Fetotomy and C-Section Flashcards
What is an episiotomy?
An incision into the vulva because it’s not totally dilated.
When performing an episiotomy, where do you make your incisions?
At 10 and 2 to avoid creating a rectovaginal fistula.
How do you close up an episiotomy?
If it’s just a small cut (1-2”), you can just let it heal naturally, otherwise need to suture closed.
What is a fetotomy?
Using gigly wire in the uterus to cut off parts of the calf.
How do you decide between a C-section and a fetotomy?
Ask the farmer who is more important, the cow or the calf.
What are 3 benefits of a fetotomy?
Reduced trauma and expense
Shorter recovery and less aftercare
Less impact on future of dam (reproductive or production)
Which indication for a fetotomy is really a management issue?
Fetomaternal disproportion.
What is the main indication for a fetotomy?
A dead fetus
What are 5 reasons for a fetotomy?
Uncorrectable fetal malposition Delivery by traction not working Fetomaternal disproportino Some fetal monsters Incomplete cervical dilation
Why do you need to weigh your pros and cons of doing a fetotomy in a cow with incomplete cervical dilation?
Because you need to be able to get your tools in, and get the pieces out.
What are the 2 main requirements for performing a fetotomy?
Enough space between the uterine wall and the fetus.
Need to be able to remove the parts with easy traction.
NOTE: If these are not possible, then consider a C-section.
What position is preferred for a fetotomy?
Standing
What is the most common fetotomy?
A partial fetotomy.
What is a partial fetotomy?
Amputation of the head, neck or limbs.
How many cuts are involved in a full fetotomy?
6-7
What are the cuts in a full fetotomy?
Decapitation or cervical amputation
Forelimbs
Detruncation
Division of pelvis
When decapitating, how far back do you want to go?
As far down the neck as you can.
When amputating the forelimbs, where are you trying to cut?
Under the shoulder blades to dis-articulate them and avoid jagged bones.
When dividing the pelvis, how do you want to make your cut?
Diagonally to make pulling of one side a little easier.
When you show up to a dystocia case, what decision do you need to make if you can’t pull the calf?
Can you do a fetotomy quickly or do you need to go to a C-section.
What is a true breach birth?
Bilateral hip flexion in a posterior presentation.
What are the 3 main indications for a C-section?
Vaginal delivery is unsafe for the dam or fetus
Inadequate room to place a fetotome
Oversize large fetus
90% of C-sections are due to one of these 5 reasons:
Fetal oversize Incomplete cervical dilation Irreducible uterine torsion Fetal deformity Errors of fetal presentation, position or posture
What is the ideal environment for a C-section?
In your hospital, where it’s clean with good lighting.
What are 3 advantages of a ventral midline C-section?
Best exposure
Least abdominal contamination
Best cosmetics
What are 3 disadvantages of a ventral midline C-section?
Restraint is difficult and needs assistance
Evisceration if suture dehiss
Respiratory compromise from dorsal recumbency
Why would you not do a ventral midline C-section on a dairy cow?
Because of the milk vein.
What is the most common C-section position?
Standing flank
What are 3 advantages to a standing flank C-section?
Easy restraint
Closure is simplified
Surgeon is comfortable
What are 3 disadvantages of a standing flank C-section?
less exposure
Peritoneal contamination
Standing animals can do DOWN (too much sedation)
Which flank is most commonly used for a standing flank C-section?
The left flank so the rumen can be used to hold everything else back.
What are 2 advantages of a recumbent flank C-section?
Moderate exposure
Closure may be more secure
What are 3 disadvantages of a recumbent flank C-section?
Hard to exteriorize
Restraint
Contamination
When closing a C-section, what type of suture pattern do you use on the uterus?
An inverting pattern
What are the 3 goals to closing the uterus after a C-section?
Serosa to serosa apposition
Tight seal (no leaking)
Minimal suture/knot exposure
What do you need to be careful not to include when closing the uterus post-C-section?
The placenta
What suture pattern is a good one to use to close the uterus post-C-section?
Utrecht pattern
When closing a C-section, why do you need to work quickly with the uterus?
Because oxytocin is working immediately, so you’re racing the uterus shrinking.
What post-op care would you provide a cow after a C-section?
Stall rest
NSAIDs + analgesia
