3Stage 1: Visible signs Seeks out isolation Thick clear mucoid vaginal dischargeSigns of abdominal colicRestlessnessCan last 2-6 hoursYou will NOT know clinically when this startsIf a cow is restless >6hrs, check her. Start worrying about reasons why she’s not going into 2nd stage: breech, uterine torsion, hypocalcemia, uterine rupture-twins.
4Stage 2: expulsion of the fetus Entrance of the fetus into the birth canalStimulation of oxytocin releaseRupture of amniotic and allantoic sacsPGF2-alpha stimulates Relaxin (prepares the birth canal/loosens connective tissue)E2 stimulates mucous secretion-lubrication of the canalFetal feet/head –pressure on fetal membranes causing rupture of water sacsCalf becomes hypoxic after rupture which increases calf movement and contractions
5Stage 2: expulsion of the fetus Increasing uterine and abdominal contractionsStage 2 should last no longer than 1 hour
6Stage 2: Visible signs Rupture of the “water sacs” Amniotic sac and feet are visible at the vulvaIncreasing frequency of abdominal contractionsExpulsion of the fetus1st: contractions every 3-5min. Then every 1 ½ minutes
7Stage 3: expulsion of the placenta Detachment of chorionic villi from the crypts on the maternal side of the placentaDue to vasoconstrictionUsually occurs within 3-8 hours of parturitionAlthough broken into stages this is a continous process
15Causes of Dystocia Hereditary Nutritional (fat heifers, excessive fat in pelvis)Management (breeding large bulls to small cows, breeding too soon after partrition)Hereditary anatomical defects of the repro tract: vulvular hypoplasia, 2 uteruses
21Maternal Causes Pelvic fractures Breeding heifers too young Hereditary or congenital hypoplasia of the birth canalexamples
22Parturition Intervention Guidelines Stage I of labor > 6 hours and cow/heifer has not begun to abdominally press.Stage 2 of labor > 2-3 hours and progress is very slow or absentAmniotic sac has been visible for 2 hours and the calf has not hit the ground
23Dystocia Watch Intervals < 3 hours intervals is required to determine length of duration of the stages of parturition.
24Equipment required for obstetrical exam Twine or robeNovasan or betadine scrubBucket or bottle of warm waterSterile lubePalpation sleeves
25Obstetrical Equipment for Pulling a Calf Same equipment required for obstetrical exam plus:
28Cont. of obstetrical equipment for calf pulling Head snareEpidural Equipment2 % lidocaine6 cc syringe18 gauge 1.5 inch needle
29Obstetrical ExamFill clean bucket with betadine or novasan solution diluted with warm water to either a “weak tea” solution or a light blue solution respectively.
302. Place obstetrical chains and handles, tube of sterile lube and head snare into the bucket.
31Clean the perineal region with a betadine or novasan scrub followed by a clean warm water rinse. Minimum of 2- 3 separate scrub/rinse cycles
32Put on 2 clean plastic OB sleeves. Lubricate both arms with sterile OB lube
33Examine the birth canal for dilation and size of the pelvic opening. Manually dilate the birth canal if needed
34Examine cervical dilation and structures in the birth canal
358. Examine uterus and birth canal for prior damage.
369. Evaluate position, presentation and posture of the calf and/or calves.
37Evaluate calf or calves viability Withdrawal reflexCorneal/palpebral reflexSuckle and tongue withdrawal reflexesAnal sphincter reflexHeartbeat felt through chest wall or umbilical artery pulse
38Methods of Correcting Dystocia Live Fetus Options:MutationForced ExtractionCesarean SectionDead Fetus Options:MutationForced ExtractionFetotomyCesarean Section
39Mutation Repulsion: Rotation: Version: Reposition of Extremities Moving from dorso-pubic or dorso-ilial to dorso-sacral positionVersion:Turning the fetus end-for end (i.e. on a transverse axis)Reposition of Extremities
40Minimum Goal of Mutation Reposition the calf into a dorso-sacral positionCalf’s front legs extended cranially and hind legs extended caudally in perspective to the calf’s body.
41Guidelines for Mutation Abnormalities in presentation, position, posture should be diagnosed and corrected prior to attempting traction.
42When the fetus is dead and repositioning is difficult or dangerous, other options should be consideredPartial or complete fetotomyCesarean Section
43Maximum of 30 minutes of mutation without progress warrants c-section or fetotomy.
44Types of Mutation Dystocias Retention of Front LimbRetention of Rear LimbRetention of the HeadIrregular Presentation or Position“Dog-sitter”Uterine TorsionTransverse Presentations
45Types of Limb Mutation Dystocias Front limbFlexed shoulder postureFlexed carpal postureElbow lock postureFoot-nape postureHind LimbHock flexion postureHip flexion posture
46Flexed Carpus manipulation Convert flexed leg to flexed carpus posture by traction on the upper foreleg if the shoulder is flexed.Apply simultaneous repulsion to the carpus in an anterior-dorsolateral direction and traction on the hoof in a medial and posterior direction
47Elbow Lock PostureOccur when forelimbs are not fully extended as they come into the pelvic inletPresentation:Tips of toes are even with the end of the calf’s noseCorrection:Repulsion on the fetal trunk and simultaneous alternating traction on the limbs
48Flexed Hock Manipulation Convert the flexed hip to a flexed hock postureApply hand traction high on the leg working your way distally until the hock is reached
49Place 1 hand on the hock while simultaneously placing a second hand over the hoof. Move the hoof posteriorly and medially into the birth canal as repulsion is applied in an anterior-lateral direction on the hock.
51Dystocia due to Retention of the Head Lateral deviationMost commonVentral deviationDorsal deviationVertex posturebride of nose is impacted against the brim of the pelvis causing the poll to be presentedFetus is often dead
52Head-Breast Posture Correction of ventral deviation of the head ProcedureRepel 1 forelimb to the flexed shoulder postureBring the head up from beneath the body of the fetusFlexed shoulder is converted to normal posture using the flexed carpal manipulation
54Correction of Lateral Deviation of the Head Repulsion of the shoulder, thorax, or brisket with concurrent traction on the headSources for Traction on the Head:2nd handJaw snare: beware of jaw fractures-head, jaw or orbital hooks
55Irregular Presentation or Position “Dog-Sitter”Uterine TorsionTransverse Presentations
56“Dog-Sitter”Rear legs are extended along the abdomen of the otherwise normally presented fetus
57Correction of the “Dog-Sitter” Only attempt mutation if the fetus is small enough to allow palpation both hind limbs during extraction.Allows for the hind legs to be repelled and allows the uterus to be protected from the hooves as the rear legs straighten out during delivery.Otherwise, rear hooves may tear the uterus as they extend behind the fetus.
58Cont. Correction of “Dog-Sitter” 180 degree version to posterior presentation and rotation to dorso-sacral positionCesarean sectionEspecially with oversized fetusFetotomyImpacted fetus in the birth canal
59Uterine TorsionAlways examine uterus for torsion if fetus appears to be presented in a dorso-ilial OR dorso-pubic position.
60Uterine Torsion Findings Spiral folding of the birth canalSimulates incomplete dilatation of the cervixBroad ligaments of the uterus are rotated and stretches across the birth canal1 on the upper and 1 on the lower surfaceFelt via Rectal Palpation.
61Methods to Correct Uterine Torsion Shaffer method (plank in the flank)Rotate fetus in uteroCesarean Section
63Correction of Transverse Presentations Mutation is usually not attempted especially if presenting transverse dorsal.Rear legs sometimes perforate the uterus as they straighten if delivery is attempted by anterior presentationConvert to posterior presentation, dorso-sacral positionCesarean Section
64Monster Fetus DO NOT ATTEMPT TO MUTATE OR PULL CESAREAN SECTION IS REQUIRED
65Forced Extraction of a Fetus Which one has already prepared for prior to the initial obstetrical examinationi.e. obstetrical chains and hooks should already be in the bucket of dilute betadine or novasan solution.
66Do not give an epidural anesthetic unless it is absolutely necessary. Prevents dam from assisting delivery of the calf
67Forced Extraction in Anterior Presentation Placement of obstetrical chainsEyelets on the dorsal surface of the forefeet
69Traction Procedure especially if fetus is oversized Unilateral traction is applied to the bottom (most anteriorly located) forelimb until its shoulder and elbow are past the pelvic inletIt can usually be felt when the shoulder passes the ilium.Otherwise, assume that when the fetlock is ~10 cm (15 cm in larger breeds) outside of the vulva, the shoulder has passed through the pelvic inlet.
70Cont. Traction of oversized fetus (anterior presentation) Full-force unilateral traction is than applied to the top forelimb (hopefully by a 2nd person)Extraction is usually is possible if the 2nd shoulder also passes the ilium into the birth canalIf not, C-SECTION IS PROBABLY REQUIRED.Traction can be attempted with a calf jack but do not exceed force of 2-3 strong men.
74Rotation of the fetus takes advantage of the widest diameter of the pelvic inlet
75If Hiplock occurs . . . Discontinue traction Clean the mucus and membranes from the calf’s nostrilsStimulate breathingTickle the nostrilsPour cold water over the head of the calf
764. With hiplock apply traction only when the cow presses Continuous traction is generally unproductivePelvic inlet becomes functionally larger
775. Apply traction caudally and somewhat dorsally This direction of pull is more perpendicular to the pelvic inlet
786. Maintain rotation of the calf’s pelvis in a dorso-ilial position. Palpation along the back of the calf is required to ensure that the calf’s pelvis is rotated 60 to 90 degrees.
79Forced Extraction in Posterior Presentation Rotate the calf into the dorso-ilial positionApply OB chains to the hind legs in a similar manner as the front legsApply traction in a caudal, slightly dorsal direction to bring the calf’s hips through the pelvic inlet.
80Cont. Forced Extraction in Posterior Presentation Rotate the calf back into a dorso-sacral position once the rear quarters have passed the pelvic inletApply slightly caudal, ventral traction
81Calf Jack Can be used with either posterior or anterior presentation NEVER APPLY MORE FORCE THAN WHAT 2-3 STRONG MEN CAN APPLY
82Cesarean Section Approaches: High left flank Low left flank Left paramedianHigh right flankLow right flankRight paramedianVentral Midline
83FetotomyShould only be performed in the dead fetus
89Injury to the CalfDystocia and excessive force used in extraction are associated with damage to neural, skeletal, and visceral structures.
90Asphyxiation and Anoxia Rupture or impaction of the umbilicus during manipulation necessitates rapid extraction to prevent anoxia and potential brain damageComplications more frequently associated with posterior presentationPosterior presentation: improper dilation of the birth canal and inhibition of complete delivery
91Femoral Nerve Paralysis Often associated with prolonged hiplock during extractionHyperextension of the femur, severe stretching and compression of the mm and nn of the upper HL; neurogenic m atrophy
92Nerve DamageInjury to the femoral n most commonly assoc w/ severe stretching of the n and assoc mmWill discuss later injury to the L6 spinal n rootcalving paralysis
93FracturesFracture of the mandible due to inappropriate use of obstetrical chains
94FracturesPlacement of obstetrical chains with one loop over the fetlock and a half-hitch around the pastern will better distribute traction and prevent injury to fetal limbs
95FracturesExcessive traction may also result in fractures of the pelvis or ribs, as well as injury to the joints and spine
96Complications Associated with Posterior Presentation Pulmonary hemorrhage, diaphragmatic hernia, and liver rupture may be caused by excessive traction on the fetus in posterior presentation
97Injury to the DamDystocia and excessive force used in extraction associated with calving paralysis, retained placenta and uterine prolapse, trauma to the birth canal or uterus
98Calving Paralysis Paresis or paralysis of the cow Damage to peroneal and obturator nervesMay be caused by prolonged hiplock or excessive force used in its resolveL6 spinal rootsciaticperoneal
99Retained PlacentaDirect association with abortion, twinning, dystocia, cesarean-section, and fetotomy.
100Uterine ProlapseAssociated with dystocia and irritation of the external birth canalComplicated by environmental insult—freezing, drying, severe laceration
101Trauma to the Birth Canal Tears and lacerations:Vulvar, vaginal and cervical tears, recto-vaginal fistula or perineal lacerationForelimbs may be forced through the dorsum of the birth canalHematomaVaginal necrosis
102Uterine Ruptures or Tears Associated with prolonged dystocia, uterine torsion, and excessive repulsion or rough manipulationTears most commonly occur in the ventral uterine wall
104Dam number 1025Saturday, April 6: calf presents breech, calving difficulty 5 and 8, calf does not survive extractionMonday, April 8: dam found dead, presented for necropsyAt least 3 other dystocia/pulls that day (score 8); good temperament of dam; first calfCowboys believed that the inner os was not fully dilated
105PeritonitisExamination of the abdominal cavity reveals a considerable volume of bloody fluid and fibrinNo evidence of frank clotting to indicate involvement of a major vessel
106Petechiation of the Heart Indicative of an acute/agonal incident or a septic insult
107Dorsal Uterine Tear Full thickness, approximately six inches long Suspicion of uterine torsion due to dorsal orientation of the tear—could “inner os” have been uterine tissue?
108Ventral Uterine TearPartial thickness, approximately three inches long with associate mucosal/ sub-mucosal hemorrhage
109Fetal LungsAppearance of the lungs indicated the calf had taken a breathSome evidence of limb contracture + breech presentationRotation of fetus w/i the uterus during mutation
111Economic Implications of Dystocia Things to consider:-Dam Value-Live Calf Value-Cost of Veterinary InterventionNow we will discuss the economic implications of dystocia management decisions.We must consider the present and future value of the dam and calf against the cost of veterinary intervention or any other calving management decision, such as using EPD sires, vaccinations, heifer selection and purchase, and pelvic measurements.In this section, we will consider both beef and dairy production.
112Dam Value Dairy cows (Holstein) - Replacement of Mature Milking Cow: $- Replacement of Springing Heifer:$- Lactation and Genetic PotentialFirst, we will look at the value of the dam on a dairy.These figures indicate the cost of replacing a mature milking cow and replacing a springer heifer. Obviously, there will be a higher incidence of dystocia in the heifer group, so this value is more relevant here.Also to be considered are the future values of these females, such as lactation income and their genetic potential, which would be estimated by some as priceless.
113Dam Value Beef Cows Purchase of Replacement Heifer: $850-900 Rearing of Replacement Heifer: $Seedstock GeneticsNext, we will consider the value of the beef heifer. Listed here are the estimated costs of purchasing or raising a replacement heifer.In the beef situation, you do not have the lactation income potential, but in a purebred seedstock operation, you again have the potentially unmeasurable value of the genetics in that animal.
114Live Calf Value Dairy Calves - 1 day old heifer calf: $500-700 - 1 day old bull calf: $Now we will begin to look at the value of the offspring on dairy and beef operations.There will be some differences in the way the values of these animals are stated due to the differences in the way beef and dairy animals are marketed.For the dairy heifers, they may be taken to the salebarn at one day of age and sold for dollars, while the bulls bring considerably less.You may also take into consideration the rearing of those heifers and sale of them for dollars or the use of them as replacement heifers in the parent herd with potentially positive genetic and lactational implications.
115Live Calf Value Beef Calves - Feeder Futures for January, 2003 - $79/cwt x 700# = $553In valuing beef claves, I looked at the futures market to market calves born now as feeder calves in January of next year. Of course, this will not be pure profit in the rearing of this calf, with costs incurred including an average of $150 to get him from weaning to feeder size.There is also the consideration of the rearing of replacement heifers and their genetic potential.
116Even if you can’t save baby… Dairy Cow value post-calving- Lactation: 18,000# x $0.87/# = $15,666- This does not include cost of lactation- Salvage: $54.00/cwt x 1000# = $540- RebreedObviously these animals are valuable when everyone comes out of a dystocia alive. The important think to keep in mind is to save the lives of as many of the players as possible.Many times, the baby may be dead through no one’s fault. If this is the case, all efforts should go into saving the dam. She is the one who can now produce lactational income, raise another calf, be salvaged at the salebarn, or, if the dystocia gods are smiling, breed back next year. If she can come back next year, we have restarted her value and income potential cycle all over again.
117Even if you can’t save baby… Beef cow value post-calving:Raise orphaned or twin calf; RebreedSalvage: $60/cwt x 900# = $540Even if you can’t save baby…
118Producer Cost for Caesarean Section Survey of veterinarians- Average charge for on-farm dystocia ending in Caesarean section- $258.92For this section, I surveyed a group of cattle veterinarians and requested disclosure of caesarean section fees in private practice. The values I received and analyzed represented nearly every region of the United States and included trip fees, emergency fees, and supportive care.Most prices I received were within $50 of each other with only a few outlyers.The average caesarean section from the practices who were involved was around $260. While this seems like a large sum of money, we will see in a minute where it may be a valuable option.
119What is the bottom line? Dairy Producer: Heifer + Calf Alive = $2300 Plus Lactation ($15,000) and Genetics-Heifer Alive = $1800-Cost of Caesarean: $26011% of value of both at that timeHere, we review the animal values that I outlined in previous slides, compared against the cost of c-section to the producer. In a dairy, the average C-section is about 11% of the value of a live pair at the time of the delivery. The lactation and genetics are future values and are gross values.Also to be considered is that even if these females won’t breed back due to adhesions or other reproductive complications, and are culled at palpation time, they will continue to milk and produce income until the end of their lactation cycle.Also, cows frequently recover better from surgery than from a difficult pull. A recovered cesarean cow will generally have a better lactation cycle than even a partially paralyzed or torn heifer.
120What is the bottom line? Commercial Beef Producer: - Heifer and Calf Alive: $1403Heifer Alive: $850Cost of Caesarean: $260-18% value of bothThis is the same analysis of the value of the pair or live dam versus the cost of c-section. For beef animals, the cost of c-section is about 18% of the pair’s value.Now obviously, you can’t go to this expense for every pair. It would never be a good idea to purposely spend 10-20% of a pair’s value at Time 0 of their life together. Therefore, cesarean section is not a replacement for other dystocia management decisions, such as breeding to sires with calving ease EPDs, choosing replacement heifers wisely, etc.We cannot say that if you save the pair at parturition, you are guaranteed an income. Even if you save the pair, they may lost production value from other causes later on. What I can guarantee you is that if you lost them at calving, you are not going to make any money on them. So, what these numbers demonstrate is what you stand to lose if you allow a pair to die during a dystocia.
121ConclusionProducers should make dystocia management decisions before breeding occursWhen a dystocia presents itself , make your decisions based on what is best for the herd’s production goalsIf you need to intervene, do so with caution and think ahead about the effects of your actions on the pair’s future production
122Thank you to all the faculty and staff of GPVEC for contributing to our education.