1. #52’s Case of a Uterine Torsion A TWIST OF FATE By: Amy Sanders Advised by Dr. Jenna Bayne

2.  March 28 th, 2014  7 years old  Charolais  Approximately 1000 lbs  BCS 5/9  Full term  Owner rectally palpated:  Uterus felt twisted  Fetus still was presumptively alive CASE PRESENTATION OF #52

3.  Usually occurs at the termination of gestation (Gestation length 280 days)  Prolonged Stage I Parturition  No clear age or season predisposition  Multiparous > Primiparous  Commonly Reported Breeds: Brown Swiss, Holstein, and Charolais is a high-risk breed.  Can be twisted CLOCKWISE or COUNTERCLOCKWISE  Can range from 180  -720  WHAT IS A “TWISTED UTERUS”?

4.  Instability of the gravid uterus  Small non-gravid horn  Excessive fetal weight  Broad ligament: Body vs. Horns  When a cow lies down  gravid uterus is suspended in abdominal cavity.  a sudden slip or fall could cause the gravid uterus to twist  Increased fetal movements during 1 st -stage labor  Decreased amounts of uterine fluid  Flaccid uterine wall  Confinement in stables for long periods can contribute  FUN FACT: TWINS can PREVENT torsion WHAT IS A “TWISTED UTERUS”?

5.  Normal Presentation  Clockwise (twisted to the RIGHT)  Counter Clockwise (twisted to the LEFT)  MORE COMMON DO THE TWIST

6.  Fever  Tachycardia  Tachypnea  Anorexia  Straining  Vaginal Discharge CLINICAL SIGNS OF UTERINE TORSION

7. HOW TO DIAGNOSE  WHAT WAS FOUND WITH #52  VAGINAL EXAM  Twist will be caudal to cervix  CORKSCREW EFFECT  Torsion <360  may be possible to reach the cervix  #52 had a 180  twist  Fetal limb could be felt through the cervix:  Upon stimulation of the limb there was no reaction from the fetus  RECTAL EXAM  Feel Broad Ligaments  The Right Broad Ligament was stretched= COUNTER CLOCKWISE TWIST

8.  Manual Detorsion via Vagina  Rolling the cow  Detorsion Rod  Cesarean Section HOW TO UNTWIST

9.  COUNTERCLOCKWISE TORSION  Lay in LEFT lateral and roll LEFT 360   CLOCKWISE TORSION  Lay in RIGHT lateral and roll RIGHT 360  NON-SURGICAL CORRECTION: “PLANK IN DA FLANK” Roberts, Stephen J and Hillman, Robert B. An Improved Technique for the Relief of Bovine Uterine Torsion.

10.  Place chains as far up the limbs you can reach as possible  Place chains through one eye on the bar  Push into cow between calf limbs and start to hand twist until tight  Place a bar in the outside eye and rotate. NON-SURGICAL CORRECTION: DETORSION ROD

11.  Uterus cannot be corrected by rolling  Cervix does not dilate to sufficiently deliver the fetus  Fetal proportion or anomalies prevent delivery of the fetus  APPROACHS:  RECUMBANT LEFT FLANK  VENTRAL MIDLINE  OBLIQUE PARAMEDIAN  STANDING LEFT FLANK SURGICAL OPTIONS: CESAREAN SECTION

12.  PROS  The cow is standing so more comfortable for the surgeon  Closure Simplified  CONS  Less exposure  Cow can go down  Peritoneal contamination PROS AND CONS OF STANDING LEFT FLANK

13.  Pre-Op Treatment:  Epinephrine 10 mL IM injection  Flunixin Meglumine (1.1 mg/kg) 15 mL IV injection  Florfenicol (6 ml/100lbs) 90 mL Subcutaneous injection  Inverted “L” block with 250 mL 2% Lidocaine  Incision midway between last rib and the wing of the ilium ending approximately ten inches vertically, individually incising through:  Skin  External Abdominal Oblique  Internal Abdominal Oblique  Transversus Abdominus  Peritoneum LEFT FLANK C-SECTION STEPS

14.  Palpate the uterus, pull limb  If forelimb:  Carpus to toe pulled out of incision site  If hindlimb:  Hock to toe pulled out of incision site  Make vertical incision through uterus and placenta  Remove calf and uterine fluid LEFT FLANK C-SECTION STEPS

15.  Uterus  Utrect Pattern  Want an INVERTING pattern for luminal seal  Chromic Gut #2  Cleansed with Sterile Saline solution around the incision site to reduce the chance of infection and reduce uterine fluid in the abdominal cavity  IMPORTANT  Place uterus back into CORRECT position  The uterus was pulled to the left so then the uterus was pushed back into the abdominal cavity placing the right horn into the right abdominal space CLOSURE

16.  Peritoneum, Transversus Abdominus, Internal Abdominal Oblique  Simple Continuous  Chromic Gut #2  External Abdominal Oblique  Simple Continuous  Chromic Gut #2  Skin  Fords Interlocking Pattern  Appositional  Nylon 3 ply CLOSURE

17.  Dead  Male  Weighed approximately 100 lbs  Fetal-maternal mismatch UNEXPECTED “TWIST”

18.  Can be good- worsens with time  Depends on:  Severity of torsion  Systemic compromise  Complications of the C-section can include:  Retained Placenta  Metritis  Incisional edema  Peritonitis  Infertility  Adhesions THE FATE OF THE COW

19. FATE OF #52

20.  Pearson H. Uterine Torsion in Cattle: A review of 168 cases. Veterinary Record 1971:597-603.  Noakes DE. Fertility and Obstetrics in Cattle. 2 ed. Cambridge, MA: Blackwell Science, 1997.  Schonfelder AMaS, Axel. Cesarean Section and Ovariohysterectomy After Severe Uterine Torsion in Four Cows. Veterinary Surgery 2006;35:206-210.  Roberts, Stephen J and Hillman, Robert B. An Improved Technique for the Relief of Bovine Uterine Torsion. Cornell Vet. 1973, 63:111-116  Youngquist RS. Current Therapy in Large Animal Theriogenology. Philadelphia, PA, 1997.  Zaborski Review Factors affecting dysotcia in cattle Zaborski Review Factors affecting dysotcia in cattle  http://www.vin.com/members/proceedings/proceedings.plx?CID=WVC2002 &PID=1051&O=VIN http://www.vin.com/members/proceedings/proceedings.plx?CID=WVC2002 &PID=1051&O=VIN  http://www.vet.uga.edu/lam/teaching/mueller/FemaleBovUrogen.swf http://www.vet.uga.edu/lam/teaching/mueller/FemaleBovUrogen.swf  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275340/#!po=60.9375 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275340/#!po=60.9375  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687017/?page=1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687017/?page=1  http://books.google.com/books?id=DYGUFOLiGWkC&pg=PA50&dq=uterine +torsion+in+cow&hl=en&sa=X&ei=cVxHU4eMMYnu2QWU2IHoCw&ved=0CCs Q6AEwAA#v=onepage&q=uterine%20torsion%20in%20cow&f=false http://books.google.com/books?id=DYGUFOLiGWkC&pg=PA50&dq=uterine +torsion+in+cow&hl=en&sa=X&ei=cVxHU4eMMYnu2QWU2IHoCw&ved=0CCs Q6AEwAA#v=onepage&q=uterine%20torsion%20in%20cow&f=false REFERENCES

21.  God  My Amazing Family  Friends all over the country  Dr. Jenna Bayne  All the Large Animal Clinicians  Food Animal Block Crew “You pick me up when I fall”  Radiology Rotation  Trimac Farm  Sebastian and Colby A GREAT BIG “WAR EAGLE” THANKS