Fetotomy and C-Section

Question 1

What is an episiotomy?

Answer 1

An incision into the vulva because it’s not totally dilated.

Question 2

When performing an episiotomy, where do you make your incisions?

Answer 2

At 10 and 2 to avoid creating a rectovaginal fistula.

Question 3

How do you close up an episiotomy?

Answer 3

If it’s just a small cut (1-2”), you can just let it heal naturally, otherwise need to suture closed.

Question 4

What is a fetotomy?

Answer 4

Using gigly wire in the uterus to cut off parts of the calf.

Question 5

How do you decide between a C-section and a fetotomy?

Answer 5

Ask the farmer who is more important, the cow or the calf.

Question 6

What are 3 benefits of a fetotomy?

Answer 6

Reduced trauma and expense
Shorter recovery and less aftercare
Less impact on future of dam (reproductive or production)

Question 7

Which indication for a fetotomy is really a management issue?

Answer 7

Fetomaternal disproportion.

Question 8

What is the main indication for a fetotomy?

Answer 8

A dead fetus

Question 9

What are 5 reasons for a fetotomy?

Answer 9

Uncorrectable fetal malposition
Delivery by traction not working
Fetomaternal disproportino
Some fetal monsters
Incomplete cervical dilation

Question 10

Why do you need to weigh your pros and cons of doing a fetotomy in a cow with incomplete cervical dilation?

Answer 10

Because you need to be able to get your tools in, and get the pieces out.

Question 11

What are the 2 main requirements for performing a fetotomy?

Answer 11

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.

Question 12

What position is preferred for a fetotomy?

Answer 12

Standing

Question 13

What is the most common fetotomy?

Answer 13

A partial fetotomy.

Question 14

What is a partial fetotomy?

Answer 14

Amputation of the head, neck or limbs.

Question 15

How many cuts are involved in a full fetotomy?

Answer 15

6-7

Question 16

What are the cuts in a full fetotomy?

Answer 16

Decapitation or cervical amputation
Forelimbs
Detruncation
Division of pelvis

Question 17

When decapitating, how far back do you want to go?

Answer 17

As far down the neck as you can.

Question 18

When amputating the forelimbs, where are you trying to cut?

Answer 18

Under the shoulder blades to dis-articulate them and avoid jagged bones.

Question 19

When dividing the pelvis, how do you want to make your cut?

Answer 19

Diagonally to make pulling of one side a little easier.

Question 20

When you show up to a dystocia case, what decision do you need to make if you can’t pull the calf?

Answer 20

Can you do a fetotomy quickly or do you need to go to a C-section.

Question 21

What is a true breach birth?

Answer 21

Bilateral hip flexion in a posterior presentation.

Question 22

What are the 3 main indications for a C-section?

Answer 22

Vaginal delivery is unsafe for the dam or fetus
Inadequate room to place a fetotome
Oversize large fetus

Question 23

90% of C-sections are due to one of these 5 reasons:

Answer 23

Fetal oversize
Incomplete cervical dilation
Irreducible uterine torsion
Fetal deformity
Errors of fetal presentation, position or posture

Question 24

What is the ideal environment for a C-section?

Answer 24

In your hospital, where it’s clean with good lighting.

Question 25

What are 3 advantages of a ventral midline C-section?

Answer 25

Best exposure
Least abdominal contamination
Best cosmetics

Question 26

What are 3 disadvantages of a ventral midline C-section?

Answer 26

Restraint is difficult and needs assistance
Evisceration if suture dehiss
Respiratory compromise from dorsal recumbency

Question 27

Why would you not do a ventral midline C-section on a dairy cow?

Answer 27

Because of the milk vein.

Question 28

What is the most common C-section position?

Answer 28

Standing flank

Question 29

What are 3 advantages to a standing flank C-section?

Answer 29

Easy restraint
Closure is simplified
Surgeon is comfortable

Question 30

What are 3 disadvantages of a standing flank C-section?

Answer 30

less exposure
Peritoneal contamination
Standing animals can do DOWN (too much sedation)

Question 31

Which flank is most commonly used for a standing flank C-section?

Answer 31

The left flank so the rumen can be used to hold everything else back.

Question 32

What are 2 advantages of a recumbent flank C-section?

Answer 32

Moderate exposure

Closure may be more secure

Question 33

What are 3 disadvantages of a recumbent flank C-section?

Answer 33

Hard to exteriorize
Restraint
Contamination

Question 34

When closing a C-section, what type of suture pattern do you use on the uterus?

Answer 34

An inverting pattern

Question 35

What are the 3 goals to closing the uterus after a C-section?

Answer 35

Serosa to serosa apposition
Tight seal (no leaking)
Minimal suture/knot exposure

Question 36

What do you need to be careful not to include when closing the uterus post-C-section?

Answer 36

The placenta

Question 37

What suture pattern is a good one to use to close the uterus post-C-section?

Answer 37

Utrecht pattern

Question 38

When closing a C-section, why do you need to work quickly with the uterus?

Answer 38

Because oxytocin is working immediately, so you’re racing the uterus shrinking.

Question 39

What post-op care would you provide a cow after a C-section?

Answer 39

Stall rest

NSAIDs + analgesia