Caesarean section Dr. Rekha Pathak Senior scientist Division of surgery
• Caesarean section is also commonly termed as C- Section in which uterus is exteriorized to take out the young one from the pregnant dam.
Indications• Uterine inertia• Various types of obstructive dystocia (for eg: Emphysematous fetus, Oversized fetus, small pelvic anal of the dam, difficulty in parturition due to pelvic fractures, position and posture dystocia etc.)• Rupture of uterus (may be due to injection or excessive manipulation of the fetus).
Cont…• Animal in highly compromised condition like pregnancy toxemia, weak prostrated dam unable to show labor etc.• In the mares twin pregnancy is also an indication for C-Section.• Uterine torsion.• Incomplete Cervical dilatation.
Ideal conditions• Clean and bright place for the operation.• Air borne contamination should be strictly avoided.• To prevent the post-operative complications and septicemia.
Site of operation• Varies with the type of species.• Dogs: Ventral midline incision behind the umbilicus on the linea alba.• In the cow: Vertical or oblique incision Left lower flank is preferred- the hind limbs are secured caudally.
Fig. 1: left lower flank incision in cattleIncision is just in front of stifle and extendscranioventrally in a slight oblique direction
•In mares, a left paramedian incision (caudal) orventral midline incision.•Take the animals on appropriate recumbency.•Checked for dehydration and administered theintravenous fluids rehydration .•Dexamethasone should be given along with antibiotics
Cont…..•Dog: The gravid uterus has dilated horns in theshape of –Y which contain the fetuses and lies on theventral abdominal floor extended up to the level ofstomach towards end of gestation
• Cow: The gravid uterus may lie directly up on the right abdominal floor• Anesthesia• Local infiltration with lignocaine 2%-----Cattle• Diazepam + Ketamine combination ------Dogs (0.5mg/kg + 5mg/kg)Premedication with atropine sulfate @ 0.04 mg/kg body weight
Bitch•The bifurcation of uterine body is first visualized•Incision is made over it in order to enable the milkingof pups (squeezing the pups out from the horns) fromboth the horns is easy• The fetuses are removed along with fetal membraneone by one•The umbilical vessels are ligated and cut and the newborn are handed over o the helper or nurse forresuscitation
Cattle:• Structures invaded are• skin,• subcutaneous fascia• combined aponeurosis of the two oblique muscles which forms the external sheath of the rectus abdominis• transverse abdominis• peritoneum.
• The uterine incision should follow the longitudinal line of greater curvature of the uterus• Uterus is packed off from the abdominal cavity
• Forelimbs or hind limbs are grasped depending upon the presentation and the fetus is taken out from the uterus• Calf should be cared by the assistants• Cleaned, dried, cleared off the mucus from the nostrils• The umbilical cord is ligated far enough from the navel and cut so that it contracts• Antiseptic application
Removal of after births• If it is easily removed by gentle traction it should be removed or otherwise, it should not be pulled with force since chances of caruncular bleeding is strong which may be fatal to the dam• If such bleeding is encountered in the dam, then we can counteract it by giving oxytocin which largely shrinks the uterus and stops the bleeding
Closure of uterus• Antibiotics can be instilled into the uterus as common procedure for all the species before closure• The uterine incision is cleaned with gauze and closed by a double row of Lamberts sutures using chromic catgut size 2-0 or 3-0 in bitch and size 2 in cattle and buffaloes
• Abdominal incisions are sutured in the usual manner, closing the peritoneum, muscle and skin
Abdominal spillage• Note: utmost care should be taken to avoid the spillage of uterine contents into the peritoneal / abdominal cavity• It should be lavaged with sterile normal saline containing non- irritant antibiotics to counteract the infection, reduce the chances of postoperative adhesions and infection.• The uterine torsion in case of cattle and buffaloes should be then corrected. 50-60 units of oxytocin hasten the uterine involution. A 5% solution of dextrose and normal saline solution should be invariably included in the schedule as most deaths have hypoglycemia and hypochloraemia.