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CESAREAN SECTION
Overview of the Condition
A cesarean section is an incision through the abdominal wall to deliver a calf or other animal. Cesarian sections, also known as C-sections, are necessary in adult dairy cattle when vaginal delivery is too difficult for the cow or could endanger her life or the life of her calf.
Indications for Cesarean Sections
C-sections are commonly performed when calves are oversized (too large), which is common when the heifer (first time mother) is immature, and for embryo transfer calves. Other indications include:
- Inadequate cervical dilation (not enough relaxation of the cervix muscles)
- Abnormal pelvic bone conformation (shape) in the cow
- Rupture of the cow's abdominal musculature
- Problems with uterine position or function
- Abnormalities of the cow's uterus or vagina
- Abnormal calf position that is not correctable in the vagina
- Fetal monsters
- Presence of a dead fetus.
Signs/Clinical Presentation
A general physical examination should be performed on the cow, including assessment of her heart rate, breathing, and temperature and to see if she is dehydrated. The mammary glands should be checked for infection, and ear temperature and rumen motility (digestive motion) are evaluated to see if she needs extra calcium. Usually more sophisticated laboratory tests are not necessary. Rectal and vaginal examinations are also performed (Figure 1). Cows that are severely dehydrated or straining may need intravenous fluids and an epidural (a nerve block), respectively, before proceeding with surgery. Most clinicians will recommend antibiotics and non-steroidal anti-inflammatory drugs. In some instances it may be possible to perform a fetotomy (vaginal removal of the calf's body) rather than a cesarean section if the fetus is dead. This is a decision best made by an experienced bovine practitioner.
Figure 1. A vaginal examination is performed by inserting a gloved arm into the vagina.
If a uterine torsion (a twisted uterus) is detected on physical examination it may be necessary to correct the torsion prior to delivering the calf. This may be done, without surgery, by rolling the cow around the uterus. To do this, the cow is cast in lateral recumbency (on its side) and a plank is placed in her flank to hold the uterus in place while the cow is rolled. A person stands on the plank to keep the uterus in position. If this is not successful, then the uterine torsion can be corrected at surgery either before or after delivering the calf.
Surgical Approach
The surgical approach for a C-section depends on the experience and preference of the surgeon, the temperament of the cow, and the facilities that are available and whether assistance is present or not. Most cesarean sections can be performed in standing cows. Surgery may be performed in lateral recumbency (with the cow on her side) if the cow is very ill or the calf is dead.
A relatively large incision is made into the abdomen so that one horn of the uterus can be exteriorized (brought to the outside) as much as possible (Figure 2). If the calf is in normal position, the hind limbs will be in the horn of the uterus. The uterus is carefully incised, chains are placed around the calf's limbs, and the calf is delivered (Figure 3). It helps to have assistants to lift the calf while the surgeon guides the delivery.
Figure 2. A large uterine horn is exteriorized from a cow that has been sedated and place in lateral recumbency.
Figure 3. Chains are placed around the calf's ankles to help deliver the calf.
Following delivery any placenta that is unattached is removed and the uterus is sutured closed. The uterus is then rinsed well and then replaced in the abdomen. Gloves, gowns, and drapes are changed and the abdomen is closed in a routine fashion.
Potential Complications of Surgery
Incisional complications can be quite common following cesarean section. If necessary, some of the skin sutures can be removed so that the area can drain. Another common problem is retained placenta. Most cattle will "clean" or deliver their placenta after 24 hours. Antibiotics are often given until the placenta has been passed. The cow should be watched for dehydration and mastitis (mammary gland infection) after a cesarean section.
When to Refer
Cesarean section is a procedure that can often be performed in the field. If there are complications, such as a severely devitalized (dead and necrotic) calf, or the cow or calf is extremely valuable, veterinarians may prefer to refer to an ACVS Veterinary Surgeon. Find a Surgeon
Prognosis and Prevention
Prognosis for recovery after cesarean section is generally favorable. To avoid C-sections, make sure the cow and bull being bred are of similar size and monitor cows carefully when they are close to delivery.
—Dr. Susan L. Fubini, DVM
Diplomate ACVS
Posted 8/21/2006
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