1

College of Veterinary and Animal Science, RAJUVAS, Bikaner Rajasthan, INDIA

. Department of Veterinary Gynecology and Obstetrics
*gnpobs@gmail.com
SURGICAL MANAGEMENT OF A MACERATED BOVINE FETUS
Pramod Kumar, GN Purohit* and JS Mehta
Fet al macerat i on may occur at any st age of
gestation and has been reported to occur in all species
(Purohi t, 2012) followi ng fetal death, regressi on of
corpus luteum and failure of abortion (Arthur et al,
1989). The condition is common in cattle and buffaloes
(Purohit and Gaur, 2011) but may be rarely encountered
i n mares (Burns and Card, 2000), small rumi nants
(Meht a et al, 2005; Aj i t kumar et al, 2007) and
companion animals. In rare instances the disintegrated
fetus parts and bones may be retained in the uterus for
prolonged periods necessitating surgical removal (Drost,
2007) which is reported for the present case.
History and clinical examination
A seven years old full term pregnant cross bred
cow was referred to the Veterinary College Hospital,
Bikaner with the history of reddish brown watery foul
smelling discharge from the vagina, since five days with
no progress in parturition. The animal evidenced severe
tenesmus and was treated with prostaglandin F
2
alpha
for inducing parturition by the local veterinarian. The
animal was depressed and evidenced rectal temperature
of 102
0
F. Vagi nal exami nati on reveal ed a hard and
partially dilated cervix. Rectal examination revealed a
contracted uterus lying on the pelvic brim, distended
with fluid, a thickened uterine wall and a crepitating
mass of fetus. Transrectal ultrasonography was done and
the bony pieces (hyperechogenic) were observed within
the echogenic pus (Fig 1). Based on clinical examination
the case was diagnosed as fetal maceration.
Treatment
To improve the general condition and to combat
toxemia the animal was administered intravenous fluids
and antibiotics. An attempt was made to evacuate the
uterus by the admi ni strati on of prostaglandi n (I nj -
Repregna Vet Mankind, 2 ml IM) and estradiol (Inj-
Progynon depot German Remedies 2 ml IM). On the
second and third day stilboesterol (Inj- Haristrol 10ml
I M) was admi ni stered. There was no change i n the
condition of the birth canal and an effort to deliver the
fetus per vaginum was futile due to improper cervical
di l at i on. I t was, t herefore, deci ded t o perform a
l aparohyst erot omy by l eft fl ank si t e under l ocal
infilteration anaesthesia as described previously (Purohit,
2012). After removal of the fetal bones and decomposed
muscles (Fig 2), the uterus was cleaned with normal
saline and diluted povidone iodine solution. The uterus
was subsequently sutured with cushings sutures using
Chromi c cat gut no. 2 fol l owed by cl osure of t he
abdominal incision as per the standard method.
Post operative care included infusion of fluids,
antihistaminics and parentral antibiotics for 5 days. There
was an uneventful recovery. The ski n sutures were
removed after 10 days post operative.
Discussion
Fetal maceration is the disintegration of a fetus
that has died after formation of the fetal bones (after 4
months of pregnancy in cattle) and has failed to abort,
although the cervix is open (Purohit and Gaur, 2011).
Although uncommon, the reason for the non delivery of
a dead fetus could be a partially dilated cervix, or the
abnormal presentation of a fairly dry fetus which causes
it to be retained in the uterus (Drost, 2007). Bacterial
i nvasi on of the fetus l eads to fetal emphysema and
maceration (3 to 4 days). There is formation of plenty of
(24-48 h) pus and the bones of the fetus separate out.The
animal discharges plenty of foul smelling, reddish gray
vulvar discharge and strains frequently (Purohit and Gaur,
2011). Fever and anorexia may develop due to infection.
The condi ti on i s noti ced by the owners when foul
smelling pus is discharged by a pregnant animal. Rarely,
it may be diagnosed during pregnancy examination.
The condition can also be diagnosed by the history,
finding of a piece of bone lodged in the cervix, rectal
palpation (free fetal bones palpable in crepitating pus
and doughy thick uterine wall) radiography (especially
in small animals) and ultrasonography (finding of
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Ruminant Science June 2013/107
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Fig 1. Sonogram of a bovi ne macerated fetus. The
hyperechogenic bones are visible in echogenic
pus.
Fig 2. The bones and disintegrated tissues of a macerated
fet us removed from t he ut erus of a cow by
laparohysterotomy.
hyperechogenic scattered bones in an echogenic or non
echogenic fluid with echogenic floating pus) (Kumar and
Purohi t, 2009). Sonographi c and pal pabl e fi ndi ngs
duri ng the present case were si mi l ar to previ ousl y
described findings characteristics to fetal maceration.
References
Ajitkumar G, Kuriakose AM, Ghosh KNA and Sreekumaran
T (2007). Fetal maceration in a goat. Indian Journal
of Animal Reproduction 28:107-108.
Art hur GH, Noakes DE and Pearson H (1989).
Veterinary Reproduction and Obstetrics. 6
th
Edn, ELBS Publication, Britain.
Burns TE and Card EE (2000). Fetal maceration and
retention of fetal bonesin a mare. Journal of American
Veterinary Medical Association 217:878-880.
Drost M (2007). Complications during gestation in the
cow. Theriogenology 68:487-491.
Kumar V and Purohit GN (2009). Ultrasonographic
diagnosis of the bovine genital tract disorders.
Vet Scan 4: Article 43 (1-11).
Mehta V, Sharma MK and Bhatt L (2005). Macerated
fet us i n goat . I ndi an Journal of Ani mal
Reproduction 26:75.
Purohit GN and Gaur M (2011). Etiology, antenatal
diagnosis and therapy of fetal complications of
gestation in large and small domestic ruminants.
Theriogenology Insight 1:45-63.
Purohit GN (2012). Domestic Animal Obstetrics. Eds
Purohi t GN, Lambert Academi c Publi shers,
Germany.
Sood P, Vasistha NK and Singh M (2009). Use of a novel
surgical approach to manage macerated fetus in
a crossbred cow. Veterinary Record 165:347-48.
The animal should be examined per vaginum
and any pieces of bones lodged in the vagina or cervix
must be removed manual l y i f the cervi x i s di l ated.
Infusion of large quantities of normal saline in the uterus
is useful in removing the pus and bone pieces 24 hrs
l at er (Drost , 2007). When t he cervi x i s not open
prostaglandins or estrogens can be given to regress the
part i al l y regressed CL and/ or i ncrease t he ut eri ne
contracti ons (Purohi t and Gaur, 2011). Suffi ci ent
lubrication and gentle removal of the bones is necessary.
In the present case all these approaches were unsuccessful
hence laparohysterotomy had to be performed.
Laparohysterotomy to remove the macerated
fetus is potentially dangerous and must be considered as
a last resort (Sood et al, 2009). The prognosis is always
poor. Rarely long standing cases may develop peritonitis
subsequent to uterine rupture. In multiparous animals
hysterectomy may be suggested. I n the present case
however hysterotomy could be successfully performed
wi t hout any compl i cat i on. I t was concl uded t hat
macerated fetus can be removed by laparohysterotomy
and with sufficient care the clinical outcome is good.
Ruminant Science June 2013/108