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Diseases and accident during
gestation
Course Title Gyn & Obst
Course code VST 507
Dr. Dauda Iliyasu (DVM,
M.Sc.)
by
Introduction
 Diseases is very easy to set in during
gestation period.
 Pregnant animals has low immunity.
 However accidents may occur during the
gestation.
 Trauma and diseases can lead to abortion
Abortion
 Abortion is defined as fetal death and
expulsion between 42 and 260 days of
gestation. The condition exclude fetal
maceration and mummification.
 Abortions may result from a broad range of
causes.
 Abortions may result as idiopathic, metabolic
or hormonal abnormalities, nutritional
deficiencies, trauma, toxicities, or infectious
processes.
 Abortion usually results when normal
relationships between fetus and dam fail.
 This results in the expulsion of a fetus that is
incapable of independent life.
 Parturition is normally initiated via the fetal
pituitary-adrenal axis.
 Effective fetal control of the pregnant uterus
is lost after the fetus dies.
 Although many factors have been
incriminated, the mechanism of abortion was
not clear.
 Abortion can occur any time during gestation.
 Most abortions that occur during the first
trimester of pregnancy are unnoticed and the
animal is treated clinically for infertility.
Average length of gestation
Species Length in Days Avg. in Months*
Cattle 279-292 9
Goats 145-155 5
Sheep 144-151 5
Swine 112-115 3 mo. 3 wks. 3
days
Dog and cat 63-65 2
Horse 330-342 11
*Average varies with animals and breeds.
Infectious causes of abortion
 The infectious causes of abortion may be
bacteria, virus and parasites.
 Bacteria abortions result from brucellosis,
leptospirosis, campylobacteriosis (vibriosis),
listeriosis, haemophilus somnus complex, and
ureaplasmosis.
 Virus, fungi and parasites that causes
abortion are IBR, BIVD, Actinomyces
pyogenes and Trichomoniasis.
 Fever, septic abortion.
Noninfectious causes of abortion
 Physical- trauma, insemination, twinning in large
animals.
 Nutritional- Iodine deficiency, Vit E/Selenium
deficiency.
 Toxic-plant poisonings.
 Genetic- CVM in Holsteins, Bulldogs in Dexters.
 Iatrogenic: administration of abortifacient drugs
What is Parturition?
 Parturition is the process of delivery of the fully
grown fetus on the completion of the normal
pregnancy period.
Parturition
Labor
Delivery
Parturition Names in Species
 Cattle Calving
 Sheep Lambing
Goats Kidding
 Dogs Whelping
 Cats Kitten
 Horse Foaling
 Pigs Farrowing
 Rabbit Kindling
Signs of Approaching Parturition
 Distended abdomen
 Mammary development & milk secretion
 Swollen vulva and relaxed pelvic ligaments
 Mucous discharge
 Relentlessness and separation from group
 Labor and Contractions
Initiation of Parturition
 The process of parturition is initiated by fetal,
and maternal interrelated events some of
which are poorly understood.
 In some species evidence shows that the
fetus exerts a control over the length of
gestation than the dam.
 The primary precursor for initiation of
parturition is prostaglandin in pig, fetal
cortisol in sheep and interplay of
prostaglandins and fetal cortisol in the cow.
Fetal control of parturition
 fetus controls time of parturition due to
stress response :
– lack of space
– lack of gas exchange
– lack of nutrients
Hormonal changes at the end of gestation
Fetal pituitary - hypothalamus axis essential
increased stress from fetal nutritional demands
and placental insufficiency
Hypothalamus release CRH
(Corticotropin releasing hormone)
Anterior pituitary in turn releases ACTH
Hormonal changes at the end of gestation
Fetal adrenal gland
 in response to ACTH releases cortisol (corticosteroids)
– effects of cortisol on fetus
 Lung produces surfactants
 liver increases storage of glycogen
 thyroid increases metabolism
– effects of cortisol on placentome
 shift from progesterone to estradiol production
 progesterone decreases
 estrogen increases
 PGF increases
Hormonal changes at the end of gestation
Placentome hormones
 estradiol
– increase gap junctions in myometrium
 leads to better co-ordination and
communication among muscle cells in the
myometrium
 begin to get coordinated contractions toward
the cervix
– increase in uterine oxytocin receptors
– primes cervix to response to relaxin
– stimulates ovary to secrete relaxin and oxytocin
– acts with PGF to trigger CL regression
Hormonal changes at the end of gestation
 Placentome hormones
PGF
– regression of CL
– synthesis and release of oxytocin and
relaxin from ovary (in some species relaxin
from placenta)
– stimulates most of the contractions in the
uterus
Hormonal changes at the end of gestation
 progesterone
– shift from progesterone to estrogen production
leads to its decrease from the placentome
– PGF stimulates luteolysis of CL and decreases
progesterone
– release from "progesterone block“
Oxytocin
 stimulates final contractions of uterus but only once
fetal head enters cervix
Hormonal changes at the end of gestation
Relaxin
comes from ovary or placenta
synthesis stimulated by PGF
stimulates softening of the cervical
connective tissue to cause dilation
promotes elasticity of the pelvic ligaments
Position of the fetus
 It is important to
describe the
position of the fetus
during delivery.
 Presentation:- Is the
relation of the spinal
axis of the fetus to
that of the dam.it be
longitudinal, trans
or vertical.
Position of the fetus
 Position: Is the relation of the dorsum of fetus
in longitudinal presentation, or the head in
transverse to the quadrants of the maternal
pelvis.
 Posture: This signifies the relation of the fetal
extremities to its own body.
Stages of Parturition
 Stage 1- Preparatory Stage (2 to 12 hours)
 Stage 2- Birthing Process (30 to 180 mins)
 Stage 3- Placenta Expulsion (1 hr to 12 hr)
Stage 1- preparatory stage
 Characterized by dilation of the cervix.
 Rhythmic contractions of the uterus.
 At the end of this stage, the cervix expands,
allowing the uterus and vagina to become a
continuous canal.
Preparatory Stage (2-6 hours)
a. Relaxation of the soft
birth canal
b. Relaxation of the bony
birth canal
c. Lubrication of the
birth canal
d. Dilation of the cervix
e. Alignment of the fetus
Stage 2- Birthing Process
 Increase in contractions with abdominal
pressing.
 The placenta, along with the head and
forelegs, are forced into the vagina (birth
canal).
 Presentation forelegs first with the nose
resting on the forelegs.
– Anterior “head first”
Stage 2- Birthing Process
– strong uterine contractions
– rupture of the allantochorion
– appearence of amnion
– maternal recumbency and straining
– not only uterine but abdominal contractions
as well
– rupture of the amnion and delivery
Stage 2- Birthing Process
 Cow usually lying down
 Fetus enters birth canal
 Front feet and head
protrude first
 Calf delivery
completed
Stage 3- Placenta Expulsion
 Associated with uterine contractions
 Normally expelled within 12 hours
 Placenta of ruminants should be expelled
within the following time periods
– Cow and ewe - 8 to 24 hours
Stage 3- Placenta Expulsion
– uterine contractions decrease but continue
– chorionic villi loosen
– expulsion of placenta
– delayed in ruminants due to presence of
cotelydons separating independently
– suckling induces oxytocin release which
triggers further uterine contractions
 Placenta
 Expulsion
Signs of Parturition in Cattle
 One week - mammary glands fill with milk,
tail head ligaments relax, and you will see a
waxing of teats.
 12-24 hours - frequent defecation and
urination, anorexia, looking for young, makes
a nest or seeks out an isolated area.
Cattle Parturition
– Parturition
82% :- occur between noon and midnight,
placenta  eaten by cow
– Bonding
heritability of maternal behavior :- low in
cattle, some breed -- more than the other
breed
cow groom their calve -- early postpartum,
concentrating on the back and abdomen
Cattle Parturition
– Bonding (cont)
critical period for formation of the cow-calf
bond -- the first few hours postpartum
– Suckling
passive transfer of immunity to calves
poor in dystocia
Cattle Parturition
 Relaxation of the pelvic ligaments
 Relaxation of the vulva and perineum
 Enlargement and edema of the udder
 Mucoid discharge from the vagina and
dissolution of the cervical seal
 Segregation from the herd along with
restlessness and anorexia may be exhibited
in the last few hours before parturition and
heifers may show signs of abdominal pain.
Signs of Parturition in Sheep
 Ten days before lambing the ewes teats become
firm and full of milk, her vulva slackens and
becomes slightly swollen.
 Closer to lambing, the ewe's cervical seal passes
from the vulva as a thick, creamy, white mucus.
 In the final stages prior to lambing, the ewe
becomes anxious and uneasy and continually
switches from a reclining to a standing position.
Sheep Parturition
– Licking and sucking
– Acceptance of the lamb
– Mutual recognition by the ewe and lamb
recognition of the lamb by the ewe : depend
on at least 3 senses : olfactory, auditory,
and vision
Artificial Induction of Labor
 The induction of labor at or near term in
animals may be required for physiological and
pathological reasons.
 Planned deliveries.
 Reduce accidental deaths due dystocia and
crushing by the mother (sow).
 hydrops of fetal membranes, prepubic tendon
rupture and maternal ill health.
Induction of Parturition in Cows
Indications
 To prevent dystocia.
 When programming calving and pasture
availability.
 In the management of medical problems, such as
hydrops allantois.
 When damaged to an engorged pendulous udder is
likely.
Induction of Parturition in Cows
Contraindications
 Should not be used in animals that are more than 2-3
weeks away from calving.
 Corticosteroids should not be used to induce
parturition when there is a dead fetus in uterus, e.g.
fetal mummification.
 Corticosteroids should not be used in animals with
known or latent infections because of their
immunosuppressive properties.
Induction of Parturition in Cows
Side effects
 The most common problem associated with
the induction of parturition in cows is
retention of the fetal membranes
Induction of Parturition in Cows
Short-acting Corticosteroids
 Dexamethasone (20 mg) or flumethasone (10
mg) IM
 is about 80% - 90% effective when administered
to cows within 1 weeks of full term.
 The interval from injection to parturition is about
48 hours ( 24-72 hours).
 The incidence of retention of the fetal
membranes is estimated to be about 75%.
Induction of Parturition in Cows
Long-acting Corticosteroids
 Dexamethasone trimethylacetate (20 mg) or
Betamethasone suspension 20 mg) I.M.
 30 days before term
 Parturition occurs about 15+8 days after injection
and is associated with a lower incidence (9 to 22%)
of retained fetal membranes .
Induction of Parturition in Cows
Corticosteroid-Prostaglandin Combination
 With this combination, calving occurs sooner
than for either drug alone (34.6+-1.4 hours).
 The incidence of retained fetal membranes is
equally as high as when each drug is used
alone.
Induction of Parturition in ewe
 Dystocia due to feto-pelvic disproportion is not
common.
 may be used in the management of ewes with
pregnancy toxemia.
 16 mg dexamethasone I.M. injection within 5 days of
term, result in normal parturition in 2 to 3 days.
Induction of Parturition in Goats
Advantages
 Improved kid survival, especially in severe weather
 Reduced kid and doe mortality because of better
observation by the owner and earlier intervention in
cases of dystocia.
 increased predictability of the time of parturition.
Induction of Parturition in Goats
Disadvantages
 Owner interfere with the normal process.
 Increased responsibility on the owner to
keep accurate breeding records and to
guarantee no subsequent breedings,
accidental or otherwise.
Dystocia
 Dystocia occurs when there is a failure in one or
more of the three main components of
parturition; expulsive forces, birth canal
adequacy and foetal size and position.
 Dystocia may occur in both ruminants and
Monogastric animals.
 In heifers and cows dystocia may be due to
abnormal foetal position, failure of the vulva to
dilate and multiple fetuses, uterine inertia,
uterine torsion respectively
Incidence of dystocia
 The incidence of pelvic deformities as a cause
of dystocia in buffaloes and cows is described
to be 1.2 and 9.2percent.
 The incidence of cervical dystocia was seen
to 11.1 to 16.7 percent in cows.
 The incidence of uterine torsion is considered
to be higher in buffaloes compared to cows.
Causes of Dystocia
 The causes of dystocia are generally
classified into maternal and fetal causes.
 The maternal causes of dystocia are
considered to be:-
1. constriction/obstruction of the birth canal.
2. Pelvic abnormalities
3. Osteomalacia of the pelvic bones and
hypoplasia of vagina and vulva.
Fetal causes of dystocia
 Fetal over size
 Fetal congenital anomalies
 Fetal anasarca
 Fetal hydrocephalus
 Fetal emphysema
 Death fetus
Immediate causes of dystocia are:
 Feto-pelvic disproportion
 Pelvic fracture of the dam
 Uterine inertia
 Abdominal hernia
 Fracture of the vertebral bones
 Poor presentation, position and pasture of
the fetus
 Thank you for listening

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Parturition

  • 1. Diseases and accident during gestation Course Title Gyn & Obst Course code VST 507 Dr. Dauda Iliyasu (DVM, M.Sc.) by
  • 2. Introduction  Diseases is very easy to set in during gestation period.  Pregnant animals has low immunity.  However accidents may occur during the gestation.  Trauma and diseases can lead to abortion
  • 3. Abortion  Abortion is defined as fetal death and expulsion between 42 and 260 days of gestation. The condition exclude fetal maceration and mummification.  Abortions may result from a broad range of causes.  Abortions may result as idiopathic, metabolic or hormonal abnormalities, nutritional deficiencies, trauma, toxicities, or infectious processes.
  • 4.  Abortion usually results when normal relationships between fetus and dam fail.  This results in the expulsion of a fetus that is incapable of independent life.  Parturition is normally initiated via the fetal pituitary-adrenal axis.
  • 5.  Effective fetal control of the pregnant uterus is lost after the fetus dies.  Although many factors have been incriminated, the mechanism of abortion was not clear.  Abortion can occur any time during gestation.  Most abortions that occur during the first trimester of pregnancy are unnoticed and the animal is treated clinically for infertility.
  • 6. Average length of gestation Species Length in Days Avg. in Months* Cattle 279-292 9 Goats 145-155 5 Sheep 144-151 5 Swine 112-115 3 mo. 3 wks. 3 days Dog and cat 63-65 2 Horse 330-342 11 *Average varies with animals and breeds.
  • 7. Infectious causes of abortion  The infectious causes of abortion may be bacteria, virus and parasites.  Bacteria abortions result from brucellosis, leptospirosis, campylobacteriosis (vibriosis), listeriosis, haemophilus somnus complex, and ureaplasmosis.  Virus, fungi and parasites that causes abortion are IBR, BIVD, Actinomyces pyogenes and Trichomoniasis.  Fever, septic abortion.
  • 8. Noninfectious causes of abortion  Physical- trauma, insemination, twinning in large animals.  Nutritional- Iodine deficiency, Vit E/Selenium deficiency.  Toxic-plant poisonings.  Genetic- CVM in Holsteins, Bulldogs in Dexters.  Iatrogenic: administration of abortifacient drugs
  • 9. What is Parturition?  Parturition is the process of delivery of the fully grown fetus on the completion of the normal pregnancy period. Parturition Labor Delivery
  • 10. Parturition Names in Species  Cattle Calving  Sheep Lambing Goats Kidding  Dogs Whelping  Cats Kitten  Horse Foaling  Pigs Farrowing  Rabbit Kindling
  • 11. Signs of Approaching Parturition  Distended abdomen  Mammary development & milk secretion  Swollen vulva and relaxed pelvic ligaments  Mucous discharge  Relentlessness and separation from group  Labor and Contractions
  • 12. Initiation of Parturition  The process of parturition is initiated by fetal, and maternal interrelated events some of which are poorly understood.  In some species evidence shows that the fetus exerts a control over the length of gestation than the dam.  The primary precursor for initiation of parturition is prostaglandin in pig, fetal cortisol in sheep and interplay of prostaglandins and fetal cortisol in the cow.
  • 13. Fetal control of parturition  fetus controls time of parturition due to stress response : – lack of space – lack of gas exchange – lack of nutrients
  • 14. Hormonal changes at the end of gestation Fetal pituitary - hypothalamus axis essential increased stress from fetal nutritional demands and placental insufficiency Hypothalamus release CRH (Corticotropin releasing hormone) Anterior pituitary in turn releases ACTH
  • 15. Hormonal changes at the end of gestation Fetal adrenal gland  in response to ACTH releases cortisol (corticosteroids) – effects of cortisol on fetus  Lung produces surfactants  liver increases storage of glycogen  thyroid increases metabolism – effects of cortisol on placentome  shift from progesterone to estradiol production  progesterone decreases  estrogen increases  PGF increases
  • 16. Hormonal changes at the end of gestation Placentome hormones  estradiol – increase gap junctions in myometrium  leads to better co-ordination and communication among muscle cells in the myometrium  begin to get coordinated contractions toward the cervix – increase in uterine oxytocin receptors – primes cervix to response to relaxin – stimulates ovary to secrete relaxin and oxytocin – acts with PGF to trigger CL regression
  • 17. Hormonal changes at the end of gestation  Placentome hormones PGF – regression of CL – synthesis and release of oxytocin and relaxin from ovary (in some species relaxin from placenta) – stimulates most of the contractions in the uterus
  • 18. Hormonal changes at the end of gestation  progesterone – shift from progesterone to estrogen production leads to its decrease from the placentome – PGF stimulates luteolysis of CL and decreases progesterone – release from "progesterone block“ Oxytocin  stimulates final contractions of uterus but only once fetal head enters cervix
  • 19. Hormonal changes at the end of gestation Relaxin comes from ovary or placenta synthesis stimulated by PGF stimulates softening of the cervical connective tissue to cause dilation promotes elasticity of the pelvic ligaments
  • 20. Position of the fetus  It is important to describe the position of the fetus during delivery.  Presentation:- Is the relation of the spinal axis of the fetus to that of the dam.it be longitudinal, trans or vertical.
  • 21. Position of the fetus  Position: Is the relation of the dorsum of fetus in longitudinal presentation, or the head in transverse to the quadrants of the maternal pelvis.  Posture: This signifies the relation of the fetal extremities to its own body.
  • 22. Stages of Parturition  Stage 1- Preparatory Stage (2 to 12 hours)  Stage 2- Birthing Process (30 to 180 mins)  Stage 3- Placenta Expulsion (1 hr to 12 hr)
  • 23. Stage 1- preparatory stage  Characterized by dilation of the cervix.  Rhythmic contractions of the uterus.  At the end of this stage, the cervix expands, allowing the uterus and vagina to become a continuous canal.
  • 24. Preparatory Stage (2-6 hours) a. Relaxation of the soft birth canal b. Relaxation of the bony birth canal c. Lubrication of the birth canal d. Dilation of the cervix e. Alignment of the fetus
  • 25. Stage 2- Birthing Process  Increase in contractions with abdominal pressing.  The placenta, along with the head and forelegs, are forced into the vagina (birth canal).  Presentation forelegs first with the nose resting on the forelegs. – Anterior “head first”
  • 26. Stage 2- Birthing Process – strong uterine contractions – rupture of the allantochorion – appearence of amnion – maternal recumbency and straining – not only uterine but abdominal contractions as well – rupture of the amnion and delivery
  • 27. Stage 2- Birthing Process  Cow usually lying down  Fetus enters birth canal  Front feet and head protrude first  Calf delivery completed
  • 28. Stage 3- Placenta Expulsion  Associated with uterine contractions  Normally expelled within 12 hours  Placenta of ruminants should be expelled within the following time periods – Cow and ewe - 8 to 24 hours
  • 29. Stage 3- Placenta Expulsion – uterine contractions decrease but continue – chorionic villi loosen – expulsion of placenta – delayed in ruminants due to presence of cotelydons separating independently – suckling induces oxytocin release which triggers further uterine contractions
  • 31. Signs of Parturition in Cattle  One week - mammary glands fill with milk, tail head ligaments relax, and you will see a waxing of teats.  12-24 hours - frequent defecation and urination, anorexia, looking for young, makes a nest or seeks out an isolated area.
  • 32. Cattle Parturition – Parturition 82% :- occur between noon and midnight, placenta  eaten by cow – Bonding heritability of maternal behavior :- low in cattle, some breed -- more than the other breed cow groom their calve -- early postpartum, concentrating on the back and abdomen
  • 33. Cattle Parturition – Bonding (cont) critical period for formation of the cow-calf bond -- the first few hours postpartum – Suckling passive transfer of immunity to calves poor in dystocia
  • 34. Cattle Parturition  Relaxation of the pelvic ligaments  Relaxation of the vulva and perineum  Enlargement and edema of the udder  Mucoid discharge from the vagina and dissolution of the cervical seal  Segregation from the herd along with restlessness and anorexia may be exhibited in the last few hours before parturition and heifers may show signs of abdominal pain.
  • 35. Signs of Parturition in Sheep  Ten days before lambing the ewes teats become firm and full of milk, her vulva slackens and becomes slightly swollen.  Closer to lambing, the ewe's cervical seal passes from the vulva as a thick, creamy, white mucus.  In the final stages prior to lambing, the ewe becomes anxious and uneasy and continually switches from a reclining to a standing position.
  • 36. Sheep Parturition – Licking and sucking – Acceptance of the lamb – Mutual recognition by the ewe and lamb recognition of the lamb by the ewe : depend on at least 3 senses : olfactory, auditory, and vision
  • 37. Artificial Induction of Labor  The induction of labor at or near term in animals may be required for physiological and pathological reasons.  Planned deliveries.  Reduce accidental deaths due dystocia and crushing by the mother (sow).  hydrops of fetal membranes, prepubic tendon rupture and maternal ill health.
  • 38. Induction of Parturition in Cows Indications  To prevent dystocia.  When programming calving and pasture availability.  In the management of medical problems, such as hydrops allantois.  When damaged to an engorged pendulous udder is likely.
  • 39. Induction of Parturition in Cows Contraindications  Should not be used in animals that are more than 2-3 weeks away from calving.  Corticosteroids should not be used to induce parturition when there is a dead fetus in uterus, e.g. fetal mummification.  Corticosteroids should not be used in animals with known or latent infections because of their immunosuppressive properties.
  • 40. Induction of Parturition in Cows Side effects  The most common problem associated with the induction of parturition in cows is retention of the fetal membranes
  • 41. Induction of Parturition in Cows Short-acting Corticosteroids  Dexamethasone (20 mg) or flumethasone (10 mg) IM  is about 80% - 90% effective when administered to cows within 1 weeks of full term.  The interval from injection to parturition is about 48 hours ( 24-72 hours).  The incidence of retention of the fetal membranes is estimated to be about 75%.
  • 42. Induction of Parturition in Cows Long-acting Corticosteroids  Dexamethasone trimethylacetate (20 mg) or Betamethasone suspension 20 mg) I.M.  30 days before term  Parturition occurs about 15+8 days after injection and is associated with a lower incidence (9 to 22%) of retained fetal membranes .
  • 43. Induction of Parturition in Cows Corticosteroid-Prostaglandin Combination  With this combination, calving occurs sooner than for either drug alone (34.6+-1.4 hours).  The incidence of retained fetal membranes is equally as high as when each drug is used alone.
  • 44. Induction of Parturition in ewe  Dystocia due to feto-pelvic disproportion is not common.  may be used in the management of ewes with pregnancy toxemia.  16 mg dexamethasone I.M. injection within 5 days of term, result in normal parturition in 2 to 3 days.
  • 45. Induction of Parturition in Goats Advantages  Improved kid survival, especially in severe weather  Reduced kid and doe mortality because of better observation by the owner and earlier intervention in cases of dystocia.  increased predictability of the time of parturition.
  • 46. Induction of Parturition in Goats Disadvantages  Owner interfere with the normal process.  Increased responsibility on the owner to keep accurate breeding records and to guarantee no subsequent breedings, accidental or otherwise.
  • 47. Dystocia  Dystocia occurs when there is a failure in one or more of the three main components of parturition; expulsive forces, birth canal adequacy and foetal size and position.  Dystocia may occur in both ruminants and Monogastric animals.  In heifers and cows dystocia may be due to abnormal foetal position, failure of the vulva to dilate and multiple fetuses, uterine inertia, uterine torsion respectively
  • 48. Incidence of dystocia  The incidence of pelvic deformities as a cause of dystocia in buffaloes and cows is described to be 1.2 and 9.2percent.  The incidence of cervical dystocia was seen to 11.1 to 16.7 percent in cows.  The incidence of uterine torsion is considered to be higher in buffaloes compared to cows.
  • 49. Causes of Dystocia  The causes of dystocia are generally classified into maternal and fetal causes.  The maternal causes of dystocia are considered to be:- 1. constriction/obstruction of the birth canal. 2. Pelvic abnormalities 3. Osteomalacia of the pelvic bones and hypoplasia of vagina and vulva.
  • 50. Fetal causes of dystocia  Fetal over size  Fetal congenital anomalies  Fetal anasarca  Fetal hydrocephalus  Fetal emphysema  Death fetus
  • 51. Immediate causes of dystocia are:  Feto-pelvic disproportion  Pelvic fracture of the dam  Uterine inertia  Abdominal hernia  Fracture of the vertebral bones  Poor presentation, position and pasture of the fetus
  • 52.  Thank you for listening