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Retrospective studies on occurence of dystocia and it's management in domestic animals.

Introduction

"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.

References

Burton, J. L., Weber, P. S. D., Bush, A. A., Neuder, L., Raphael, W., Erskine, R. J., Carrier, J., and Godden, S. (2006). Parturient steroids and labor duration associate with dystocia and stillbirth. J. Dairy Science. 84: 8.

Dematawewa, C. M. B., and Berger, P. J. (1997). Effect of dystocia on yield, fertility, and cow losses and an economic evaluation of dystocia scores for Holsteins. J. Dairy Sci. 80: 754-61.

Dobson, H., Tebble, J. E., Smith, R. F. and Ward, W. R., (2001). Is stress really all that important. Theriogenology. 55: 65-73.

Frazer, G. S., Perkins, N. R. and Constable, P. D., (1996). Bovine uterine torsion: 164 hospital referral cases. Theriogenology 46: 739-58.

Hansen, M., Misztal, I., Lund, M. S., Pedersen, J. and Christensen, L.G. (2004). Undesired phenotypic and genetic trend for stillbirth in Danish Holsteins. J. Dairy Sci. 87: 1477-86.

Kertz, A. F., Reutzel, L. F., Barton, B. A. and Ely, R. L., (1997). Bodyweight, body condition score, and wither height of pre-partum Holstein cows and birthweight and sex of calves by parity: a database and summary. J. Dairy Sci. 80: 525-29.

Kolkman, I., De Vliegher, S., Hoflack, G. and Van Aert, M. (2007). Protocol of the Caesarean section as performed in daily bovine practice in Belgium. Reprod Domest Anim. 42: 583-89.

Laven, R. and Howe, M. (2005). Uterine torsion in cattle in the UK. Vet. Rec 157: 96.

Lombard, J.E., Garry, F.B., Tomlinson, S.M. and Garber, L.P. (2007). Impacts of dystocia on health and survival of dairy calves. J. Dairy Sci. 90: 1751-60.

McClintock, S.E. (2004). A genetic evaluation of dystocia in Australian Holstein--Friesian cattle. Ph.D. Thesis, University of Melbourne.

McGuirk, B.J., Going, I. and Gilmour, A.R. (1999). The genetic evaluation of UK Holstein Friesian sires for calving ease and related traits. Anim. Sci. 68: 413-22.

Mee, J.F. (2008). Prevalence and risk factors for dystocia in dairy cattle: A review. The Vet, J. 176: 93-101.

Meijering, A. (1984). Dystocia and stillbirth in cattle--a review of causes, relations and implications. Livestock Prod. Sci. 11: 143-77.

Newman, K.D. and Anderson, D.E. (2005). Cesarean section in cows. Vet Clin North Am Food Anim Pract. 21:73-100.

Noakes, D.E., Parkinson, T.J. and England, G.C.W., (2001). Dystocia and other disorders associated with parturition, 8th ed. Arthur's Veterinary Reproduction and Obstetrics, Saunders, pp. 179, 205-17.

Oltenacu, P.A., Frick, A. and Lindhe, B. (1988). Use of statistical modeling and decision analysis to estimate financial losses due to dystocia and other disease in Swedish cattle. In: Proceedings of the 5th International Symposium on Veterinary Epidemiology and Economics, Copenhagen, Denmark. pp. 353-55.

Sloss, V. and Dufty, J.H. (1980). Dystocia-Handbook of Bovine Obstetrics. Williams and Wilkins, Baltimore, London, pp. 98-127.

Steinbock, L. (2006). Comparative analysis on genetics of stillbirth and calving difficulty in Swedish dairy cattle breeds. Licentiate thesis. Swedish University of Agricultural Sciences, Uppsala. p. 22.

Youngquist, R.S. and Threlfall, W.R. (2007). Current Therapy in Large Animal Theriogenology. Saunders Elsevier. St. Louis, Mo., pp. 1061.

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: anilpatiluasd@yahoo.co.in

(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.
Publication:Intas Polivet
Article Type:Report
Geographic Code:9INDI
Date:Jul 1, 2014
Words:3277
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