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

2. Stage 1: initiation of myometrial contractions

3. 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.

4. 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

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

6. 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

7. 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

8. Fetal positioning
Presentation
Position
Posture

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

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

11. 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

12. Normal fetal positioning

13. Transverse Position

14. Causes of dystocia
Basic
Immediate

15. 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

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

17. Immediate causes of dystocia
Fetal causes
Maternal causes

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

19. Schistosomus reflexus

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

22. 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

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

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

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

27. Calf Jack (Puller)

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

29. 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.

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

31. 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

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

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

34. Examine cervical dilation and structures in the birth canal

35. 8. Examine uterus and birth canal for prior damage.

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

37. 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

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

39. 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

40. 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.

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

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

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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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.

50. Lateral view
Caudal view

51. 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

52. 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

53. Lateral Deviation of the Head

54. 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

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

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

57. 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.

58. 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

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

60. 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.

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

62. Transverse Presentations

63. 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

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

65. 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.

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

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

68. Traction on Fetus

69. 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.

70. 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.

71. 3) Rotation of the Fetus

72. How to rotate the calf to avoid hiplock

73. Completion of Rotation

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

75. 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

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

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

78. 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.

79. 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.

80. 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

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

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

83. Fetotomy
Should only be performed in the dead fetus

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

88. Injury to calf, injury to dam

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

90. 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

91. 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

92. 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

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

94. 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

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

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

97. 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

98. 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

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

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

101. 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

102. 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

103. @#$*%&!!

104. 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

105. 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

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

107. 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?

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

109. 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

110. @#$*%&!!

111. 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.

112. Dam Value Dairy cows (Holstein)
- Replacement of Mature Milking Cow: $
- Replacement of Springing Heifer: $
- 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.

113. Dam Value Beef Cows Purchase of Replacement Heifer: $850-900
Rearing of Replacement Heifer: $
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.

114. Live Calf Value Dairy Calves - 1 day old heifer calf: $500-700
- 1 day old bull calf: $
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 dollars, while the bulls bring considerably less.
You may also take into consideration the rearing of those heifers and sale of them for dollars or the use of them as replacement heifers in the parent herd with potentially positive genetic and lactational implications.

115. 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.

116. 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.

117. 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…

118. 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.

119. 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.

120. 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.

121. 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

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

123. The End
Any questions?