Vaginal Prolapse & Cesarean Section

Question 1

What is the proper incision length on the uterus for a cesarean section in a cow?

Answer 1

the length from the tip of the toe (of the fetus) to the hock

Avoid extreme tension to prevent tearing of the uterus

Question 2

T/F: Dairy heifers and animals receiving excessive estrogenic content of feed are predisposed to developing vaginal prolapse

Answer 2

False

Older beef cattle and animals receiving excessive estrogenic content of feed are predisposed to developing vaginal prolapse

Question 3

What is the surgical approach of choice for cesarean section in sows?

Answer 3

flank approach

• Can’t use ventral midline because of extensive mammary chains
• In sows, make two incision in uterus - one in each horn, along greater curvature
• Very rare to perform C-section on a pig - uterine malposition is usually the main indication

Question 4

What suture pattern is shown here?

Answer 4

shoelace retention sutures

• Simple; can use umbilical tape
• Must take out at first sign of labor in pregnant cow!

Question 5

T/F: Regarding cesarean sections in cattle, even if a live calf is delivered at surgery and the procedure goes well, the prognosis is still guarded

Answer 5

False

• If a live calf is delivered at surgery, and the procedure goes well, there is a good prognosis!*
• Survival rate for a FOAL is guarded.*

Question 6

On average, there is a ____% decrease in fertility following cesarean section in cattle

Answer 6

15%

Due to adhesion of serosa of uterus and damage to endometrium

Question 7

Identify this piece of equipment:

Answer 7

vaginal prolapse retainer

• Use a caudal epidural
• Non-invasive, simple; plastic retainer
• Sutured to the skin at the level of the tuber Ischia
• Can give birth with this in place

Question 8

What is the surgical approach of choice for cesarean section in a cow carrying a contaminated fetus or uterine infection?

Answer 8

Ventrolateral celiotomy

The main advantage of this approach is minimal contamination of the abdomen! The incision site also stays clean post-op; cows don’t lie on it

Question 9

What are some disadvantages of ventral midline and paramedian approach for cesarean section in large animals?

Answer 9

• Difficult to exteriorize the uterus
• Possibility of contamination
• Increased vascularity – do NOT use in high producing dairy cow with large milk vein
• Large abdomen – do NOT use in very heavy dairy cow
• Chance of herniation or evisceration

Question 10

Mares have a collective foaling rate of about ____% following C-section

Answer 10

Mares have a collective foaling rate of about 35% following C-section

(Foaling rate is normally 50-75%)

Question 11

What is the most common reason for C-section in bovines?

Answer 11

oversized fetus

• Usually the result of breeding the cow too young.*
• Small cow + big calf = no bueno.*

Question 12

What is being shown here?

Answer 12

manual reduction of a vaginal prolapse

Also, no gloving. Gross.

Question 13

For a paramedian celiotomy, the incision is made between __________ and __________

Answer 13

For a paramedian celiotomy, the incision is made between the ventral midline** and the **milk vein. Can go as far caudal as the udder.

Question 14

For closure of the uterus in the mare, it is important to place __________ suture pattern around the uterus because of their diffuse placentation

Answer 14

For closure of the uterus in the mare, it is important to place hemostatic suture pattern around the uterus because of their diffuse placentation

Question 15

What is the proper way to close the uterus after cesarean section?

Answer 15

double layer inverting suture patterns using absorbable suture

Cushing, Lembert, Utrecht (most commonly used)

Question 16

What are the ideal conditions for cesarean section?

Answer 16

1. Live fetus
2. Dam is a good surgical risk
3. Favorable environment

Question 17

Through what layers will you incise during a paramedian celiotomy?

Answer 17

• Skin
• Subcutaneous tissue
• External rectus sheath
• Rectus abdominis muscle
• Internal rectus sheath
• Peritoneum

Question 18

What suture pattern is shown here?

Answer 18

Modified Caslick Retention Suture

• Also used for windsuckers/pneumovagina
• Leave a bit at the bottom so they can urinate
• Looks like railroad tracks
• Best if used after parturition

Question 19

Where on the uterus is the incision usually made?

Answer 19

Greater curvature

Less bleeding!

Question 20

T/F: During a vaginopexy the surgeon tacks the anterior dorsal wall of the vagina to the inside of the sacrosciatic ligament

Answer 20

True

Question 21

What muscle layer is NOT incised in ventrolateral celiotomy that IS incised in a ventral midline approach?

Answer 21

transverse abdominal muscle layer​

Question 22

What is the main indication for performing a low flank celiotomy approach in a cow?

Answer 22

Recumbent cow

• Almost same procedure as standing but the incision is started more ventrally
• Incision goes to milk vein if necessary

Question 23

What surgical approaches are used for cesarean section in bovines?

Answer 23

• Standing position:
  
  • ​Left and right flank celiotomy
• Dorsal recumbency:
  
  • ​Ventral midline and paramedian celiotomy

Question 24

T/F: The animal can give birth with this in place

Answer 24

True

This is a prolapse retainer in a sheep

Question 25

What is the most common surgical approach for cesarean section in beef cattle?

Answer 25

Standing Left Flank Celiotomy

• 40 cm long iincision in middle of flank from 13^th rib to tube coxae*
• DO NOT USE if the fetus is dead! It is hard to prevent leakage of uterine fluid into muscle layers*

Question 26

After cesarean section, it is critical to make sure the calf gets how much colostrum within 12 hours?

Answer 26

10% body weight in colostrum within 12 hours

Question 27

For treatment of vaginal prolapse, which suture pattern simulates the action of the constrictor vestibuli muscle?

Answer 27

Buhner Suture Pattern

• Preferred because most anatomically/physiologically correct
• Simulates the action of the constrictor vestibuli muscle
• Use 15” (long) Buhner needle and umbilical tape - sharp cutting needles
• Placing antibiotics (for mastitis) on the tape helps to slide easier and prevent infection

Question 28

T/F: Vaginal prolapse is typically non-recurring

Answer 28

False

Vaginal prolapse RECURS like a motherf***er

Question 29

What are some factors influencing choice of incision site for cesarean section in large animals?

List them all word for word, because why not.

Answer 29

Because there are a shit ton. That’s why not.

1. Experience and preference of the surgeon
2. Experience and preference of the client
3. Environment for surgery and post-op
4. Availability of restraint devices
5. Availability of assistant – not a one-man show! (unless a flank- maybe can do by yourself)
6. Physical condition of the dam, will she stand for surgery?
7. Viability of the fetus - important because of contamination – how to check fetal viability
   
   1. US – left or right low flank transabdominal
   2. Rectal palpation: Pinch between toes, pull legs, anus, poke in the eye, put finger in the mouth (suckle)
8. Condition of uterine fluids
9. Accessibility to the uterus - for leakage, if you need to repair a tear - predisposes to infection with some approaches
10. Type and use of animal: show animal - use ventral or paramedian
11. Post-op marketability
12. Individual variations
    
    1. Vascularity – milk cow
    2. Obesity
    3. Edema
    4. Udder development – first calf heifer with edema

Question 30

What is the surgical approach of choice for cesarean section in the equines and camelids?

Answer 30

Ventral Midline Celiotomy