A TWIST OF FATE By Amy Sanders Advised

A TWIST OF FATE By: Amy Sanders Advised by Dr. Jenna Bayne #52’s Case of a Uterine Torsion

CASE PRESENTATION OF #52 March 28 t h , 2014 7 years old Charolais Approximately 1000 lbs BCS 5/9 Full term Owner rectally palpated: § Uterus felt twisted § Fetus still was presumptively alive

WHAT IS A “TWISTED UTERUS”? Usually occurs at the termination of gestation (Gestation length 280 days) Prolonged Stage I Parturition No clear age or season predisposition Multiparous > Primiparous Commonly Reported Breeds: Brown Swiss, Holstein, and Charolais is a high-risk breed. Can be twisted CLOCKWISE or COUNTERCLOCKWISE Can range from 180 -720

WHAT IS A “TWISTED UTERUS”? Instability of the gravid uterus Small non-gravid horn Excessive fetal weight Broad ligament: Body vs. Horns When a cow lies down gravid uterus is suspended in abdominal cavity. a sudden slip or fall could cause the gravid uterus to twist Increased fetal movements during 1 s t -stage labor Decreased amounts of uterine fluid Flaccid uterine wall Confinement in stables for long periods can contribute FUN FACT: TWINS can PREVENT torsion

DO THE TWIST Normal Presentation Counter Clockwise (twisted to the LEFT) MORE COMMON Clockwise (twisted to the RIGHT)

CLINICAL SIGNS OF UTERINE TORSION Fever Tachycardia Tachypnea Anorexia Straining Vaginal Discharge

HOW TO DIAGNOSE WHAT WAS FOUND WITH #52 VAGINAL EXAM Twist will be caudal to cervix CORKSCREW EFFECT Torsion <360 may be possible to reach the cervix #52 had a 180 twist Fetal limb could be felt through the cervix: Upon stimulation of the limb there was no reaction from the fetus RECTAL EXAM Feel Broad Ligaments The Right Broad Ligament was stretched= COUNTER CLOCKWISE TWIST

HOW TO UNTWIST Manual Detorsion via Vagina Rolling the cow Detorsion Rod Cesarean Section

NON-SURGICAL CORRECTION: “PLANK IN DA FLANK” COUNTERCLOCKWISE TORSION § Lay in LEFT lateral and roll LEFT 360 CLOCKWISE TORSION § Lay in RIGHT lateral and roll RIGHT 360 Roberts, Stephen J and Hillman, Robert B. An Improved Technique for the Relief of Bovine Uterine Torsion.

NON-SURGICAL CORRECTION: DETORSION ROD Place chains as far up the limbs you can reach as possible Place chains through one eye on the bar Push into cow between calf limbs and start to hand twist until tight Place a bar in the outside eye and rotate.

SURGICAL OPTIONS: CESAREAN SECTION Uterus cannot be corrected by rolling Cervix does not dilate to sufficiently deliver the fetus Fetal proportion or anomalies prevent delivery of the fetus APPROACHS: § § RECUMBANT LEFT FLANK VENTRAL MIDLINE OBLIQUE PARAMEDIAN STANDING LEFT FLANK

PROS AND CONS OF STANDING LEFT FLANK PROS § The cow is standing so more comfortable for the surgeon § Closure Simplified CONS § Less exposure § Cow can go down § Peritoneal contamination

LEFT FLANK C-SECTION STEPS Pre-Op Treatment: § Epinephrine 10 m. L IM injection § Flunixin Meglumine (1. 1 mg/kg) 15 m. L IV injection § Florfenicol (6 ml/100 lbs) 90 m. L Subcutaneous injection Inverted “L” block with 250 m. L 2% Lidocaine Incision midway between last rib and the wing of the ilium ending approximately ten inches vertically, individually incising through: § § § Skin External Abdominal Oblique Internal Abdominal Oblique Transversus Abdominus Peritoneum

LEFT FLANK C-SECTION STEPS Palpate the uterus, pull limb § If forelimb: § Carpus to toe pulled out of incision site § If hindlimb: § Hock to toe pulled out of incision site Make vertical incision through uterus and placenta Remove calf and uterine fluid

CLOSURE Uterus § Utrect Pattern § Want an INVERTING pattern for luminal seal § Chromic Gut #2 § Cleansed with Sterile Saline solution around the incision site to reduce the chance of infection and reduce uterine fluid in the abdominal cavity IMPORTANT § Place uterus back into CORRECT position § The uterus was pulled to the left so then the uterus was pushed back into the abdominal cavity placing the right horn into the right abdominal space

CLOSURE Peritoneum, Transversus Abdominus, Internal Abdominal Oblique § Simple Continuous § Chromic Gut #2 External Abdominal Oblique § Simple Continuous § Chromic Gut #2 Skin § Fords Interlocking Pattern § Appositional § Nylon 3 ply

UNEXPECTED “TWIST” Dead Male Weighed approximately 100 lbs Fetal-maternal mismatch

THE FATE OF THE COW Can be good- worsens with time Depends on: § Severity of torsion § Systemic compromise Complications of the C-section can include: § § § Retained Placenta Metritis Incisional edema Peritonitis Infertility Adhesions

FATE OF #52

REFERENCES Pe arson H. Uterine Torsion in Cattle: A review of 168 cases. Veterinary Record 197 1: 597 -603. No ake s DE. Fertility and Obste trics in Cattle. 2 ed. Cambridge, MA: Blackwell Scie nce , 1997. Sch onfe lder AMa. S, Axel. C esar ean Section and Ovariohysterectomy After Sev ere Uterine Torsion in Fou r Cows. Veterinary S urgery 20 06 ; 35: 206 -210. Robert s, Stephen J and Hillman, Robert B. An Improved Technique for the Rel ief o f Bo vine Ute rine T or sion. Cornell Vet. 1973, 63: 111 -116 Youngq uist RS. Current Ther apy in Large Animal Theriogenology. Philadelp hia, PA , 1997. Za borsk i Review Facto rs a ff ecting dysotcia in cattle http : // www. vin. com/me m bers/proceedings. plx? C ID=WVC 2002&PI D=10 51&O=VIN http: // www. ve t. uga. e du/lam/t eaching/mueller/Female. Bov. U ro gen. swf http: //www. ncbi. nlm. nih. gov/p mc/articles/PMC 2275340/# ! po=60. 9375 http: //www. ncbi. nlm. nih. gov/p mc/articles/PMC 1687017/? page=1 http: // bo ok s. google. com/books? id=DYGUFOL i. GWk. C&pg=PA 50 &dq=uterine+tor sion +in +co w&hl=e n&sa=X &ei=c. Vx. HU 4 e. MMYnu 2 QWU 2 IHo. Cw&ved=0 CCs. Q 6 AEw. A A# v =on epage&q=ute rine %20 torsion%20 in%20 cow&f=false

A GREAT BIG “WAR EAGLE” THANKS God My Amazing Family Friends all over the country Dr. Jenna Bayne All the Large Animal Clinicians Food Animal Block Crew “You pick me up when I fall” Radiology Rotation Trimac Farm Sebastian and Colby