Dystocia: All in a Day’s WorkDystocia: All in a Day’s Work

Shelby Hayden

Jen Sullivan

Meredyth Jones

Sarah Burkindine

Stage 1Stage 1: initiation of : initiation of myometrial contractionsmyometrial contractions

Stage 1Stage 1: Visible signs: Visible signs

Seeks out isolationThick clear mucoid vaginal dischargeSigns of abdominal colicRestlessnessCan last 2-6 hours

Stage 2Stage 2: expulsion of the fetus: expulsion of the fetus

Entrance of the fetus into the birth canal

Stimulation of oxytocin release

Rupture of amniotic and allantoic sacs

Stage 2Stage 2: expulsion of the fetus : expulsion of the fetus

Increasing uterine and abdominal contractions

Stage 2 should last no longer than 1 hour

Stage 2Stage 2: Visible signs: Visible signs

Rupture of the “water sacs”Amniotic sac and feet are visible at the

vulvaIncreasing frequency of abdominal

contractionsExpulsion of the fetus

Stage 3Stage 3: expulsion of the : expulsion of the placentaplacentaDetachment of chorionic villi from the

crypts on the maternal side of the placenta

Due to vasoconstriction

Usually occurs within 3-8 hours of parturition

Fetal positioningFetal positioning

Presentation

Position

Posture

Fetal PresentationFetal Presentation

Anterior, longitudinalPosterior, longitudinal

Transverse ventralTransverse dorsal

Fetal PositionFetal Position

Dorso-sacral

Dorso-pubic

Right and left dorso-ilial

Fetal PostureFetal Posture

Relation of the calf’s head, neck and limbs to the body of the cow

Normal fetal positioningNormal fetal positioning

Transverse PositionTransverse Position

Causes of dystociaCauses of dystocia

Basic

Immediate

Causes of DystociaCauses of Dystocia

Hereditary

Nutritional (fat heifers, excessive fat in pelvis)

Management (breeding large bulls to small cows, breeding too soon after partrition)

Causes of DystociaCauses of Dystocia

Infectious (Brucella, Campylobacter, BVD, Bluetongue, leptospirosis, corynebacterium, Trichomonas, Listeria, IBR)

Traumatic (rupture of prepubic tendon, uterine torsion)

Miscellaneous (hydrops, uterine inertia)

Immediate causes of dystociaImmediate causes of dystocia

Fetal causes

Maternal causes

Fetal CausesFetal Causes

Size: breed, age of the dam, sire, sex

Abnormal: presentation, position, posture

Fetal Monsters: schistosomas reflexus, perosomus elumbis

Schistosomus reflexusSchistosomus reflexus

Maternal CausesMaternal Causes

Pelvic fractures

Breeding heifers too young

Hereditary or congenital hypoplasia of the birth canal

Parturition Intervention GuidelinesParturition Intervention Guidelines

Stage I of labor > 6 hours and cow/heifer has not begun to abdominally press.

Stage 2 of labor > 2-3 hours and progress is very slow or absent

Amniotic sac has been visible for 2 hours and the calf has not hit the ground

Dystocia Watch IntervalsDystocia Watch Intervals

< 3 hours intervals is required to determine length of duration of the stages of parturition.

Equipment required for Equipment required for obstetrical examobstetrical exam

Twine or robeNovasan or

betadine scrub

Bucket or bottle of warm water

Sterile lubePalpation sleeves

ObstetricalObstetrical Equipment for Pulling a Equipment for Pulling a CalfCalf

Same equipment required for obstetrical exam plus:

Calf Jack (Puller)Calf Jack (Puller)

Cont. of obstetrical equipment for Cont. of obstetrical equipment for calf pullingcalf pulling

Head snareEpidural Equipment

– 2 % lidocaine– 6 cc syringe– 18 gauge 1.5 inch needle

ObstetricalObstetrical ExamExam

1. Fill clean bucket with betadine or novasan solution diluted with warm water to either a “weak tea” solution or a light blue solution respectively.

2. Place obstetrical chains and handles, tube of sterile lube and head snare into the bucket.

3. Clean the perineal region with a betadine or novasan scrub followed by a clean warm water rinse.

• Minimum of 2- 3 separate scrub/rinse cycles

4. Put on 2 clean plastic OB sleeves.

5. Lubricate both arms with sterile OB lube

6) Examine the birth canal for dilation and size of the pelvic opening.

• Manually dilate the birth canal if needed

7. Examine cervical dilation and structures in the birth canal

8.Examine uterus and birth canal for prior damage.

9.Evaluate position, presentation and posture of the calf and/or calves.

10. Evaluate calf or calves viability• Withdrawal reflex• Corneal/palpebral reflex• Suckle and tongue withdrawal

reflexes• Anal sphincter reflex• Heartbeat felt through chest wall or

umbilical artery pulse

Methods of Correcting Methods of Correcting DystociaDystocia

Live Fetus Options:– Mutation– Forced Extraction– Cesarean Section

Dead Fetus Options:– Mutation– Forced Extraction– Fetotomy– Cesarean Section

MutationMutationRepulsion:Rotation:

– Moving from dorso-pubic or dorso-ilial to dorso-sacral position

Version:– Turning the fetus end-for end (i.e. on a

transverse axis)

Reposition of Extremities

Minimum Goal of MutationMinimum Goal of Mutation

Reposition the calf into a dorso-sacral position

Calf’s front legs extended cranially and hind legs extended caudally in perspective to the calf’s body.

Guidelines for MutationGuidelines for Mutation

1. Abnormalities in presentation, position, posture should be diagnosed and corrected prior to attempting traction.

2. When the fetus is dead and repositioning is difficult or dangerous, other options should be considered

• Partial or complete fetotomy• Cesarean Section

3. Maximum of 30 minutes of mutation without progress warrants

c-section or fetotomy.

Types of Mutation DystociasTypes of Mutation Dystocias

Retention of Front LimbRetention of Rear LimbRetention of the HeadIrregular Presentation or Position

– “Dog-sitter”– Uterine Torsion– Transverse Presentations

Types of Limb Mutation Types of Limb Mutation DystociasDystocias

Front limb – Flexed shoulder

posture– Flexed carpal

posture– Elbow lock posture– Foot-nape posture

Hind Limb– Hock flexion

posture– Hip flexion posture

Flexed Carpus manipulationFlexed Carpus manipulation

1. Convert flexed leg to flexed carpus posture by traction on the upper foreleg if the shoulder is flexed.

2. Apply simultaneous repulsion to the carpus in an anterior-dorsolateral direction and traction on the hoof in a medial and posterior direction

Elbow Lock PostureElbow Lock Posture

Occur when forelimbs are not fully extended as they come into the pelvic inlet

Presentation:– Tips of toes are even with the end of the calf’s

nose

Correction:– Repulsion on the fetal trunk and simultaneous

alternating traction on the limbs

Flexed Hock ManipulationFlexed Hock Manipulation

1. Convert the flexed hip to a flexed hock posture

Apply hand traction high on the leg working your way distally until the hock is reached

2. Place 1 hand on the hock while simultaneously placing a second hand over the hoof.

3. Move the hoof posteriorly and medially into the birth canal as repulsion is applied in an anterior-lateral direction on the hock.

Caudal view

Lateral view

Dystocia due to Retention of Dystocia due to Retention of the Headthe Head

Lateral deviation– Most common

Ventral deviationDorsal deviationVertex posture

– bride of nose is impacted against the brim of the pelvis causing the poll to be presented

– Fetus is often dead

Head-Breast PostureHead-Breast Posture

Correction of ventral deviation of the head Procedure

1. Repel 1 forelimb to the flexed shoulder posture

2. Bring the head up from beneath the body of the fetus

3. Flexed shoulder is converted to normal posture using the flexed carpal manipulation

Lateral Deviation of the HeadLateral Deviation of the Head

Correction of Lateral Deviation Correction of Lateral Deviation of the Headof the Head

Repulsion of the shoulder, thorax, or brisket with concurrent traction on the head

Sources for Traction on the Head:– 2nd hand– Jaw snare: beware of jaw fractures– -head, jaw or orbital hooks

Irregular Presentation or Irregular Presentation or PositionPosition

“Dog-Sitter”Uterine TorsionTransverse Presentations

““Dog-Sitter”Dog-Sitter”

Rear legs are extended along the abdomen of the otherwise normally presented fetus

Correction of the “Dog-Sitter”Correction of the “Dog-Sitter”

Only attempt mutation if the fetus is small enough to allow palpation both hind limbs during extraction.– Allows for the hind legs to be repelled and

allows the uterus to be protected from the hooves as the rear legs straighten out during delivery.

– Otherwise, rear hooves may tear the uterus as they extend behind the fetus.

Cont. Correction of “Dog-Sitter”Cont. Correction of “Dog-Sitter”

180 degree version to posterior presentation and rotation to dorso-sacral position

Cesarean section– Especially with oversized fetus

Fetotomy– Impacted fetus in the birth canal

Uterine TorsionUterine Torsion

Always examine uterus for torsion if fetus appears to be presented in a dorso-ilial OR dorso-pubic position.

Uterine Torsion FindingsUterine Torsion Findings

Spiral folding of the birth canal– Simulates incomplete dilatation of the cervix

Broad ligaments of the uterus are rotated and stretches across the birth canal– 1 on the upper and 1 on the lower surface– Felt via Rectal Palpation.

Methods to Correct Uterine Methods to Correct Uterine TorsionTorsion

Shaffer method (plank in the flank)Rotate fetus in uteroCesarean Section

Transverse PresentationsTransverse Presentations

Correction of Transverse Correction of Transverse PresentationsPresentations

Mutation is usually not attempted especially if presenting transverse dorsal.– Rear legs sometimes perforate the uterus as

they straighten if delivery is attempted by anterior presentation

Convert to posterior presentation, dorso-sacral position

Cesarean Section

Monster FetusMonster Fetus

DO NOT ATTEMPT TO MUTATE OR PULL

CESAREAN SECTION IS REQUIRED

Forced Extraction of a FetusForced Extraction of a Fetus

Which one has already prepared for prior to the initial obstetrical examination– i.e. obstetrical chains and hooks should

already be in the bucket of dilute betadine or novasan solution.

Do not give an epidural anesthetic unless it is absolutely necessary.– Prevents dam from assisting delivery of the

calf

Forced Extraction in Anterior Forced Extraction in Anterior PresentationPresentation

1) Placement of obstetrical chains

• Eyelets on the dorsal surface of the forefeet

2)2) Traction on FetusTraction on Fetus

Traction Procedure especially Traction Procedure especially if fetus is oversizedif fetus is oversized

Unilateral traction is applied to the bottom (most anteriorly located) forelimb until its shoulder and elbow are past the pelvic inlet– It can usually be felt when the shoulder passes

the ilium.– Otherwise, assume that when the fetlock is ~10

cm (15 cm in larger breeds) outside of the vulva, the shoulder has passed through the pelvic inlet.

Cont. Traction of oversized Cont. Traction of oversized fetus (anterior presentation)fetus (anterior presentation)

Full-force unilateral traction is than applied to the top forelimb (hopefully by a 2nd person)– Extraction is usually is possible if the 2nd

shoulder also passes the ilium into the birth canal

– If not, C-SECTION IS PROBABLY REQUIRED.

Traction can be attempted with a calf jack but do not exceed force of 2-3 strong men.

3)3) Rotation of the FetusRotation of the Fetus

How to rotate the calf to avoid hiplockHow to rotate the calf to avoid hiplock

Completion of RotationCompletion of Rotation

•Rotation of the fetus takes advantage of Rotation of the fetus takes advantage of the widest diameter of the pelvic inletthe widest diameter of the pelvic inlet

If Hiplock If Hiplock occurs . . . . . .

1. Discontinue traction

2. Clean the mucus and membranes from the calf’s nostrils

3. Stimulate breathing– Tickle the nostrils– Pour cold water over the head of the calf

4.4. With hiplock apply traction With hiplock apply traction only when the cow pressesonly when the cow pressesContinuous

traction is generally unproductive

Pelvic inlet becomes functionally larger

5. Apply traction caudally and somewhat dorsally

This direction of pull is more perpendicular to the pelvic inlet

6.6. Maintain rotation of the Maintain rotation of the calf’s pelvis in a dorso-ilial calf’s pelvis in a dorso-ilial position.position.

•Palpation along the back of the calf is required to ensure that the calf’s pelvis is rotated 60 to 90 degrees.

Forced Extraction in Posterior Forced Extraction in Posterior PresentationPresentation

Rotate the calf into the dorso-ilial position

Apply OB chains to the hind legs in a similar manner as the front legs

Apply traction in a caudal, slightly dorsal direction to bring the calf’s hips through the pelvic inlet.

Cont. Forced Extraction in Posterior Cont. Forced Extraction in Posterior PresentationPresentation

Rotate the calf back into a dorso-sacral position once the rear quarters have passed the pelvic inlet

Apply slightly caudal, ventral traction

Calf Jack Calf Jack

Can be used with either posterior or anterior presentation

NEVER APPLY MORE FORCE THAN WHAT 2-3 STRONG MEN CAN APPLY

Cesarean SectionCesarean Section

Approaches:– High left flank– Low left flank– Left paramedian– High right flank– Low right flank– Right paramedian– Ventral Midline

FetotomyFetotomy

Should only be performed in the dead fetus

Fetotomy EquipmentFetotomy Equipment

FetotomeWire ThreaderWire saw handlesWire introducer

Krey Hook OB chainLubicantEpidural equipment

Injury to the CalfInjury to the Calf

Asphyxiation and AnoxiaAsphyxiation and Anoxia

Rupture or impaction of the umbilicus during manipulation necessitates rapid extraction to prevent anoxia and potential brain damage

Complications more frequently associated with posterior presentation

Femoral Nerve ParalysisFemoral Nerve Paralysis

Often associated with prolonged hiplock during extraction

Nerve DamageNerve Damage

FracturesFractures

Fracture of the mandible due to inappropriate use of obstetrical chains

FracturesFractures Placement of obstetrical

chains with one loop over the fetlock and a half-hitch around the pastern will better distribute traction and prevent injury to fetal limbs

FracturesFractures

Excessive traction may also result in fractures of the pelvis or ribs, as well as injury to the joints and spine

Complications Associated with Complications Associated with Posterior PresentationPosterior Presentation

Pulmonary hemorrhage, diaphragmatic hernia, and liver rupture may be caused by excessive traction on the fetus in posterior presentation

Injury to the DamInjury to the Dam

Calving ParalysisCalving Paralysis

Paresis or paralysis of the cow

Damage to peroneal and obturator nerves

May be caused by prolonged hiplock or excessive force used in its resolve

Retained PlacentaRetained Placenta

Direct association with abortion, twinning, dystocia, cesarean-section, and fetotomy.

Uterine ProlapseUterine Prolapse

Associated with dystocia and irritation of the external birth canal

Complicated by environmental insult—freezing, drying, severe laceration

Trauma to the Birth CanalTrauma to the Birth Canal

Tears and lacerations: – Vulvar, vaginal and cervical tears, recto-vaginal

fistula or perineal laceration– Forelimbs may be forced through the dorsum of

the birth canal

HematomaVaginal necrosis

Uterine Ruptures or TearsUterine Ruptures or Tears

Associated with prolonged dystocia, uterine torsion, and excessive repulsion or rough manipulation

Tears most commonly occur in the ventral uterine wall

@#$*%&!!

Saturday, April 6: calf presents breech, calving difficulty 5 and 8, calf does not survive extraction

Monday, April 8: dam found dead, presented for necropsy

Dam number 1025Dam number 1025

PeritonitisPeritonitis

Examination of the abdominal cavity reveals a considerable volume of bloody fluid and fibrin

Petechiation of the HeartPetechiation of the Heart

Indicative of an acute/agonal incident or a septic insult

Dorsal Uterine TearDorsal Uterine Tear

Full thickness, approximately six inches long

Ventral Uterine TearVentral Uterine Tear

Partial thickness, approximately three inches long with associate mucosal/ sub-mucosal hemorrhage

Fetal LungsFetal Lungs

Appearance of the lungs indicated the calf had taken a breath

@#$*%&!!

Economic Implications of Dystocia

Things to consider:

-Dam Value

-Live Calf Value

-Cost of Veterinary Intervention

Dam ValueDam Value

Dairy cows (Holstein)- Replacement of Mature Milking

Cow: $1200-1500- Replacement of Springing

Heifer: $1800-2500

- Lactation and Genetic Potential

Dam ValueDam Value

Beef CowsPurchase of Replacement Heifer: $850-900Rearing of Replacement Heifer: $750-800

Seedstock Genetics

Live Calf ValueLive Calf Value•Dairy Calves

- 1 day old heifer calf: $500-700

- 1 day old bull calf: $100-150

Live Calf Live Calf ValueValue

•Beef Calves

- Feeder Futures for January, 2003

- $79/cwt x 700# = $553

Even if you can’t save Even if you can’t save baby…baby…

•Dairy Cow value post-calving

- Lactation: 18,000# x $0.87/# = $15,666

- This does not include cost of lactation

- Salvage: $54.00/cwt x 1000# = $540

- Rebreed

Even if you can’t save Even if you can’t save baby…baby…

•Beef cow value post-calving:

- Raise orphaned or twin calf; Rebreed

- Salvage: $60/cwt x 900# = $540

Producer Cost for Producer Cost for Caesarean SectionCaesarean Section

•Survey of veterinarians

- Average charge for on-farm dystocia ending in Caesarean section

- $258.92

What is the bottom What is the bottom line?line?•Dairy Producer:

-Heifer + Calf Alive = $2300

Plus Lactation ($15,000) and Genetics

-Heifer Alive = $1800

Plus Lactation ($15,000) and Genetics

-Cost of Caesarean: $260

11% of value of both at that time

What is the bottom What is the bottom line?line?

•Commercial Beef Producer:

- Heifer and Calf Alive: $1403

- Heifer Alive: $850

- Cost of Caesarean: $260

-18% value of both

ConclusionConclusion

•Producers should make dystocia management decisions before breeding occurs

•When a dystocia presents itself , make your decisions based on what is best for the herd’s production goals

•If you need to intervene, do so with caution and think ahead about the effects of your actions on the pair’s future production

Thank you to all the faculty and staff of GPVEC for contributing to our education.

The EndThe End

Any questions?