Fetotomy And C Section

Question 1

When doing an episiotomy, where are you going to make your incision?

Answer 1

10 and 2 position

Question 2

If delivery with traction is not possible, what are your two options for deliver?

Answer 2

Fetotomy

Cesarean section

Question 3

Which has a longer recovery time and may impact future fertility, fetotomy or c-section?

Answer 3

C-section

Question 4

What are indications for fetotomy?

Answer 4

Dead fetus

Uncorrectable fetal malposition

Delivery by traction not working

Fetomaternal disporportion (large fetus)

Fetal monsters

Incomplete cervical dilation

Question 5

What requirements for fetotomy?

Answer 5

Need adequate space between uterus wall and fetus (if uterus contracted around fetus, not a good candidate)

+/- with grossly oversized fetus/emphysematous fetus

Question 6

What do you need to do a fetotomy?

Answer 6

Epidural

Lubrication

Most do while cow is standing

Fetotome
Wire passer and gigli wire 
Threader and brush 
Handles 
Betadine 
Lens embryology knife 
Krey hook 
Eye hook 
Wire cutters

Question 7

What is a partial fetotomy?

Answer 7

Amputation of head, neck, or limbs

Most common fetotomy

• wry neck (malposition )
• fetal oversize

Question 8

What cuts can you make for a full fetotomy with a calf in cranial presentation?

Answer 8

Decapitation/cervical amputation

Amputation of forelimbs (Sub Q or per cutaneous)

Detruncation 
Transection through thoracolumbar 
Evisceration 
Destruction of rib cage 
Lumbar transection 

Pelvic division
Divided diagnosable

Question 9

What aftercare do you do for fetotomy?

Answer 9

Lavage uterus

Systemic antibiotics

Anti-inflammatories
IV or oral Ca
Iv fluids +/-
Ecbolics — oxytocin/lutalyse

Question 10

What are indications for C—section?

Answer 10

Vaginal delivery is unsafe for dam or fetus

Inadequate room for fetotome placement

Oversized/large fetus

Question 11

90% of c-sections are due to what 5 reasons?

Answer 11

Fetal oversize: pre and post-emphysematous changes

Incomplete cervical dilation or cervical closure on dead fetus

Irreducible uterine torsion

Fetal deformity

Errors in presentation, position, posture

Question 12

What approaches can be used for C section?

Answer 12

Ventral midline

Standing flank

Bovine recumbent flank

Question 13

What are the advantages to a ventral midline approach for C section?

Answer 13

Best surgical exposure (large calf, fetal monster, posterior presentation)

Least abdominal contamination

Best cosmetic effect (marketing)

Question 14

What kind of analgesia do you use for a ventral midline C section?

Answer 14

General anesthesia is rarely used

Line block

Ace+butorphanol

Epidural reduces straining

Question 15

When doing a ventral midline C section, where do you make your incision into the uterus?

Answer 15

Greater curvature

Question 16

What are the advantages to a standing flank C section?

Answer 16

Restraint easy for healthy animal

Closure simplified

Surgeon comport

Question 17

What are disadvantages to a standing flank C section ?

Answer 17

Less exposure of uterus
Peritoneal contamination
Standing animals can go down

Question 18

On which side is the most common for a standing flank C section?

Answer 18

Left flank

— can use rumen to hold uterus/fetus in place

Question 19

What local anesthesia can be used for C section?

Answer 19

Distal or proximal paravertebral

Inverted L

Line block

Question 20

What layers are you making your incision through for a standing flank Csection?

Answer 20

Skin 
External abdominal oblique 
Internal abdominal oblique 
Transverse abdominal 
Peritoneum

Question 21

How do you close the uterus following C section?

Answer 21

Inverting pattern with 1 or 2 absorbable suture
—Utrecht
—Cushing
—Lembert

Non penetrating
Do not include placenta

Question 22

What are your 3 goals for closing a uterus following c section?

Answer 22

Serosa to serosa apposition

Tight seal — no leaking

Minimal suture/knot exposure

Question 23

Post op procedure for C-section ?

Answer 23

Stall rest
Antibiotics

Ecbolics (oxytocin or lutalyse)

Analgesia + NSAIDS

Oxytocin can be given before or after uterine closure (surgeon preference)