Urogenital Surgery Female

Question 1

what are the goals of a c section in a cow

Answer 1

preserve the cow, preserve the calf, preserve future reproduction

Question 2

what are some maternal reasons to do a c section

Answer 2

immaturity, lack of cervical dilation, uterine torsion, pelvic deformities, uterine hydrops, uterine tear

Question 3

list fetal reasons to do a c section

Answer 3

fetal oversize, pathology of the fetus, malposition, an elective (high value calf)

Question 4

true or false: when done as last resort, c sections have a good prognosis

Answer 4

false! they have a poor prognosis. you should decide in less than 20 mins if youre going to do one or not, and you should use your mentors to help you decide

Question 5

before doing a c section, what are some important things to examine?

Answer 5

the cow: is she exhausted? is she toxemic. hypovolemic, or hypocalcemic? should you pre treat her with calcium?

the fetus: is it dead or alive? if it’s dead, has it decomposed yet? do i need to do a fetotomy?

Question 6

what is one VERY important thing to remember about J lube?

Answer 6

it causes peritonitis in calves and kills them, DO NOT use it

Question 7

what are the two ways you can do a c section?

Answer 7

standing: L paralumbar fossa most commonly (can also do R side or oblique but these are much less common)

recumbent: ventral midline, right paramedian, right paramammary, left paralumbar.

recumbent is much harder and really gross

Question 8

with a L sided paralumbar fossa approach, what do you need to remember about the rumen?

Answer 8

ideally it prevents small intestines from coming out your incicison but not always. You can also get rumen prolapse with straining and you may want to use a lidocaine epidural to help with this. the uterus is going to be medial to the rumen when you go in.

Question 9

when would you use a paramammary approach in lateral recumbency for a c section?

Answer 9

if there’s emphysematous fetus–>can help you exteriorize the uterus and avoid abdominal contamination

Question 10

when would you do a ventral midline/paramedian approach for a C section?

Answer 10

if you have a down cow/reluctant to stand cow

Question 11

should you use antibiotics when a cow has a c section? why or why not? what other medications should you be giving?

Answer 11

YAS QUEEN because fibrinous peritonitis is super common 2/3 of cases get it, and there’s usually E coli and trueperella pyogenes up in there!

also give NSAIDs for analgesia

Question 12

how should you adequately restrain your cow before doing a c section?

Answer 12

physical: cute or head lock or maternity pen
chemical: can do a ketamine stun, do a caudal epidural and do it before your gear up for calving (still clean)

Question 13

describe how you should surgically prep your cow before a c section

Answer 13

slip 10/40 blade, scrub with idodine scrub then alcohol, put a drape on, gown up, put on plastic sleeves either inside out or sterile ones, and make sure you have an assistant to help you

Question 14

what are the tissue layers youre cutting through when doing a L flank approach?

Answer 14

skin, sub q, external abdominal oblique, internal abdominal oblique, transversus abdominus, peritoneum. MAKE SURE not to go thru the rumen by accident

Question 15

how do you exteriorize the uterus on a L flank approach?

Answer 15

reach behind the rumen and find the uterus and try to identify hind legs/foot/hock of the calf. Put one hand on the fetlock and the other under the hock and pull the leg up to and over the incision locking the leg in the incision via the fetlock and the hock

Question 16

if a calf is in posterior presentation when youre doing a c section, why is this a problem?

Answer 16

it’s hard to grab a front leg and requires extra help. it may even be impossible to exteriorize and you may have to open the uterus in the abdomen=BAD

Question 17

what can you do if a cow has a uterine torsion?

Answer 17

roll the cow to correct

you can correct it before you remove the calf: but this risks uterine rupture, but makes it easier to externalize the uterus and it makes it easier to suture too

can correct after you remove the calf: less risk for rupturing the uterus, but it’s harder to exteriorize the uterus and harder to suture

Question 18

what is the risk of rolling a cow with a plank to correct a torsion?

Answer 18

once shes down she might not get back up and that is bad news bears

Question 19

once you have exteriorized the calf, how do heck do ya get it out fren?

Answer 19

you have to make a full thickness incision in the uterus and avoid spillage into the abdomen! and the tissue can be quite delicate and will tear easily so you need to make sure your incision is long enough

Question 20

after you’ve cut into the uterus, how you get the calf out?

Answer 20

you can use sterile calving chains. if you have an assistant make sure they only touch the chains and/or the calf, nothing else!

grab the fetlock while your assistant puts on the chains and then do the other foot. then you can pull the calf up and out. be sure to hold the uterus dorsal so contents dont spill. check for a second calf!

Question 21

after the calf is out and youre getting ready for the placenta to come out, what do you need to do?

Answer 21

hold the uterus up and out of the incicison while the placenta comes out and you’re getting ready to close

Question 22

if the placenta isn’t coming out on its own what do you do

Answer 22

gently trim it out

Question 23

how should you close up the uterus?

Answer 23

2 layers of inverting is best: utrecht, cushing, lembert. use cat gut #2 or #3

dont go full thickness and dont sew the placenta into your incision

use serpentine suture, needle drivers take way too long

Question 24

after youve sewn up the uterus, what do you need to do before putting it back inside?

Answer 24

lavage it! if there are nay clots they will form adhesions. rinse the uterus off with sterile saline and you can just grab the clots with a gloved hand. dont use gauze to wipe them away. if the fetus was nasty and gross you could also lavage the abdomen

Question 25

so you’ve lavaged the uterus and now youre closing the body wall. briefly describe how youre gonna do that

Answer 25

close the peritoneum and transversus together with a simple continuous pattern with absorbable suture

close the internal abd oblqiue in the same way

close the external abdominal oblique in the same way

then close the skin with non absorbable suture with ford interlocking pattern and finish with a few simple interupted

Question 26

should you cut the umbillicus?

Answer 26

no! let the vessels stretch a bit. can clamp it but dont cut it

Question 27

list some common INTRA operative complications with a c section in cows

Answer 27

• difficulty exteriorizing the uterus
• cow can go down
• rumen or small intestine evisceration
• uterine tears

Question 28

list some common POST operative complications with a c section in cows

Answer 28

peritonitis (10%)
wound infection/dehiscence (10%)
sub Q emphysema (from too much dead space or you dind’t close the peritoneum well enough and air leaks from abdomen, 35-40%)
death (15-20%)

Question 29

why is there such a poor prognosis with a c section of am emphysematous fetus? What are some things you can do to support a cow with this?

Answer 29

toxemia, pyrexia, hypotension, shock!

could give hypertonic saline, NSAIDs, and antibiotic therapy during and/or after the procedure.

Question 30

_____ is the single most important factor for cow survival and future fertility

Answer 30

exteriorization of the uterus