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Farm Animal Final Year > Principles of managing dystocia > Flashcards

Principles of managing dystocia Flashcards

1
Q

What are the 3 stages of parturition?

A
  1. Onset of contraction
  2. Expulsion of fetus
  3. Expulsion of placenta
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2
Q

What is the duration of pregnancy in:

The bitch?

A

63-65 days

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3
Q

What is the duration of pregnancy in

The queen?

A

65-70 days

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4
Q

What is the duration of pregnancy:

The mare?

A

11 months

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5
Q

What is the duration of pregnancy in

The cow?

A

280-284 days

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6
Q

What is the duration of pregnancy in

The sow?

A

112-118 days

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7
Q

What is the duration of the 1st stage of parturition in:

The bitch?

A

6-24 hours for first offspring

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8
Q

What is the duration of the 1st stage of parturition in:

The queen?

A

1-2 hours for first offspring

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9
Q

What is the duration of the 1st stage of parturition in:

The mare?

A

1-4 hours

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10
Q

What is the duration of the 1st stage of parturition in:

The cow?

A

6 -12 hours

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11
Q

What is the duration of the 1st stage of parturition in:

The sow?

A

12-24 hours

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12
Q

What is the duration of the 2nd stage of parturition in:

Bitch?

A

10-30 minutes for first offspring, total is 2-24 hours

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13
Q

What is the duration of the 2nd stage of parturition in:

Queen?

A

Can pause delivery of offspring, total 12-24 hours

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14
Q

What is the duration of the 2nd stage of parturition in:

Cow?

A

0.5 – 6 hours

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15
Q

What is the duration of the 2nd stage of parturition in:

Sow?

A

2-6 hours

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16
Q

Consider the different elements involved in the pregnant animal (using the image below) and describe briefly what areas could cause a dystocia problem.

A
  • Abdominal or uterine muscles not contracting properly or efficiently
  • Mucus plug not moving
  • Cotyledons don’t separate
  • Pelvic ligaments do not relax
  • Cervix does not dilate sufficiently
  • Fetal Maternal
  • Disproportion
  • Breach/wrong way
  • Excess amnion
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17
Q

Look at this?

A
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18
Q

When aiming to resolve the dystocia problem, and identify its underlying cause from the many options presented in the previous diagram, we first need an adequate history. Questions to consider are:

A
  • Age / parity?
  • Full term / premature?
  • Breeding history?
  • General management during pregnancy?
  • When did straining start?
  • Has a waterbag appeared, and if so when first seen?
  • Has there been escape of fluids?
  • Have parts of foetus appeared in the vulva?
  • Has examination been performed or assistance been attempted? If so what has been done?
  • Is the animal still eating?
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19
Q

While you are gathering that information from the owner a brief general clinical examination is important; you need to assess the status of the animal (is she exhausted, recumbent or still fairy bright), a quick TPR and visual inspection of the vulva may help but remember this is often an emergency and one should quickly progress to investigate the dystocia problem with a vaginal examination.

We’ll use the cow as an example of what to consider in a vaginal exam, species differences exist but the main aspects of systematic examination of a dystocia case can be applied to all species.

Before you start consider:

A
  • Safety vet and animal: adequate restraint , remove other animals in pen
  • Sedation? Not unless necessary because of a fractious animal, possible side effects on fetus and possible recumbency dam
  • Clean environment, make sure the floor is clean and provide footing as it may be/get wet and slippery
  • Scrub arms and wear disposable gloves/sleeves
  • Use plenty lubricant, by the time you arrive most of the dam’s fetal fluid which provide lubrication during the normal parturition process have been expelled
  • Epidural? Not unless necessary because of uncontrollable straining, if it turns out to be a malpresentation that can be corrected, we need the dam to be able to help deliver the calf once you have corrected its presentation, which she won’t if we have given an epidural
  • Wash external genitalia: hygiene important as you may end up doing a C-section
20
Q

The vaginal examination consists of 6 steps:

A
  1. Check for injury/abnormality birth canal
  2. Check the position uterus, umbilical cord & fetus
  3. Check for signs of live fetus
  4. Assess dilation of cervix
  5. Assess relative size fetus
  6. Assess dilation vagina, vulva
21
Q

Why is step 1 important?

With a lubricated gloved arm you palpate the full length and all sides of the birth canal for any injuries or abnormalities; what is it you’re looking for and why is it important that this is your first step?

A
  • How big is the fetus
  • Is the fetus there in the birthing canal
  • Is the canal dilated?
  • Are there any tears at all?
  • Is the uterus twisted?
  • Is it safe for the animal to continue?
  • Do we need to intervene?

You are looking for signs of injury to the birth canal (such as damage to the vaginal mucosa/cervix) or abnormalities of genital tract (such as an abnormal bone structure due to previous fracture). If there is any injury present already, you need to inform your client of this before you continue your vaginal examination. Often clients have tried to calve the cow themselves and sometimes a small lesion may have significant negative consequences (for example Clostridium septicum infection), you need to make sure the owner is aware these existed before you start.

22
Q

Why is step 2 important?

Check the position uterus, umbilical cord & fetus?

A

Position uterus & umbilical cord; Presentation, position, posture fetus

Position of the uterus: A uterine torsion is a complication you could pick up during a vaginal exam; the vagina ‘ends’ abruptly at the pelvic brim, mucosa is drawn into tight, spirally arranged folds. You can confirm by rectal examination if unsure, as the broad ligaments will be stretched and cross-over, as shown in image below

Position umbilical cord: can sometimes carefully be replaced if wrapped around a leg, if wrapped around the abdomen it is much more difficult to replace and one should be aware that during delivery the blood supply will be interrupted sooner than normally expected.

Presentation Posture Position fetus: can you identify a tail, flexed neck, flexed carpi, twins? Remember it is often easier to assess the presentation of the calf by repelling the fetus (push it back into the uterus). Don’t forget to use lubricant (always) and an epidural when needed (i.e. if abdominal contractions are too strong and you can’t repel or reposition the fetus).

23
Q

Why is step 3 important?

Check for signs of live fetus

A

Signs of a live fetus. There are a range of options listed below which can help you identify if an animal in utero is alive (or not).

Decide which of the following are definite indications and which are not 100% reliable (no response but fetus may still be alive).

Limb withdrawal (pinch firmly between claws)

  • Not 100% reliable

Suck reflex (swallow reflex when pressing on base of tongue)

  • Not 100% reliable

Corneal/palpebral reflex (fibrillation of eye ball, convulsive reflex response)

  • Not 100% reliable

Pulse A. umbilicalis in umbilical cord (difficult to feel, particularly in anterior presentation)

  • Definite indication

Ictus cordis/apex beat (difficult to feel, particularly in posterior presentation)

  • Definite indication

Anal reflex in posterior presentation

  • Not 100% reliable

Not many response we can check are very reliable; if they are positive we know the calf is alive, but if it is negative (no corneal/withdrawal/anal reflex) we’re still not 100% sure.

Sometimes it is pretty clear; if dead for more than 24-48 hours, you’ll start to see/feel/smell fetal emphysema and detachment of hair. If there is no fetal emphysema and the cornea is cloudy and grey most pathologists would say the animal has been dead for 6-12 hours. This can be important when client are not happy with the service and claim the calf has died as you arrived too late. In these cases a PM investigation may help resolve some of those issues.

24
Q

Step 4 - Assess dilation of the cervix

Sometimes the cervix is not well dilated, and it is important to know there are two processes involved in cervical dilation; which process is affected will decide if you will be able to dilate the cervix manually or not.

What is active dilation of the cervix?

A

Takes place during 1st stage of parturition, relaxation of cervix due to relaxine and oestrogen release (2-8 hours),

If the cervix does not feel soft and smooth, the uterus is contracted around the fetus and on rectal examination the uterus feels like a balloon, active dilation did not take place. This is not frequently occurring, previous trauma could play role or abnormal hormonal preparation.

25
Q

Step 4

What is passive dilation of the cervix?

A

Takes place during 2nd stage of parturition, dilation due to uterine contractions and pressure of fetus and fetal fluids in birth canal

If the cervix is smooth, soft, and there is sufficient space around fetus it is often possible to dilate the cervix by pulling fetus into the birth canal. Make sure there is no hypocalcaemia causing atony of uterus. Passive dilation did not occur as no fetus was pushed up into the birth canal.

26
Q

Step 5 (part 1)

Relative size of the fetus

Which bony part on the fetus defines its widest point?

A

The widest (bony) point fetus is at the greater trochanter of the femur; the thorax can be ‘higher’ but is more flexible and can be compressed during delivery. This is not possible with the pelvis and greater trochanter which is therefore the limiting factor (on the fetal side), that determines is delivery is possible.

27
Q

When delivering a calf the calves widest point of the pelvis need to fit in the widest point of the dam’s pelvic cavity:

A
28
Q

Look at this plan for determining how to deliver a calf?

A
29
Q

Step 6

Assess dilation of the vulva and vagina. How would you go about this and where do you think problems may occur?

A

Vaginal examination with plenty of lube and rectalling gloves

Problems:

  • If the examiner is too forceful
  • Or if they aren’t dilated
  • Or not enough lube?
30
Q

Look at this diagram to consider where problems have occured in parturition?

A
31
Q

What us wrong here?

A

Primary uterine inertia due to overstretching : hydrops allantois

32
Q

Whats wrong here?

A

Weak abdominal straining (herniation of uterus)

33
Q

Whats wrong here?

A

Iatrogenic stricture of the vagina

34
Q

what is wrong here?

A

Incomplete dilation and constriction of birth canal due to duplication of the cervix

35
Q

What is wrong here?

A

Relative fetal oversize (breed)

36
Q

What is wrong here?

A

Fetal pathology: Anasarca (hydrops foetalis)

37
Q

What is wrong here?

A

Fetal pathology: Schistosoma reflexus

38
Q

Whats wrong here?

A

Fetal pathology: Bulldog calf (autosomal recessive gene, chondrodysplasia)

39
Q

What’s wrong here?

A

Fetal pathology: Perosomus elumbis (malformation neural tube, partial agenisis of the caudal spinal cord)

40
Q

What’s wrong here?

A

Fetal pathology: Parasitic limb

41
Q

What is wrong here?

A

Fetal pathology: hyrdocephalus

42
Q

What is wrong here?

A

Fetal pathology: hydrops ascites (Water belly)

43
Q

What is wrong here?

A

Fetal pathology: curly calf syndrome (deletion of a small segment of DNA)

44
Q

There are many complications to consider when you are managing a dystocia case:

A

Dam: haemorrhage due to damage to the vaginal artery, the animal becoming recumbent (down cow syndrome)

Neonate: weakness, fractures: legs, ribcage, mandible

Vet, assistant: injury due to slippery surface, cow or equipment used (calving jack)

45
Q

To avoid complications such as above it is important to decide when to ask for help, the checklist below can help you with that:

A
  1. Be prepared (have adequate equipment)
  2. Have adequate veterinary knowledge (of dam and fetal anatomy and the parturition process)
  3. Follow a systematic approach (six step vaginal examination)
  4. Phone a friend / back up (for advice, be able to describe the situation and your assessment of it and ask if there are other options to consider)
  5. Decide within 5-15 minutes (for example to proceed with a caesarean instead of attempting a forced extraction, the prognosis for cow and calf are likely to be better the sooner you make this decision)

And when you resolved the dystocia problem successfully: always check for presence of remaining fetus, even if you already delivered twins already!

Farm Animal Final Year (131 decks)

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