Heifer Dystocia Flashcards
Daisy the HF heifer with calving difficulties:
- The farmer tells you they’ve just finished milking and he can see 2 feet sticking out the vulva, but does not know if they are back or front legs
- The heifer already looked like she was calving before milking but he wasn’t sure
- The farmer is worried about his heifer.
- He’s been rearing her for 26 months months and wants to get her into the milking herd. He has left her in the crush for you to deal with, she’s been there since he called you.
Was it a good idea to leave the heifer in the crush until you arrived?
A stress-free and clean environment is important around calving time; in this case the heifer was left in the crush for a long time. The stress involved interferes with the normal parturition process, so further dilation and soft tissue of the birthcanal may stop and the stress involved may reduce her immune status. It would have been a better option for her to be kept in clean, quiet, well-bedded box until the vet arrives with frequent observations. Take home message; be clear to the client when you’ll arrive, if it is 15 minutes just leave the heifer where she is, but if it takes much longer he may increase her chances by reducing stress and putting her somewhere else until just before you arrive.
- The farmer tells you they’ve just finished milking and he can see 2 feet sticking out the vulva, but does not know if they are back or front legs
- The heifer already looked like she was calving before milking but he wasn’t sure
- The farmer is worried about his heifer.
- He’s been rearing her for 26 months months and wants to get her into the milking herd. He has left her in the crush for you to deal with, she’s been there since he called you.
What questions do you ask the farmer while you’re getting ready to examine the heifer to help you manage this case?
Breeding history, i.e. type of bull used? (in this case Hereford through natural mating)
What has been tried thus far, i.e. calving aid?
Is the birth premature or overdue?
What has recently been observed in this dam?
Has a recent vulval discharge been noticed?
Have uterine or abdominal contractions been noted and if so when?
Have any fetal membranes / fluid been expulsed?
Have any fetuses been delivered (in multiparous species)
What signs are you looking for in the heifer to confirm that she’s in the FIRST stage if parturition? (4)
· Uterine contractions
· Shivering
· Nesting behaviour
· Vulva discharge
Clinical examination
You proceed with a more detailed examination
Describe the practical steps you consider in the clinical examination of this heifer before you proceed to a vaginal examination? In a cow which is having calving difficulties?
Considerations/steps before the vaginal exam:
· Rapid assessment of the general condition of this heifer (TPR, mucous membranes and inspection of the vulva to assess general status and risk of shock/ haemorrhage/systemic disease/ injury).
· Safety of yourself, others and the heifer (large straw bedded pen preferred over crush, or ensure the crush has sides that open in case she would go down during the procedure). If the heifer would be in a pen with other cows, you would move her to a pen by herself.
· Ensure a clean environment with good footing that is not slippery (i.e. a clean and dry straw bedded pen).
· Clean external genitalia (hygiene is important especially if you end up performing C-section) with disinfectant (chlorhexidine/iodine) solution. Move tail to out of the way by tying a rope to the tail and around the neck or leg. Wear disposable gloves.
· Consider sedating the heifer in case she’s fractious, you will only use it in those cases because of the sedative effects on the fetus which may reduce viability.
· Consider analgesia, as she may be in pain.
· Consider epidural anaesthesia, as it wil control abdominal straining by anaesthetizing the pelvic cavity, however if only a minor reposition would be needed, you’d prefer to avoid the epidural as you may benefit from the heifer’s abdominal contractions after you’ve repositioned the calf. If repositioning is difficult becase of uncontrollable straing, you can decide to provide the epidural as it will have a rapid effect if placed correctly.
With regards to the vaginal examination: As long as you got ‘check for injury/abnormalities in the birth canal’ top of your list you’re good. The other steps can be completed in any order, as long as you assess all six steps.
List 3 potential causes of dystocia that are due to MATERNAL factors? (4)
· Inadequate explusive forces
- uterine inertia (primary and secondary)
- week abdominal straining
· Inadequate size of birth canal
- incomplete dilation
- inadequate pelvis space
List two potential causes of FETAL factors that can cause dystocia? (4)
· Oversize
- relative and absolute
- congenital monsters
- fetal pathology
· Fetal disposition
- presentation/position etc.
What is the biggest cause of dystocia in cows?
Foeto-maternal disproportion
Clinical examination findings: BAR, not apparently dehydrated, uncomfortable, restless and BCS 4.5
Vaginal examination:
- No injury or abnormality of the birth canal, pelvic diameter normal for this heifer
- Normal position of the uterus, fetus in anterior presentation, dorsal position, lateral deviated head
- Signs of live fetus: positive apex beat, positive withdrawal reflex
- Dilatation of cervix: incomplete, cervical ring still palpable
- Relative size fetus: large, difficult to assess size (as you can’t pull the calf into the pelvic cavity as the head is flipped back), but the calf’s feet feel pretty big
- Dilatation vagina, vulva: limited
What do you decide to do next?
Assisted delivery £80
Correcting the laterally deviated head can be quick, as well as the assisted delivery. It only needs calving chains/ropes, handles and lubricant which are likely present on farm. If the calf is large (think about indications of fetal oversize) there is the risk of damaging the cow (i.e. vaginal artery rupture), delivering a dead calf (due to prolonged traction), or ending up in a hiplocked situation. The procedure is going to cost around £80.
C-section £300-500
The C-section will be more expensive than an assisted delivery, you can do it on site but need to have the surgical kit with you. There is a risk of contaminating the abdominal cavity when extracting the calf (as previous manipulation has been attempted), and there is the risk of post-surgical infection. The prognosis is good (our patient is BAR), the cost would be around £300-500 including the surgical procedure, medicines and aftercare. The cost of a live calf is worth a lot more than estimated treatment costs of a c section.
Status of heifer: alert, not apparently dehydrated, uncomfortable, restless with a BCS of 4.5. She is fairly cooperative but was straining heavily during the vaginal exam.
You decided, in discussion with the farmer, to correct the malpresentation (lateral deviated head) and perform an assisted delivery.
The heifer is ready in the crush; you have checked if the sides of the crush can open in case she would go down, and they can, so that is not a reason to move her.
Describe step by step the procedure you undertake to position this calf correctly for delivery –
- Place epidural to remove abdominal contractions
- Provide plenty of lubricant (>1litre) around the calf’s front limbs and head to facilitate repelling and repositioning
- Repel the calf back into the uterus to create sufficient space to reposition the head
- Reposition the head, ensuring the sharp teeth of the calf do not damage the uterine wall by cupping your hand around its mandible
- Provide analgesia if not done already
Once re-positioning of the calf is complete…
You’ve positioned the calf correctly and ready to move on to the next steps.
Describe now how you will deliver the calf
- Dilate cervix/vagina/vulva using your arms up to your elbows to stretch the birthcanal, usually a couple of minutes, until there is sufficient space for the calf’s head.
- Put calving chains/ropes on the front limbs and place a headrope
- Pull slightly caudoventral, applying traction of 1 strong person, and palpate to assess if the greater tubercles of the humerus of the calf are positioned less than 10cm cranial of the pelvic entry. If this is the case, the calf can be extracted using the appropriate technique
- Pull the calf until its head is out, then twist the calf 90 degrees to align the calf hips in optimal position in pelvic cavity of dam, then pull in caudal direction.
- Ideally you will only pull when heifer is pushing (abdominal contractions), to leave time for soft tissue to stretch and the calf to breath when the chest is out. If the epidural was effective she won’t push; you would pause once the calf’s chest is out.
In the case of a large calf, it is particularly important to rotate once the head is out for pulling further. What does rotating hopefully achieve to ensure a smoother extraction?
Provides best fit for the greater trochanters to pass through the pelvic cavity of the dam
Which position is easiest for the cow to be in during a manual delivery
Lateral recumbency
When checking the heifer for a second calf, the uterus feels normal and you can’t easily remove the placenta.
Uh oh - When palpating all around the vaginal wall, you find a lesion of approximately 3 cm in diameter with perivaginal fat protruding from it.
You identify a small vaginal lesion, what will you do about it?
Call your boss and ask for advice –
Your boss answers the phone -
“Hi…. yep, don’t worry about it. If it’s small it’ll probably heal on its own so leave it be. Might want to consider infectious agents though, they could case an issue…. p.s can you collect some milk on your way back to the practice?”
(Note - Suturing would be fiddly, and you can just leave it if small)
Which infectious agent(s) are you concerned about with the vaginal lesion on the cow? (3)
Fusobacterium necrophorum
Clostridium septicum/chauvoei/sordelli/novyi
Trueperella pyogenes
Which medications are useful for a vaginal tear?
· TMPS – suitable as you are expecting fusobacterium necrophorum (anaerobe gram negative) clostridium septicum/chauvoei/sordelli/novyi (anaerobe gram +) and Trueperella pyogenes (fac anaerobe gram+)
· Penicillin – yes
· Streptomycin - yes
· Amoxicillin - yes
· Procaine benzylpenicillin - yes
· NSAIDs (yes if not given already)
· Oxytocin (unlikely to be needed as the calf should be sucking soon)
