UTERINE TORSION: UTERINE TORSION By -TOUQEER AHMED UTERINE TORSION: UTERINE TORSION Torsion of uterus is the rotation of pregnant uterus on its longitudinal axis. Contd..: Contd.. Rotation of uterus may cause narrowing to complete obstruction of the birth canal. When this occurs the calf is unable to enter the cervix and therefore the cow will not enter Stage 2 of labor. It is observed more commonly in multiparous and advanced pregnant animals. Slide 4: There is vascular compromise which render the uterine wall Congested and fragile. Delay in diagnosis results in the delivery of dead foetus since hypoxia can result from placental separation, due to venous congestion,even if the membranes have not ruptured. Slide 5: Severe vascular congestion of the uterine wall PREDISPOSING FACTORS: PREDISPOSING FACTORS In cases of sudden fall, sudden push from other animal and bumpy movements during transportation, the fetus in advanced pregnant uterus may respond with violent movements exposing unstable pregnant uterus to torsion. Reduced amount of amniotic fluid leads to decrease in distance between fetus and uterine wall. Fetus feels abrupt movements of dam as a painful stimulus and in response, performs strong reflexive movements which may cause the rotation of uterus. Contd..: Contd.. Reduced amount of amniotic fluid also decreases the size of uterus which allows free intra-abdominal movement of uterus. During pregnancy, there is a relatively small increase in the length of the broad ligaments causing the uterus to curve around the point of attachment.This anatomical arrangement permits an increased uterine mobility in late gestation and predispose to development of a uterine torsion . Contd..: Contd.. Swimming in water is considered the most common cause in case of buffaloes. While lying down, buffaloes go down on fore legs first and while getting up, the hindquarters are elevated first, thus each time, the pregnant uterus is temporarily suspended in the abdominal cavity and is prone to torsion. PATHOGENESIS: PATHOGENESIS The twisting of the uterus makes a pressure on the middle uterine vein which results in disturbances in the venous circulation and increases the CO2 tension in foetal blood. As a result the foetus makes vigorous movements and this aggravates the condition and causes the uterus to be turned more to a severe degree. Contd…: Contd … This presses upon the middle uterine artery and decreases the O2 going to the foetus . If the case is neglected the foetus dies and may undergo emphysemation or mummification. Clinical signs.: Clinical signs. Colicky pain. Arching back. Straining Kicking at abdomen. These symptoms disappear after few days and the animal suffer only from anorexia. NOTE - These signs should not be confused with a case of simple digestive disorder. DIAGNOSIS: DIAGNOSIS Methods History : It would reveal as if calving was eminent but without true labor pain, uneasiness, restlessness, kicking at abdomen etc.. External examination : Weak and rapid pulse, depression, low body temperature, haemorrhagic symptoms like anaemia,weakness etc. Dx….: Dx …. The dorsal commissure of vulva may be pulled forward and to left or right. Fig: Twisting of the vulva due to right uterine torsion. Dx….: Dx …. Per vaginal examination : It reveals spiral twisting of vaginal wall and stenosis of vagina. Rectal examination : It would reveal that one side broad ligament pulled strongly downward and under the twisted uterine body and cervix and the opposite broad ligament pulled tightly across over the uterine body and cervix. Tightly stretched middle uterine artery and twisting of uterus. Slide 15: The relative portion of the broad ligament is diagramed for A) 180 degree right (clockwise) uterine torsion (lower left) B)180 degree left (counter-clockwise) uterine torsion ( lower right). TREATMENT: TREATMENT Two types: Non-surgical. Rotation of foetus and uterus when hands may pass through the twisted portion (for lesser degree torsion). Rolling of dam (very fast). Rolling of dam using plank (Schaffer’s method). Surgical. Laparohysterotomy (Caesarean Section). Rolling : Rolling Rolling in the laying position in the direction of torsion is indicated if the buffalo is recumbent and the fetus can not be reached due to the location or severity of the torsion, or if the animal is pre-parturient. Sharma’s modified Schaffer's method: Sharma’s modified Schaffer's method This method was designed for buffaloes due to their thick skin which causes skidding of plank during detorsion of uterus and their pendulous abdomen which warrants greater pressure for fixation of pregnant uterus. Schaffer's method…: Principle is to rotate the dam to the same degree and direction to which the uterus has rotated, keeping the fetus fixed by fixing uterus with a plank (length: 11.9 feet, width: 9 inch and thickness: 2 inch). Schaffer's method… Principle: Schaffer's method…: A) Three assistants are standing on the lower end of plank and another assistant is ready to press the upper end of plank, B) and C) while the buffalo is being rolled, two assistants fix the lower end of plank, one assistant moves upon the plank and other assistant modulates the pressure on the plank by pressing the upper end of plank. Schaffer's method… Procedure: Caesarean: Caesarean Caesarean is usually attempted when All other methods of detorsion had failed. There is failure of complete cervical dilatation subsequent to successful detorsion . The uterine and cervical tissues in the vicinity of the torsion have become extremely friable and may subject to rupture when traction is applied THANKS..: THANKS..