caesarean section in cow, mare, ewe, bitch

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Historical development and procedure of caesarean section An assignment on Submitted by: Dhiren B. Bhoi Reg. No.-03-0303-07 Submitted to: Dr. G. M. Siddiquee Professor and Head, Dept. of Clinics

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ORIGINS OF OBSTETRICS ‘Obstetrics’ is a Latin word; meaning:- midwife. It is thought to derive from obstare (to “stand before”), because the attendant stood in front of the woman to receive the baby. First successful caesarean section was performed by an Irish midwife, Mary Donally, in 1738 in the Britain. Drife, 2002

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Instrumental delivery was restricted to stillborn babies and involved the use of hooks, destructive instruments, or compressive forceps. Such instruments were described in Sanskrit texts and were known in Arabia, Mesopotamia. This probably carried a high maternal mortality Drife, 2002

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“Susruta Samhita” is earliest known work dealing with surgery. Dhanvantari made great improvement in general techniques of surgery and performed many new and major operations. Almost all surgical aspects were dealt in ancient medical veterinary treatises. However, anaesthetic techniques are not mentioned. Surgical treatment of animal disease was very much developed during Vedic period. Somvanshi, 2006 History of Surgery

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Anesthetic properties of chloroform were discovered by James Young Simpson and first employed in deliveries in 1847. Various techniques of surgical operations along with instruments have been dealt in detail in Shalihotra’s and Palakapya’s works. Ether was first used in labor in Boston in 1847 and popularized by New England obstetrician Walter Channing (1786–1876). Somvanshi, 2006

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Caesarean Section A process in which the fetus is surgically removed from the dam during parturition by making a large incision on the abdomen. Definition The name “caesarean” is probably derived from Julius Caesar. It is also known the Latin word ‘caedere’, means ‘to cut’. The term‘section’, probably has its origin in the Latin verb secare/seco, meaning “to light, strike, or reach,” or “to cut into, separate, divide, or part”.

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Sänger argued that operative complications from cesareans would occur less frequently if the myometrium were closed and an effort made to avoid spillage of intrauterine secretions into the peritoneal cavity. His procedure featured a meticulous, water-tight approximation of the uterine wound, employing buried sutures. Exteriorization of the uterus was practiced. But this procedure didn’t include the suturing of the uterus. Drife, 2002

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After 1882, closure of the uterus was finally recognized as both a feasible and necessary part of cesarean technique. H.R.Storer, of Boston, first performed a cesarean hysterectomy in 1868, on a woman with a leiomyoma that obstructed birth. Cavallini and later Porro had experimented pregnant hysterectomy in animal models in 1878. Cavallini had operated on dogs and sheep; Porro had used rabbits. Each had proved to his satisfaction that, uterus was not necessary for life and that its surgical removal was technically possible. Drife, 2002

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Following careful hand washing with carbolic acid, Porro performed a classic cesarean by a midline abdominal incision. The patient under chloroform anesthesia. After delivery, an iron-wire snare was passed around the uterus. Uterus was then amputated and the remaining cervical stump was bought out of abdomen through lower end of midline incision. Drainage tubes inserted & abdominal wall closed with silver-wire. The sutures were removed on the seventh day. Technique of Porro’s Operation Gupta, 2008

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After 1882, cesarean without hysterectomy popularized by Sänger. By twentieth century, Porro operation had been entirely superseded. Improved anesthesia and new surgical methods introduced. In recent years, availability of potent uterotonics & broad-spectrum antibiotics, development of embolization techniques & methods of vessel ligation have reduced the mortality among the animals. In recent decades, additional modifications in cesarean operative technique have been introduced, e. g. blunt dissection, ligation by quatorization. Uzoigwe and Jeremiah, 2006

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New and less tissue reactive suture materials are now available. The standard methods for opening and closing of fascia and uterus also changed. Replacing traditional sharp entry by techniques of blunt dissection. Marked change didn’t occur in cesarean technique in last 75 years. Although, new antibiotics, anaesthetics and aseptic surgical attempt resulted into a success. Samuel and Glezerman, 2003

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The first caesarean section of modern times is attributed to a Swiss sow by Jacob Nufer, in 1900. The first successful caesarean section in the sheep performed by Lukacs in Hungary in 1908. Veterinarians of the 19th century performed caesarean sections, usually on small animals, but the procedure was done on cattle only sporadically before World War II. By 1950s, however, caesarean on cows become commonplace. Somvanshi, 2006

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Caesarean section in Cattle Indications - Inadequate cervical dilation- Abnormal pelvic bone conformation (shape) in the cow- Rupture of the cow's abdominal musculature- Improper uterine position or function- Abnormalities of the uterus or vagina- Abnormal calf position that is uncorrectable in vagina- Fetal monsters- Presence of a dead fetus.  - Fetal oversize - Fetal emphysema Campbell and Fubini, 1990

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surgical approaches for cesarean section --Standing left paralumbar celiotomy, --Standing right paralumbar celiotomy, --Recumbent left paralumbar celiotomy, --Recumbent right paralumbar celiotomy, --Recumbent ventral midline celiotomy, --Recumbent ventral paramedian celiotomy, --Ventrolateral celiotomy, --Standing left oblique celiotomy. Selection of an approach should be based on the type of dystocia, the cow’s condition, the environmental conditions, the availability of assistance, and surgeon’s preference. Loren et al, 2008

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Standing left paralumbar celiotomy. The placement of the incision is indicated by the dashed line. Recumbent ventral midline celiotomy and recumbent ventral paramedian celiotomy.

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The proper positioning of the cow and incision site for the ventrolateral celiotomy. Standing left oblique celiotomy.

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Anaesthesia --Generally caesarean section in cattle is performed under the local infiltration anaesthesia using 2% lignocaine hydrochloride, --Local infiltration technique depends on the surgical site, epidural block is also used depend on the condition and the degree of straining. Judd, 2003

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Surgical Technique Preparation of the Surgical set and washing of hand, Preparation of the site, Apply betadine iodine on the site, A large bold incision is made into the abdomen, Control the bleeding, ligation, Follow a blunt dissection, Cut a facial layer, and two muscle layers, Reach to the peritoneum, Hold the peritoneum and make a stab incision, Let the peritoneal fluid to drain, and open it, Roberts, 1982

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Cont… Try to reflect the omentum, Reach to the gravid uterus and exteriorate it, Palpate the fetal parts, Apply a sterilized drap on it Make an incision on uterus avoiding injury to a fetus, Hold fetal legs and gently remove it. Avoid intra-peritoneal contamination, Hold the incised uterine edges, Remove the fetal membranes gently if possible, Remove the uterine fluid, Roberts, 1982

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Wash it with the normal saline-3 times, Start suturing the uterus with Lambert followed by Cushing suturing technique in a double layer using #1 catgut. Suture the peritoneum using #1 catgut, by lock stitch or simple continuous method. Suture two muscle layers separately using #2 catgut by lock stitch or simple continuous method. Apply some antibiotic powder in-between 2 muscle layers. Suture skin layer with a cotton thread using horizontal mattress method. Cont… Roberts, 1982

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Preparation of the site

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Surgical site

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Bold large incision is made on abdomen

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Blunt dissection of the muscles

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Approximation of the uterus and incision on it

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Gentle traction of fetal legs

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Gently remove the fetus, holding its limbs

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Removal of the placenta avoiding bleeding

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Muscle suturing

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Care of newborn

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Post operative treatment and care Give a broad-spectrum antibiotic, Analgesic, Anti-inflammatory drug, Anti histaminic, For 3-7 days, Oxytocin, 100 IU, Glucose 5%, Haemostatics if necessary, Give laxative feeds, Daily dressing of a wound, Roberts, 2004

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Method:I-Joel-Cohen method for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. Method 2:Pfannenstiel incision, in which the uterus is sutured in two layers, and both peritoneal layers sutured. (Stark et al, 1995)

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Caesarean Section in Mare Indications are similar to that of the cows. Surgical site In Europe, the incision is often made low in the left flank because the ceacum occupies the right flank. In America, veterinarians generally make an incision along the mare's midline because no muscles are encountered, the area has fewer blood vessels, and the surgeon has easy access to the uterus. Arthur et al, 1989

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Anaesthetic recommendations -Ketamine 1.5 to 2.0 mg/kg is used for anesthetic induction. -Xylazine is preferred over a promazine derivative as blood pressure is less likely to be depressed. -Dosage of Xylazine: 0.25-0.5 mg/kg IV or 0.5-1.0 mg/kg IM. -Once anesthetized,it should monitored as it becomes recumbent. -Morphine can be administered intraoperatively to decrease surgical and postoperative pain at a dose of 1 mg/kg . -Surgical site is prepared in a same way as in cattle and lignocaine is given for local infiltration. Othick and Stashak, 2004

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Surgical technique -A large bold incision is made on the prepared site -Cut the muscle layers and peritoneum, -Reach to the uterus, -One surgeon puts a hand into incision, -locates uterus Palpate the fetal parts, -An incision then is made on the uterus -locate the foal's legs -foal is pulled out through incision by its hind legs -Suturing is done in a same manner as in cattle. Othick and Stashak, 2004

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Complications With advances in surgical techniques, prognosis for the mare is good, Risks for contamination, infection, abdominal hernia. In the past, a major complication was death from hemorrhage within 24 to 48 hours of the surgery. Retained placenta occurs in 30% to 50% of mares, Conception may be slightly lower than average,

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Adhesions may develop between the uterine incision, the abdominal wall, and the peritoneum. Foal: side effects from anesthesia and sometimes a lack of blood flow and oxygen to foal from the placenta during delivery. In some cases, a foal may suffer lack of oxygen to brain, resulting in permanent brain damage. Cont… Othick and Stashak, 2004

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Caesarean section in Bitch Indications Correction of dystocia---Maternal ---Fetal Primary uterine inertia Incomplete cervical dilatation Inguinal hernias containing a portion of uterus General debility & inanition make parturition impossible This condition is mostly seen in toy breeds Dystocia in the brachycephalic breeds of dogs with large heads and small pelvis, such as Boston and other bulldogs, Pekinese, boxer, and pugs. Breed predisposition

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Anaesthesia The drug of choice is usually of small dose, ¼ to ½ gr. of morphine and 1/100 to 1/150 gr. of atropine. About 40 min later 1/20 to 1/10 gr. of apomorphine is given after the operative site has been prepared ether, fluothane or methoxyflurane is administered until the surgical stage of anaesthesia is produced. In extremely toxaemic or debilitated dogs, some ataractics & local anaesthesia in preference to the general anaesthesia. Pentobarbital is contraindicated --depressant effect on live fetuses Kilde and Soma, 1968

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Surgical site Incision is made on flank at an oblique angle parallel to last rib. Some prefers left flank incision 3-5 inch. long parallel to spine and beginning 1-1/2 inches behind the coastal arch and 1-1/2 inches above the mammary glands. It provided better access to the uterus, & scar is less noticeable. Midline incision or linea alba incision, Leonard, 1950 and Roberts, 2004

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Surgical technique All aseptic precautions are mandatory, The skin and muscle layer is bluntly dissected, Approach the uterus, & make an incision at the bifurcation. Fetuses are hold and removed by gentle traction, Uterine suturing:- #1 catgut by single layer Lambert suture, Muscular layers:- #1 catgut by simple continuous method. Roberts, 2004

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Prepared surgical site Skin incision

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Checking the bleeding if any Muscle incision

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Uterine Exteriorization Exteriorized Uterus

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Uterine incision First pup is removed along with placenta

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Surgically removed pup Skin suture

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Care of newborn pup

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Caesarean section in Ewe and Doe Surgical site:- ---preferred through the flank, through the ventral abdominal wall between the linea alba and the subcutinious abdominal vein, ---midline incision. Anaesthesia:- ---chloral hydrate or a combination of chloral hydrate and pentobarbital ---Tranquilizers and local or paravertebral anaesthesia can be used if the fetus(es) is/are alive. Sabrina et al, 2004

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Surgical technique Surgical technique and Suturing methods are as similar as in cattle Post-operative care Give laxative feeds Antibiotic, analgesic, antihistaminics for 3-4 days. Daily dressing is advisable. Sabrina et al, 2004