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AR 404

Obstetrics and Genital Diseases

4(2-2)

Theriogenology A branch of veterinary medicine which deals with all aspects of animal reproduction including physiological, pathological and therapeutics is known as theriogenology. Andrology: All aspects of male reproductive system/function are dealt in the section of andrology. Gynecology: It deals with the overall general reproductive health of the female animal. Obstetrics: This word is derived from a Latin word Obstetricare; which means to assist in delivery. It is a branch of veterinary science which deals with necessary or advisable aid during the act of parturition. or It is the art of managing cases of animal birth. or It is the branch of surgery which deals with the management of pregnancy and labour.

OBSTETRICAL ANATOMY
In obstetrics, pelvis is the most anatomical structure of the body. Bony Pelvis The bony pelvis is bounded at the site and below by two coxae and above by the sacrum and first three coccygeal vertebrae. Function: (i) Pelvis serves to contain, sustain and protect the urogenital and end parts of the digestive tract. (ii) It also gives support for the attachment of many muscles. (iii) It serves as an important component for birth passage through which the fetus has to pass at the time of parturition. Formation: The bony pelvis composed of: a) The sacrum b) First three coccygeal vertebrae c) Two oss coxae SACRUM This bone is composed of five fused vertebrae in horse and ruminants; while in dogs and pigs, it is composed of three fused vertebrae. It is somewhat triangular in form with the base articulating cranially with the last lumber vertebra and caudally with the first coccygeal vertebra. The dorsal surface exhibits the sacral spines. The ventral surface is smooth and concave. The wings of the sacrum articulate or fuse with the ilium laterally. OS COXAE This is a paired bone and it is known as the largest of the flat bones.

Formation: Each coax comprises of three small components: (i) Ilium (ii) Ischium (iii) Pubis These paired bones form the chief boundaries of the pelvis and framework of the uppermost segment of the hindlimb which it connects with the spine. These three bones (ilium, ischium and pubis) joins to form acetabulum. The two os coxae unite in the mid line at ischio-pubis symphysis. Ilium The ilium is the largest bone of the os coxae. It is irregularly triangular in shape. The broad, flat, dorsal part of the ilium is called the wing. The external portion of the wing is called tuber coxae, hip bone or hook bone. The internal or medial portion of the wing is called the tuber sacrale and its ventral medial aspect articulates with the sacrum. The medial or pelvic surface of the ilium is smooth and grooved for the obturator vessels and nerves. The ilium and acetabular part of ischium form the lateral wall of the pelvis. Ischium It is next inside to the ilium and form caudal part of floor of the pelvis. The caudal/lateral portion of ischium is commonly refereed as pin bone or tuber ischii. The anterior border of ischium forms the posterior boundary of the obturator foramen. Greater ischiatic notch is cranial to ischiatic spine and lesser ischiatic notch is caudal to ischiatic spine. Symphysis pelvis is formed by the fusion of the ischium and pubic bone. While ischial arch is formed by joining of two ischii at caudal portion. Pubis It is the smallest of the three bones of the os coxae and form cranial portion of the floor of the pelvis. The dorsal or pelvis surface is smooth and usually concave in females. While in males it may be convex. The cranial and medial border of the pubis provides attachment for the prepubic tendon. The caudal border of the pubis forms the cranial border of the obturator foramen. Occasionally in the young heifer, a sharp tuberosity projecting into the pelvic canal is present on the cranial portion of the symphysis pubis. This prominence may rarely caused by contusion or even laceration of the birth canal during a difficult parturition. Acetabulum The acetabulum is formed by the fusion of the ilium, ischium and pubis. These bones form a cotyloid cavity which lodging the head of the femur. The ventral or inferior surface of the sacrum forms the largest portion of roof of the pelvis. Pelvis Inlet The pelvic inlet is bounded by following: Dorsally base of the sacrum Ventrally Pelvic brim Laterally Ilio-pectineal line In all species, the pelvic inlet is roughly oval in shape with sacro-pubic diameter being the largest. Cat has the most elliptical pelvic inlet, while mare and some bitch has nearly rounded pelvic inlet. In cow, ischial tuberosity is prominent and high. The iliac and coxal tuberosity are smaller in mare.

Pelvic Outlet The pelvic outlet is bounded by following: Dosrally sacrum and first three coccygeal vertebrae Ventrally Ischial arch Laterally Posterior border of sacro-sciatic ligament Caudal portion of the pelvic cavity is smaller in diameter than the cranial portion. However it is capable of dilating at the time of parturition to allow passage of the fetus which is brought about by the relaxation of the pelvic ligament esp. sacro-sciatic ligament. PELVIC LIGAMENTS Ligament: A strong band of fibrous tissue serving to bind bones or other parts together or to support an organ. There are three single or paired pelvic ligaments that maintain the relationship of the pelvis to the spinal column. (i) Dorsal and lateral sacroiliac ligaments: These are attached to the medial wing of the ilium and the lateral portion of the sacrum and summits of the sacral spines. (ii) Sacro-schiatic ligament: It is an extensive quadrilateral ligamentous sheath that completes the lateral walls of the pelvic cavity. The ligament extends from the lateral border of the sacrum and the transverse processes of the first two coccygeal vertebrae to the ischaitic spines and tuber ischii. It furnishes attachment for the large gluteal muscles and the vulva. It prevents posterior portion of the pelvis to move towards sacrum. Both ligaments form strong flexible and yielding wall of pelvic cavity. Under the pressure of parturition, they yield sufficiently to allow constricted pelvic outlet to be equal in dimension to the larger bony pelvis (pelvic inlet). (iii) Prepubic tendon: Tendon: It is a firm, white fibrous inelastic cord which attaches muscles to the bones. Prepubic tendon is the tendon of insertion of recti-abdominis muscles. It also furnishes attachment for internal and external oblique, gracilis and the pectineal muscles. It is attached to the anterior border of the pubic bone. Functions: It prevents the pubis and ischium from passing upward and backward, towards the sacrum when the body weight is placed upon the coxofemoral articulation. It is of more importance in mares; because rupture of tendon may cause herniation but in bovines, it usually does not rupture but herniation may occur due to rupture of some muscles. PELVIC ARTICULATIONS These are of 5 types as follows; a) Right and b) Left sacro iliac c) Sacro-lumbar d) Ischio-pubic symphysis d) Sacro-coccygeal These articulations are important because they become flexible at the time of parturition. Pelvic cavity in domestic animals is somewhat conical in shape, with the base of bone located cranially. Caudal portion of pelvic cavity is smaller in diameter than cranial one. However, it

is capable of dilating at the time of parturition to allow passage of fetus. This ability to dilate is brought about by relaxation of pelvic ligaments especially sacro-schiatic ligament. Difference between Pelvic Cavity of Male and Female Differential Features Diameter of pevic inlet Bones of the pelvis Ischial arch Pelvic cavity Obturator foramen Cranial floor of pelvis Male Smaller Thicker and heavier Narrow Smaller and less roomy Smaller Convex Female Larger Narrow and lighter Wider Wider and spacious Larger Concave

Coxofemoral Articulation (Hip Joint) It is a ball and socket joint with the head of the femur fitting into the acetabular fossa, which is made deeper by cotyloid ligament. There are three parts of this cotyloid ligament: a) Round ligament b) Transverse ligament c) Accessory ligament Round ligament: It extends from sub-pubic groove in the acetabulum to the head of the femur. In occasional cases, this ligament may be small or even absent. Transverse ligament: It is that portion of cotyloid ligament which crosses the acetabular notch. Accessory ligament: It is found only in horses. It extends from prepubic tendon to the head of the femur. Dislocation of Hip Joint There is an increased frequency of dislocation of this joint in cow due to the following reasons: i) Shallowness of the acetabulum ii) Lack of bulky muscles around the joint iii) Small or occasionally absence of the round ligament iv) Absence of accessory ligament v) Excessive relaxation of the pelvic ligament in older animals in advanced pregnancy. vi) Large size and weight of abdomen in advance pregnancy, twin pregnancy and dropsical condition of fetal membrane. vii) Animals with cystic ovaries viii) Awkward gait of the animal PELVIC NERVES The walls of the pelvic cavity contain numerous vessels and nerves which serve the viscera and muscles of the hind quarter. These nerves are derived from the various branches of the lumbar and sacral nerves included in cranial to caudal order: (a) Obturator nerve (b) Cranial gluteal nerve

(c) Ischiatic nerve (d) Caudal gluteal nerve (e) Pudendal nerve These five nerves are of some obstetrical significance since these may be subjected to trauma during a difficult calving and damage can result in partial or complete paralysis of limbs.

(a) Obturator nerve:


It is derived from the ventral branches of the 4th and 6th lumbar vertebrae. It passes backward and downward under the peritoneum and is grooved on the pelvic surface of iliac shaft and then to the anterior part of the obturator foramen. This nerve supplies the external obturator, abductor, pectineus and gracilis muscles; all of which abduct the limbs. (b) Cranial gluteal nerve It originates from the 6th lumbar and 1st sacral nerve and after subdividing into several branches emerges to the greater ischiatic foramen with the cranial gluteal blood vessels. Fibers are supplied to the gluteal muscles, and tensor fascia latae; all of which have a common action of abducting the limb. (c) Ischiatic nerve It originates from the 4th lumbar and 1st two sacral nerves. It runs ventro-caudally to the greater ischiatic foramen from which it emerges from the pelvic cavity. Thereafter, it passes along the lateral surface of the sacro-ischiatic ligament and then down the femur where it divided into fibular and tibial nerves. It controls the muscles of the lower limb and also supplies the gluteal muscles, gluteal biceps, semitendinosus, and semimembranosus muscles. (d) Caudal gluteal nerve It originates from the first two or occasionally 3rd sacral nerves. It passes downward and backward in close association with the sciatic nerve. It supplies to the gluteal biceps and semitendinosus muscles. (e) Pudendal nerve It originates from the 2nd sacral and sometime, fibers of 3rd and 4th sacral nerves. Initially it is located under the peritoneum or embedded in the sacro-schiatic ligament together with the internal pudendal vessels. It supplies the skin, and muscles of the tail and pelvic diaphragm. PELVIMETRY It refers to the measurement of dimensions of the pelvic cavity. The study of the pelvimetry is much desired for selective breeding. Information obtained are used to reduce the incidence of dystocia in heifers as the heifers with small pelvic area has incidence of dystocia twice high than those with average pelvic area. Pelvic area is moderately to highly heritable and can be increased in herd through selection of breeding heifers and breeding bulls. Pelvic cavity measurement is taken prior to the first breeding season and combined with reproductive tract examination. The average pelvic area growth has been calculated as: 0.27 cm 2 per day from yearling to two years old heifer. Research has been shown that yearling pelvic size is the most reliable yearling factor indicating potential difficulty since the pelvic growth is linear

from 9 to 24 mo of age. Pelvic area of bull is smaller than that of heifer of the same weight and age. Pelvic area must be adjusted to an average weight or age of bull in group in order to compare the genetic potential. Estimated pelvic area growth has been 0.25 cm2 per day in bulls ranging from 10 to 15 mo of age and 700 to 1400 lbs. These values can be used to adjust a bull to a given standard but both age and weight adjustment should not be used on the same bull. Types of Pelvimeters Pelvic measurement can be obtained by using pelvimeter which are of following types: (i) Rice pelvimeter It is a metal inside caliper instrument which is used for pelvic measurement. (ii) Bovine pelvimeter It is a hydraulic type pelvimeter with a cylinder connected to a recorder by flexible tubing. (iii) Equibovine pelvimeter It is also named as Krautmaum Litton bovine pelvimeter. It is an electronic micrometer with a digital display. Each instrument is designed to be placed in the rectum of the animal and pelvic measurements are used on the scale outside the animal. Types of Pelvimetry There are two types of methods for determining dimensions of pelvic cavity as follows: (a) External or indirect pelvimetry: It is carried out by calculating pelvic diameter based on measurement taken between angles of ilia and distance between ischii to the height of the hip joint to the highest of the croup. This method is inaccurate and no longer of use. (b) Internal or direct pelvimetry: It refers to the measurement of interior of pelvis through the rectum with pelvimeter. The general procedure is restrain the animal, remove the feces from the rectum and instrument should be carefully carried into the rectum with hand. Use of force should be avoided during the procedures to obtain the width of the pelvic inlet at its widest point between the right and left shaft of ilium --- this is the horizontal diameter of pelvis. Then obtained the height of pelvic inlet between dorsal pubic tubercle on the floor of the pelvis and sacrum on the top --- this is the vertical diameter of pelvis. These two measurements are read in centimeter (cm) and multiplied together to get the pelvic area in centimeter square (cm2). Pelvic area (cm2) = horizontal diameter (cm) x vertical diameter (cm) The approximate dimensions of pelvis of the domestic animals are given below: Specie Sacro-pubic diameter (inch) Bisiliac diameter (inch) Mare 8.0 10.0 7.5 9.5 Cow 7.5 9.5 5.7 7.5 Sheep 3.0 4.25 2.5 3.5 Bitch 1.3 2.5 1.1 2.25 Sacro-pubic diameter: It is also called dorso-ventral or vertical diameter. Bisiliac diameter: It is called transverse or horizontal diameter.

OBSTETRICAL TERMINOLOGY
PRESENTATION It signifies the relation of long axis or spinal axis of the fetus to that of maternal birth canal. Types of Presentation It may be: (i) Longitudinal (ii) Transverse (iii) Vertical We will discuss below one by one; (i) Longitudinal presentation When the long axis of the fetus is in line to that of the maternal birth, then it is said to be a longitudinal presentation. It may be anterior or posterior longitudinal according to the extremity of fetus adjacent to the pelvic outlet. (a) Anterior longitudinal presentation: When the anterior extremity of fetus passed into the birth passage. (b) Posterior longitudinal presentation: When the posterior extremity of fetus is engaged into the maternal birth passage. (ii) Transverse presentation If the long axis of the fetus is presented cross-wisely in relation to the maternal birth canal, so that the head of the fetus is adjacent to one flank and the hip to the other flank of the dam. The transverse presentation is either dorsal or ventral; according to whether dorsal or ventral aspect of the fetal trunk is adjacent to the pelvic inlet. Exact transverse is not possible due to limited pelvis space due to which oblique variant is present. (iii) Vertical presentation When the long axis of the fetus is in upright position to that of the maternal birth canal. Exact vertical is not possible due to limited pelvic space. Only oblique variant of vertical presentation can occur. It may be dorsal or ventral; according to the surface of the fetal trunk being engaged with pelvic inlet. Presentation Facts: 95% calves and 99% foals are delivered in anterior longitudinal presentation whilst 5% calves and 1% foals are normally delivered in posterior longitudinal presentation. In case of single tone sheep (having one fetus inside); this ratio (95%) is same considerable whiles it is variable in case of twin pregnancy. In case of polytoccus animals, 30 to 40% of young ones are normally delivered in posterior longitudinal presentation. POSITION It indicates the relation of the dorsum of the fetus to the quadrent of the maternal pelvis. Quadrents include; sacrum --- dorsally, two ilia ---- laterally, and the pubis ---- ventrally. The position may be: a) Dorso-sacral position; normal one b) Dorso-iliac position (lateral position) c) Dorso-pubic position (ventral position)

Position Facts: In equine, normal gestational position is dorso-pubic or ventral. Foal rotates from ventral to dorsal (dorso-sacrum) position at the time of parturition. If sometimes this phenomenon fails, then foals may parturite with ventral position. Positional defects are more common in equine compared to bovine. Positional defects also failed in ovine but exact mechanism is still known. One theory; probably in the first stage of parturition, vigorous reflex come and may change the position of the fetus. POSTURE It signifies the relation of the movable appendages of a longitudinally presented fetus to its own body. The movable appendages may be flexed or extended. Normal posture: forelimbs are extended and head rested on the metacarpal bone. Postural defects: Postural defects are more common cause of dystocia. If one limb is retained, delivery may possible but if head is turned or deviated, then delivery not possible elsewhere. DEFECTS OF PRESENTATION 1. Ventro-vertical: It is called Dog sitting presentation; variable number of limbs are engaged in the birth passage. Deviation from normal, hind limbs also engage at pelvic brim in parturition. This defect is not common in bovine and rare in equine. Correction: Repulsion is performed; push it back to abdomen and uterus because there is no more room in the pelvic cavity to manipulate/correct the presentational defect. 2. Dorso-ventral: Hind limbs are closer to the pelvic inlet. This defect is rare in equine. Correction: It is very difficult. Sometimes, C-section (for live fetus) or fetotomy (for dead fetus) is performed at last resort. 3. Dorso-transverse: This defect is rare in equine and bovine. In this defect, fetus is presented cross wisely and dorsum of the fetus is adjacent to the pelvic inlet. 4. Ventro-transverse: A variable number of limbs passed into the birth passage. In this defect, fetus is presented cross wisely and ventral aspect of the fetus is adjacent to the pelvic inlet. DEFECTS OF POSTURE More common cause of dystocia Postural Defects of Head a) Lateral deviation of head: Head is displaced towards lateral side. It is most common cause of ruminant dystocia. Deviation of head; delivery not possible in any specie. b) Upward deviation of head: It is also known as Wry neck

It is reported in equine but very rare. Correction is very difficult due to long neck of foal. Fetotomy for dead fetus and C-section for live fetus are performed. c) Downward deviation of head: It is called Vertex posture. Head is displaced downward between the forelimbs. d) Poll deviation: Poll is adjacent to the maternal birth passage at the time of parturition. Postural Defects of Forelimbs a) Carpal flexion: Forelimbs are flexed at carpal joint. It may be unilateral or bilateral. b) Incomplete extension of elbow joint: Muzzle and hooves are at the same level due to incomplete flexion of the elbow joint. c) Shoulder flexion: Forelimbs are turned alongside or under the body. It may be unilateral or bilateral. Postural Defects of Hindlimbs a) Hock flexion: It may be unilateral or bilateral. It is usually observed when fetus is presented when fetus is presented in posterior longitudinal presentation. b) Hip or coxo-femoral flexion: It may be unilateral or bilateral. Bilateral hip flexion is known as breech presentation. It is very difficult to correct this defect.

OBSTETRICAL OPERATIONS
(Obstetrical maneuvers) Dystocia: difficult birth Eutocia: normal physiological birth Steps for proceeding in obstetrical operations: i. complete history ii. Examine the animal (physical and clinical) iii. Make correct diagnose There are numerous obstetrical operations, but use conservative procedure. It must be undertaken in the best interest of owner, dam and fetus. Most of the time conservative procedures are helpful but sometimes they fail. Redical and heroic procedures should not be performed. A combination of different procedure may b applicable. Decide your plan of action by keeping in view the viability of fetus. Decide the procedure/operation with alternate procedure. Consider the available assistance for any operation. You may call your colleague, technical assistance, paramedical staff and layman for assistance. During handling, conserve your energies. Both hands should be used in dystocia cases so that you donot get fatigued. By applying a procedure, you must take care of correct placement of instruments and then movement and prognosis of fetus. If sometimes fetal membrane or any other part causing hindrance, it should be removed. While handling a dystocia case, you should be gentle in approach. Precautions:

Excessive lubricants should be used. Lubrication is the key to success in handling of a dystocia case. Lubrication should be non-irritant and available easily. Best is one which can stick to birth passage i.e. vaseline but you may use simple oil. Try to maintain strict aseptic condition. When 1st stage or especially 2nd stage of labour prolonged, it becomes very difficult to expel out the fetus by mother without external assistance. Dystocia may be resulted due to cervix constriction; in the following condition: Uterine torsion: - cervix constrict and nothing comes out. Premature labouring:- cause cervix constriction; animal get fatigued by continuous s straining. In the 2nd stage of labour, fetus engaged to birth passage but not expelled out. How to proceed? i. History ii. Inspection include the physical examination without touching and disturbing the animal. iii. Clinical examination; palpate the animal iv. Make diagnosis and then prognosis. In dystocia cases, specific examination is done pertaining to reproductive tract. Precautions: Try to maintain strict asepctic conditions. Approach should be gentle and humane. Rough handling should be discouraged. Dystocia cases are usually reported in odd hours but they are treated as emergency cases. First you should make a plan of action/delivery. You should be correct in rectifying the defect. In most of the cases, fetal fluid is lost and passage becomes dry, then you must substitute the lost fluid by excessive lubrication. Lubrication is key to success in such cases. At the end, you may apply traction on the fetus.

Major Classes of Obstetrical Procedures


There are four major classes of obstetrical procedures; i.e. 1. Mutation 2. Forced extraction or traction 3. Fetotomy 4. Caesarian section (C-section) 1. MUTATION Mutation include all the procedures which are used to return the fetus to its normal presentation, position and pasture. These procedures are: a) Repulsion b) Rotation c) Version d) Adjustment and extension of extremities a) Repulsion: It means push back. It is also known as retropulsion. It includes the repulsion of fetus back into the uterus and abdominal cavity when engaged with body pelvis. It is performed to correct any defect because there is no more room for correction in birth passage, so we have to push the fetus back to avail sufficient space to correct the defect. Some space is there is the uterus and abdominal cavity. Repulsion is a fundamental procedure used in all the obstetrical procedures. Repulsion can be performed with hands and arms of the operator. In anterior presentation:

Repulsion is applied on the proximal part of extremity: - At level of chest and shoulder - Around the neck In posterior presentation: Repulsion is applied on the following points: - At hip joint - At ischial arch Instruments: Sometimes, instruments are also used to assist the obstetrical procedures. Repeller: It is of different types: a) Spike repeller: used in case of dead fetus b) Bowl repeller: used in living/viable fetus c) Crutch repeller Apply these instruments on proper place and guard with hands; otherwise instrument may slip and engage into birth passage. How repulsion can be facilitated? Repulsion can be facilitated by: i) Excessive lubrication; posture of animal also very important whether animal is recumbent standing or inclined. ii) By raising the hind quarter of the animal iii) If animal is on sternal recumbency, put animal on lateral recumbency; because visceral abdominal organs put the pressure on pelvis in sternal recumbency. iv) Use of obstetrical instruments. Repulsive forces are accomplished with bouts of strained of animals. v) Administer epidural anaesthesia Repulsion in Small Animals: In case of cat and dog, repulsion is accomplished with fingers of the operator. In case of small ruminants; hands can be used. b) Rotation: It entails alteration of position of fetus by moving it along its long axis in order to bring it into dorso-sacral position. This procedure is mush more easily affected on the responsive live fetuses. Live fetus: respond to digital pressure on eye. This will trigger a convulsive reaction which can cause slight rotational force; hence complete the procedure.

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