Food/Fiber Cesarean Sections

Uterine torsions

Uterine torsions are not uncommon in cattle and are relatively common in camelids. Horses are rarely affected, with uterine torsions causing colic early in the last trimester.

Camelids are theorized to develop torsions due to the uneven distribution of weight in the uterus and their tendency to roll when in a new environment. However, everything is just a theory.

Diagnosis

Uterine torsions are identified in cattle at the time of parturition. Labor does not progress. On examination, the vagina often has a noticeable twist and the cervix is usually closed.

Uterine torsions in camelids are identified anytime (or multiple times) in the last few weeks of gestation. The vagina may or may not twist.

Uterine torsions in horses are identified early in the trimester and are associated with abnormal rectal findings (and normal vaginal findings). The broad ligaments of the uterus may be palpably abnormal, with one extending over the top of the uterus and the other diving below. The rectum may be tighter than usual and may twist.

Treatment

Ideal treatment is nonsurgical and early in the process. Delayed therapy means constricted blood supply to the fetus and to the uterus. This can lead to death of the fetus or hypoxic babies. The uterus may rupture or necrose.

Detorsion rods

If the cervix is open, detorsion rods or manipulation of the fetus can be used to untwist the uterus. These methods can damage a compromised uterus.

Rolling

The dam is rolled to catch up to the baby (in the twisted uterus) while holding baby still. In camelids, the uterus is held in place with gentle hand pressure while the dam is rolled in the direction of the torsion. In larger animals, a “plank in the flank” is used to hold the uterus still. For this option, a long flat board is placed across the flank of the laterally recumbent animal. A person stands on the flank to hold the uterus in position while the dam is rolled in the direction of the torsion. This method is not advised in a compromised uterus.

Csection

If rolling doesn’t work or isn’t an option, Csection can be performed. Ideally the uterus would be detorsed prior to removal of the fetus; however, this can be challenging and works best early in the disorder. The uterus is rocked back and forth until enough momentum develops to carry it through the loop (like taking the swing over the top of the swing set).  This works better if fluid is still present within the uterus.

If the uterus cannot be detorsed, it can be very challenging to bring the uterus outside of the flank incision (to enable the fluids to drain out). If the cervix is still closed and the calf isn’t too deteriorated, this is less of a concern as the uterine fluid should be sterile. In this situation, it is generally okay if some uterine fluid is spilled while getting the calf out. Once the calf is out, it is relatively easy to hold the uterus in place for it to be sutured. After it is closed, detorsion is easy.

Resources

Uterine torsions in the bovine, a review, 2008 IP- lots of good details on potential causes, diagnosis, and treatment

A study of 55 field cases of uterine torsion in dairy cattle, 2008 CVJ – epidemiologic analysis of risk factors and intervention successes

Comparative study 2 detorsion methods, 2016 VA- a variant of the plank method (no plan); and camelids can act like cattle (torsion palpable vaginally) or like horses (not).

Vet student explanation– lots of images and literature review

Dystocia in camelids 2012 OJAS  – mostly about camels

Uterine torsion and Csection in llamas and alpacas, 2009 Sm Rum Research – nice review of pathophysiology and prognosis

Managing Reproduction Emergencies in the Field, 2021 VCNA Vol 37 pp 339-366-  preparturient disorders of mares and stallions

 

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.