Calving and dystocia in cattle

Question 1

What is the first stage of labour, how does this work?
What will you see the cow do?

Answer 1

• Dilation of the cervix + initiation of contractions
• may take 3-6 hours
• The cow separate herself from herd-mates
• Her appetite will decrease
• She may frequently alternate between lying and standing
• A thick string of mucus is often seen hanging from the vulva
• Towards the end bouts of abdominal straining occur more frequently, usually every 2-3 minutes
• The abdominal straining pushes uterine contents against the cervix giving it further stimulation to dilate

Question 2

What is the second stage of labour?

Answer 2

• Expulsion of the foetus
• may last a few hours

Question 3

What is the 3rd stage of labour?

Answer 3

• Expulsion of the placenta
• RFM if not expelled within 12hours

Question 4

What is needed for ideal calving facilities?

Answer 4

• Gate + quick release head lock
• Mobile milking line
• Well bedded + dry
• Good access to food + water
• Good lighting
• Well ventilated in quiet part of farm

Question 5

When would you intervene in a calving?

Answer 5

• No progress has been made by the cow after 1 hour of the water bag starts showing
• If you thought she was showing signs of 1st stage labour but has not progressed to 2nd stage after 6 hours – possible twisted uterus
• She appears in extreme discomfort
• There is significant bleeding from the vulva

Question 6

If a cow starts calving and then totally stops what may have occurred?

Answer 6

• Calf twisted = uterine torsion

Question 7

What are the biggest causes of dystocia in cows?

Answer 7

• Malpresentation
• Foeto-maternal oversize (large calf, fat dam, young dam, dead calf)
• Congenital abnormality (schistosoma, spina bifida, hydrocephalus)
• Hydrops allantois
• Schmallenberg virus
• Primary inertia (hypocalcaemia)

Question 8

How would you diagnose a dystocia?

Answer 8

• History - age, how long straining? Water broken? when?
• General impression - cows attitude, BCS, behaviour
• General exam - hypocalcaemia
• Obstetrical examination - Vulva slackened, vaginal exam, rectal exam (if indicated)

Question 9

What should be looked for on vaginal exam?

Answer 9

1. Lesions (tears) or haemorrhage
2. Position of uterus and calf
3. Relaxation and dilatation of vulva, vagina, cervix
4. Signs of life from calf
5. Possibility of extraction
6. Position of umbilical cord (particularly with breech presentations)

Question 10

What is correct approach to dystocia?

Answer 10

• Restrain
• Clean
• Lubricate
• Identify
• 3 R
  – Reposition (calf or uterus)
  – Repulsion
  – Rotation
• Extract

Question 11

What are tricks than can be used for calving?

Answer 11

• Position cow “downhill” (or uphill)’ - get more space
• Best lubricant = J-lube
• Pump warm water & lube into uterus
  – Fill her up !
  – makes space
• Sink plunger for repulsion
• Epidural anaesthesia
• Clenbuterol – relaxes uterus
  – but she won’t help in delivery
  – increases uterine blood perfusion – calf survival

Question 12

What happens if you put rope on above the fetlock?

Answer 12

• Higher chance of leg fracture

Question 13

What happens if you put rope on below the fetlock?

Answer 13

• Higher risk of rope slipping off

Question 14

How would you decide what to do with anterior presentation?

Answer 14

• The head should be easily lifted into the pelvis, and remain there and not flop back into the uterus
• If the forelimbs are crossing over there is insufficient room for calving per vaginum, as the cows pelvis is putting pressure on the humeri and the width of the shoulder is too large
• Should be able to easily (traction by one person) bring the calf up so the fetlocks are a hands breadth out of the vulva. This means the shoulder is within the pelvic canal. Failure to achieve this means the calf is too big to be extracted per vaginum

Question 15

How would you decide what to do with posterior presentation?

Answer 15

• Assess space by sliding hand over tail head
• Two people should be able to exteriorise the limbs to the point at which the hocks are past the vulva. Failure to do so rules out calving per vaginum
• Check position of umbilical cord. Could be round hock. If so then as you pull calf break cord and calf may die/drown before you get it out. Advice farm of risk. Could do caesarian section or calve and take the risk

Question 16

If in posterior presentation or breech what should be checked regarding umbilicus?

Answer 16

• Make sure not round the leg as when you pull, it will break the umbilical cord straight away

Question 17

If correcting leg placement what should always be done?

Answer 17

• Cup the legs to prevent tearing the uterus

Question 18

What should be done after calving?

Answer 18

• Check that the last stage of labour – expulsion of membranes occurs.
• Check / encourage her to eat and drink
• If she is bruised or torn consider if need antibiotic
• Consider giving pain relief – NSAID
• Cold hose back end to reduce swelling?
• She is at risk or endometritis so keep an eye on any discharges and get her checked out

Question 19

How do you say the difference between front legs or back legs?

Answer 19

• All joints will bend same way in front legs
• First 2 joints bend same way and third joint bends opposite way in hind legs

Question 20

What is episiotomy? When is it performed?

Answer 20

• Cutting of vagina to aid delivery
• Only really used in holstein friesian heifers
• Try manually stretching vulval lips for 20mins before cutting
• Cut at 10-11 o’clock or 1-2o’clock
• Cut when calf’s head in passing through vulva
• Interrupted deep dissolvable sutures + Continuous skin suture

Question 21

What are complications of episiotomy?

Answer 21

• Wound infection + breakdown
• Distorted vulva conformation
• pneumo-vaginum
• uro-vaginum
• Weak point to muscles = may affect ability to calve naturally again
• If cut at 12 noon = rectovaginal fistula

Question 22

What is the method for embryotomy / foetotomy?

Answer 22

• Must have enough space
• Caudal epidural anaesthesia
• Clenbuterol
• Sufficient lubrication to facilitate movements required
• Good equipment, well maintained

Question 23

When would you perform a full embryotomy?

Answer 23

• Large dead calf
• Abnormal calf - foetal monster

Question 24

When would you perform a partial embryotomy?

Answer 24

• Hip locked
  -euthanise if still alive
  -cut off trunk as close to vulva as possible
  -pass wires to split pelvis + remove
• Head back - unable to correct and dead calf
  -remove head
• Leg back - unable to correct and dead calf
  -remove leg
  -must ensure elbow, shoulder + scapula are removed or no narrowing achieved

Question 25

What should be done post embryotomy?

Answer 25

• Check for a twin
• Check for damage to the uterus, cervix + vagina + treat accordingly
• Remove foetal membranes (if possible)
• Anti-inflammatories + antibiotic therapy advised

Question 26

What are complications of fetotomy?

Answer 26

• Uterine tears
• Cervical tears
• Vaginal tears
  -from sharp bone edges
• from incorrect, rough handling of embryotome
• RFM
• Metritis
• Adhesions

Question 27

What are risk factors for uterine torsion?

Answer 27

• Poor rumen fill
• Space in the abdomen
• Hilly land
• Process of standing up / lying down

Question 28

What way are majority of torsions?

Answer 28

• Anti-clockwise (when stood behind cow)

Question 29

What are presentations of uterine torsions?

Answer 29

• Appear to start calving but do not progress
• No straining as Ferguson’s reflex not stimulated
• May just see slightly raised tail
• Dry cow off colour/down/toxic

Question 30

What would you see on exam finding of an uterine torsion?

Answer 30

• Vaginal exam causes arm to ‘corkscrew’ (normally anticlockwise)
• May just feel a ‘lip’ in front of cervix
• May not be able to feel cervix or calf (depending on degree of torsion)
• Exam per rectum - palpation of the torsion

Question 31

How would you correct an uterine torsion?

Answer 31

• ‘Swing’ calf with coordinated ballottment of abdomen to flip the calf and uterine horn back into the correct position
  -MUST be able to reach and firmly grasp calf by hand or with a rope
• Twist legs of calf and uterus may twist too – esp. if calf upside down
  -Use arm, broom stick,
  -‘gyn-stick’
• Roll the cow
  -Majority of cases require cow to be rolled from left lateral recumbency, onto her back, and into right lateral recumbency
  -If calf can be reached, grasp a leg firmly or place a calving rope and be held firmly whilst the cow is rolled over
  -If the calf cannot be reached, a plank can be placed across the abdomen and weighed down to apply pressure to the abdomen whilst the cow is rolled
• Caesarian section
  -Unable to untwist uterus

Question 32

What are complications of uterine torsion?

Answer 32

• If high degree torsion, the blood supply can be occluded leading to very friable tissue at the site of the torsion
• If not noticed early can lead to a dead emphysematous calf and a toxic cow
• During Caesarian uterus can be difficult as untwists away from you when suturing

Question 33

What are major indications for caesarean section?

Answer 33

1. Foetal oversize/foeto-maternal disproportion
2. Irreducible uterine torsion
3. Insufficient cervical dilatation

Question 34

What are minor indications for caesarean section?

Answer 34

4. Foetal malpresentaion
   * ONLY as a last resort if unable to reposition
5. Abnormal calf
   * Where embryotomy/foetotomy not feasible
6. Dead/empyhsematous calf
   * Where embryotomy/foetotomy not feasible
7. Constricted vagina and vestibulum
   * Where massage has not relieved the constriction

Question 35

Why would you elect for a caesarean section?

Answer 35

• Double muscled breeds
• Embryo transfer calves

Question 36

What would your approach to caesarean be?

Answer 36

• Halter to gate / stocks
• Full access crush
• Sedation - ONLY if unsafe to perform
• Anaesthesia - caudal epidural, paravertebral nerve block, (inverted L / Line block)

Question 37

What can be used for pre-op medication of caesarean?
+ What preperations would you want?

Answer 37

• Tocolytic (clenbuterol)
• NSAIDs
• Calcium - if appropriate
• Adequate lighting
• Standing / right lateral recumbency
• Warm water to prep

Question 38

How would you do a c-section? (step-by-step)

Answer 38

1. Left flank approach - clip + sterile prep, vertical incision 1 hand below transverse processes and 1 hand behind last rib
2. Locate uterine horn containing calf + exteriorise
3. Incise uterus - hock to tip of toe
   - avoid bleeding caruncles (ligate)
   - guarded blade / scissors to avoid damage
4. Remove calf
5. Check for multiples
6. Removal foetal membranes
7. Close uterine incision - absorbable monofilament, round bodied needle + inverting pattern
   - 1 or 2 layers + bury knots - ensure no leakage
8. Clean off contamination from uterus, rumen + remove blood clots from abdomen
9. Routine closure of body wall + skin
10. Post-op meds - oxytocin, calcium
11. Check calf + ensure sufficient colostrum

Question 39

What are complications for c-sections?

Answer 39

• Haemorrhage
  -Post-op check next day may reveal off colour cow, tachycardia/murmur, pallor
  -Re-open, locate site of bleeding and ligate
• Peritonitis
  -Post-op check next day may reveal off colour cow, pyrexia
  -Re-open, identify any site of leakage, flush abdomen with sterile fluid
  -At 7 days post-op become palpable on rectal examination
  -Poor prognosis
• Localised adhesions – may detect at post natal check
  -Ovarian
  -Uterine
• Retained foetal membranes
• Metritis
• Wound infection/seroma/breakdown/emphysema

Question 40

Why would you have poor fertility following a c-section?

Answer 40

• Delayed uterine involution
• RFM
• Endometritis
• Salpingitis
• Adhesions
• Abortion

Question 41

What would you do with an uterine prolapse?

Answer 41

1. Caudal epidural anaesthesia +/- clenbuterol
2. Put protective cover under uterus
3. Remove foetal membranes and clean off contamination
4. Apply liquid lubricant and gradually feed uterus back in
   * AVOID using finger tips – may rupture uterus
   * EITHER feed in in section starting close to the vulva or evert from horn tips
5. Once replaced ensure horn tips fully everted by using a bottle to extend the reach of your arm, or fill the uterus with water
6. Give oxytocin, NSAIDs, antibiotics, calcium
7. If swollen sugar or salt have been used. Gentle pressure and support?
8. Place Buhner suture ?????? About 50:50 split between vets