Recent trends to

Relive dystocia in
Domestic Animals
VOBG-809
Veterinary Obstetrics

Submitted To-
Dr. M.T. Panchal
Prof. Dept. of ARGO

Submitted By-
S.P. Gavit
M.V.Sc
Gynaecology
Welcome
Dystocia in Heifers vs. Cows

Heifer s

Growing- smaller than a mature cow.

Never had a calf before- the tissues of the birth
canal have not ever been dilated.

Cows

The size of their birth canal.

the calf is extremely large.
the calf is malformed or malpositione.
.
Dystocia Scoring System-

An example of a record keeping dystocia scoring system:

0 - no assistance required
1 - easy pull - typically means a single person pulling
2 - hard pull - typically means 2 people pulling
3 - mechanical pull (calf jack used)
4 - c-section

An alternative example:

1 - no assistance required
2 - easy pull
3 - hard pull, mechanical pull, or veterinary procedure required
The approach to an obstetrical case

3. History of the case

Full term arrive or premature.

Primigravid or multigravida.
Previous breeding history.
Straining – slight, intermittent or frequent &
forceful.
Water-bag.
Fetus appear in the vulva.
Multiparous species.
Bitch and cat-vomiting.
2. General Examination

Temperature, Respiration & Pulse .

If animal is dull, depress & appear to be
exhausted, the resuscitation is most important
before operation.
Protruding parts of fetus, dry or moist may
help in assessing the nature of dystocia.
3. Specific Examination

Condition of vulva and vagina - dry, moist or

swollen.
Condition of the fetus- living, dead,
emphysemated or monster.
Presentation, position and posture of the fetus.
Dry fetus -amount of lubricant requires.
Torsion of the uterus.

Normal Dilatation of cervix

 Causes of Dystocia

A. Maternal causes
3. Birth canal (constriction)
1. Force/Uterus (Expulsive
defects) c. Inadequate pelvis

Uterine inertia Immaturity

Uterine rupture Fracture
Torsion of uterus Breed
Diet
8. Force/Abdominal Development
Disease
Age
Pain b. Insufficient dilatation
Debility
Rupture diaphragm Uterine torsion
Hernia of uterus Cervix
Perforated trachea Vagina
Vulva
B. Fetal causes of dystocia c. Posture
  Anterior
3. Fetal over size Limb flexion
carpal
5. Faulty disposition elbow
shoulder
g. Presentation, Head flexion
Posterior lateral
Transverse upward
k. Position, downward
Ventral Posterior
Lateral Hock flexion
Hip flexion

19.Fetal death.
Dystocia of Mare

Elbow Flexion
Unilateral
Carpal Flexion

Bilateral Carpal
Flexion
Lateral Deviation
of the Head

Anterior Presentation,
Dorsal Position, Extended
Posture
“Dog Sitting” Position

Ventral Deviation
of the Head
Anterior Presentation,
Ventral Position

Dorso Transverse
Presentation
 Ventro Transverse
Presentation,
Uterine Body
Gestation

Vntero
Transverse
Presentation
Posterior Presentation,
Ventral
Position, Extended
Posture

Bilateral
Hip Flexion
(Breech)
Bilateral
Hock
Flexion

Twins
Dystocia of Cow
 Anterior presentation—
one foreleg retained.

Anterior presentation—
downward deviation of head.

(From Diseases of Cattle, USDA Special

Report, 1942.)
 Anterior presentation—
Anterior presentation—forelegs
forelegs crossed over
bent at knee.
neck

(From Diseases of Cattle, USDA Special

Report, 1942.)
 Anterior presentation—
with hind feet in pelvis.

Croup and
thigh presentation

(From Diseases of Cattle, USDA Special

Report, 1942.)
 Posterior presentation— Posterior presentation—
the fetus on its back. All feet presented.

(From Diseases of Cattle, USDA Special

Report, 1942.)
 Anterior presentation—
Anterior presentation—
upward deviation of head.
with back down
.

(From Diseases of Cattle, USDA Special

Report, 1942.)
 Croup and hock presentation

Dorsolumbar presentation

(From Diseases of Cattle, USDA Special

Report, 1942.)
Head turned sideways

Hiplock
Twist causing obstruction

Breech presentation .
 Anterior Presentation
Posterior Presentation

Limb flexion Head flexion Hock flexion

Carpal Lateral Hip flexion
Elbow Upward
Shoulder Downward

Lateral Head deviation Dog sitting Posture

Most common obstetrical operations

3. Forced extraction
5. Traction after correction, which includes
Repulsion
Rotation
Version
Extension of the extremities of the fetus.

16. Fetotomy

18. Cesarean section

1. Forced extraction-

The withdrawal of the fetus from the dam

through the birth canal by means of the
application of outside force or traction.
Proper placement of OB chains
Head and shoulders – pull downward at a 45° angle, nearly
parallel with the rear legs of the cow. Raise the calf's hips
and lessens chance of hip lock.
"Hip lock" - push the calf back a short distance and rotate
the calf a half a turn and pull downward and forward
between the cow's legs.
If the cow is lying down, roll her on her back and pull the
calf forward over the udder between the hind legs. Make
sure the calf begins breathing normally as the umbilical
cord will be pinched closed.
Posterior presentations (backwards calf) - posterior
presentation is a problem because the calf's hind legs and
hips do not dilate the cervix as well as the front legs and
head.
Due to premature rupture of the umbilical cord, early
assistance and rapid delivery is needed.
A backwards calf in the setting position with feet and legs
up under him (breech presentation) must be detected early
in labor and corrected. Cows will start labor but nothing
will show externally except occasionally the tail of the calf.
If not detected, labor will cease and calf is emphysematous
three to seven days later.
Cows with torsion of the uterus (posterior uterus and cervix
twisted) will act similar to cows with a breech presentation;
however, they will usually show much more pain. On
examination, the calf is difficult to palpate and the twisted
opening can be determined. If detected early, the torsion can
be corrected or a caesarean performed to obtain a live calf.
A calf puller should be used correctly and only by
experienced people. A calf puller can apply traction
equivalent to the pull of seven men. First examine the cow,
making sure the calf is in the proper presentation and
position, lubricate the vagina, then apply gradual traction. If
no progress, a caesarean may be needed.
Excessive traction may kill the calf, traumatize the cow and
both may be lost.
Correcting abnormal presentations and positions after
extended labor usually requires professional help.
Proper use of OB chains
Proper use of
OB chains
CHAINS:-
CHAINS:-
Anterior presentation - pasterns or above the knee or elbow.
The noose of the obstetrical chain above the fetlock and place a
half hitch around the pastern.
Posterior presentation - pastern or above the hock.

The best arrangement is a double half-hitch, where the first

loop is placed above the fetlock and the second half-hitch is
placed below the dewclaws. Apply traction steadily,
alternating the pull from one leg to the other.

1st apply the traction in an downward direction until the calf's

shoulders are through the pelvis. Then a downward pull is
needed to help move the calf's hips through the wider portion
of the cow's pelvis.

Always use plenty of lubricant during this procedure.

Improper Use of Force!

Attach the obstetrical handles and

pull gently, making sure the
chains have not slipped. Although
some calves can be delivered by
pulling both legs evenly, it's
usually best to alternately pull on
one leg and then the other a few
inches at a time. This is called
"walking out the shoulders."
SNARE
Anterior presentation- A snare may be applied around the lower
jaw and tightened firmly so not slip and fracture the dental plate.
A loop of the chain around the neck behind the head when the
fetus is dead.
For live fetus a loop of obstetrical chain is more commonly used
around the poll, under the ear and through the mouth in the
manner of “war bridle” for applying traction to the head.
Post presentation- snare may be fastened around the hind
legs.(Sheep)
In dogs and cats snare or gauze around the hind legs or gasping
the hocks with sponge forceps will assist traction. Excessive
twisting of the fetal pelvis around the by the means of forceps
may injure the lumbosacral articulation.
HOOKS
Blunt or knobbed Krey’s hook or short obstetrical hooks on
loop or cord in the orbit helps in traction of head.
Long blunt hook use in the hiplock condition in the anterior
presentation.
In sheep/goat snare and forceps are applied to the fetus head,
around the neck or to the fore legs. Whenever forceps are
applied, the wall of the genital tract should be examined
before traction is applied, to make sure that it is not caught in
the forceps.
In dogs and cats forceps may be applied to the head of the
fetus after the head is repelled out of the pelvis to the uterus;
but great care should be taken to prevent tearing an ear or
laceration the skin, fracturing the mandible, or crushing the
skull.
Anterior - 2 point traction- One loop over the fetlocks and a second
half hitch below the fetlocks.

Anterior - 3 point traction - By placing a head snare behind the

calf's head and in the mouth & one loop over the fetlocks and a
second half hitch below the fetlocks.
Fetal extractor (calf jack)- 

This can be very useful if used

correctly but can also be
extremely dangerous if misused.

Fetal extractor (calf jack)

2. Traction after correction

Mutation: -

Mutation is defined as those operations by

which a fetus is returned to normal presentation,
position, and posture by repulsion, rotation,
version and adjustment or extension of the
extremities
Repulsion/Retropulsion:

It consists of pushing the fetus out of the maternal

pelvis or birth canal in to the abdominal cavity and
uterus, where space is available for the correction of the
position or posture of the fetus and its extremities.

In anterior presentation the crutch or hand of the operator is

usually place on the fetus between the shoulder and chest or
across the chest beneath the neck.

In posterior presentation it is placed in the perineal region or

the ischial arch.

In sheep, goat and swine repulsion is performed by the arm

and hand or by fingers in the bitch and cats.
Rotation

Rotation is the turning of the fetus on its long

axis to bring the fetus in to a dorso-sacral position.
In the cow the presence of the fetus in dorso-iliac or
dorso-pubic position frequently is accompanied
by900 to 1800 torsion of the uterus.
Version

Version is the rotation of fetus on its transverse

axis in to an anterior or posterior presentation.

Version is usually limited to 900 By repulsion on the cranial or

caudal end of the fetus and traction on the other end, the
transverse presentation is changed to a longitudinal presentation.

If possible the fetus should be turned in to a posterior

longitudinal presentation as that prevents the head and neck
from complicating the correction of the abnormal presentation or
posture.
Extension of the extremities of the fetus-

Extension and adjustment of the extremities is the

correction of abnormal postures usually due to
flexion of one or more of the extremities causing
dystocia.

Repulsion of the proximal portion of the extremity.

Lateral rotation of the middle portion of the extremity,
carpus, tarsus or neck
Traction on the distal portion of the extremity.
Fetotomy-

Fetotomy is defined as those operations are

performed on the fetus for the purpose of reducing
its size by either its division or removal of certain of
its parts.
Cesarean section –

CS is the delivery of the fetus, usually at parturition,

laparohysterotomy.

Operation performed when

Mutation
Forced extraction
Fetotomy
are deemed inadequate or difficult to be employed to relive the
impending or present dystocia or when it is desired that the fetus
be delivered alive.
 Cow
Sites for cesarean section:-
Upper right flank, with animal standing.
An oblique abdominal incision in the lower left.
Right flank region below the fold of the skin in the flank .
Parallel the ventral border of the ribs.
Operation: -

Asepsis
General anesthesia
Skin is incise.
Facia
Trans.abd. muscle Knife and scissor.
Peritoneum
Inserted arms into the abdominal cavity.
Apex of the uterine wall pulled.
The uterine horn and fetal membranes are incised longitudinally over
the greater curvature.
Avoiding the cotyledons.
Chains are applied to the limbs of the fetus by exerting traction in the
ventral and caudal direction the fetus is removed.
If necessary the incision in the abdominal wall and uterus should be
enlarge to prevent tearing.
If uterine torsion is present the direction of the torsion accurately
ascertained before the cow is forced down.
The uterine incision is closed with double row of Lembert or Cushing
suture of no. 1 or 2 chromic catgut.
 Mare

Sites for cesarean section:-

The left flank incision starting at the middle of the last rib
and extending caudal and ventrally towards the stifle.
The upper left flank or the left paramedian or midline
abdominal areas.
Lower left flank is the best site.
Operation

The incision on greater curvature over a fetal prominence.

A complication SC diffuse bleeding .
To prevent bleeding, the continuous “whipstitch” suture of catgut
be placed through endometrium, submucosa and serosa
completely around the uterine incision for a depth 1 cm being
careful not to include the placenta.
This suture was inverted in to the uterine cavity by a double raw
of Lembert or Cushing sutures use to close the uterus after the
fetus is removed.
The peritoneum, muscle and facia abdominal 4 chromic catgut.
Modified Mayo or overlapping mattress suture for closure of the
wound on the ventral abdomen. The skin incision was closed with
non-absorbable nylon suture.
 Bitch
Sites f or cesarean section:-

The flank incision at an oblique angle parallels the last ribs.

A left flank incision 3 to 5 inches long parallel to the spine and
beginning 1 – 1½ inch behind the costal arch and 1 -1 ½ inch
above the mammary gland.
Operation:

The horn is incised near the bifurcation.

The fetus may be removed through the same hysterectomy
incision. The uterus is incised longitudinally on the site opposite
the attachment of the broad ligament,
Care being exercise not to incise through a placental area.
Umbilical cord is clamped with forceps
The uterine incision closed by the single row of Lembert suture of
catgut.
The flank incisions are sutured with several rows of catgut, with
nylon or silk in the skin.
Hysterectomy:

Indicated when trauma, injury and even rupture of the

uterus have been produce by unsuccessful Fetotomy,
mutation or forced extraction operations or the fetus is
emphysematous or uterus is atonic, severely infected and
disease.
Uterine torsion:-

A twisting of uterus on its long axis.

Handling/ Treatment-

Rolling the Dam.

Schaffer’s method - A modification in the rolling technique
Laparotomy for the intra abdominal correction of Torsion.
Rotation if the fetus and uterus through the birth canal.
Abdominal ballottement .
Detorsion rod.
Laparotomy for the intra abdominal correction of Torsion.

Cow right para lumbar fossa.

Mare left para lumbar fossa

Right side torsion:

The right hands and the arms are passed downward between
the uterus and abdominal wall until the bottom or ventral
surface of the uterus can be felt.

Left side torsion:

The hand and the arms are passed over the top of the uterus and
down between rumen and uterus.
Abdominal ballottement-

Right side torsion-

An assistant on the right side pushes downward and

inwards in the upper right flank while an assistant on
the left side pushes upward and inward on the lower
left flank.

Left side torsion

The upper left flank and the lower right flank are
pushed strongly with the fists.
Application of Detorsion rod

Detorsion rod
 Uterine inertia

Primary Uterine inertia:-

Lack of tone or failure of the uterine muscle to contract.

Most commonly seen in Dogs & Cow especially in older dairy cows.
Causes-
Diseases of uterine muscle.
Due to lack or failure of release of hormones.
Lace of exercise, excessive fatness, Debility and senility causes weakness
of uterine contraction at parturition.
Treatment:-
Inj. Oxytocine/Pitutrin- Large Animal 20-100 units, Small animal- 10-
20 units.
Inj. should be given with saline by an IV drip.
Feathering-(Dog) - Feathering the vagina by inserting finger and
stroking the dorsal wall of the vagina to stimulate the production of
oxytocine by animal.
If no respond after 3-5 hours Cesarean Section recommended.
Secondary inertia:-

Prolonged by dystocia & it is characterized by exhaustation of uterine

muscles.
Cattle- Retracting/bandl’/ contracting ring dystocia:- Where the
uterine muscle just cranial to the cervix contract tightly, so normal
expulsion of the fetus in to birth canal do not take place.
In this condition by per vaginal palpation revealed normal PPP-
Presentation, Position, Posture but uterine muscle contract over fetus.

Treatment:-

Lubrication of birth canal, and removal the fetus by traction if normal

PPP.
Cesarean indicated at last.
 Medicinal Treatment

CLOPROSTENOL SODIUM

PGF2Alfa Analogue
Removal of Mummified Fetus
Induction of Parturition
Cattle - 2ml IM 1.3 ml IV

TIAPROST –

PGF2Alfa Analogue
Removal of Mummified Fetus
Induction of Parturition
Cattle - 3.5 ml IV
Horse– 3 ml IV
Removal of mummified fetus
Cattle – 3.5 ml IV
OXYTOCINE

Induction of parturition( Only in case of Dose- IM/IV

sufficient cervical dilatation).
Cow- 75-100 UNITS
Cat/Bitch/ Sheep/Goat- Mare- 75-100 UNITS
Useful in expulsion of last fetus in Ewe- 30-35 UNITS
polytochous animals. Bitch- 5-25 UNITS
C/B- Queen- 5-10 UNITS
In CS as local infiltration. (speed up
involution control bleeding after the
removal of fetus)
Horse- Uterine inertia, Uterine prolaps.
VALETHAMATE

Anticholinergic
Hard cervix in Dystocia
Inadequate cervical dilatation in
dystocia
Cattle/Mare- 40- 50 mg IM
Sheep/Goat- 10-20 mg IM
Dog/Cat- 5-10 mg IM

DEXAMETHASONE-
C/S/G – Induction of Parturition.
Cattle- 40 mg IV
S/G- 2-5 mg IV
1. LIGOCAINE
2. KETAMINE
3. DIAZEPAM
4. XYLAZINE
5. PENTAZOCINE
1. LIGOCAINE
2. KETAMINE
3. DIAZEPAM
4. XYLAZINE

5. PENTAZOCINE
Any Questions ?