Retrospective studies on occurence of dystocia and it's management in domestic animals.
"There is no such thing as an easy calving ... just varying degrees of difficulty ... from the dam's perspective" (paraphrasing McClintock, 2004).
Reproduction plays an important role in economy of any livestock husbandry. When we talk about reproduction, among other things we talk of parturition and neonatal survival. The most frequent situation concerning parturition is normal birth (eutocia), but we can also have the opposite i.e. a difficult birth (dystocia) and its diagnosis and treatment is important in Veterinary practice.
Dystocia occurs when there is failure in one or more of three main components of calving: expulsive forces, birth canal adequacy and fetal size and position (Noakes et al., 2001). The causes of dystocia are broadly classified as maternal and fetal causes. Despite there being an awareness of problem of dystocia for such a long time, it still causes significant economic loss to both large and small livestock and even in pets. Dystocia is costly because it implies more labour, medication, neonatal mortality and sometimes dam also. Losses among cows and buffaloes also include delayed reproduction and decreased milk production.
The objective of present study was to record occurrence of dystocia in different animals and to attempt relieve dystocia by conservative treatment (i.e. medicinal treatment and or manual assistance/ forced extraction), fetotomy or cesarean section and record the outcomes.
Materials and Methods
The occurrence of dystocia in different animals was recorded in cases presented and treated during past eight years (2006-2013). Aspects recorded were: animal species, etiology of dystocia, method adopted to relieve dystocia and outcome and subsequent complications during follow up period were recorded.
Different approaches were used to resolve dystocia cases, which were adjusted to each situation following observation of major clinical signs and after evaluation of cow and calf vitality. The decision was also influenced by differences between species, breeds, cultural and economic differences between owners and farm value for mother-neonatal segment.
Criteria to choose procedure to correct dystocia
Calf alive and although big, delivery per vaginum considered to be possible: conservative treatment involving medicinal treatment and or manual/forced extraction were employed.
Calf dead and too big for vaginal delivery: Fetotomy was performed for reduction of fetal removed size by cutting it into small pieces that can be through birth canal.
Calf alive and or dead but too big to pass through birth canal: Cesarean section was performed under Xylazine sedation and local linear infiltration with 2% Lignocaine HCl via ventrolateral oblique incision. In dogs following Diazepam sedation, Propofol and Ketamine cocktail anesthesia was used for induction and maintenance. Hysterotomy was performed by midventral approach.
Results and Discussion
In order of descending financial importance, dystocia impacts production (41% of costs), fertility (34%) and cow/calf morbidity and mortality (25%), excluding costs associated with increased culling, Veterinary costs and other management costs (Dematawewa and Berger, 1997). Production losses are greatest in high yielding cows and in early lactation (Lombard et al., 2007). Furthermore, Dobson et al. (2001) reported delayed uterine involution, delayed onset of luteal activity postpartum and more abnormal progesterone profiles following dystocia. In addition to effects of dystocia on cow culling and mortality and on stillbirth, dystocia increases likelihood of both cow/calf respiratory and digestive disorders, as well as retained placenta, uterine disease, mastitis and hypocalcaemia therapy (Lombard et al., 2007). When the costs associated with interrelated sequelae of dystocia are included, total cost of dystocia is four times greater than treatment costs alone (Oltenacu et al., 1988).
A total of 253 animals were treated for dystocia over a period of eight years of which high incidence was observed in cattle (n=88) followed by buffaloes (n=74), goats (n=38), dogs (n=36) and sheep (n=17) (Table 3). Among these 253 cases, most common etiology was fetal cause (n= 138), while maternal cause was recorded in 115 cases. Fetal causes of dystocia (Table 1) were common in cows (n=53, 20.95%) followed by buffaloes and goats. Whereas maternal causes of dystocia (Table 2) were common in buffaloes (n=39, 15.42%) followed by dogs.
While all types of dystocia occurred in both primiparae and pluriparae, the predominant types and risk factors differed between these parity groups. In primiparae, primary types of dystocia in descending order of importance are feto-pelvic disproportion (FPD) (Fig. 1), abnormal fetal position and vulval stenosis. In pluriparae, the primary types of dystocia were abnormal fetal malposition, uterine inertia, uterine torsion, FPD and cervical stenosis. Similar observations were made by Mee (2008), according to whom fetal malposition occurs at a low prevalence (<5%) in primipara but it is most common cause of dystocia in pluriparae accounting for 30% of cases. The correction of fetal presentation, position and postures by adopting retropulsion, extension, traction and rotation was performed before forced extraction was attempted (Fig. 2).
By far the most common type of dystocia in cattle is FPD, failure to relieve dystocia lead to emphysematous fetus and this was one of the major reasons to perform caesarean operations. According to McClintock, (2004), evolution, cross breeding programmes and domestication have resulted in animals producing fetuses that are relatively larger compared to their dams. The two primary determinants of FPD are, in order of importance, calf birth weight and maternal pelvic size with these two factors accounting for 50% and 5-10% of the phenotypic variance in dystocia, respectively (Meijering, 1984). Feto-pelvic disproportion was major cause and cross breeding with large dairy breeds (especially HF in cattle and Murrah and Jafferabadi in buffaloes)-associated with increased risks of dystocia.
Genotype can account for upto 60% of variation in birth weight though heritability of dystocia is low (2-10%) (McClintock, 2004). An increase in calf birth weight and associated increase in gestation length, dystocia and stillbirth risk have been, in part, attributed to 'Holsteinization' amongst Swedish (Steinbock, 2006), Danish (Hansen et al, 2004) and UK (McGuirk et al., 1999) Friesian cattle and in Australian Jersey cattle (McClintock, 2004).
High incidence of dystocia was observed with male calves (n=277, 62.81%) the proportion of male fetuses observed in cases of dystocia was high in all five species (Table 4). It may be attributable to higher birth weight. According to Kertz et al. (1997), birth weight of male calves, singleton calves and calves from pluriparae are 9%, 8% and 15% greater than those of female calves, twins and calves from primiparae, respectively.
Excess or inadequate body condition at calving is a significant risk factor for increased incidence of calving assistance and dystocia. Higher incidence of uterine inertia was seen in dairy cattle buffaloes and dogs which may be due to metabolic pressures placed on calcium and energy stores and important influence calcium has on uterine contraction. Uterine inertia, where cervix is fully dilated but myometrial contractions are too weak to expel fetus, is associated with approximately 10% of all dairy cattle dystocia, primarily in pluriparae (Sloss and Dufty, 1980). Even fat mobilisation in over fat primiparae can reduce magnesium availability and calcium mobilisation leading to uterine inertia and prolonged stage two of calving (Mee, 2008). Uterine inertia may be primary, as in hypocalcaemia, hypomagnesaemia, old age, debility, lack of exercise and pre-term calving and possibly hyposelenaemia (Mee, 2008) or secondary, as in prolonged, malposition and twin calving (Noakes et al., 2001).
Uterine torsion is relatively uncommon (approximately 5% of dystocia cases, primarily in pluriparae) (Frazer et al., 1996), but appears to be increasing in prevalence (10%) in Veterinary assisted dystocia (Laven and Howe, 2005). In the present study, uterine torsion was the most common cause of maternal dystocia (29.56%) and high incidence was seen in buffaloes (67.64%). This may be due to difficult cases being referred from surrounding areas. The intermediate risk factors are excessive fetal movement during stage one of calving as fetus adopts birth posture, increased uterine instability at term and possibly a deeper abdomen in some dairy breeds. Ultimate risk factors include fetal oversize and gender, debility and insufficient exercise (Noakes et al., 2001). Most of these cases (64.70%) were corrected by modified Schaffer's method using plank (Fig. 3) and rest of animals were subjected to cesarean section. On correction, lateral turning of head of fetus was common finding which had to be corrected before forced extraction through vagina.
Incomplete dilatation of vulva was more common in primiparae while incomplete dilatation of cervix is more common in pluriparae. According to Burton et al. (2006), these conditions are associated with confinement and periparturient environmental stress, premature assistance, hormonal asynchrony and preterm calving.
The conservative method of pervaginal delivery by medicinal treatment and or manual assistance or forced extraction was method most frequently used and followed by cesarean section and fetotomy (Table 3). The conservative treatment involved medicinal treatment and or manual assistance or forced extraction.
Though, cesarean section is used as last resort for solving dystocia situation in India, in the present study it was used with good results and minimum complications. Irreducible uterine torsion, incomplete cervical dilatation (Fig. 4) and pelvic deformities were the maternal factors where in cesarean section was opted for. Within the fetal factors emphysematous fetus (Fig. 5), oversized fetus and fetal monsters (Fig. 6) were the conditions where in cesarean was performed. Similar observations were made by Kolkman et al. (2007). Newman and Anderson (2005) suggested C-section to be classified in 3 different categories: elective, emergency with a non-emphysematous calf or emergency with emphysematous calf. Furthermore, they state that most important parameter to determine success of procedure is health status of both dam and calf at time of procedure. Thus, cows subjected to an emergency C-section are more likely to encounter intra and post-operative complications and less likely to survive compared with cows submitted to elective surgery, since prognosis is proportional to duration of dystocia. Newman and Anderson (2005) also revealed that when a C-section is considered as an ultimate choice/is the last option, a negative outcome is more likely, but when it is performed in an early stage of parturition its outcome is more rewarding. Similar observations were made in present study also. Few cases which had suffered from dystocia and undergone cesarean section in previous delivery were presented again anticipating dystocia. But most of them had normal delivery with minimal manual assistance (Fig. 7).
Transvaginal partial fetotomy (Fig. 8) was the least used method. This technique was performed to preserve dam's life, when fetus was dead and owner was not ready for cesarean. Youngquist and Threlfall (2007) opined that experience of operator is a very important factor to perform a fetotomy and technique is falling into disuse, maybe because of it's complications of uterine tear, more time consuming and demands a lot of physical strength. Incidentally, Noakes et al. (2001) refers that many Veterinarians have lost skills to perform fetotomy, which could explain why C-section is more frequently used even when fetus is dead.
Among a total of 441 neonates delivered, 238 neonates survived the ordeal while 203 were born dead or succumbed immediately after birth (Table 5). High neonatal survival was observed with dogs. This might be due to the fact that much Veterinary obstetric work is still of a 'fire brigade' nature with parturient mother not having been seen prior to emergency consultation. Clearly this is unsatisfactory and many problems could, with prior knowledge of the case, have been anticipated and prevented. Although it may be difficult to justify provision of standard of antenatal care available to ruminants, small animal practice does offer opportunity for some degree of antenatal care.
Certain complications were observed with all three methods employed to relieve dystocia (Table 6). Complications observed with conservative method (medicinal treatment and or manual assistance/forced manual extraction were fetal metacarpal/metatarsal fractures and mandible fractures, emphysematous fetus due to failure to relieve, uterine trauma or rupture, uterine prolapse, obturator or sciatic nerve damage, uterine inertia, trauma vaginal tract and external genitalia, retained fetal membranes, septicemia, anorexia or death of mother. Complications associated with partial fetotomy were lacerations to vaginal walls, lacerations of uterine wall, perforatons, metritis, peritonitis, severe trauma to external genitalia, hemorrhage, retained fetal membranes, septicemia, anorexia or death of mother. Complications observed with Cesarean section were myiasis of wound, wound infection, dehiscence, pyrexia, septicemia, anorexia and death due to other complications.
To conclude, dystocias and their associated losses can have a significant economic impact on cow-calf producers. Results from this study showed some differences between species and breed realities concerning the time to intervention and approach to dystocia. Partially, these differences are also influenced by differences in Veterinarians attempting treatments, surgeon's availability and economic status of owners.
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A. S. Patil (1), Ramesh Rathod (2) and B. N. Nagaraja (3)
Veterinary Hospital College of Agriculture University of Agricultural Sciences (UAS) Dharwad--580005 (Karnataka)
(1.) Assistant Professor and Corresponding author. E-mail: email@example.com
(2.) Veterinary Officer, Dept of AH and VS, Bagalkot
(3.) Professor, Dept of Surgery and Radiology, Veterinary College, KVAFSU, Bengaluru
Table 1: Incidence of fetal causes of dystocia in different species Sr. Species Fetal causes No. Fetal Fetal Fetal Congenital maldisposition emphysema oversize defects 1 Cattle 14 12 16 9 2 Buffalo 6 9 12 6 3 Goat 4 8 6 3 4 Sheep 1 3 4 -- 5 Dog 4 4 6 -- 29 36 44 18 Sr. Fetal causes Total No. Mummified/ Twins macerated 1 2 1 54 2 2 -- 35 3 -- 6 27 4 -- -- 8 5 -- -- 14 4 7 138 Table 2: Incidence of maternal causes of dystocia in different species Sr. Species Maternal causes No. Uterine Uterine Insufficient Narrowed torsion inertia cervical pelvic dilation cavity 1 Cattle 11 6 9 3 2 Buffalo 23 4 5 1 3 Goat -- 3 4 3 4 Sheep -- 3 2 2 5 Dog -- 8 3 4 34 24 23 13 Sr. Maternal causes No. Hydropsy Abdominal Over Total inability fat to strain 1 2 3 -- 34 2 4 2 -- 39 3 -- 1 -- 11 4 -- -- 2 9 5 -- 3 4 22 6 9 6 115 Table 3: Treatment opted to resolve dystocia Sr. No. Species Treatment opted Total Medicinal Fetotomy Cesarean and Forced section extraction 1 Cattle 57 8 23 88 2 Buffalo 51 6 17 74 3 Goat 31 3 4 38 4 Sheep 12 4 1 17 5 Dog 14 - 22 36 165 21 67 253 Table 4: Gender of neonates born after dystocia management Sr. Gender of Animal species Total No. neonate Cattle Buffale Goat Sheep Dog 1 Male 59 46 26 11 135 277 2 Female 30 29 18 6 81 164 Total 89 75 44 17 216 441 Table 5. Comparision of Neonatal vitality with treatment opted Sl. Species Live neonates No. Medicinal Fetotomy Cesarean Total and forced section extraction 1 Cattle 22 -- 10 32 2 Buffalo 14 -- 2 16 3 Goat 24 -- -- 24 4 Sheep 6 -- -- 6 5 Dog 92 -- 68 160 158 -- 80 238 Sl. Species Dead neonates Grand No. total Medicinal Fetotomy Cesarean Total and forced section extraction 1 Cattle 36 8 13 57 89 2 Buffalo 37 6 16 59 75 3 Goat 13 3 4 20 44 4 Sheep 6 4 1 11 17 5 Dog 36 -- 20 56 216 128 21 54 203 441 Table 6: Complications Vs treatment opted Sl. Cause of Complications observed No. dystokia in treatment methods Medicinal + Forced extraction No of Complications animals 1 Uterine torsion 22 5 2 Uterine inertia 20 3 3 Insufficient 13 4 cervical dilation 4 Narrowed pelvic 1 -- cavity 5 Hydropsy 6 2 6 Abdominal 4 1 inability to strain 7 Over fat -- -- 8 Fetal 27 5 maldisposition 9 Fetal emphysema 16 6 10 Fetal oversize 33 3 11 Congenital 14 2 defects 12 Mummified/ 3 2 macerated 13 Twins 6 2 Total 165 35 Sl. Cause of Complications observed No. dystokia in treatment methods Fetotomy No of Complications animals 1 Uterine torsion -- -- 2 Uterine inertia 4 1 3 Insufficient -- -- cervical dilation 4 Narrowed pelvic 5 1 cavity 5 Hydropsy -- -- 6 Abdominal 2 -- inability to strain 7 Over fat 2 1 8 Fetal 2 1 maldisposition 9 Fetal emphysema 6 2 10 Fetal oversize -- -- 11 Congenital -- -- defects 12 Mummified/ -- -- macerated 13 Twins -- -- Total 21 6 Sl. Cause of Complications observed Grand No. dystokia in treatment methods total Cesarean section No of Complications animals 1 Uterine torsion 12 1 34 2 Uterine inertia -- 1 24 3 Insufficient 10 1 23 cervical dilation 4 Narrowed pelvic 7 -- 13 cavity 5 Hydropsy -- -- 6 6 Abdominal 3 1 9 inability to strain 7 Over fat 4 -- 6 8 Fetal -- 29 maldisposition 9 Fetal emphysema 14 2 36 10 Fetal oversize 11 -- 44 11 Congenital 4 -- 18 defects 12 Mummified/ -- -- 3 macerated 13 Twins 2 -- 8 Total 67 6 253
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|Title Annotation:||Clinical Article|
|Author:||Patil, A.S.; Rathod, Ramesh; Nagaraja, B.N.|
|Date:||Jul 1, 2014|
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