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Procedures Used in the Management of Dystocia

I. Resource Material
A. Reading Assignment
1. Arthur, et al, Chapter 9, The Approach to an Obstetrical Case, pgs. 184-192; Chapter 12 -
Manipulative Delivery per Vagina, pgs. 218-225; Chapter 13 - Dystocia due to Fetal
Oversize, Treatment. pgs. 236-240.
B. Other References
1. Roberts Chapter VIII - Procedures Preliminary to the Handling of Dystocias, pgs. 287-297;
Chapter IX - Obstetrical Operations for Relieving Dystocia, pgs. 298-324.
2. Current Therapy in Theriogenology, 1st Ed., 1980, Section V, Delivery by Forced
Extraction and Other Aspects of Bovine Obstetrics, pgs. 247-257.
3. Sloss & Dufty, Chapter Eleven - Procedures on the Fetus, pgs. 162-179.
4. Fetotomy in Large Animals by Bierschwal & de Bois, pgs. 9-37.
5. Society for Theriogenology, Proceedings of the 1988 Annual Meeting, pgs. 1-12.
C. Other
1. Syllabus
2. Objectives:
Given the above resource material and following a series of lectures, demonstrations and hands-on
experiences, the student will be able to:
1. Collect valid data for an animal with the primary complaint of "having difficulty giving
birth".
2. Discuss the preparation and evaluation of an animal presented with a dystocia.
3. List the methods that can be used to determine the status of a fetus in utero.
4. Discuss the prognosis in cases of dystocia.
5. Discuss the length of time that expires between the onset of parturition and death of the
fetus in the large domestic species.
6. Classify the instruments used in veterinary obstetrics.
7. Define and discuss the major classes of obstetrical operations.
8. Discuss the manipulative procedures that are utilized in the correction of dystocias.
9. Discuss forced extraction with emphasis on indications, contraindications and principles.
10. Define the common terms associated with fetotomy, and discuss the indications
contraindications and principles of the procedure.

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11. Describe the technique for the induction of epidural anesthesia in the cow and mare and
the indications for this procedure.
12. List Williams' three consideration factors for the salvage in cases of dystocia and the three
weight factors those considerations should be weighted against.
13. Discuss the immediate care of the newborn following delivery by outside assistance.
14. Discuss the aftercare of the dam following the correction of a dystocia.

Examination of the Animal with a Dystocia
Each case of dystocia constitutes a clinical problem which may be solved if a correct procedure is
followed. It is only after eliciting information from the owner or caretaker and after a methodical
examination of the animal that one can make a diagnosis which is essential in correcting the
abnormality to delivery.

History
As with all medical problems,it is essential that one obtain as much history as possible associated with
the case. This can be obtained at the time the preliminary examination and preparations for handling
the dystocia are being made. The history of the case as well as certain other information should be
obtained from the owner as well as by observations. This information should include the dam's age,
previous breeding record, (especially the number of pregnancies), and whether or not the animal has
experienced previous dystocias or abortions. It is also important to determine whether parturition has
started prematurely, is at full term, or is overdue. The progress of the birth can be assessed from the
duration and intensity of labor contraction, time of rupture of the fetal membranes, and appearance of
fetal parts at the vulva. In multipara, it is important to determine if any fetuses were expelled and if
so, were they dead or alive. One should also try to determine if attempts were made to deliver the
fetus(es) by the owner or others, and if so,the nature of the assistance should be determined. If the
cow is recumbent, information should be sought regarding the duration of the recumbency.
General Examination
It is important to diagnose any clinical conditions which may affect the dam and her offspring during
delivery and the subsequent postpartum period. If urgent assistance is required to save the fetal and
maternal life, a detailed examination should be done immediately after delivery of the fetus. The
bodily condition, demeanor, and posture of the dam should be noted. Recumbent animals should be
urged to rise, inability to do so may be a sign of obturator paralysis, parturient paresis, or other
conditions causing paraplegia of pregnancy. Determination of the rectal temperature may be omitted
since inaccurancies may arise through relaxation of the anus, or from the effects of labor. On the other
hand, clinical examination of the mucous membranes, skin, heart, lungs and digestive system may
provide vital information. Particular attention should be paid to the vulva. The nature of the discharge,
whether it is watery, mucoid, bloody, or foul-smelling will often indicate the condition of the fetus.
The character of the fetal membranes if hanging from the vulva are of further assistance in
determining the condition of the fetus and the possible length of time the condition has existed. If a
portion of the fetus protrudes from the vulva, its condition, position and posture should be observed as

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these may give valuable information regarding the fetus. The vulva itself should be noted to gain
information on the amount of edema or trauma present as an indicator of the length of time the
dystocia has existed and whether someone has already attempted to deliver the fetus.
In cases in which it is clear from the clinical signs that the fetus is dead and the uterus grossly
infected, and there is an indication for inducing epidural anesthesia, this should be done before
proceeding to a vaginal examination.
Detailed Examination of the Animal
Proper restraint of the patient is necessary to avoid injury to the examiner and a detailed evaluation of
the patient should not be undertaken until this is done.
The tail of the cow should be held out of the way, either by an assistant or tied with a tail rope. In the
mare, the tail should be bandaged or covered with a plastic sleeve. The external genitalia should be
thoroughly washed with warm water and an antiseptic to avoid carrying debris into the birth canal.
The operator should then thoroughly wash and lubricate the hands and arms and proceed to make a
vaginal examination.
If the history of the case leads the examiner to know or suspect that others have been examining and
attempting to relieve the dystocia, it is extremely important that the birth canal and caudal portions of
the uterus be examined carefully for evidence of trauma.
The birth canal should be examined to determine if it is dilated, twisted, moist or slippery, inflamed,
swollen, dry, necrotic, contains pathological bands, stenotic areas or tumors, or contains gummy
mucus indicating that parturition has not yet begun or is in the early stages. The degree of dilation or
relaxation of the cervix should be noted as well as whether there is any evidence of torsion. The size
of the pelvic inlet, vulva, and vagina in relation to the size of the fetus should also be checked.
The fetus should be examined to determine if it is dead or alive as this will alter the prognosis and
make a difference in the manner in which the case is managed. If the amnion is not ruptured, this
should be done to facilitate proper palpation of the fetus. Signs of life in the fetus can be determined
by pulling on the limb or pinching it, in the live fetus, this will cause movement of the limb. In the
bovine fetus, a reliable sign is the presence of the interdigital reflex which can be illicted by firmly
pinching between the claws in the region of the interdigital web. Other signs of life include the
presence of a sucking reflex, response to the eyeball/eyelid reflex, palpation of the heartbeat (in the
anterior presentation), and pulsations in the umbilical cord. Inserting a finger into the anus of a fetus
in the breech presentation will cause contraction of the anal sphincter if the fetus is alive. If the fetus
is dead, the degree of autolysis should be accurately assessed by the amount of subcutaneous edema
or emphysema, whether or not the hair is sloughing and whether or not a putrid, fetid odor is present.
The fetus should be carefully examined to determine any possible abnormality of presentation,
position or posture. In a breech presentation, the tail is often found hanging from the vulva or lying in
the birth canal. If the head is not in the birth canal in anterior presentation, its location can be
determined by finding the neck, the mane of the equine fetus, or the ears and head by swinging the
arm and hand around the cephalic part of the body. If the feet are in the birth canal, it should be
determined whether they are front or hind feet. These maybe differentiated on the following basis:
a. Front limbs have two readily movable joints, fetlock and knee, between the hoof and
elbow, while the hind limbs have one joint, the fetlock, between the hoof and hock.

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b. If the joint immediately above the fetlock flexes in the same direction as the fetlock, then it
is a forelimb, whereas when it flexes in an opposite direction, it is a hind limb.
If the feet of the fetus are protruding from the vulva with the soles ventral, then the fetus is either in
anterior longitudinal presentation, dorso-sacral position, or posterior longitudinal presentation, dorso-
pubic position, the latter is rarely encountered. If the feet of the fetus are dorsal, then the fetus is either
in a posterior longi- tudinal presentation, dorso-sacral position, or in anterior longitudinal
presentation, dorso-pubic position. If no part of the fetus is in the birth canal, the condition is probably
a transverse dorsal or rotated bicornual pregnancy. In the latter condition, the birth canal is very long
and the fetus can be touched only at arm's length. If more than two limbs are in, entering, or are near
the pelvis, the condition should be carefully evaluated to differentiate between twins, a schistosomus
reflexus fetus, a double monster, an anterior longitudinal presentation with the rear limbs of the fetus
extended over or under the body, or in the mare in a transverse ventral presentation.

Prognosis in Dystocia
The prognosis in a dystocia depends on a number of factors:
a. The more prolonged the dystocia the poorer the prognosis.
b. The greater the trauma, irritation and infection of the birth canal caused by inexperienced
individuals attempting to relieve the dystocia, the graver the prognosis.
c. Species is a very important factor - in the mare for example, the prognosis in dystocia is
graver because:
o (a) The fetus usually dies within 30 to 40 minutes after the commencement of labor.
o (b) Labor contractions are violent and powerful, predisposing to impaction of the
fetus in pelvis or lacerations of the birth passage.
o (c) The pelvis and fetal extremities are longer, thus making dystocia more difficult.
o (d) The mare is more susceptible to trauma, irritation, infection and inflammation of
the birth passage and peritonitis.
In general, it is very difficult to save the life of a mare if she has been in labor for more than 24 hours
and the fetus is emphysematous. The same is true of other animals, but the prognosis is usually better
as other species are more resistant to infection. The fetus in the cow and ewe usually dies after 6 to 12
hours of labor. In sows, the first fetus usually dies after 4 to 6 hours of labor. The other pigs may
survive for 24 hours, however, after 24 to 36 hours of labor, all fetal pigs are invariably dead.
Williams has appropriately described that the handling of dystocia as resembling a salvage operation
on a "ship on the rocks". If possible the following should be salvaged:
1. The value of the surviving dam - its future breeding life, its food value for milk and meat,or
its value for work.
2. The value of the newborn
3. The sentimental value of the newborn

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In the prognosis of a case, these should be weighted against the:
1. Veterinary fees
2. Mortality risk of the dam and the newborn
3. The cost of labor and feed until the dam has recovered her value for milk, meat, work or
breeding. When these factors are considered with the owner after a careful examination of the
patient, the prognosis and handling of the case will be understood and as such, embarrassing
situations can be avoided.

Obstetrical Equipment
The major classification of obstetrical equipment is as follows:
1. Instruments of Traction: Obstetrical (OB) cords and straps, OB chains, and handles, OB
snares, OB hooks (long and short, blunt and pointed), OBforceps, OB pulleys and OB fetal
extractors.
2. Instruments of Repulsion: Kuhn's Crutch, OB repeller with or without spearhead.
3. Instruments of Incision and Excision: Finger fetotomy knives (straight or
curved), guarded fetotomy knives, hoe blade castration knife, BP scalpel (naked or guarded
blade), fetatomes(various types),OB chisel (plain or guarded), and various types of wire
saws.
4. Instruments of Rotation: detorsion rod, OB forceps.

The Use of Epidural Anesthesia in Obstetrics
Epidural anesthesia is widely utilized in the management of obstetrical problems in the mare and cow
because:
1. Itstops abdominal standing and makes mutation of the fetal extremities, repulsion of the
fetus, correction of breech presentation and uterine torsion easier.
2. It abolishes or reduces all pain and is therefore more humane and should be administered
when great power is used as in some forced extractions.
3. It greatly increases the speed, ease, and safety to the operator and patient in fetotomy
operations.
4. With proper epidural anesthesia, the animal stands quiet without moving about or lying
down, which is helpful to the operator.
5. Often the cow that is down and refuses to stand will rise and stand normally following the
administration of epidural anesthesia.
6. Defecation is suspended.

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7.The animal does not rapidly expel lubricants pumped into the uterus.
8. When used in caesarean section, it controls straining and prevents prolapse of the intestine
through the surgical incision.
9. It is used to aid replacement of prolapse of the vagina, cervix, uterus, rectum or bladder.
10. By controlling straining, it may prevent prolapse of the uterus immediately after a difficult
parturition.
11. It alleviates straining associated with severe vulvitis or vestibulitis.
Obstetrical Operations
The obstetrical operations may be divided into four major classifications: Mutation, forced extraction,
fetotomy and caesarean section (hysterotomy)
A. Mutation is defined as those operations by which a fetus is returned to a normal
presentation, position, and posture by repulsion, rotation, version, or extension of the
extremities.
o 1. Repulsion (Retropulsion): Consists of pushing the fetus out of the birth canal into
the uterus where there is more room to correct the abnormal position of the fetus and
its extremities.
Repulsion may be accomplished by the operator's arm or by the use of a crutch or repeller. In anterior
presentation, the crutch or hand of the operation is usually placed on the fetus between the shoulder
and chest or across the chest beneath the neck. In the posterior presentation, the hand or crutch is
placed in the perineal region over the ischial arch.
Repulsion is difficult or impossible in the recumbent animal resting on its sternum as the abdominal
viscera are pushing the fetus back toward the pelvis. If the animal is recumbent, it should be placed on
its side with its four legs extended.
2. Rotation: Is turning of the fetus on its long axis to bring it into a dorso-sacral position.
In correcting dystocias in unipara by rotation of the body, the fetus should be repelled cranially out of
the pelvic cavity. If this cannot be accomplished, as in cases of prolonged dystocia, proper lubrication
of the fetus and birth canal is necessary to make rotation of the fetus possible.
In dorso-ilial position, repulsion is usually not necessary but may be helpful. Lubrication of the birth
canal caudal and downward traction on the extremities, and rotation of the fetus with the operator's
arm in the birth canal readily corrects this abnormal position.
If the fetus is in a dorso-pubic position it should be repelled out of the pelvis, leaving the limbs in the
pelvic cavity, chains are fastened to the fetlock and cross traction is applied by two assistants.
Depending upon which way the fetus is to be rotated, one leg is pulled at first upward, then
horizontally to the left or right and then downwards, while the other leg is being pulled underneath the
first leg downward and obliquely toward the right or left.
3. Version is the rotation of the fetus on its transverse axis into an interior or posterior
presentation. This is done most often in the mare in transverse presentation of the fetus. The

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version is usually limited to 90 degrees and by repulsion on one end of the fetus and traction
on the other, the transverse presentation is changed to a longitudinal presentation. If possible,
the fetus should be turned into a posterior presentation; this prevents the head and neck from
complicating the delivery.
4. Extension and adjustment of the extremities: This is the correction of abnormal postures,
usually due to flexion of one or more of the extremities, thus causing dystocia. Abnormal
postures are difficult and usually impossible to correct within the pelvis, as such, the fetus
should be repelled out of the pelvis before these procedures are attempted. Although flexion
of the limbs usually results in dystocia in uniparous animals, it is a rare cause of dystocia in
multiparous animals.
Three basic mechanical principles are necessary to effect a prompt easy correction of a flexed
extremity.
(1) Retropulsion on the proximal portion of the extremity, such as the shoulder or chest, is
performed in anterior presentation in the correction of flexed carpus, elbow or shoulder joints
with the forelimb extended beneath the body, or the head and neck flexed alongside beneath
or over the body of the fetus.
(2) Lateral rotation of the middle portion of the extremity (carpus, tarsus) lateral rotation and
repulsing of the flexed tarsus, carpus or neck into the cranial and lateral flank provides
adequate room in most cases for the medial extension of the fetlock or nose into the pelvis in
small fetuses, this may be done in one motion with the hand, while in larger fetuses, this may
require a repeller or an assistant's arm,or other obstetrical equipment as a mandibular snare,
eye hooks, etc.
(3)Traction on the distal portion of the extremity such as the pastern, the head or until these
distal structures can be reached, traction may be applied to the structures between the body
and the distal portion of the extremity.
B. Forced Extraction (Traction)
Traction is the most frequently applied obstetrical procedure intended for augmenting and
occasionally replacing the dam's expulsive efforts. Normal fetal presentation, position and posture,
and a reasonable normal birth canal to fetal size relationship areindispensable prerequisites for safe
and effective delivery. As such, the indications for forced extractions are cases in which:
1. Abnormalities of presentation, position or posture have been corrected, either by
manipulation or fetotomy.
2. Fetal mass has been reduced by fetotomy.
3. Maternal expulsive forces are inadequate.
4. Mild oversize of the fetus or stenosis of the soft birth canal have resisted maternal efforts.




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Basic Principles
For safe and effective delivery, forced extraction must mimic natural expulsion as closely as possible.
In addition to propelling the fetus, expulsive efforts simultaneously guide the fetus in a manner that
reduces resistance. Thus, the general direction is adjusted to the arc formed by the greater curvature of
the pregnant horn and the birth canal. In anterior presentation, one forelimb slightly precedes the
other, thus reducing the width of the shoulders. The shoulders enters the pelvis with the fetus slightly
tilted off the dorso-sacral position. The distance between the sacro-iliac and ilio-pubic junction is
greater than the width of the pelvic inlet. Similarly passage of the hip is facilitated by rotation of the
fetal body before entry into the pelvic inlet.
Myometrial contractions and synchronized tenesmus are intermittentallowing for expansion of the soft
birth canal over the fetal parts. Along with this fetal fluids, particularly anmionic fluid, provides
excellent lubrication of the birth canal, thus minimizing friction. Frequently, however, forced
extraction has to be performed in protracted cases of dystocia with a dry birth canal.
Adherence to these basic principles calls for the following sequence of steps in forced extraction:
1. Attachment of chains, etc. to the extremities:
To avoid injury to the limb, a chain should be placed above the fetlock and a half hitch around the
pastern. If a fetal extractor (calf puller) is used, the chains should be attached in such a manner that
one leg precedes the other by a few inches. This will allow the shoulder to pass through the birth canal
at an oblique angle which is extremely important with the delivery of a relatively large fetus.
Traction on the two feet is referred to as "2-point traction" and is adequate in many cases. In
anterior presentation, however, it is common for the head to resist passage through the birth canal.
When the head has entered the birth canal but does not proceed, a reversed telescoping of
compressing effect occurs resulting in an increase in total fetal volume and as such, compounding the
problem. To prevent this from occurring "3-point traction" should be considered which simply
involves the use of a head snare, chain, or some other device used to apply traction to the head, neck
and eventually the chest of the fetus. The end result is elongation of the head and neck with resulting
decrease in fetal diameter.
2.Adequately lubrication of the fetus and birth canal:
Infusion of lubricant solution into the uterus provides continuous lubrication.
3. Traction
o a. Direction of traction
o When the fetus is in the uterus traction when applied in either the anterior or posterior
presen- tation should be upward and backward to lift the fetus up and over the brim of
the pelvis into the birth canal. At this stage, with the fetal extremities approaching the
vulva, the direction of traction should at first be backward and slightly upward, and as
the fetal legs and head engage in the vulva, the direction of traction should be acutely
downward. After the head in anterior presentation or the hips in posterior presentation
pass through the vulva, the direction of traction should be more and more downward
so that when the back of the fetus is passing through the vulva, the direction of
traction is perpendicular to the spinal axis of the dam or parallel to her hindlimbs. The

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application of traction in this fashion allows the delivery of the fetus to simulate the
normal arc associated with physiological birth.
o b. Alternate traction of presented limbs.
o c. Rotation of the fetal trunk by traction on crossed limbs to facilitate delivery of the
shoulder or hips and stifles through the widest area of the pelvic inlet.
o d. Traction should be synchronous, as far as possible with the expulsive efforts of the
dam.

Use of Fetal Extractors
The fetal extractor, or so-called "calf puller", is one of the most common obstetrical instrument used
to remove the fetus from the birth canal. When properly used, the fetal extractor is effective and
relatively safe. On the other hand the injudicious use of the fetal extractor may produce severe,
irreversible trauma to the dam and fetus. The traction force generated by the fetal extractor exceeds
the maternal force by nearly six times. As such, it is imperative that this fact be considered when this
instrument is being used.
Forced Traction Force (in lbs.)
Maternal 150
Two strong men 250
Fetal extractor 800
Tractor 10,000

Hindson, Vet Rec. 102 (1978)
The General rule is that no more force should be applied with the fetal extractor than could be applied
by two to three strong individuals.
C. Fetotomy
Fetotomy can be defined as the sectioning or dismemberment of a fetus to facilitate its delivery
through the birth canal. This procedure is usually performed only on dead fetuses; if the fetus is alive
and cannot be safely delivered by mutation and forced extraction, then a caesarean section is
indicated.
Indications for the use of fetotomy include:
1. An oversized fetus
2. Abnormalities in presentation, position, or posture or a combination of these which cannot
be corrected by mutation.
3. When the fetus is emphysematous and the dam is toxic.

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4. Fetotomy is generally recommended in preference to c-section when the required operation
is simple, involving only one or two procedures. In cases where more complicated fetotomy
procedures would be required. A caesarean section should be recommended.
Some of the terminologies used in fetotomy include:
1. Total fetotomy, this refers to the successive dismemberment of the entire fetus.
2. Partial fetotomy is the removal of only those parts of the fetus necessary for its delivery.
3. Percutaneous fetotomy - sectioning of the fetus through the skin.
4. Subcutaneous fetotomy - sectioning of the fetus beneath the skin, leaving the skin attached
to the fetus.
5. Decollation - section through the neck at the level of the anterior thorax.
6. Decapitation - section through the neck at the occiput.
7. Direct fetotomy - section of the fetus in which the fetatome wire extends forward from the
head of the fetatome forming an angle near 180 degrees with the shaft of the fetotomy. In this
case, the cut is towards the operator.
8. Indirect fetotomy - section of the fetus in which the fetatome wire forms an acute angle, or
an angle near 90 degrees with the shaft of the fetatome. The cut is partly away from or at right
angle to the operator.
Prior to the introduction of the wire-saw fetatome, the subcutaneous method was utilized by some
veterinarians to alleviate dystocias, however, because this method was both exhaustive and time
consuming, it was never widely accepted. The introduction of newer, improved models of wire-saw
fetatomes resulted in a renewed interest in fetotomy. In general, total fetotomies are not generally
performed because even with the percutaneous method, it has been found to be time consuming. As
such, most authorities recommend a ceasarean section in place of a total fetotomy. Partial fetotomy
has, however, retained its usefulness.
Before one embarks on performing a fetotomy, there are certain factors which should be considered.
In general, fetotomy should not be attempted unless.
1. Proper fetotomy instruments are available.
2. There is adequate space in the birth canal for introduction and alignment of the fetatome.
3. The patient can be restrained in an area that allows adequate space for operating the wire
saw.
4. Adequate help is available.
Another clearly definite contraindication is the presence of injuries in the birth canal of the dam.
Basic guidelines for total or partial fetotomy include:
1. Amputate as much as possible of the part to be removed with a single cut.
2. Do not leave sharp edged skeletal remnants which can produce trauma to the birth canal.

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3. When amputating lower limbs, direct the section through or below the carpal or tarsal joints
to prevent the chain from slipping off.
Another important feature which should always be borne in mind is that adequate lubrication of the
birth canal is essential to the success of the procedure.
Technique for percutaneous fetotomy includes:
1. Threading the OB wire through the fetatome.
2. Guiding the wire around the part to be removed with a wire guide or chain.
3. Bringing the wire saw out of the vulva for threading the second opening in the head of the
fetatome.
4. Placing the head of the fetatome on the desired point on the fetal body.
5. Fixing the fetatome by securing a chain attached to the fetus on the breeching plate or
handle of the fetatome.
6. Attaching the wire handles to the OB wire (the wire ends should extend about 1 l/2 to 2
feet behind the fetatome to allow for long strokes) and with a sawing motion removing the
part.
Always remember that the position of the head of the fetatome determines the direction of the cut.
Progress of the cut has to be monitored and the position of the head of the fetatome and/or wire
adjusted if and when necessary.

Fetotomy in Anterior Presentation
Fetotomy of the fetus in anterior presentation begins with removal of the head at the occiput. This is
the only indirect cut made in the entire procedure that does not require counterforce to hold the head
of the fetatome in position against the forces generated by the pull of the fetatome wire during the
cutting process. The constricted nature of the neck behind the occiput holds the wire in place
adequately without counterforce.
The second procedure is removal of the forelimbs. The foot is chained above the fetlock. The
fetatome is fully threaded. The foot-chain is passed through the loop of obstetrical wire and the wire is
placed between the claws of the hoof of the fetus. The chain is looped on the lateral side of the leg.
The wire saw will eventually be released and passed up the medial side of the leg once the head of
thefetatome is positioned dorsal and caudal to the scapular cartilage. The fetatome head is placed in
position and the chain, which provides counterforce, is attached to the butt-plate of the fetatome. The
wire is released from between the claws of the calf and worked up the leg into the axiliary space,
making certain that the wire passes beneath the scapulo-humeral joint on the anterior and behind the
elbow on the posterior side of the leg and the cut is made.
The second leg is removed in the same way. If the manipulation is difficult on the down leg, the cow
can be rolled to her opposite side to make the cut easier. It is preferable to keep the cow standing if
possible; a light epidural will help make this possible.

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At this point, the Krey's hook is attached to the severed spinal column of the neck and its chain passed
through the looped fetatome wire. The looped wire is passed up the chain and over the torso of the
fetus. The head of the fetatome is positioned along the side of the fetus or near its back and Krey's
hook chain is attached to its butt plate for counterforce. A right angle cut is made through the
midsternal plane. After the cut is made, thoracic viscera is removed.
The next cut involves a similar procedure but the section that is left to be removed will be the largest
one. If it will not pass through the birth canal, it can be further reduced in size by an additional cut.
The fetatome is partially unthreaded, the fetatome wire guide is attached to the wire of the head of the
fetatome and the wire passed through the diaphragm and back around the ribs near the vertebral
column. The wire is pulled to the outside of the birth canal and re-threaded through the fetatome. The
Krey's hook is left attached to the fetal spinal column and the head of the fetatome is held together
with the Krey's hook so that the cut will be made as close to the costo-vertebral attachments as
possible. Once the cut is made, the rib cage can be rolled into a small unit and removed.
The abdominal viscera are removed. The Krey's hook is attached to the pelvic spine. The fetatome is
partially unthreaded. The fetatome wire guide is attached to the wire and passed between the legs of
the calf. This is usually easier to accomplish by going dorsally, passing the wire guide handle between
the legs and then procuring it ventrally from between the legs. The wire is positioned between the
ischial arch. The tail is included so it will be left attached to the leg not affixed by the Krey's hook.
Positioning of the wire in this manner is not absolutely essential, but will make it less likely that the
wire will slip so that the cut is made through the femur rather than the pelvis. The two legs can then
be easily removed.
Fetotomy in Posterior Presentation
Fetotomy of the fetus in posterior presentation follows a pattern similar to that in anterior
presentation. If legs are retained, the wire guide is attached to the wire at the head end of the half-
threaded fetatome and passed around one retained leg. It is important that the wire be positioned
medial to the stifle joint. The head of the fetatome is held on the side of the base of the tail opposite to
the leg to be removed and the cut is made. The second leg, if retained, can be removed in the same
manner if it cannot be repositioned by the flexed hock manipulation.
If legs are presented, an indirect cut must be made. The procedure is analogous to that of the removal
of a forelimb. The head of the fetatome is positioned just cranial to the tuber coxa on the side of the
leg to beremoved. The looped wire is seated in the ischial arch and the tail is included with the leg to
be first removed.
The second leg is removed together with the abdominal region behind the rib cage by indirect
fetotomy. The fetus is eviscerated and the thoracic section behind a plane caudal to the scapula
removed next. This piece is the largest one and may require division of the ribs in a manner similar to
that described in anterior presentation fetotomy.
To complete the fetotomy, a direct cut can be made removing either one forelimb or a forelimb and
most of the remaining thoracic part. To accomplish this, the fetatome is half unthreaded and the wire
attached to the wire guide. The Krey's hook is attached to the spinal column of the fetus and the fetus
retracted to the pelvic inlet. The fetatome wire is passed between the front leg and the neck, around
the leg, and rethreaded through the fetatome. The location of the final cut will be dependent on
placement of the fetatome head. If it is placed behind the leg to be severed, the cut will be made
between the scapula and rib cage. If the head of the fetatome is placed on the opposite side of the

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Krey's hook, the cut will include part of the rib cage and spinal column and, this will reduce the size
somewhat more. The latter section is preferred by most theriogenologists.
Other Useful Fetotomy Operations
1. Subcutaneous Decapitation or Amputation of the Head: This operation is indicated when
one or both forelimbs are retained and the head has passed through the vulva and become
swollen, edematous, or emphysematous so that it cannot be repelled or can be repelled only
with great difficulty. It may also be indicated in those cases where the pelvis is unable to
accommodate the head and forelimbs of the fetus at the same time.
Procedure
Incise the skin on each side of the head from the occipital bone, carrying the incision in front of the
ear to the anterior angle of the mandible. Reflect the skin back to the occipital - atlanto joint. Severe
the ligaments and muscles, disarticulate the head; reflect the skin from the mandible, make a
transverse incision through the trachea, esophagus and muscles of the throat. The head is now free,
and the remaining skin-flaps can be used to supply traction.
2.Cephalotomy or craniotomy diminution of the size of the head to facilitate its passage
through the birth canal.
Indications - When the fetal head becomes firmly impacted within the maternal pelvic, and it is
impractical either to repel or extract it, or when the head because of hydrocephalus or other cranial
deformity is too large to enter or pass through the pelvis.
Procedure
Cephalotomy is accomplished by fixing the head with a snare around the lower jaw. The cranium may
be broken down with an obstetrical chisel or fetatome. In cases ofhydrocephalus, sometimes simply
incising the distended cranium may cause sufficient reduction in size to permit delivery. In most
cases, however, the fetatome is necessary to separate the enlarged cranium from the rest of the head
by passing a loop of obstetrical wire around the base of the enlargement and fixing the head of the
fetatome in the frontal region.
3. Amputation of the Head and Neck - This operation is indicated when the head and neck are
retained alongside, beneath, or above the body of the fetus and cannot be corrected by
mutation. It may also be indicated in cases of dystocia due to a juvenile or hypoplastic pelvis,
or a large fetal head, where there is insufficient room to accommodate the head and neck and
the two limbs.
Procedure
Amputation of the head and neck may be performed by the wire saw or fetatome. The fetatome is
preferred because if the operation is properly performed, the neck is amputated close enough to the
body so that traction on the forelimbs will pull the scapular and shoulder joints over the exposed
stump of the cervical vertebra. Occasionally in large mares, it may be necessary to remove the
forelimb opposite the side to which the head and neck are flexed, and to apply traction to the fetus in
order to enable the operator to reach the neck and pass the fetatome wire around it. The fetatome wire
saw is attached to a wire saw director or obstetrical chain and passed over the base of the neck and
drawn around it. The head of the fetatome is held forcibly between the shoulder joint and neck of the

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fetus and the neck is severed as close to the body as possible. The head and neck are then removed
with the hands, snare or Krey's hooks, and the fetus delivered by traction.
4. Amputation of the Anterior Limb at the Humero-Radial Articulation: This operation is only
indicated in the removal of the forelimbs in the transverse ventral presentation in the mare
prior to version as amputation of the entire forelimb is difficult or impossible in this
presentation.
Technique
Traction should be applied to the limb. A loop of fetatome wire is passed up the leg, over the
olecranon and tightened. The head of the fetatome is placed firmly in the pectoral region and held or
strapped securely to extended leg in the metacarpal region to avoid slipping and the humerus
amputated through its distal end.
5. Detruncation inthe Anterior Presentation - This is indicated in rare instances when the fetus
is in a dog sitting posture with the hindlimbs extended alongside or beneath the body and
wedged into or against the maternal pelvis. If mutation is impossible due to protracted
dystocia,or if the head and forelegs are outside the vulva, then fetotomy is usually necessary.
Procedure
A loop fetatome wire is passed around the body of the fetus and the head of the fetatome is inserted
into the birth canal and positioned over the lumbar region of the fetus. After the wire is manipulated
back of the last ribs, detruncation is rapidly accomplished. On occasions, two cuts through the trunk
of a large fetus may be necessary using Kery's hooks on the exposed vertebrae for traction, further
reduction on the fetal body is facilitated. In cases where the fetus is large or emphysematous, or if the
birth canal is swollen, small or dry evisceration along with adequate lubrication tend to make this
operation easier and safer. Following detruncation, the forequarters are removed following which the
hindquarters are turned to a posterior longitudinal dorso sacral position and delivered.
6. Amputation of The Lower Forelimb - On rare occasions, dystocia may result from bilateral
engaged carpal flexion, the head and flexed carpi being impacted within the pelvic cavity.
Repulsion of the head and limbs may be impossible and, even when possible, may be quite
unsafe.
Procedure
The presence of the head usually prevents access to the flexed carpi. Thus the head is amputated first.
Following removal of the head the fetatome wire is passed through the flexed carpus brought to the
exterior and threaded into the fetatome. The head of the fetatome is positioned as close as possible to
the distal carpus and the lower forelimb amputated.
Fetotomy Operation in the Posterior Presentation.
7.Fetotomy in the Normal Posterior Presentation - Is indicated when the diameter of the fetal
pelvis is relatively larger than the diameter of the fetal maternal pelvic inlet, and wedging or
hiplock occurs. This operation may also be indicated where the fetus is emphysematous.
Technique

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A transverse incision is made through the skin and muscle just cranial to the wing of the ilium. A loop
of fetatome wire is carried upon one hindleg and placed in this incision. The head of the fetatome is
placed between the hindlimbs and one hindleg and a portion of the pelvis are removed.
8. Amputation of the Rear Limbs at the Tarsus - This operation may be indicated in the mare
to provide additional room for removal of the forelimbs in the transverse ventral presentation.
It may also be indicated in cases in which the metatarsal bone is wedged into or across the
pelvis or when mutation of a hock flexed posture in the mare or cow is impossible. It may
occasionally be necessary in monsters with ankylosed hindlimbs, such as Perosmus elumbis.
Modus Operandi - The head of the fetatome is placed on the lower row of tarsal bones or the head of
the metatarsal bone and the limb is amputated in this area.
D. Caesarean Section
Caesarean section is indicated in those cases when mutation, forced extraction or fetotomy are
deemed inadequate or too difficult to be employed to relieve the impending or present dystocia, and
when it is desired that the fetus be delivered alive. Indications for caesarean section include fetal
oversize, feto-pelvic disproportion, incomplete dilation of the cervix, irreducible torsion of the uterus,
hydrops of the fetus, hydrops allantois or abnormalities of presentation, position or posture, ventral
hernias and prolonged cases of dystocia.
Immediate Care of the Newborn
Many newborn animals that have been delivered following dystocia die without breathing despite a
strong heart beat and normal or depressed reflexes. Many of these can be saved if immediate steps are
taken to provide resuscitation.
If spontaneous respiration is not initiated within a few seconds after the newborn is delivered or if the
newborn is making gasping sounds, resuscitation should be promptly instituted.
A. Establish a Patent Airway
1.Manually clear the nares of fetal membranes and gently strip fluids from the nostrils and
oral cavity.
2. Provide head-down postural drainage.
3. Provide thoracic coupage
4. Suction fluids from the oropharynx.
B. Stimulate Breathing
1. Rub the body briskly with towels
2. Nasal tickling with a straw
3. Flex limbs (stretch receptors)
C. Evaluate Vital Signs

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Check the heart rate, respiratory rate and effort, reflexes, and mucous membranes (color and CRT).
Any new- born with a weak or slow heart rate, pale m.m. with delayed CRT, and lacking ventilatory
effort should be resuscitated.
D. Resuscitation Procedures
1.The most efficient resuscitative procedure is intermittent positive pressure
ventilation (IPPV). This is accomplished by using a non-rebreathing system with oxygen
administered by a mask or preferably an endotracheal tube.
In the absence of an IPPV apparatus inserting a rubber tube, attached to an oxygen source, into the
upper nostril and allowing gas to flow at a rate of 5 liters/min or by applying mouth-to-nose
resuscitation at the rate of 25/min until a spontaneous rhythm is established.
2 .Rhythmic compression and release of the thorax is also beneficial.
An increased heart rate is the best indication of adequate resuscitation, and as long as a heart beat is
present, there is hope for survival.
E. Post-Resuscitation
1.The new-born should be dried and kept warm. In cases where it is weak and hypothermic,
the use of heat lamps and the intravenous administration of warm 5-10% dextrose solution is
verybeneficial.
2.The umbilicus should be disinfected with an antiseptic.
3.The new-born should be examined for congenital abnormalities.
4.One should ensure that the new-born receive an adequate amount of colostrum during the
first 12 to 18 hours of life.
5.During the first 24 hours of life, the newborn should be closely monitored.

Aftercare and Examination of the DamAfter Mutation, Forced Extraction or Fetotomy
Following a dystocia operation, the genital tract of the dam should always be examined for the
presence of another fetus which may be in the uterus or abdominal cavity. In the sow, the farrowing of
the last fetus is usually followed by the sow becoming quiet and content, nursing her pigs, urinating,
eating and drinking. If the sow remains restless, uneasy, shows anorexia and intermittent straining,
she should be examined for the presence of another fetus. In these cases radiographic examination of
the abdomen is very beneficial.
After every Dystocia operation, the uterus and soft birth canal should be examined for lacerations and
ruptures. Small superficial lacerations of the cervix, vagina or vulva are of little importance or
significance unless retention of the placenta favors infection. If the fetal membranes are retained,
attempts to remove them at this areaseldom successful and vigorous traction may result in eversion of
the uterine horn.
Contamination of the birth canal and uterus is inevi- table. As such, the use of local antibicrobral
agents in the uterus is clearly indicated.

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Following fetotomy, the uterus should be lavaged with warm water to remove hair and other debris
following which it should be medicated with a broad spectrum antimicrobial.
If the animal is unable to rise, the operator should try to determine the cause of the paraplegia or
paralysis.
The udder should be examined to make sure that no pathology is present, and that teat wounds and
lacerations did not occur if they have occurred, then they should be treated.