Dystocia: All in a Day’s Work Shelby Hayden Jen Sullivan Meredyth Jones Sarah Burkindine

Stage 1: initiation of myometrial contractions

Stage 1: Visible signs Seeks out isolation Thick clear mucoid vaginal discharge Signs of abdominal colic Restlessness Can last 2-6 hours You will NOT know clinically when this starts If a cow is restless >6hrs, check her. Start worrying about reasons why she’s not going into 2nd stage: breech, uterine torsion, hypocalcemia, uterine rupture-twins.

Stage 2: expulsion of the fetus Entrance of the fetus into the birth canal Stimulation of oxytocin release Rupture of amniotic and allantoic sacs PGF2-alpha stimulates Relaxin (prepares the birth canal/loosens connective tissue) E2 stimulates mucous secretion-lubrication of the canal Fetal feet/head –pressure on fetal membranes causing rupture of water sacs Calf becomes hypoxic after rupture which increases calf movement and contractions

Stage 2: expulsion of the fetus Increasing uterine and abdominal contractions Stage 2 should last no longer than 1 hour

Stage 2: Visible signs Rupture of the “water sacs” Amniotic sac and feet are visible at the vulva Increasing frequency of abdominal contractions Expulsion of the fetus 1st: contractions every 3-5min. Then every 1 ½ minutes

Stage 3: expulsion of the placenta Detachment of chorionic villi from the crypts on the maternal side of the placenta Due to vasoconstriction Usually occurs within 3-8 hours of parturition Although broken into stages this is a continous process

Fetal positioning Presentation Position Posture

Fetal Presentation Anterior, longitudinal Posterior, longitudinal Transverse ventral Transverse dorsal

Fetal Position Dorso-sacral Dorso-pubic Right and left dorso-ilial

Fetal Posture Relation of the calf’s head, neck and limbs to the body of the cow Legs and neck extended; head over front limbs Head back; legs flexed

Normal fetal positioning

Transverse Position

Causes of dystocia Basic Immediate

Causes of Dystocia Hereditary Nutritional (fat heifers, excessive fat in pelvis) Management (breeding large bulls to small cows, breeding too soon after partrition) Hereditary anatomical defects of the repro tract: vulvular hypoplasia, 2 uteruses

Causes of Dystocia Infectious (Brucella, Campylobacter, BVD, Bluetongue, leptospirosis, corynebacterium, Trichomonas, Listeria, IBR) Traumatic (rupture of prepubic tendon, uterine torsion) Miscellaneous (hydrops, uterine inertia)

Immediate causes of dystocia Fetal causes Maternal causes

Fetal Causes Size: breed, age of the dam, sire, sex Abnormal: presentation, position, posture Fetal Monsters: schistosomas reflexus, perosomus elumbis

Schistosomus reflexus

Maternal Causes Pelvic fractures Breeding heifers too young Hereditary or congenital hypoplasia of the birth canal examples

Parturition Intervention Guidelines Stage I of labor > 6 hours and cow/heifer has not begun to abdominally press. Stage 2 of labor > 2-3 hours and progress is very slow or absent Amniotic sac has been visible for 2 hours and the calf has not hit the ground

Dystocia Watch Intervals < 3 hours intervals is required to determine length of duration of the stages of parturition.

Equipment required for obstetrical exam Twine or robe Novasan or betadine scrub Bucket or bottle of warm water Sterile lube Palpation sleeves

Obstetrical Equipment for Pulling a Calf Same equipment required for obstetrical exam plus:

Calf Jack (Puller)

Cont. of obstetrical equipment for calf pulling Head snare Epidural Equipment 2 % lidocaine 6 cc syringe 18 gauge 1.5 inch needle

Obstetrical Exam Fill clean bucket with betadine or novasan solution diluted with warm water to either a “weak tea” solution or a light blue solution respectively.

2. Place obstetrical chains and handles, tube of sterile lube and head snare into the bucket.

Clean the perineal region with a betadine or novasan scrub followed by a clean warm water rinse. Minimum of 2- 3 separate scrub/rinse cycles

Put on 2 clean plastic OB sleeves. Lubricate both arms with sterile OB lube

Examine the birth canal for dilation and size of the pelvic opening. Manually dilate the birth canal if needed

Examine cervical dilation and structures in the birth canal

8. Examine uterus and birth canal for prior damage.

9. Evaluate position, presentation and posture of the calf and/or calves.

Evaluate calf or calves viability Withdrawal reflex Corneal/palpebral reflex Suckle and tongue withdrawal reflexes Anal sphincter reflex Heartbeat felt through chest wall or umbilical artery pulse

Methods of Correcting Dystocia Live Fetus Options: Mutation Forced Extraction Cesarean Section Dead Fetus Options: Mutation Forced Extraction Fetotomy Cesarean Section

Mutation Repulsion: Rotation: Version: Reposition of Extremities Moving from dorso-pubic or dorso-ilial to dorso-sacral position Version: Turning the fetus end-for end (i.e. on a transverse axis) Reposition of Extremities

Minimum Goal of Mutation Reposition the calf into a dorso-sacral position Calf’s front legs extended cranially and hind legs extended caudally in perspective to the calf’s body.

Guidelines for Mutation Abnormalities in presentation, position, posture should be diagnosed and corrected prior to attempting traction.

When the fetus is dead and repositioning is difficult or dangerous, other options should be considered Partial or complete fetotomy Cesarean Section

Maximum of 30 minutes of mutation without progress warrants c-section or fetotomy.

Types of Mutation Dystocias Retention of Front Limb Retention of Rear Limb Retention of the Head Irregular Presentation or Position “Dog-sitter” Uterine Torsion Transverse Presentations

Types of Limb Mutation Dystocias Front limb Flexed shoulder posture Flexed carpal posture Elbow lock posture Foot-nape posture Hind Limb Hock flexion posture Hip flexion posture

Flexed Carpus manipulation Convert flexed leg to flexed carpus posture by traction on the upper foreleg if the shoulder is flexed. Apply simultaneous repulsion to the carpus in an anterior-dorsolateral direction and traction on the hoof in a medial and posterior direction

Elbow Lock Posture Occur when forelimbs are not fully extended as they come into the pelvic inlet Presentation: Tips of toes are even with the end of the calf’s nose Correction: Repulsion on the fetal trunk and simultaneous alternating traction on the limbs

Flexed Hock Manipulation Convert the flexed hip to a flexed hock posture Apply hand traction high on the leg working your way distally until the hock is reached

Place 1 hand on the hock while simultaneously placing a second hand over the hoof. Move the hoof posteriorly and medially into the birth canal as repulsion is applied in an anterior-lateral direction on the hock.

Lateral view Caudal view

Dystocia due to Retention of the Head Lateral deviation Most common Ventral deviation Dorsal deviation Vertex posture bride of nose is impacted against the brim of the pelvis causing the poll to be presented Fetus is often dead

Head-Breast Posture Correction of ventral deviation of the head Procedure Repel 1 forelimb to the flexed shoulder posture Bring the head up from beneath the body of the fetus Flexed shoulder is converted to normal posture using the flexed carpal manipulation

Lateral Deviation of the Head

Correction of Lateral Deviation of the Head Repulsion of the shoulder, thorax, or brisket with concurrent traction on the head Sources for Traction on the Head: 2nd hand Jaw snare: beware of jaw fractures -head, jaw or orbital hooks

Irregular Presentation or Position “Dog-Sitter” Uterine Torsion Transverse Presentations

“Dog-Sitter” Rear legs are extended along the abdomen of the otherwise normally presented fetus

Correction of the “Dog-Sitter” Only attempt mutation if the fetus is small enough to allow palpation both hind limbs during extraction. Allows for the hind legs to be repelled and allows the uterus to be protected from the hooves as the rear legs straighten out during delivery. Otherwise, rear hooves may tear the uterus as they extend behind the fetus.

Cont. Correction of “Dog-Sitter” 180 degree version to posterior presentation and rotation to dorso-sacral position Cesarean section Especially with oversized fetus Fetotomy Impacted fetus in the birth canal

Uterine Torsion Always examine uterus for torsion if fetus appears to be presented in a dorso-ilial OR dorso-pubic position.

Uterine Torsion Findings Spiral folding of the birth canal Simulates incomplete dilatation of the cervix Broad ligaments of the uterus are rotated and stretches across the birth canal 1 on the upper and 1 on the lower surface Felt via Rectal Palpation.

Methods to Correct Uterine Torsion Shaffer method (plank in the flank) Rotate fetus in utero Cesarean Section

Transverse Presentations

Correction of Transverse Presentations Mutation is usually not attempted especially if presenting transverse dorsal. Rear legs sometimes perforate the uterus as they straighten if delivery is attempted by anterior presentation Convert to posterior presentation, dorso-sacral position Cesarean Section

Monster Fetus DO NOT ATTEMPT TO MUTATE OR PULL CESAREAN SECTION IS REQUIRED

Forced Extraction of a Fetus Which one has already prepared for prior to the initial obstetrical examination i.e. obstetrical chains and hooks should already be in the bucket of dilute betadine or novasan solution.

Do not give an epidural anesthetic unless it is absolutely necessary. Prevents dam from assisting delivery of the calf

Forced Extraction in Anterior Presentation Placement of obstetrical chains Eyelets on the dorsal surface of the forefeet

Traction on Fetus

Traction Procedure especially if fetus is oversized Unilateral traction is applied to the bottom (most anteriorly located) forelimb until its shoulder and elbow are past the pelvic inlet It can usually be felt when the shoulder passes the ilium. Otherwise, assume that when the fetlock is ~10 cm (15 cm in larger breeds) outside of the vulva, the shoulder has passed through the pelvic inlet.

Cont. Traction of oversized fetus (anterior presentation) Full-force unilateral traction is than applied to the top forelimb (hopefully by a 2nd person) Extraction is usually is possible if the 2nd shoulder also passes the ilium into the birth canal If not, C-SECTION IS PROBABLY REQUIRED. Traction can be attempted with a calf jack but do not exceed force of 2-3 strong men.

3) Rotation of the Fetus

How to rotate the calf to avoid hiplock

Completion of Rotation

Rotation of the fetus takes advantage of the widest diameter of the pelvic inlet

If Hiplock occurs . . . Discontinue traction Clean the mucus and membranes from the calf’s nostrils Stimulate breathing Tickle the nostrils Pour cold water over the head of the calf

4. With hiplock apply traction only when the cow presses Continuous traction is generally unproductive Pelvic inlet becomes functionally larger

5. Apply traction caudally and somewhat dorsally This direction of pull is more perpendicular to the pelvic inlet

6. Maintain rotation of the calf’s pelvis in a dorso-ilial position. Palpation along the back of the calf is required to ensure that the calf’s pelvis is rotated 60 to 90 degrees.

Forced Extraction in Posterior Presentation Rotate the calf into the dorso-ilial position Apply OB chains to the hind legs in a similar manner as the front legs Apply traction in a caudal, slightly dorsal direction to bring the calf’s hips through the pelvic inlet.

Cont. Forced Extraction in Posterior Presentation Rotate the calf back into a dorso-sacral position once the rear quarters have passed the pelvic inlet Apply slightly caudal, ventral traction

Calf Jack Can be used with either posterior or anterior presentation NEVER APPLY MORE FORCE THAN WHAT 2-3 STRONG MEN CAN APPLY

Cesarean Section Approaches: High left flank Low left flank Left paramedian High right flank Low right flank Right paramedian Ventral Midline

Fetotomy Should only be performed in the dead fetus

Fetotomy Equipment Fetotome Wire Threader Wire saw handles Wire introducer Krey Hook OB chain Lubicant Epidural equipment

Injury to calf, injury to dam

Injury to the Calf Dystocia and excessive force used in extraction are associated with damage to neural, skeletal, and visceral structures.

Asphyxiation and Anoxia Rupture or impaction of the umbilicus during manipulation necessitates rapid extraction to prevent anoxia and potential brain damage Complications more frequently associated with posterior presentation Posterior presentation: improper dilation of the birth canal and inhibition of complete delivery

Femoral Nerve Paralysis Often associated with prolonged hiplock during extraction Hyperextension of the femur, severe stretching and compression of the mm and nn of the upper HL; neurogenic m atrophy

Nerve Damage Injury to the femoral n most commonly assoc w/ severe stretching of the n and assoc mm Will discuss later injury to the L6 spinal n rootcalving paralysis

Fractures Fracture of the mandible due to inappropriate use of obstetrical chains

Fractures Placement of obstetrical chains with one loop over the fetlock and a half-hitch around the pastern will better distribute traction and prevent injury to fetal limbs

Fractures Excessive traction may also result in fractures of the pelvis or ribs, as well as injury to the joints and spine

Complications Associated with Posterior Presentation Pulmonary hemorrhage, diaphragmatic hernia, and liver rupture may be caused by excessive traction on the fetus in posterior presentation

Injury to the Dam Dystocia and excessive force used in extraction associated with calving paralysis, retained placenta and uterine prolapse, trauma to the birth canal or uterus

Calving Paralysis Paresis or paralysis of the cow Damage to peroneal and obturator nerves May be caused by prolonged hiplock or excessive force used in its resolve L6 spinal rootsciaticperoneal

Retained Placenta Direct association with abortion, twinning, dystocia, cesarean-section, and fetotomy.

Uterine Prolapse Associated with dystocia and irritation of the external birth canal Complicated by environmental insult—freezing, drying, severe laceration

Trauma to the Birth Canal Tears and lacerations: Vulvar, vaginal and cervical tears, recto-vaginal fistula or perineal laceration Forelimbs may be forced through the dorsum of the birth canal Hematoma Vaginal necrosis

Uterine Ruptures or Tears Associated with prolonged dystocia, uterine torsion, and excessive repulsion or rough manipulation Tears most commonly occur in the ventral uterine wall

@#$*%&!!

Dam number 1025 Saturday, April 6: calf presents breech, calving difficulty 5 and 8, calf does not survive extraction Monday, April 8: dam found dead, presented for necropsy At least 3 other dystocia/pulls that day (score 8); good temperament of dam; first calf Cowboys believed that the inner os was not fully dilated

Peritonitis Examination of the abdominal cavity reveals a considerable volume of bloody fluid and fibrin No evidence of frank clotting to indicate involvement of a major vessel

Petechiation of the Heart Indicative of an acute/agonal incident or a septic insult

Dorsal Uterine Tear Full thickness, approximately six inches long Suspicion of uterine torsion due to dorsal orientation of the tear—could “inner os” have been uterine tissue?

Ventral Uterine Tear Partial thickness, approximately three inches long with associate mucosal/ sub-mucosal hemorrhage

Fetal Lungs Appearance of the lungs indicated the calf had taken a breath Some evidence of limb contracture + breech presentation Rotation of fetus w/i the uterus during mutation

@#$*%&!!

Economic Implications of Dystocia Things to consider: -Dam Value -Live Calf Value -Cost of Veterinary Intervention Now we will discuss the economic implications of dystocia management decisions. We must consider the present and future value of the dam and calf against the cost of veterinary intervention or any other calving management decision, such as using EPD sires, vaccinations, heifer selection and purchase, and pelvic measurements. In this section, we will consider both beef and dairy production.

Dam Value Dairy cows (Holstein) - Replacement of Mature Milking Cow: $1200-1500 - Replacement of Springing Heifer: $1800-2500 - Lactation and Genetic Potential First, we will look at the value of the dam on a dairy. These figures indicate the cost of replacing a mature milking cow and replacing a springer heifer. Obviously, there will be a higher incidence of dystocia in the heifer group, so this value is more relevant here. Also to be considered are the future values of these females, such as lactation income and their genetic potential, which would be estimated by some as priceless.

Dam Value Beef Cows Purchase of Replacement Heifer: $850-900 Rearing of Replacement Heifer: $750-800 Seedstock Genetics Next, we will consider the value of the beef heifer. Listed here are the estimated costs of purchasing or raising a replacement heifer. In the beef situation, you do not have the lactation income potential, but in a purebred seedstock operation, you again have the potentially unmeasurable value of the genetics in that animal.

Live Calf Value Dairy Calves - 1 day old heifer calf: $500-700 - 1 day old bull calf: $100-150 Now we will begin to look at the value of the offspring on dairy and beef operations. There will be some differences in the way the values of these animals are stated due to the differences in the way beef and dairy animals are marketed. For the dairy heifers, they may be taken to the salebarn at one day of age and sold for 5-700 dollars, while the bulls bring considerably less. You may also take into consideration the rearing of those heifers and sale of them for 850-900 dollars or the use of them as replacement heifers in the parent herd with potentially positive genetic and lactational implications.

Live Calf Value Beef Calves - Feeder Futures for January, 2003 - $79/cwt x 700# = $553 In valuing beef claves, I looked at the futures market to market calves born now as feeder calves in January of next year. Of course, this will not be pure profit in the rearing of this calf, with costs incurred including an average of $150 to get him from weaning to feeder size. There is also the consideration of the rearing of replacement heifers and their genetic potential.

Even if you can’t save baby… Dairy Cow value post-calving - Lactation: 18,000# x $0.87/# = $15,666 - This does not include cost of lactation - Salvage: $54.00/cwt x 1000# = $540 - Rebreed Obviously these animals are valuable when everyone comes out of a dystocia alive. The important think to keep in mind is to save the lives of as many of the players as possible. Many times, the baby may be dead through no one’s fault. If this is the case, all efforts should go into saving the dam. She is the one who can now produce lactational income, raise another calf, be salvaged at the salebarn, or, if the dystocia gods are smiling, breed back next year. If she can come back next year, we have restarted her value and income potential cycle all over again.

Even if you can’t save baby… Beef cow value post-calving: Raise orphaned or twin calf; Rebreed Salvage: $60/cwt x 900# = $540 Even if you can’t save baby…

Producer Cost for Caesarean Section Survey of veterinarians - Average charge for on-farm dystocia ending in Caesarean section - $258.92 For this section, I surveyed a group of cattle veterinarians and requested disclosure of caesarean section fees in private practice. The values I received and analyzed represented nearly every region of the United States and included trip fees, emergency fees, and supportive care. Most prices I received were within $50 of each other with only a few outlyers. The average caesarean section from the practices who were involved was around $260. While this seems like a large sum of money, we will see in a minute where it may be a valuable option.

What is the bottom line? Dairy Producer: Heifer + Calf Alive = $2300 Plus Lactation ($15,000) and Genetics -Heifer Alive = $1800 -Cost of Caesarean: $260 11% of value of both at that time Here, we review the animal values that I outlined in previous slides, compared against the cost of c-section to the producer. In a dairy, the average C-section is about 11% of the value of a live pair at the time of the delivery. The lactation and genetics are future values and are gross values. Also to be considered is that even if these females won’t breed back due to adhesions or other reproductive complications, and are culled at palpation time, they will continue to milk and produce income until the end of their lactation cycle. Also, cows frequently recover better from surgery than from a difficult pull. A recovered cesarean cow will generally have a better lactation cycle than even a partially paralyzed or torn heifer.

What is the bottom line? Commercial Beef Producer: - Heifer and Calf Alive: $1403 Heifer Alive: $850 Cost of Caesarean: $260 -18% value of both This is the same analysis of the value of the pair or live dam versus the cost of c-section. For beef animals, the cost of c-section is about 18% of the pair’s value. Now obviously, you can’t go to this expense for every pair. It would never be a good idea to purposely spend 10-20% of a pair’s value at Time 0 of their life together. Therefore, cesarean section is not a replacement for other dystocia management decisions, such as breeding to sires with calving ease EPDs, choosing replacement heifers wisely, etc. We cannot say that if you save the pair at parturition, you are guaranteed an income. Even if you save the pair, they may lost production value from other causes later on. What I can guarantee you is that if you lost them at calving, you are not going to make any money on them. So, what these numbers demonstrate is what you stand to lose if you allow a pair to die during a dystocia.

Conclusion Producers should make dystocia management decisions before breeding occurs When a dystocia presents itself , make your decisions based on what is best for the herd’s production goals If you need to intervene, do so with caution and think ahead about the effects of your actions on the pair’s future production

Thank you to all the faculty and staff of GPVEC for contributing to our education.

The End Any questions?