Dystocia due to uterine torsion in a doe and its surgical management.
Uterine torsion is a maternal dystocia characterized by rotation along its axis during late, first or early stage of labour. It has been reported to occur in all domestic anima ls, seen most commonly in dairy cows and occasionally in goats and sheep (Roberts, 1996; Arthur et al., 1989). The condition was first descri bed in 1766 by Boutrolle (Fleming, 1930). The dystocia due to uterine torsion is one of the major obstetrical emergencies frequently met by a large animal practitioner. Indications for caesarean section include foetal oversize, feto-pelvic disproportion, incomplete dilation of cervix, irreducible torsion of uterus, hydrops of foetus, hydrops allantois or abnormalities of presentation, position or posture, ventral hernias and prolonged cases of dystocia (Roberts, 1996). In the present communication successful management of uterine torsion and removal of intrauterine live fetuses by caesarean section is placed on record.
Materials and Methods
A naturally bred non-descript two and half years old pluriparous doe was referred with history of full term pregnancy and exhibited all signs of parturition since last 18 hours but fail to deliver kids. The animal was showing exhaustive expulsive efforts, moderately anorectic but thirsty, had colic pain, kicking at its abdomen, switching in its tail and there is no sign of appearance of water bags or foetal extremities when presented for treatment. Teats were engorged with milk. The clinical examination revealed increased heart rate (96/minute) and respiration rate (36/minute). On per vaginal examination os was found completely closed and showed some rotational appearance indicative of uterine torsion. Digital examination per vaginum showed tenseness of broad ligaments of left side with depression on right side and diagnosed as pre cervical right uterine torsion and degree of torsion was approximately 120[degrees]. In this case, surgery was warranted by considering survival of dam/kid and it was decided to perform caesarean section.
Following restraining of animal in lateral recumbency, surgery was accomplished under epidural anaesthesia using 2.5 ml of 2% Lignocaine hydrochloride (Xylocain (a)). The site was prepared in left lower flank incision parallel to left subcutaneuous abdominal vein for aseptic surgery in routine manner. No sooner the abdomen was incised, the inten se uterus approximated the incision line. Uterus was incised and two live kids (male and female) were removed from two uterine horns (bicornual pregnancy). The foetal membrane was also removed. The uterus was flushed with normal saline and Betadine (b) solution. Antibiotic pessaries Furea boli (c) were kept intrauterine and uterine incision line was closed with double row of Lambert sutures using catgut no. 01 (Fig. 1) while pushing back the uterus into abdominal cavity a superficial uterine rupture was seen on body of uterus which was also closed with double row of Lembert sutures using catgut no. 01. After complete suturing uterus was rolled in opposite direction of uterine torsion to achieve complete detorsion and put in normal position (Fig. 2). The peritoneal cavity was thoroughly cleaned with Betadine solution. The abdominal wound was closed routinely with black braided silk (Fig. 3). The cervix was found 1-2 fingers dilated. Adequate fluid therapy with 5% DNS and [D.sub.5] intravenously during and after surgery along with parenteral therapy of injection Intacef Tazo (d) @ 10-15 mg/kg body weight, Melonex (d) 2 ml and Tribivet (d) 2ml was intramuscularly daily for five days. Injection Oxytocin (e) 40 IU was injected in the uterine musculature. The doe recovered uneventfully after the delivery of the twin foetuses (Fig. 4) and wound healed with out any complication. The cutaneous sutures were recovered on the 8th post-operative day.
Results and Discussion
Successful handling of uterine cases requires skill and correct clinical judgement so that life of either dam or foetus of both is not jeopardized. Caesarean section is indicated in those cases when mutation, forced extraction or fetotomy are deemed inadequate or too difficult to be employed to relieve impending or present dystocia and when it is desired that foetus be delivered alive (Roberts, 1996).
A caesarean section had to be performed to resolve of uterine torsions after a failed attempt at rolling doe, because of incomplete cervical dilation. The cervix was found 1-2 fingers dilated after operation. The incidence of non-dilatation of cervix was accompanied by a higher incidence of cervical laceration following vaginal delivery (Aubry et al., 2008). The etiology of the condition is not well understood. It generally occurs during late 1st stage or early 2nd stage labour but there are some reports of prepartum uterine torsions (Roberts, 1996; Arthur et al., 1989; Frazer et al., 1996). The various authors have reported sings of uterine torsion as expulsive/straining efforts, anorexia, colic pain, kicking at its abdomen and switching in its tail, increased heart rate and respiration rate (Ansari and B uchoo, 2008; Siddiquee and Chaudhary, 2000) in a ewe and goat respectively.
The instability of gravid uterus is certainly most important predisposing factor in bovine uterine torsions. Each uterine horn is supported in a dorsolateral direction by broad ligaments, which are attached to the ventral surface of uterus. Most commonly, torsion extends caudally beyond cervix, such that vaginal wall is involved in rotation (Sloss and Duft, 1980). Excessive foetal weight appears to be a predisposing factor for uterine torsion (Frazer et al., 1996) in our case. Out of the 49 uterine torsions in dairy cattle for which the information was available, 36 calves (71%) were alive, including 1 set of twins, and 15 calves were dead also including 1 set of twins (Aubry et al., 2008).
Ansari, M. M. and Buchoo, B. A. (2008). Caesarean section in uterine torsion in a bicornual pregnant ewe of Kashmir valley. North East Veterinarian. 7: 28.
Arthur, G. H., Noakes, D. E. and Pearson, H. (1989). Veterinary Reproduction and Obstetrics, 6th edn, ELBS, Tindall.
Aubry, P., Warnick, L. D., De sCoteaux, L. and Bouchard, E. (2008). A study of 55 field cases of uterine torsion in dairy cattle. Can Vet J. 49: 366-72.
Fleming, G. (1930). Fleming's Veterinary Obstetrics. London: Bailliere, Tindall and Cox, pp. 235-50.
Frazer, G. S., Perkins, N. R. and Constable, P. D. (1996). Bovine uterine torsion--164 hospital referral cases. Theriogenology. 46: 739-58.
Roberts, S. J. (1986). Veterinary Obstetrics and Genital Diseases (Theriogenology) 3. Woodstock. pp. 230-352.
Siddiquee, G.M. and Chaudhary, S. (2000). Dystocia due to uterine torsion in goats-an analysis of six cases. Intas Polivet. 1: 276-78.
Sloss, V. and Dufty, J. H. (1980). Dystocia. Displacement of the gravid uterus. In: Sloss V, Dufty JH, editors. Handbook of Bovine Obstetrics. Baltimore, Maryland: Williams and Wilkins, pp. 108-110.
Md. Moin Ansari (1)
Division of Veterinary Surgery and Radiology Faculty of Veterinary Sciences and Animal Husbandry Sher-e-Kashmir University of Agricultural Sciences and Technology (SKUAST-K) Shuhama Srinagar--190006 (Jammu and Kashmir)
(1.) Assistant Professor-cum-Scient ist (Senior Scale) and Corresponding author. E-mail: firstname.lastname@example.org
(a)--Brand of Astra IDL, Bengaluru
(b)--Brand of Winmedicare Ltd., Mumbai
(c)--Brand of Pfizer Ltd, Mumbai
(d)--Brand of Intas Animal Health, Ahmedabad
(e)--Brand of Novartis Ltd, Mumbai
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|Title Annotation:||Short Communication|
|Date:||Jul 1, 2014|
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