Title: “Handling of dystocia in animals

by CESAREAN SECTION”
Assignment on a course: Advanced Veterinary
Obstetrics( VOG-7112 )
Submitted by: Kiflie Dereje Ayele; Mar.,2023
Type of study area: Masters of veterinary in “
Veterinary Obstetrics and Gynecology”
Year of study: First year ,First semester.
Academic institution: University of Gondar ,
college of Veterinary Medicine & Animal Sciences.

Submitted to: Professor Nibret

Moges (DVM, MSc, PhD).
 Outlines
I. What is a Cesarean Section?
II. Indications of C-Section
III. Surgical Approaches
IV. Individual Approaches In Cow
V. Surgical Approaches in other animals
VI. Factors in selection of Surgical Approaches
VII.Comparing of Approaches
VIII.Pre-operative Procedures
IX. Post-operative Procedures
X. CONCLUSIONS AND RECOMMENDATIONS
HANDLING OF DYSTOCIA IN ANIMALS
CAESAREAN
BY

SECTION

“Caesar is a title used by Roman emperors, especially those

from Augustus to Hadrian. One of the Caesars in thousands of
years ago was dytociated ,and got born by ordinary knife
incision , hence the name Caesarean section birth.”
I. What is a C-section?
A cesarean section(c-section) delivery is a surgical
procedure in which a fetus is delivered through
incisions in abdomen and uterus. Also called
Hysterotomy delivery.
It is performed when a vaginal delivery is not
possible zat the health of the dam or neonate is
at risk , and fetotomy is not viable.
NB: Hysterotomy is incision of the uterus(C-Section ).
Hysterectomy is surgical removal of the uterus.
II. Indications
➢ Feto-pelvis disproportion
➢ Fetal(mal-orientations and
monstrosity) which is not
corrected by mutation or
fetotomy
➢ Uterine(torsion & rupture)
➢ Incomplete dilation of cervix
III. Surgical Approaches
There are eight surgical approaches available for bovines. Each
has its own advantages & disadvantages:
1. Standing left paralumbar laparatomy(SLPL)
2. Standing right paralumbar laparatomy(SRPL)
3. Standing left oblique laparatomy(SLOL)
4. Recumbent left paralumbar laparatomy(RLPL)
5. Recumbent right paralumbar laparatomy(RRPL)
6. Recumbent ventral midline celiotomy(RVMLC)
7. Recumbent ventral paramedian laparatomy(RVPML)
8. Recumbent Ventrolateral laparatomy(RVLL)
Figure-5
IV. Individual Approaches In Cow
1. Standing left paralumbar laparotomy(SLPL)
➢ The most commonly used.
➢ The incision: vertically in the middle of the paralumbar fossa.
Starting 10 cm ventral to the transverse processes of the
lumbar vertebrae and continuing ventrally, far enough to allow
removal of the calf(30-40cm)(Figure-1).
➢ The rumen aids in retaining the abdominal viscera
2. Standing right paralumbar laparotomy(SRPL)
➢ Preferable when fetus palpated in the right horn
➢ In a cow that has had repeated caesareans on the left side
➢ For cows with the hydrotic condition(Figure-1).
3. Standing left oblique laparotomy(SLOL)
➢ Incision starts 4–6 cm ventral and cranial to the tuber coxae
and is extended cranio-ventrally at a 45°angle towards up to
30 cm the caudal rib where it stops.
➢ Accessibility(uterine horn apex) easy to exteriorize.
➢ oblique muscles are incised in the same direction as the
skin(Figure-4).
4. Recumbent ventral midline celiotomy
➢ The cow is positioned in dorsal recumbency.
➢ Incision: starting 5cm caudal to the umbilicus(Figure-2 & 5).
➢ Less than optimal closure may result herniation/evisceration.
➢ Excellent exteriorization the uterus.
V. Approaches in other animals
❖ Horses- Midline, paramedian or ventral flank laparotomy
❖ Sheep and goat- Mid-paralumbar fossa(Figure-6B).
❖ Pig- Vertical paralumbar fossa or ventral flank on either
side(Figure-6A).
❖ Canine (dogs)- ventral midline incision or flank approach
❖ Feline- (Cats)- ventral midline incision or flank approach

Figure-6: (A)
incision sites in
sow (B )
incision sites in
sheep
VI. Factors in selection of
Surgical Approaches
1. Exteriorization of the uterus
➢ Labour power to carry and pull out large fetus
➢ Risk of contamination by dead emphysematous fetus
2. Inability(cow)to stand throughout the procedure
3. Risk of herniation or evisceration
4. Closure: easy/difficult due muscle tension
5. Risk of bloat or aspiration pneumonia
6. Restraints needed
7. The rumen aids in retaining the abdominal viscera
8. Cosmetic incision
It is important to EXTERIORIZE the
uterus , held remain outside by an
assistant or uterine forceps.
This is to limit the contamination
of the peritoneal cavity with
uterine contents (especially by
dead fetus)
Incisions on Uterus be:
a) On the greater curvature . Distant from either the cervix or apex of
the horn. From either the metatarsus or metacarpus to the hoof is
sufficiently long to permit extraction of the calf.
b) Between caruncles (to avoid bleeding). Bleeding of large vessels be
ligated. Remove Fetal membranes at the time of surgery.
c) Layers Suturing
➢ Uterus: Continuous inverting patterns of either (a)double row
lambert (b)double row cushing pattern(Figure-8) (c)continuous
locking or Ford interlocking (Figure-7&9)
➢ Peritoneum: simple continuous pattern(Figure-10).
➢ Abdominal muscles: continuous lock (Figure-7&9) or horizontal
interrupted(Figure-12).
➢ Chromium cat gut(Uterus , Peritoneum & Abdominal muscles)
➢ Skin: simple interrupted (Figure-14) or horizontal interrupted
(Figure-12) using nylon sutures
➢ Infuse penstrep b/n the suture layers.
 Figure-7:
continuous interlock
sutured uterus

Fig-8: Left(Double row

lembert pattern) &
Right(Double row cusing
pattern)
Figure-9: Continuous locking or Ford
interlocking SP (inverting)

▪ Tension sutures, which are

usually everting sutures.
▪ Inversion is desirable only to
close hollow viscera to prevent
leakag.

Figure-10: Simple continuous Figure-11: A far–near near–far SP (inverting).

SP(inverting).
Figure-12:Horizontal interrupted SP(eversion )
Figure-13: Interrupted vertical SP(slight eversion)

Figure-14: Simple interrupted SP(inverting).

Figure-15: Cruciate SP(Inverting)
VII. Comparing of Approaches
(A) All Standings Approaches:
Layers: skin , external and internal abdominal oblique
muscles , transverse abdominal muscle ,peritoneum , omentum
and uterus.
Compared With All Recumbents:
DISADVANTAGES
▪ An inability(cow) to stand throughout the procedure
▪ Exteriorization difficult
ADVANTAGES
▪ No risk of(herniation/evisceration/bloat/aspiration)
▪ For Uncomplicated dystocia
▪ Closure is easy
▪ Restraint: A crush/chute
(B) All Recumbents Approaches:
COMPARED WITH STANDINGS
REQUIRE: Heavy sedation and manpower to cast the cow
INDICATED: for down cow , cow likely to go down.
CONTRAINDICATED:
➢ In GIT distention, Uterine distention(Hydrops)
➢ Aspiration is a real hazard in sedated/anaesthetized recumbent
cattle. Prevented by: (1) Withholding all food for 24–48 hours
before anesthesia. (2) Arranging that the occiput is above general
body level(Figure-16).

Figure-16
(C) Recumbent Paralumbars Approaches:
a) Recumbent left paralumbar laparotomy (RLPL)
b) Recumbent right paralumbar laparotomy(RRPL)
Compared with standings:
➢ Exteriorization is more difficult
➢ Closure is more difficult
➢ Alternative to standing laparatomy
➢ Same Layers to standing laparatomy
(D) Recumbent Ventrals Approaches:
a) Recumbent ventral midline celiotomy(RVMLC)
b) Recumbent ventral paramedian laparatomy(RVPML)
c) Recumbent Ventrolateral laparatomy(RVLL)
Compared With Standing & Recumbent Laparatomys:
Indicated:
▪ Excellent exteriorization
▪ Incision is not visible in a standing cow(Cosmetic incision)
Contraindicated:
▪ Wound infection due to ventral incision location
▪ Herniation/evisceration due to ventral incision location
▪ A three-layer closure is a must(by an everting interrupted
horizontal mattress pattern)
Layers Incised
▪ Layers(RVPML & RVLL):skin, the external and internal rectus
abdominis muscle ,peritonium , omentum and uterus.
▪ Layers(RVMLC):skin, linea-alba,peritonium,omentum and
uterus
VIII.Pre-operative Procedures
A. Restraints
B. Equipments
C. Surgical field preparations
D. Drugs
A. Restraints: crush/chute & rope and sedatives. Avoid Sedation,
if necessary , xylazine – IM or IV (0.05-0.1 mg/kg)
B. Equipments(sterile): scalpel blade & handle,scissors
,foreceps, needle(suturing & treatment), suturing material
(absorbale & non-absorbable),gauze ,glove ,plastic sleeve,etc.
C. Surgical field:
➢ Washed & shaved: In flank incision from transverse processes to
milk vein and from last rib to tuber-coxae.
➢ Apply 7.5% povidone-iodine.
➢ Sterile drapes should be applied etc.
D. Drugs
1) NSAIDs/analgesics
2) Antibiotics: Recommended if any vaginal manipulation or
prolonged dystocia , due the cervix is open and uterine
fluids are contaminated. Timing is important to ensure the
drugs are at high concentrations at the time of surgery .
3. Anesthesia Locale(Types of Local Nerve blocks): a
line or inverted-L is required for an oblique incision as the
paravertebral will not cover the ventral aspect. all the
following are reasonable options:
i. Epidural
ii. paravertebral block
▪ Proximal paravertebral block
▪ Distal paravertebral block
iii. Inverted-L block or line block
i. Epidural: can help minimize straining if the cow is actively in
labor. Use 2-8 mg/kg BW or 5 ml of 2% lidocaine , in the
sacrococcygeal space (the most movable space when the tail is
pumped up and down). A 1.5″ 18 gauge needle is inserted in
that space at a 45o angle toward the tail.
ii. Paravertebral anesthesia(Figure-17&18):
▪ Proximal paravertebral block: For this block, the spinal nerves
T13, L1 and L2 are blocked directly as they exit the spinal cord. At
each site, ~20 ml of lidocaine is injected. A 1.5″ 18 gauge Needles
are inserted above the transverse processes T13, L1 and L2 and
walked off the dorsal margin of each bone.
▪ Distal paravertebral block: This block is also aimed at spinal
nerves T13, L1 and L2 but is coming at them from a more distal
position. As the nerves traverse caudally, the injection sites are at
the tips of L1, L2 and L3. At each site, 10-20 ml is injected.
Figure-17
 Figure-18

iii. Line block or inverted-L block: An 18-gauge x 1.5-inch

needle is used to administer 2% lidocaine hydrochloride at several
sites . At each point, 5 ml subcutaneously in each direction of the
incision line and 10 ml into the musculature About 80-100 ml
(total) of lidocaine is required(Figure-19).
Figure-19: inverted-L block
IX.Post-operative Procedures
a) Care to Calf:
▪ Calf should be dried and navel dipped with iodine
▪ Administration of colostrum
▪ Introduce the calf in front of dam to form a maternal bond
b) Care to dam:
▪ Oxytocin 30-50 IU should be administered
▪ 300- 450 ml Calcium Borogluconate
▪ Antibiotics are continued for 3 to 5 days
▪ NSAIDS drugs for 2 days
▪ Skin sutures removed after 2-3 weeks
▪ Postnatal examination of the genital tract
▪ Insemination preferred after 60 days postpartum
c) Complications: Peritonitis, hemorrhage, metritis,
retained fetal membranes, vaganitis, mastitis ,uterine
prolapse, suture abscess, herniation, infertility.
d) Success rates: Maternal survival rates following
caesarean operation in most of surveys report ranges
from 90- 98%.
e) Postoperative fertility: Conception rate ranged
from 48-80% compared with 89% after normal calving.
Increased incidence of abortion, hydrallantois and
failure of the cervix to dilate at the next parturition.
X. CONCLUSIONS AND
RECOMMENDATIONS
➢ There are several surgical approaches for cesarean section in a cow
with each its relative advantage and disadvantages.
➢ However, most surgeons use a standing left paralumbar
laparotomy. But the standing left oblique approach is preferable
under most circumstances because the uterus is readily
exteriorized, limiting peritoneal cavity contamination.
Paralumbar approach is not recommended for the removal of
emphysematous fetuses rather ventral midline celiotomy
is the only best approach.
➢ RECOMMENDATIONS: Veterinarians should have to consider
alternate surgical approaches during cesarean section depending
on the circumstances for a better outcome of the surgical
procedure.