic feed
5. Chronic use as embryo donor

Question 3

Specific pathogenesis for Cervicovaginal Prolapse:

1. Initially?
2. Always starts at ______

Answer 3

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

Question 4

3 main steps of treatment for Cervicovaginal Prolapse:

1.
2.
3.

Answer 4

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

Question 5

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…

Answer 5

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

Question 6

Retention of cervicovaginal prolapse after it’s been replaced:

1. ____ suture. Describe it.
2. Goals of this suture?
3. Ideally should be ____ and ____

Answer 6

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

Question 7

Buhner Suture for Cervicovaginal Prolapse:

1. Describe the incisions before suturing?

Answer 7

1. dorsal and ventral to vulva in midline, through skin and subq, deep enough to allow completed suture to migrate cranially

Question 8

Buhner Suture for Cervicovaginal Prolapse:

When inserting needle:
1. Hand should be where?

2. You want the needle to pass as far ___ and ___ as possible.
3. Aiming for ____

Answer 8

1. inside vestibulum
2. cranially and laterally
3. opposite incision

Question 9

Buhner Suture for Cervicovaginal Prolapse:

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

Answer 9

1. ventrally

2. two fingers width

Question 10

Buhner Suture for Cervicovaginal Prolapse:

1. Suture must be removed if…
2. umbilical tape can lose it’s strength if…

Answer 10

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

Question 11

Cervicovaginal Prolapse:

Prevention methods:

1.
2.
3.

Answer 11

1. Permanent surgery
2. Risk factors
3. Recurrence

Question 12

Permanent Pexy for Cervicovaginal Prolapse:

1. When to perform?
2. Two techniques?

Answer 12

1. Chronic embryo donor (ie, not genetic)
2. Vaginopexy aka Minchev = tack cranial dorsal vaginal wall to sacrosciatic ligament
   OR
   Cervicopexy aka Winkler

Question 13

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

Answer 13

Vaginal Prolapse Retainer

Question 14

Two BROAD indications for c-section:

1.
2.

Answer 14

1. To relieve dystocia

2. Elective c-section

Question 15

Causes of Dystocia that would require C-section:

1.
2.
3.
4.
5.
6.
etc

Answer 15

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

Question 16

Possible approaches for C-section:

1.
2.
3.
4.
5.

Answer 16

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

Question 17

Routine approach for c-section?

Answer 17

Standing paralumbar celiotomy

Question 18

Standing paralumbar celiotomy:

1. Specific area to target?
2. incision should be (small/large)?
3. What layers are you cutting for?

Answer 18

1. Caudal third of paralumbar fossa
2. large, 40 cm
3. skin, subq, external oblique, internal oblique, transversus abdominus, peritoneum.

Question 19

Standing paralumbar celiotomy:

1. Sweep abdomen for ____ before extending initial incision.
2. Describe closure technique:

Answer 19

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)

Question 20

Ventral Midline approach for C-section:

Reasons it is challenging?
1.
2.
3.

Answer 20

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

Question 21

Ventral Midline approach for C-section:

1. Tip for facilitating exteriorization of the uterus?

Answer 21

1. make incision, than tip cow.

Question 22

Ventrolateral celiotomy for C-section:

1. Cow in what position?
2. Skin incision should parallel ____
3. Layers you are cutting through?

Answer 22

1. lateral recumbancy with elevated upper hind leg
2. superficial mammary vein
3. Skin, Subq, abdominal obliques, transversus abdominus

Question 23

Ventrolateral celiotomy for C-section:

1. (easy/difficult) incision to make.
2. Recommended for what scenario?

Answer 23

1. difficult. It’s a prolonged procedure, kneeling surgeon, risk of contamination
2. emphysematous fetus

Question 24

Left Oblique celiotomy for c-section:

1. An alternative for ____
2. Start incision where?
3. Extend incision at what angle?
4. End incision where?

Answer 24

1. standing c-section
2. 10 cm cranial and ventral to tubor coxae.
3. 45 degree
4. 5 cm from last rib

Question 25

Left Oblique celiotomy for c-section:

Advantages:
1.

Disadvantages:
2.
3.

Answer 25

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

Question 26

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?

Answer 26

1. hock - fetlock (carpus fetlock)

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

Question 27

Delivering the calf during C-section:

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

Answer 27

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

Question 28

Closure of the uterus after c-section:

1. ____ pattern using ____ suture
2. Key point?

Answer 28

1. Inverting pattern (utrecht, cushing, lambert) using no 2 absorbable suture
2. avoid exposed suture material

Question 29

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

Answer 29

Utrecht suture pattern

Question 30

Prognosis after C-section in cows:

1. What percent survive?
2. What percent carry another calf to term?

Answer 30

1. > 80%

2. 60%

Question 31

Prognosis after C-section in cows:

Factors associated with mortality:

1.
2.
3.

Answer 31

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

Question 32

Nerve Blocks used during C-section:

2. 3.

Answer 32

1. Paravertebral nerve block
2. Inverted L block
3. Line block

Question 33

C-section in small ruminants:

1. Additional indication?
2. Different approaches?

Answer 33

1. Pregnancy ketosis
2. Paralumbar fossa or ventrolateral approach in lateral recumbency,
   Ventral midline

Question 34

C-section in Pigs:

1. Anesthesia?
2. What position should they be in?
3. Two approaches?

Answer 34

1. epidural (lumbosacral) or local
2. lateral recumbency
3. Paralumbar fossa or ventrolateral

Question 35

Equine C-section

1. Mare survival = __%
2. Mare survival when combined with colic sx = __%

Answer 35

1. 85-90%

2. 40%

Question 36

Equine C-section

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

Answer 36

1. 66%

2. 5%

Question 37

Equine C-section

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

Answer 37

1. rebreeding

2. 50%