Clinical management of dystocia due to conjoined twins in a crossbred cow.
The incidence of fetal monster has been reported in cows (Patil et al., 2004; Honnappagol et al., 2005; Solanki et al., 2011) and buffaloes (Bugalia et al., 1990; Bugalia et al., 2001; Prasad et al., 2006; Dhami et al., 2000). Further, Sureshkumar et al. (1999) documented dicephalus tetrapus tetrabrachius monster in a buffalo. Twinning can range from incomplete bilateral forms such as cyclopia, through various grades of supernormal forms such as double headed types, double monsters and conjoined twins, culminating in completely separate monozygotic or duplicate twins. The definite etiological agents for conjoined twins are unknown (Leipold and Dannish, 1986), however abnormal duplication of germinal area in fetus will give rise to congenital fetal abnormalities with partial duplication of body structures (Bugalia et al., 1990). Such embryonic duplications occur about 1 in 1 lacs bovine births (Roberts, 1986). Fetal duplication nearly always cause dystocia (Sloss and Dufty, 1980) requiring fetotomy or cesarean to relieve. The present paper reports a case of dystocia due to monozygotic monocaudatus conjoined twin fetus in a crossbred cow and its successful clinical management through fetotomy.
History and Clinical Findings
A 3.5 years old, primigravida full term pregnant HF crossbred cow was reported in labour. The water bag had ruptured and both fore limbs were protruded out at vulva without any progress for last 2 hrs. The animal was straining intermittently in both standing and recumbent position. The animal when attended was alert, standing and straining severely. Vulvar lips and vagina were found congested. The digits of both fore limbs of fetus were protruding out at vulva, but no head or mouth was visible.
After proper lubrication of birth canal, a detailed per vaginal examination revealed a completely dilated cervix with a dead fetus in anterior longitudinal presentation, dorso-sacral position with presence of head and extended forelimbs in birth canal. Forced traction was applied to effect delivery of fetus, but was futile, hence further deep and detailed examination of fetus following its repulsion was done, revealing some additional lateral growth, simulating rib cage of another conjoined twin fetus, on right side of rib cage of fetus already in birth canal and it was locking the fetus at pelvic inlet when traction was applied. No other parts however could be palpated for want of space in pelvis. It was tentatively diagnosed as a case of conjoined twin causing dystocia.
Since efforts to deliver abnormal fetus by mutation and forced traction were unsuccessful and animal assumed recumbent position, a partial fetotomy was performed per vaginum using fetotomy knife in sitting position. The conjoined twin fetuses were separated by dissecting flexible skin fold at right rib-cage of protruded dead fetus. Deeper dissection with simultaneous traction on protruded legs resulted in delivery of conjoined twin fetus with some skin fold still attached at thoraco-abdominal region. Cephalaxin powder 20 gm was instilled in uterus to combat infection.
Upon delivery, the monster was a conjoined twin heifer calf with two heads, two necks and two trunk/ thorax with four forelimbs, joined together side by side laterally at rib-cage upto abdomen, followed by single umbilical cord, a lumbo-sacrum, a tail and a pair of hind limbs (Fig. 1 and 2). On dissection of monster, normal thoracic viscera were present in both conjoined twins, but abdominal viscera and pelvic organs were common for both with an enlarged single liver and spleen.
The cow expelled the fetal membranes normally within 2 hrs of fetal delivery, but developed posterior weakness with sternal recumbency for two days. It was treated by i/v inj. of Dextrose 25% 450 ml and Calcium-magnesium borogluconate 450 ml together with i/m inj. of Analgin (a) 20 ml, Strepto-penicillin 5.0 gm, Neuroxin (b) 10 ml and Hivit (c) 10 ml, but animal did not get up. For next two days i/v Calcium borogluconate 450 ml and i/m Meloxicam (d) 15 ml, Avil (a), 10 ml, Strepto-penicillin 5.0 gm and Neuroxin 10 ml were repeated. Animal remained in sternal recumbency for 2 days, but was active, alert, eating everything (Fig. 3) and shifting on either sides and got up of its own after 48 hrs of calving, started roaming and made uneventful recovery, reaching peak milk production upto 18 kg per day in next 15 days.
The conjoined twins arise from a single ovum and are monozygotic. They are relatively more common in cow, sow, bitch and cat. The two thorax of present monster were fused per-cutaneously from lateral sides (thoracopagus) in area of rib cage. The monster had two separate chests with two pairs of forelimbs, two necks and two normal heads, but with a common rear parts (moncaudatus), i.e. a lumbo-sacral region, a tail and pair of hind limbs, with a well developed vulva. As per Roberts (1986) the gross features of present monster calf can be described as dicephalus tetrapus tretrabrachius monocaudatus conjoined twins. According to Jubb and Kennedy (1970) and Noden and Dalhunta (1985) conjoined twins are non-inherited teratological defects and monozygotic, thus monstrosities arise due to incomplete embryonic division into components usually at primitive streak development stage. Alike present case duplication of cranial part of fetus is more than of caudal parts and also duplication can occur at both cranial and caudal ends with middle area of monster remaining single (Roberts, 1986). The present case seems to be a non-inherited teratogenic defect of development of monozygotic fetus with duplication of cranial parts. Sloss and Dufty (1980) and Solanki et al. (2011) were of the opinion that fetotomy of large conjoined twins is often a difficult formidable task and caesarean section can easily be performed to deliver monster. Shukla and Pandey (2005) and Prasad et al. (2006) successfully managed dystocia due to dicephus dipus tetrabrachius ischiopasgus conjoined monster and thoraco-sternopagus monster respectively, in buffaloes by cesarean section. In the present case, however, partial fetotomy together with continuous traction resulted in successful separation of skin fold of conjoined twins from thoracic region and assisted fetal delivery fetus per vaginum. The prolonged sternal recumbency observed in dam may be due to pelvic nerve compression on account of protracted dystocia, forced traction and frequent locking of monster fetus at pelvic inlet. This however recovered gradually within two days with uneventful recovery and attaining full potential of milk production in regular time interval. The animal although exhibited postpartum estrus, became a chronic repeat breeder and conceived after 7-8 cycles and delivered a normal male calf subsequently 20 months later.
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A.J. Dhami (1), B.C. Parmar and H.L. Makwana
Department of Animal Reproduction Gynaecology and Obstetrics College of Veterinary Science and Animal Husbandry Anand Agricultural University (AAU) Anand--388001 (Gujarat)
(1.) Professor/Head and Corresponding author. E-mail: email@example.com
(a)--Brand of MSD Animal Health, Pune
(b)--Brand of Zydus Animal Health, Ahmedabad
(c)--Brand of Zoetis Animal Health, Mumbai
(d)--Brand of Intas Animal Health, Ahmedabad
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|Title Annotation:||Short Communication|
|Author:||Dhami, A.J.; Parmar, B.C.; Makwana, H.L.|
|Date:||Jul 1, 2014|
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