Ruminants 3

Question 1

Indications for a C section ?

Answer 1

» Irreducible obstructive dystocia
» Absolute foetal oversize
» Uncorrected faulty posture / position / presentation
» Congenital monster
» Irreducible uterine torsion
» Prolonged duration of dystocia
» Delayed assistance
» Insufficient progress towards vaginal delivery
» Appropriate manual / mechanical traction is ineffective
» Foetal distress
» Elective caesarean section

Question 2

Causes of dystocia?

Answer 2

Question 3

C section positioning in cattle?

Answer 3

• Standing generally preferred as it facilitates manipulation of the uterus
• Right lateral recumbency if unable to stand or requiring heavy sedation to
  handle
• Preventing the cow from changing position is essential

Question 4

Small ruminants positioning for c section ?

Answer 4

• Right lateral recumbency
• Tied to a table/straw bale

Question 5

Calf factors pre-op?

Answer 5

• Size & weight
• Position & location
• Preparation for resuscitation
• Availability of Doxapram (Dopram TM)

Question 6

Cow factors pre-op?

Answer 6

• Uterine contraction (Clenbuterol)
• Abdominal contraction (Epidural)
• Recumbent vs standing
• Temperament & available safe restraint

Question 7

Equipment pre-op?

Answer 7

• Sterile calving ropes
• Kruse caesarean knife
• Tie a long rope to the contralateral HL

Question 8

What approach to C-section?

Answer 8

Left sided paralumbar fossa laparotomy

• Preferred approach
• Rumen easier to manipulate than distal GIT
• Minimises egress of viscera and abdominal contamination
• Caudal third of the paralumbar fossa to facilitate exteriorization of the uterus
• Large incision (~40 cm) to avoid trauma to the incision while manipulating the
  uterus

Question 9

Describe Hysterotomy & calf delivery part of C-section?

Answer 9

»Determine uterine and calf position
»Identify closest HL in anterior and FL in posterior presentations
»Gently grasp a limb, apply traction and ‘rock’ the limb towards the
incision
»Lock the limb in the incision

Question 10

Pt 2 of Hysterotomy & alf delivery?

Answer 10

»Hysterotomy incision outside the abdomen to decrease
contamination
»Kruse caesarean knife can be used to safely incise within abdomen if
required
»A longitudinal incision over the plantar metatarsus and hock through
all layers of uterus (care to avoid damaging calf)

Question 11

Part 3 of Hysterotomy & calf delivery?

Answer 11

»The other limb can be identified and exteriorized
»The calf can then be elevated and rotated as a (non) sterile assistant
applies traction to deliver, pulling dorsally and caudally
»During traction the uterus should be maintained extra-abdominally
»ALWAYS check for a second calf

Question 12

Hysterotomy closure?

Answer 12

»Place the membranes back in the uterus (or cut off if contaminated)
»“Utrecht” Far-Near-Far-Near continuous inverting pattern in 1 or 2
layers
»#2 synthetic absorbable suture material
»Care not incorporate foetal membranes
»Assess integrity of seal before closure

Question 13

IN SMALL RUMINANTS - what to onsider in C -section?

Question 14

What alternative approaches to C section?

Answer 14

» Right sided paralumbar fossa laparotomy
» Left ventrolateral laparotomy

Question 15

Describe a right paraL fossa approach?

Answer 15

• Calf in the right horn (especially posterior presentations)
• Intractable uterine torsion
• History of previous surgery on the left flank

Question 16

Describe Left ventrolat laparotomy?

Answer 16

• Useful dead emphysematous foetus
• Improved uterine exposure and reduced contamination of abdomen
• Requires right lateral recumbency and elevated right hind limb
• Closure is more involved and prolonged

Question 17

What common complications from C-section?

Answer 17

»Infections
* Peritonitis
* Metritis
* Incisional infection and wound
dehiscence

»Retained foetal membranes
»Abomasal disorders
»Adhesions

Question 18

How to minimise abdo contamination?

Answer 18

Question 19

Indications for Episiotomy?

Answer 19

» Incomplete relaxation of the posterior vagina / vulva (usually in heifers)
» Prevent tearing of vagina wall

Question 20

Approach for episiotomy?

Answer 20

1. Epidural anaesthesia
2. Surgical preparation
3. Dorsolateral incision 2-3cm from dorsal vulval commissure (10 or 2 ‘o’ clock position)
4. Extend incision through skin, SC tissues and vestibular mucosa (up to 10cm)
5. Delivery of foetus
6. Closure of successive layers (synthetic absorbable)

Question 21

Vaginal/ Cervical prolapse - when? /why?

Answer 21

» Usually in mature cows/ewes- last trimester
» Elevation of intraabdominal pressure
* Pregnant uterus
* Fat
* Rumen distention
* Due to relaxation and softening of pelvic canal/perineum (oestrogens and relaxin)

Question 22

If severe damage to prolapse or unresponsive to tx then what ?

Answer 22

Elective caesarean might be indicated (premature neonates)
* +- induction

Question 23

Approach to vaginal /cervical prolapse?

Answer 23

1. Epidural
2. Clean
3. Replace
4. Bruhners suture

Question 24

Surgical approach to uterine prolapse?

Answer 24

1. Protect the uterus
2. +/- Intravenous Calcium Borogluconate
3. Caudal epidural anaesthesia + NSAIDs
4. Clean uterus + remove foetal membranes
5. 2x assistants support uterus in a towel
6. If recumbent, then ‘frog-leg’
7. Start at the vulval margins & progressively invert using knuckles
8. Make sure the uterus is fully inverted
9. Bruhners suture – very controversial use
10. Oxytocin