Fetotomy (One of the most valuable obstetrical technique) Presented by Dr. Ala’a ELDin Zain Mahmoud Dept. of Theriogenology Fac. Vet. Medicine Assiut University Egypt EVET C-059-I0

Basic Obstetrical Techniques to correct an existing Dystocia 1) Traction (Fetus) 2) Correction (Fetus). 3) C. Section (Dam) 4) Fetotomy (Fetus). 5) Episiotomy (Dam) 6) Cervicotomy (Dam).

After trials of either manual correction of abnormal PPP or strong traction of the fetus and no progress is made. The Veterinary Surgeon must resort to: 1.C. Section if the fetus is live 2.Fetotomy if the fetus is dead

The choice of obstetrical technique after manual correction have failed is determine by: 1.Economic value of female. 2.Viability of fetus. 3.Expertise of veterinarian. 4.Equipment’s & facilities available for veterinarian. 5.Owner’s preference.

Fetotomy Definition : Is the reduction in the size of the fetus by the removal or destruction of its parts in order to permit safe delivery. The fetotomy technique is indicated to preserve the life of dam for: 1.Future breeding. 2.Fattening and slaughter.

Aims of Fetotomy 1.Rapidly decrease the size of fetus lead to safe extraction process. 2.Avoids the stress & injuries that follow prolonged manipulation. 3.Avoids the additional expenses & risks from performing C. section.

Indications: Fetotomy is performed for: 1.Feto-pelvic disproportion. (Oversize). 2.Irreducible/ or incorrect PPP. 3.Fetal malformation. 4.An emphysematous or edematous fetus.

Fetotomy can be performed by two ways : Sub-cutaneous or intr-afetal method. Per-cutaneous or extr-afetal method. * The method can be combined or modified according to needs.

Sub-cutaneous method Means: Sufficient skeletal, muscular structures and viscera were removed or destroyed (by using guarded knife or cutting hook) to reduce size of the fetus. Disadvantage of method: 1) Need a lot of physical strength. 2) Time consuming.

Per-cutaneous method Means: Sectioning of the fetus by cutting through skin, muscle and bone with a fetotome to remove the incorrect flexed parts or reduce the size of the fetus. Advantage of method: 1.Being faster and easy to perform. 2.More adaptable to various situations.

For Successful Fetotomy Certain considerations must be undertaken at: 1- Prior to initial examination. 2- At initial examination. 3- Epidural anaesthesia. 4- Preparation and sterilization of instruments.

Prior to initial examination, the operator must be: 1.Restrained the animal very well (mare). 2.Examined the animal clinically. 3.Warped and tied the tail to one side. 4.Thoroughly cleansed the perineal region. 5.Wears a sterile rubber sleeves.

At initial examination, the operator must be: 1.Determine the condition of genital tract. 1.Presence of any laceration 2.Presence of a pelvic mass (mare). 3.Degree of cervical relaxation. 4.Presence of uterine muscular spasms. 2.Suggest what the number and where the cuts should be made. 3.Application of copious volume of lubricant. 4.Kill of a weak alive fetus.

Epidural anaesthesia ** Is a single injection of 10 ml (2.0 – 2.5%) of local anaesthetic solution (xylazine) into the epidural sac. ** The site of injection is the middle of the first intra-coccegeal space. Purposes for epidural anaesthesia: 1.Eliminate abdominal contraction during fetotomy. 2.Provide analgesia to perineal region. 3.Reduce reflex straining initiated by manipulations.

Different Types of Fetotomy Cuts ** There are three types of cuts : Transverse cut ( The section is perpendicular to the long axis of fetotome) Oblique cut (The section is oblique to the long axis of fetotome) Longitudinal cut (The section is parallel to the long axis to the fetotome).

Preparation of Fetotome for Different Types of Cuts: ** The wire saw pass through both channels of fetotome and each end fix in metal handle. Perform a loop of saw wire at the head of fetotome (Transverse and Oblique cuts).

**The wire saw pass through one channel of fetotome and the end is fix in handle. The other end of wire is tied in wire director, which pass around the part of fetus to be cut, then remove the director. The wire passes by threader through the other channel and fixes the end in other handle. (Longitudinal cut).

Application of different types of cuts : Transverse cut applied to remove forelimb, hind limb, sectioning the trunk or cutting the base of neck (extended head and neck). Oblique cut applied to remove forelimb at point of axilla or hind limb at point of hip joint. Longitudinal cut applied to remove the base of neck (laterally deviated head and neck) and bisection of the pelvis.

General considerations at fetotomy procedure: 1.Careful thought should be given prior to all manipulations. 2.Ensure that head of fetotome is in correct position on fetus body. 3.Hold the fetotome securely during cutting procedure. 4.Repeated in and out arm movements are contraindicated. 5.Minimize the number of cuts that need, can short the intervention time and permit a traumatic delivery of dead fetus.

A. Sub-cutaneous fetotomy method (Using scalpel or guarded knife) I. Removal of fore limb: **The limb is snared and sustained traction. ** Small incision with scalpel into skin in front of fetlock joint. ** Long incision is made from pastern to scapular cartilage. ** Finger dissection of skin around limb to scapular region. ** Broken down attachment of pectoral muscles in the axilla area. **Des-articulate the fetlock joint. ** Traction is applied to the denuded limb. (Photo).

II. Removal of hind limb: **The limb is snared and sustained traction. ** Small incision with scalpel into skin in front of hook joint. ** Long incision is made up to the hip joint of limb. ** Finger dissection of skin around limb to gluteal region. ** Broken down attachment of muscles and ligaments. **Vigorous traction the articulate head of femur freed from acetabulum and removed. (Photo).

B. Per-cutaneous fetotomy method (Using fetotome) I. Anterior presentation: ** Amputation of fore limb (in correct malpostures). ** Amputation of the head &neck (lateral deviation). ** Amputation of the head &neck (extended) &fore limb. ** Amputation of trunk (include other fore limb). ** Bisection of hind limbs. (Photo)

II. Posterior presentation: ** Amputation of hind limb (in correct malpostures). ** Amputation of one hind limb at hip joint. ** Amputation of both hind limbs (one operation). ** Section of lumber and thoracic areas. ** Bisection of anterior part of fetus. (Photo)

III. Fetal abnormality: ** Hydrocephalus case (Single fetotomy cut from behind the ear across the eyes will permit removal half of fetal head, thereby permitting assisted vaginal delivery of fetus). (Photo)

Care of the dam after fetotomy 1.Try to remove the remnants of placenta. 2.Wash the uterus with mild antiseptic solution. 3.Inject oxytocin (20-30 IU) to enhance the uterine involution. 4.A local antibiotic doses (2-4 gm). 5.Systemic antibiotics (infected cases).

Conclusions 1.The veterinarian & owner consider a dead fetus to be an indication of fetotomy. 2.Results from fetotomy can vary, depending on a level of expertise offered by the veterinarian &facilities available. 3.A common fault to chose fetotomy only after the birth canal have already been traumatized by unproductive attempts at manual correction. 4.The good veterinarian should be skilled in the former, but have recourse to the latter and should use both techniquesat appropriate time.

Never go to a crazy vet. Do not ask me about what had happened