Urogenital Surgery Female Flashcards
what are the goals of a c section in a cow
preserve the cow, preserve the calf, preserve future reproduction
what are some maternal reasons to do a c section
immaturity, lack of cervical dilation, uterine torsion, pelvic deformities, uterine hydrops, uterine tear
list fetal reasons to do a c section
fetal oversize, pathology of the fetus, malposition, an elective (high value calf)
true or false: when done as last resort, c sections have a good prognosis
false! they have a poor prognosis. you should decide in less than 20 mins if youre going to do one or not, and you should use your mentors to help you decide
before doing a c section, what are some important things to examine?
the cow: is she exhausted? is she toxemic. hypovolemic, or hypocalcemic? should you pre treat her with calcium?
the fetus: is it dead or alive? if it’s dead, has it decomposed yet? do i need to do a fetotomy?
what is one VERY important thing to remember about J lube?
it causes peritonitis in calves and kills them, DO NOT use it
what are the two ways you can do a c section?
standing: L paralumbar fossa most commonly (can also do R side or oblique but these are much less common)
recumbent: ventral midline, right paramedian, right paramammary, left paralumbar.
recumbent is much harder and really gross
with a L sided paralumbar fossa approach, what do you need to remember about the rumen?
ideally it prevents small intestines from coming out your incicison but not always. You can also get rumen prolapse with straining and you may want to use a lidocaine epidural to help with this. the uterus is going to be medial to the rumen when you go in.
when would you use a paramammary approach in lateral recumbency for a c section?
if there’s emphysematous fetus–>can help you exteriorize the uterus and avoid abdominal contamination
when would you do a ventral midline/paramedian approach for a C section?
if you have a down cow/reluctant to stand cow
should you use antibiotics when a cow has a c section? why or why not? what other medications should you be giving?
YAS QUEEN because fibrinous peritonitis is super common 2/3 of cases get it, and there’s usually E coli and trueperella pyogenes up in there!
also give NSAIDs for analgesia
how should you adequately restrain your cow before doing a c section?
physical: cute or head lock or maternity pen
chemical: can do a ketamine stun, do a caudal epidural and do it before your gear up for calving (still clean)
describe how you should surgically prep your cow before a c section
slip 10/40 blade, scrub with idodine scrub then alcohol, put a drape on, gown up, put on plastic sleeves either inside out or sterile ones, and make sure you have an assistant to help you
what are the tissue layers youre cutting through when doing a L flank approach?
skin, sub q, external abdominal oblique, internal abdominal oblique, transversus abdominus, peritoneum. MAKE SURE not to go thru the rumen by accident
how do you exteriorize the uterus on a L flank approach?
reach behind the rumen and find the uterus and try to identify hind legs/foot/hock of the calf. Put one hand on the fetlock and the other under the hock and pull the leg up to and over the incision locking the leg in the incision via the fetlock and the hock
if a calf is in posterior presentation when youre doing a c section, why is this a problem?
it’s hard to grab a front leg and requires extra help. it may even be impossible to exteriorize and you may have to open the uterus in the abdomen=BAD
what can you do if a cow has a uterine torsion?
roll the cow to correct
you can correct it before you remove the calf: but this risks uterine rupture, but makes it easier to externalize the uterus and it makes it easier to suture too
can correct after you remove the calf: less risk for rupturing the uterus, but it’s harder to exteriorize the uterus and harder to suture
what is the risk of rolling a cow with a plank to correct a torsion?
once shes down she might not get back up and that is bad news bears
once you have exteriorized the calf, how do heck do ya get it out fren?
you have to make a full thickness incision in the uterus and avoid spillage into the abdomen! and the tissue can be quite delicate and will tear easily so you need to make sure your incision is long enough
after you’ve cut into the uterus, how you get the calf out?
you can use sterile calving chains. if you have an assistant make sure they only touch the chains and/or the calf, nothing else!
grab the fetlock while your assistant puts on the chains and then do the other foot. then you can pull the calf up and out. be sure to hold the uterus dorsal so contents dont spill. check for a second calf!
after the calf is out and youre getting ready for the placenta to come out, what do you need to do?
hold the uterus up and out of the incicison while the placenta comes out and you’re getting ready to close
if the placenta isn’t coming out on its own what do you do
gently trim it out
how should you close up the uterus?
2 layers of inverting is best: utrecht, cushing, lembert. use cat gut #2 or #3
dont go full thickness and dont sew the placenta into your incision
use serpentine suture, needle drivers take way too long
after youve sewn up the uterus, what do you need to do before putting it back inside?
lavage it! if there are nay clots they will form adhesions. rinse the uterus off with sterile saline and you can just grab the clots with a gloved hand. dont use gauze to wipe them away. if the fetus was nasty and gross you could also lavage the abdomen
so you’ve lavaged the uterus and now youre closing the body wall. briefly describe how youre gonna do that
close the peritoneum and transversus together with a simple continuous pattern with absorbable suture
close the internal abd oblqiue in the same way
close the external abdominal oblique in the same way
then close the skin with non absorbable suture with ford interlocking pattern and finish with a few simple interupted
should you cut the umbillicus?
no! let the vessels stretch a bit. can clamp it but dont cut it
list some common INTRA operative complications with a c section in cows
- difficulty exteriorizing the uterus
- cow can go down
- rumen or small intestine evisceration
- uterine tears
list some common POST operative complications with a c section in cows
peritonitis (10%)
wound infection/dehiscence (10%)
sub Q emphysema (from too much dead space or you dind’t close the peritoneum well enough and air leaks from abdomen, 35-40%)
death (15-20%)
why is there such a poor prognosis with a c section of am emphysematous fetus? What are some things you can do to support a cow with this?
toxemia, pyrexia, hypotension, shock!
could give hypertonic saline, NSAIDs, and antibiotic therapy during and/or after the procedure.
_____ is the single most important factor for cow survival and future fertility
exteriorization of the uterus
