Approach to Dystocia and its management (1).pptx

1. Approach to Dystocia Case
and its managment

2. Introduction to Dystocia
 Dystocia can be defined as “the inability of the cow to expel neonates through the
birth canal from the uterus on its own”.
 Simply we can say that “dystocia is the difficulty in parturition/birth”.
 Dystocia is the combination of two Greek words:
1- Dys = difficult
2- Tocos = birth
 The opposite of dystocia is “Eutocia”
 Dystocia is an important factor regarding the farm economics

3.  The acceptable range of dystocia on a farm is 1.5-3%
 In case of heifers it should not be more than 3% ideally.
 In case of experienced dams it must not exceed 1.5%
 Before starting the discussion about dystocia there are some terms and processes
that need to be understood.

4. Normal Birth Process
 Near to completion of gestation Size of fetus and size of uterus increases
Uterine irritability Placental degeneration Fetal hypoxia (stress to fetus)
Fetal ACTH Fetal adrenal gland Fetal adrenal gland increases in size 3-4
times and secretes CORTISOL
 CORTISOL causes 4 functions:
I. Secretes mineralocorticoids
II. Causes deactivation of 15-hydroxy PG dehydroxylase
III. Secretes glucocorticoids causes aromatization(i.e. convert progesterone into
estrogen) estrogen causes uterine contractions these contractions
causes release of PGF2 alpha PG causes lysis of C.L. and source of
progesterone is destroyed

5. IV. Secretes amnionic cyclooxygenases this causes synthesis of PGF2 alpha
C.L. lysis source of progesterone is blocked
Thus produced estrogen and PGF2 alpha push the fetus into cervix
oxytocin is released as the effect of Fergusson Reflex Cervix relaxes
and fetus is pushed outside the mother’s body.

6. Stages of Parturitions
 Parturition has 3 stages
1- Cervical Dilation:
The first step in the calving process is cervical dilation or in simpler terms; a relaxation
of the muscles keeping the uterus closed to keep the calf inside and everything else
outside. This occurs 4-24 hours before the actual calving event.
2- Foetal Expulsion (Calving):
This stage will, from first water bag, last from less than an hour up to two hours
without assistance or complications. In this stage the calf comes out of the uterus.

7. 3- Placental Expulsion (Afterbirth):
Generally, the cow will expel the uterine contents in 4-12 hours after the birth,
depending on the difficulty of the birth and any issues that may cause retention. Once
this stage is complete the calving process is technically complete.

8. Common Terminologies
 Presentation: It is the relation between the long axis of the fetus and the maternal
birth canal. Presentation can be anterior longitudinal or posterior longitudinal
according to the extremity of the fetus adjacent to the maternal pelvis.
 Position: It indicates the surface of the maternal birth canal to which the fetal
vertebral column is applied; accordingly it can be dorsal position, ventral position
or right or left lateral position.
 Posture: It refers to the disposition of the movable appendages of the fetus and
involves flexion or extension of the fetal neck or limbs.

9. Some Maneuvers
 Retropulsion: It means pushing the fetus into the uterus from the maternal birth
canal. This action is essential to find out defects in presentation, position and
posture. It can be done by applying pressure with the hand or using the crutch
repeller, on the presenting part of the fetal body.
 Extension: It means the extension of the flexed joints when there are postural
defects. The flexed joints can be extended with hand or using snare (rope).
 Traction: It is the application of force to the presenting parts of the fetal body, to
help the dam in expulsion of fetus. This can be done using snare or hooks.
 Rotation: It is the technique of alteration of the position of a fetus by moving it
around its longitudinal axis so as to bring into the normal position.

10. Causes of Dystocia
The causes of dystocia can be of 2 types mainly.
1- Maternal Causes
2- Fetal Causes

11. 1- Maternal Causes
 Dystocia that is caused by maternal factors is called as maternal dystocia.
 Its main factors/causes are as follow:
A. Feto-Maternal Disproportion: The dimensions of the bony pelvis are too small to
allow passage of the fetus. This is most commonly caused by maternal immaturity
and often occurs as a result of heifers being served at too young an age. A small
pelvis is a component in dystocia due to fetopelvic disproportion.
B. Incomplete Cervical Dilatation: Failure of the cervix completely to dilate is a
relatively common cause of dystocia in the dairy bovine. It may occur both in the
heifer and multiparous cows. It is one of the common causes of dystocia.

12. C. Uterine Torsion: Torsion of uterus usually occurs in a pregnant uterine horn and is
defined as the twisting of the uterus on its longitudinal axis. Rotation of the uterus
on its long axis with twisting of the anterior vagina is a common cause of bovine
dystocia.
D. Uterine Inertia: The condition where the uterine expulsive forces fail to deliver a
fetus is known as uterine inertia.
E. Hernia of the Gravid Uterus: Occasionally in cows hernia of the gravid uterus occurs
through a rupture of the abdominal floor.
F. Any kind of injury, outgrowth or tumor of pelvis.
G. Rupture of pre-pubic tendon.
H. Abscess formation.

13. 2- Fetal Causes
 Dystocia that is caused by fetal factors is called as fetal dystocia.
 The factors that lead to fetal dystocia are as follow:
A. Fetal oversize: It has been well documented by numerous researchers that birth
weight is usually the major factor causing calving problems. In fact, research from
Miles City, Montana, would indicate birth weight is the trait most highly correlated
with dystocia, followed by sex of calf, pelvic area and gestation length and cow
weight. Genetics and breed of sire play the most important role in determining calf
birth weight. The heritability of birth weight is nearly 48%.
B. Fetal Maldispositions: The normal presentation is anterior longitudinal with the
head resting on the forelimbs. Any abnormal presentation, posture or position can
lead to dystocia.

14. C. Twinning: Twin gestation in cattle often culminates in dystocia. Twin dystocia is of
three types: both fetuses present simultaneously and become impacted in the
maternal pelvis, one fetus only is presented but cannot be born because of
defective posture. position or presentation; posture is often most at fault, the lack
of extension of limbs or head being due to insufficient uterine space; uterine
inertia, defective uterine contractions are caused, either by the excessive fetal load
or by premature birth.
D. Fetal Diseases/Abnormal Fetus: There may be some diseased fetus or any
abnormality in the fetus that leads to the dystocia. These abnormalities can be
teratological as well. Some common diseases and abnormal conditions are listed as
follow that leads to dystocia.

15.  Ascites (usually presented posteriorly, fails to rotate)
 Hydro-cephalous (bulging out of head)
 Fetal anasarca
 Emphysematous Fetus
 Giant fetus
 Double head fetus
 Fetus with extra limbs
 Hydramnios and hydrallantois condition

16. How to Approach the Case
Approach to a dystocia case contains following steps:
 Complete History of the patient
 General Visual and Clinical Examination
 Specific Examination
 Per Rectal Examination
 Per Vaginal Examination
 Decision Making and Planning

17. 1- Complete History of the Patient
 The first and very important step in approaching a dystocia case is the complete
history of the case.
 Whenever called for a dystocia case, always remember that any kind of dystocia
can be present.
 Always take the full history about the case from owner or the handler of the animal.
This is a very important thing that will help you in your final decision making .
 The history must include following things:
I. Age of the dam
II. Breed of the dam
III. Weight of the dam

18. IV. Is she a first calver or an experienced cow?
V. Nutrition during pregnancy
VI. Was it bred with the sire of same breed (inbreeding) or with a sire of different
breed (outbreeding)
VII. Weight of the sire
VIII.Age of the sire
IX. Was it inseminated through A.I or she was a foster mother for a transferred
embryo
X. If the dam has calved before, what was its behavior
XI. Did she parturate normally or that was a case of dystocia too

19. XII. When did she start the labor pains
XIII. How much time has passed since the water bag has arrived
XIV.Any forced traction used
XV. Any type of medication that has been done e.g. hormonal therapy, any kind of
layman therapy etc.
XVI.Expected date of calving/gestational length

20. 2- General Visual and Clinical Examination
 The cow’s physical and general condition should be noted.
 Body temperature and pulse rate should be noted and the significance of
abnormalities considered.
 Particular attention should be paid to vulva.
 Fetal movement should be noticed at the cow’s left flank.
 If this is vigorous, it indicates the placental separation which causes fetal
anoxia and hypermotility.
 Signs of placental separation may be seen at the vulva if part of the chorioallantois
with detached cotyledons are visible, a light yellowish vaginal discharge may
indicate fetal anoxia or fetal death with associated expulsion of meconium

21.  Physical condition and body condition score of the cow
 Is the cow standing or recumbent
 If there are any membrane or fetal part visible in the vulva
 If so, identify the membrane and its condition or the fetal presentation and
position.
 Is there any vaginal discharge that may indicate, for example, fetal death

22. 3- Specific Examination
 The cow should be restrained for the safety of the veterinarians, any assistances
and the animal concerned, in a clean environment.
 With an assistant holding the tail to one side, the external genitalia and
surrounding parts are thoroughly washed since the tail hairs are frequently
introduced into the vulva and vagina and can cause severe lacerations.
 Without the previous induction of epidural anesthesia and the resultant paralysis of
the rectum, it is almost impossible to make a vaginal examination in the cow
without introducing some fecal contamination.
 If on examination the vagina is found to be empty, attention should be directed to
the cervix .

23. 4- Per Rectal Examination
 Examination of reproductive organs by palpation
 Length of reproductive tract
 Approachable parts of fetus
 Size of fetus
 Check presence of torsion
 If torsion is present check its degree or severity
 Check any pelvic deformity or exostoses

24. 5- Per Vaginal Examination
 After washing the genital parts of the cow and the arms and hands of the
obstetrician, the internal examination starts.
 During this examination the vagina, vulva and the uterus should be checked for
possible injuries, to ascertain the dilatation of the cervix and finally the position,
viability and size of the calf.
 The lubricated hand should be inserted into the vagina and the condition of the
cervix is assessed.
 If the cervix is closed, the protruded but soft external os can be identified but fully
dilated cervix cannot be distinguished identified but fully dilated cervix cannot be
distinguished uterine wall.

25.  The size of the pelvis should also be determined whether it is narrow or normal.
 It also ascertains whether the forelimbs or hind limbs are present in the birth canal.

26. 5- Decision Making and Planning
 The main objective here is to save the life of both the dam and that of the calf.
 The decision is made according to the clinical examination and the severity of the
case.
 But the most important factor that is considered in the process of decision making
is the Fetal Viability.

27. What is Fetal Viability
 Fetal viability can be defined as the:
“Evaluation of the vital signs of the unborn calf”
 Or simply we can say that:
“Fetal viability is to determine that either fetus is alive or dead when it is
inside the mother’s body.”

28. Why it is necessary to assess fetal viability:
The main objectives of assessing the fetal viability are as follow:
 The assessment of the viability of the presented fetus is necessary at an early stage
in the examination because this influence the options for treatment.
 If the fetus is dead, then it may be important to be able to estimate the time
interval since death.
 The death time estimation helps us to determine the severity of case

29.  When there is fetal emphysema and detachment of hair, then the fetus has been
dead for at least 24-48 h
 If after the fetus has been removed there is no emphysema and the cornea is
cloudy and grey, then the fetus has been dead for 6-12 h.

30. How to assess Fetal Viability
 Assessment can be done by attempting to elicit reflexes such as corneal/palpebral,
suckling, anal if they are in posterior presentation, and limb withdrawal.
 Some of these reflexes are used in anterior presentation and some are used in
posterior presentation and some are used in both cases.
 We will discuss these one by one.

31. Methods to assess Fetal Viability
1) Anterior presentation:
 Signs of life of a fetus in anterior presentation can be determined by the interdigital
claw reflex, swallowing reflex, palpebral reflex, palpation of heart beat and
pulsation in the umbilical cord.
i) Interdigital claw reflex:
 It is stimulated by firmly pinching the inter digital web. Positive response to pedal
withdrawal is the sign of life of a fetus.
 A vigorous (normal and live) fetus usually withdraws its foot only once.
 When the reaction is exaggerated or in the form of pedaling motions, it may
indicate hypoxia and! Or acidosis.

32.  When the head has entered the pelvic canal, the inter digital claw reflex is
sometimes absent even though the fetus is normal.
 During straining, it may give false indication due to straining pressure; limbs of
fetus remain pressed in the birth canal but when pressure relaxes, it (limb) seems to
retract both in live and dead fetus.

33. ii) Swallowing reflex:
 It is stimulated by applying pressure on the base of the tongue.
 A vigorous calf will usually react by swallowing or by making gentle sucking
motions.
 Exaggerated sucking reflex indicates hypoxia and! or serious acidosis.

34. iii) Palpebral reflex:
 It is stimulated by placing slight pressure on the eyeballs, the eye reflex can be felt
as a vibration of the eyes or as a movement of the eyelids.
 Important Note:
With worsening condition, these reflexes disappear in definite order. The interdigital
claw reflex is negative first, and the eye reflex remains positive for the longest period.
Because during hypoxia anaerobic glycolysis and accumulation of lactic acid occurs
first in muscles and decreases their reactivity. This explains why reflexes of the
extremities become -ve first.)

35. iv) Palpation of heart beat:
 The heart beat is palpated by passing the hand between the front legs of the fetus
and by grasping the sternum from below, preferably with fingers on the left side of
the chest wall.
 The normal heart rate should be about 120 beats/ minute.
 The drop in heart beats indicates that the fetus is in poor condition.

36. v) Pulsation in umbilical cord:
 The umbilical cord can be located by searching the area between the curvature of
the last ribs and the flaccid abdomen.
 Pulsation and tension of the vessels can be best evaluated by slight pressure on the
umbilical cord.
 During normal parturition, pulse frequency gradually increases from about 90 to
120/ minute.
 Drop in pulse frequency indicates that the calf is in poor condition.

37. 2) Posterior presentation:
 Vitality of a fetus in posterior presentation can be determined by the pedal reflex,
anal reflex and pulsation in the umbilical cord.
i) Anal reflex:
 It is stimulated as a constriction of the anal sphincter when a finger is pushed
against or into the anus.
 This reflex is not very reliable because it is absent in some vigorous foetus.

38. ii) Interdigital claw reflex:
 The interdigital claw reflex of the rear feet is lost sooner than that of the front feet
and can sometimes be negative in a live fetus.
 The pedal reflex can be absent when a live fetus is wedged in the birth canal.
 Therefore its prognostic value is not as good as when performed on the front feet.

39. iii) Pulsation of the umbilical cord:
 The umbilical cord can always be easily reached in calves in posterior presentation
and its evaluation is always effective in determining vitality of the calf.

40. 3)Other Evidences of Fetal Life:
i) Inspection of mucus membrane:
 If the fetal head is protruding from the vulva, the ocular mucus membrane may be
inspected.
 The mucus membranes should be pink in a healthy well oxygenated calf. Cyanosis
indicates low degree of hypoxia.
 Extreme pallor mucus membranes suggest that the fetus is severely anoxic.

41. Evidence of Fetal Death:
 Absence of positive signs of life as mentioned above.
 After 12 hours of the fetal death, blood staining of the amniotic fluid occurs.
 After 72 hours of the fetal death, development of corneal opacity commences.
 Degeneration and separation of the placenta with loss of fetal fluid.

42. 5- Decision Making and Planning
According to Fetus Viability
 According to fetus viability we decide which option is best to take out the calf.
If Calf is Alive If Calf is Dead
1- Mutation 1- Forced Traction
2- Forced Traction 2- Fetotomy
3- C-Section

43. Mutation
 Mutation is defined as those operations by which a fetus is returned to a normal
presentation, position and posture by repulsion, rotation, version and adjustment
or extension of the extremities.
 Normal birth will proceed in uniparous animals only with the fetus in anterior or
posterior longitudinal presentation, dorso-sacral position and with the head and
neck and limbs extended.
 Most multipara can have a normal birth with the fetal limbs folded alongside of or
beneath the body, since the limbs are small and flexible.
 In multipara, fetuses may be in a dorso-illiac or dorso-pubic position and be born
without difficulty.

44. Forced Traction/Extraction
 The withdrawal of fetus from birth canal of the dam by application of force is
called forced traction.
 Such a force may be developed by cords, hooks and forceps. Lubrication of
the genitalia is important for forced traction.
 A very important consideration is the magnitude of the supplementary force which
may be used, since excessive force inappropriately applied can cause severe trauma
to the dam and fetus.

45. Fetotomy
 It is sectioning of a fetus into two or more parts within the uterus and vagina.
 Its purpose is to reduce the size such that delivery through the birth canal becomes
possible.
 Fetotomy should be considered only when the fetus is known to be died.
 By using the instrument called embryotome or fetotome, the fetus in anterior
presentation first remove the head, then the foreleg and also remove the thorax
and finally division of the pelvis.

46. Caesarian/C-Section/Hysterectomy
 The delivery of the fetus usually at parturition by laparohysterotomy is called
caesarean section.
 The cesarean operation is a routine obstetric procedure in case of dystocia.
 Paravertebral or lumbar epidural anesthesia is recommended in the recumbent
state.
 Analysis of published cases shows that the following six major indications account
cumulatively for 90% of all caesarean operations:

47. I. Feto-maternal or fetopelvic disproportion (Either relative or absolute fetal
oversize).
II. Incomplete dilatation of the cervix.
III. Uterine torsion that cannot be corrected otherwise.
IV. Monstrous fetus.
V. Faulty fetal disposition (Presentation, position or posture).
VI. Fetal emphysema

48. Economic Significance of Dystocia
Dystocia has a very important role in the farm economics. It
affects the economics in following ways.
1) Direct Losses:
I. Dystocia causes death of calves and cows, production losses in both dam and calf
and delayed reproduction rates.
II. Of all preweaning deaths, 45.9% can be attributed to dystocia.
III. In a study conducted at California Dairies it was seen that dystocia was responsible
for 6.4% of all cow deaths and 24% of deaths of first-calf heifers.

49. IV. Dystocia may cause prolonged hypoxia and acidosis, which, if not resulting in the
death of the full-term fetus, may result in weakness and prolonged recumbency
after delivery.
V. Exerted on the fetus during delivery may cause cardiopulmonary malfunction that
can reduce the chances of the survival of the neonate.

50.  2) Indirect Losses:
 In a study of beef animals, it was found that prolonged parturition resulted in a
slightly delayed onset of estrus post-calving.
 Slightly more services/conception and reduced subsequent conception rate. This
effect was particularly pronounced in heifers.
 Bovine dystocia is associated with a higher incidence of retained fetal membranes,
uterine disease (Endometritis, metritis, pyometra, uterine rupture) and
periparturient hypocalcemia).

51. Predisposing Factors for Dystocia
 Calf Birth Weight
 Calf Sex
 Cow Body Weight at Calving
 Gestation Length
 Cow Body Condition During Dry Period and at Calving
 Cow Age at Calving
 Nutrition
 Management
 Infection

52.  Exercise
 Genetics

53. Prevention of Dystocia
I. Selection of sires that result in low dystocia frequency due to feto- maternal
disproportion.
II. Heifers should be monitored regularly and provided with assistance promptly if
stage II labor is prolonged.
III. Producers must be well trained to intervene appropriately in dystocia and
recognize when to call the veterinarian.
IV. A balanced nutritional program helps control losses associated with mineral
deficiency.
V. If calving difficulty is a problem in your herd, feed heifers well enough to weigh at
least 85% of their expected mature weight at first calving.

54. VI. Maintenance of calcium homeostasis throughout transition is imperative for
uterine health.
VII. Education of producers and farm owners on the management and in strategies to
reduce dystocia and its effect on calves should be a priority.
VIII.At the national level, genetic selection programs with adequate weighting for
calving ease is recommended.

55. Thank you!