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ABSTRACT:

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Bovine uterine torsion is a common form of dystocia encountered by farm animal veterinary surgeons worldwide with reports of 1–20% of all attended calvings (Frazer et al., 1996). Anecdotally there have been suggestions that the incidence has been increasing although this may be biased by veterinarians seeing relatively less of the more basic forms of dystocia due to improved obstetrical competence demonstrated by farmers (Laven & Howe, 2005; Robin, 2005). A recent UK study of Holstein Friesian cattle estimated the incidence to be 0.24%, accounting for up to 22°% of all veterinary attended dystocias (Lyons et al., 2012). This article reviews the condition within the context of the fndings of this study.

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AETIOLOGY

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Cows are thought to be more prone to developing the condition than other domestic animals due to uterine instability resulting from the broad ligament attachments (Sloss & Dufty, 1980). The broad ligament supports the uterus dorsolaterally but attaches to the ventral lesser curvature. As pregnancy advances, the broad ligaments do not extend proportionately with the gravid horn, leading to instability (Frazer et al., 1996; Drost, 2007). Interestingly the condition is seen rarely in Bos indicus cattle where the broad ligament attachment changes from a ventral to a dorsal position towards the tip of the horn offering greater stability (Sloss & Dufty, 1980). In comparison, the condition is seen commonly in buffalo due to a poorly developed musculature of the broad ligaments making it even more prone to torsion (Prabhakar et al., 1994; Nanda et al., 2003).

It has also been suggested that the way a cow stands from lying in sternal recumbency may contribute to the circumstances by which torsion may occur. At the point when the front end is resting on the knees and the hind limbs are fully extended the longitudinal axis of the uterus is almost vertical allowing the uterus to rotate more easily about this axis (Noakes, 2009).

RISK FACTORS

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Specific risk factors for uterine torsion have not been fully elucidated although the condition is likely to be multifactorial. Torsions are more commonly seen amongst cows than heifers, and the presence of a single large calf in anterior presentation is the usual presentation. Brown Swiss cattle have been identified as a breed at increased risk, which is thought to be due to the depth of their abdominal cavity (Frazer et al., 1996). Increased calf mobility is likely to initiate the event, but the circumstances under which this occurs are unknown. However, it is possible that increased maternal activity around calving, such as through being moved between pens, may contribute to an increased risk.

CLINICAL SIGNS

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Cows with a uterine torsion often present with vague clinical signs. A list of reported clinical signs for 66 cases of uterine torsion is shown in Fig. 1, demonstrating that failure of normal progression of labour is the most frequently reported, seen in 85% of cases. This is consistent with a published case series from the US (Frazer et al., 1996). Fig. 2 shows a case of uterine torsion encountered by one of the authors where a displaced vulval commissure was observed.

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Figure 1. Percentage of cows with uterine torsion with different clinical signs (n=66).

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Figure 2. Displacement of the vulval commissure seen in a case of uterine torsion (left: pre-correction; right: post-correction). Note discolouration around the anus and increased skin tension between the anus and vulva.

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DIAGNOSIS

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Diagnosis is usually simple by vaginal examination when spiral folds are palpated in the vagina. Where the obstetrician is unsure, rectal examination can facilitate diagnosis through palpation of the broad ligaments. With the more usual anticlockwise presentation (viewed from behind), the broad ligament can be felt as a tight band running dorsally from the right side, ventrally to the left. Occasionally, the origin of the torsion is located pre-cervical making diagnosis more difficult by vaginal examination alone. In these cases, a rectal examination can also facilitate diagnosis.

It is possible that the condition is under diagnosed in milder cases (e.g. ≤45°) where delivery of the calf may still be possible.

TREATMENT

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Manual correction per vaginum

Most cases of uterine torsion can be corrected manually per vaginum. A prerequisite for attempting this technique is that a sufficient amount of foetus can be felt to allow sufficient manipulation. The process is greatly facilitated by being able to palpate the head and neck area of the calf. With the more usual anti-clockwise presentation, the calf should be rocked back and forth with the obstetrician applying force in the clockwise direction (and vice versa for clockwise torsions). This can be facilitated by an assistant applying external force to the abdomen by using their fists in a downward motion on the right hand side to coincide with the frequency of movements being applied internally (Fig. 3). This adds to the overall rotational momentum. A live calf is also usually advantageous where spontaneous movements can aid correction.

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Figure 3. Representation of external force to assist in the manual correction of an anticlockwise uterine torsion in a standing cow (viewed from behind).

Black arrow = direction of uterine torsion.

Blue arrow = direction of force for correction applied through internal manipulation. Red arrow = direction of force applied externally by an assistant.

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Some vets may use a detorsion rod (Manning et al., 1982). Ropes are applied to the feet of the calf and then to the end of the rod. Broad handles allow sufficient torsion pressure to be applied and the calf rotated. However, this method does carry the risk of trauma to the calf's limbs so caution should be exercised.

Rolling

When manual correction is failing to correct the torsion, or calf access is limited either due to its location or severity of torsion (≥360°), alternative correction methods should be considered. With the presence of an obviously dead calf, the obstetrician may consider alternative methods sooner due to the greater difficulty associated with manual correction. Rolling methods require an absolute minimum of two competent assistants in addition to the attending veterinary surgeon, although three is preferable. For an anticlockwise torsion, the cow should be placed in left lateral recumbency. From this position, the following three options are available:

  • • 
    Rolling alone

Simple rolling of the cow alone to the opposite side can be effective. The procedure is made safer by applying hobbles to the hind limbs. Care needs to be taken to ensure that the cow is rolled in the correct direction, i.e. if the torsion is anticlockwise then the cow should be rolled in the same direction – cast on the left and rolled.

  • • 
    Rolling with per vaginum manipulation

In addition to the rolling described above, a method of fixing the calf's position will increase the likelihood of correction. This may be done by the obstetrician grasping as much of the calf as possible while the cow is rolled. However, this method carries a higher risk of injury to the operator and therefore should be avoided. Sedation may be necessary and the use of hobbles should be considered essential.

  • • 
    Rolling with a plank –‘Schäfers’ method

A safer alternative for fixing the calf's position is to use a plank of wood, which is placed across the abdomen of the cow at right angles to the longitudinal axis (Fig. 4). Weight is placed onto the plank through an assistant either walking along the plank as the cow is rolled or lying on the plank as a safer alternative. A scaffold plank of some 4–5 metres in length is ideal for this purpose. Sufficient plank length is necessary in order to maintain pressure on the abdomen throughout the rolling. It is common for this method to work on the first or second attempt with foetal fluids often exiting the vagina after successful correction.

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Figure 4. Position of a plank in the recumbent cow for correction of an anticlockwise uterine torsion.

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With any method used, sedation should be avoided due to potential adverse effects on calf viability from the increased myometrial contractility brought about by α2-adrenoreceptor agonists. However, safety of personnel must take precedence in this scenario.

Surgical

Surgical correction of uterine torsion should be considered as a last resort. Intra-abdominal correction can be difficult to perform and there is a risk of uterine rupture due to the friable nature of the uterus resulting from torsion related oedema. In addition, intestinal displacement can hamper uterine access. Performing a caesarean section without correction is ill-advised since the uterus is likely to move to the normal position after foetus removal complicating access to the uterine incision for repair.

With the high success rate, relative safety for the operator and less stress invoking for the cow, the authors advise attempted manual correction in the first instance followed by rolling methods if necessary. Due to the potential complications associated with surgery, every attempt should be made to correct the torsion prior to caesarean section. With the high success rates associated with the non-surgical methods, surgical correction should only be necessary in the minority of cases.

POST CORRECTION MANAGEMENT

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Following correction, further obstetrical assistance is commonly required for delivery of the calf. In the study performed by the authors, 43% required further obstetrical intervention with the most common reason being incomplete cervical dilation (78% of those requiring further assistance). This is consistent with other reports on complication rates (Aubry et al., 2008). Despite this, calves can still be delivered without the need for caesarean section in the majority of cases. Opinion differs on how long to leave the cow after correction before further intervention is required. If possible, the calf should be delivered immediately after correction. When this is not possible the authors advocate leaving the cow for up to three hours to allow second stage parturition to proceed. After this time the farmer may be able to deliver the calf or alternatively a repeat visit should be made by the veterinary surgeon.

Failure to deliver the calf at this stage would indicate caesarean section. However, a balance needs to be struck in this approach between the value of the calf and the value lost by performing the caesarean section, not only through the cost of the procedure but in decreased cow performance in the subsequent lactation. Therefore in suckler cows, earlier surgical intervention may be preferred. The presence of intact foetal membranes is strongly associated with the calf being alive which may facilitate decision making. Communication with the farmer at this stage is crucial for successful management of the case.

PROGNOSIS

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Few studies exist regarding long-term survival of dams following uterine torsion. Frazer et al. (1996) reported a 78% short-term survival amongst hospital referrals. For longer term survival a dam survival rate of 93% and 84% at 100 and 200 days post calving respectively has been recorded by the authors along with a 57% culling rate among those surviving parturition (Lyons et al., 2012). Fertility was responsible for just over half the culls.

Calf mortality is typically high with uterine torsions, probably due to prolonged parturition associated with the condition and subsequent foetal hypoxia. However, this is variable with calves recorded as born alive in 24–71% of cases (Pearson, 1971; Manning et al., 1982; Frazer et al., 1996; Aubry et al., 2008; Lyons et al., 2012). Prompt recognition of a problem by the farmer is likely to be the main factor underlying the mortality seen and so farmer training on parturition management may reduce associated calf mortality.

CONCLUSION

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

Uterine torsions are a common cause of veterinary attended dystocia associated with high calf mortality and dam culling rate. Further work should be targeted towards establishing risk factors for the condition so that management practices may be implemented to decrease the incidence of the condition. However, careful management and good client communication are essential for successful outcomes.

QUESTIONS

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES

1. In the panel's experience, what risk factors are associated with an individual animal developing a uterine torsion?

Steve Borsberry replies:

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Before answering the questions posed to the panel, I am of the opinion that in dystocia cases a vet's approach is predominantly formed by his/her previous experiences. No doubt ‘we’ have all heard of a neighbouring practice's calving from hell, we were not there and discovered later that it was at 2 o'clock in the morning, mid December, in a ditch on a grass hill, raining and the only help was an elderly farmer who had recently had a hip replacement!I am not particularly weak and have relatively long arms, even so find it difficult to palpate a calf's leg let alone its head. I spend a limited amount of time trying to correct torsion per vaginum then resort to rolling or caesarean or both depending on the circumstances.

Our experience is not dissimilar to Lyons et al., 2012 with an estimated incidence of uterine torsion of 0.13%. At a meeting some years ago a well respected veterinary surgeon stated that he personally dealt with over 100 torsions a year. I pose the question, are torsions over diagnosed rather than under diagnosed? Are some calf malpresentations, such as lateral, mistakenly diagnosed as uterine torsion?

Casting and rolling is a health and safety issue and where I am at variance with the authors is that it would be an unusual case where I would not use a sedative (Xylazine). I would agree that torsions are found more in cows compared to heifers; dairy cows are 700+ kg and suckler cows 800+ kg, many of these suckler cows are fractious and simply applying casting ropes, without sedation, is not without danger. Once the torsion has been corrected, administration of α2-antagonists to reverse the affects of the α2-agonist does not appear to have had detrimental affects on the viability of the calf and reduces myometrial contractions produced by the α2-agonist. N.B. If a caesarean has been performed under sedation the live calf benefits from α2-antagonist administration.

In the majority of cases, the risk factors associated with developing a uterine torsion must occur in the first stage of labour, had they occurred prior to this surely more cases would be seen during pregnancy especially the final trimester. The depth of the abdomen as postulated regarding Brown Swiss cattle may be a factor however, I cannot recall any major problems with Jersey or Guernsey cows; but is this due to the fact that the relative foetal size in the Channel Island cows is likely to be less when compared to the Brown Swiss?

When ‘outbreaks’ (2 – 4 cases) occur on a farm, it is difficult to establish a cause. I have found simply casting a cow has corrected some torsions. Hormone changes around calving do encourage cows to mount each other; if cows stumble or collapse to the floor this may also be a risk factor. Similarly, introducing new cows to a close-to-calving group can produce head bunting and fighting – could this be a risk factor?

No doubt, due to the time at which uterine torsion occurs (first stage labour), excessive calf mobility may be a great factor – the larger the calf, the more likely that a torsion may not correct itself.

Colin Lindsay replies:

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It is very difficult to determine consistent risk factors, however in our practice there is a suspicion that moving cows prior to calving and calving cows on sloping fields can increase the risk.

As an aside, good stockmanship is required for the early detection of a uterine torsion. Sometimes the symptoms are very subtle, such as restlessness and holding the tail up, with no abdominal contractions.

I have diagnosed two uterine torsions anterior to the cervix in 22 years of Farm Animal practice. One was a successful outcome, one wasn't. In both cases the diagnosis was made per rectum. The vaginal examination was normal. The salutary lesson from these cases was ‘always perform a rectal examination on cows with slow or delayed parturition’.

John Macfarlane replies:

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Our practice workload is predominantly with beef suckler herds and sheep, so we seldom encounter uterine torsion in dairy animals. That said, our only case in a heifer was on a dairy unit. All other cases have been in cows and always in uniparous pregnancies. With one exception, all cases have been in normal anterior presentation (the exception being in normal posterior presentation).

Virtually all cases have occurred during the housed period, with a significant majority being on total mixed ration feeding. In my experience calves delivered after uterine torsions are not usually oversized.

Interestingly, we recognise that uterine torsions often occur in runs, both at a farm level and across the practice. I now resist the temptation to advise the farmer that he won't see another one for a while!

Pre-cervical torsions are not that unusual and can catch the unwary – always carry out a rectal examination.

Jon Mouncey replies:

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I believe the aetiology of this condition is not fully understood, however in my mind the main predisposing cause contributing to the development of a uterine torsion in cattle is the anatomical arrangement of the bovine uterus where the broad ligaments attached to the ventral surface of the uterus support each uterine horn in a dorsolateral direction. But the design flaw lies in that in an advancing pregnancy these broad ligaments do not elongate relative to the growing gravid uterus, resulting in the uterus becoming positioned beyond the stable area of attachment, and resting on the abdominal floor supported by the rumen, abdominal viscera and abdominal wall.

Certainly when cattle rise, hindlimbs first, I can envisage the gravid uterus becoming suspended in the abdominal cavity and at that point a slip, fall or butt from another cow could feasibly result in a uterine torsion. Perhaps this may be more so in breeds of cattle with a deep capacious abdomen such as Holstein Friesian and Charolais, especially where there may be reduced rumen volume prior to calving. In my experience uterine torsion is more common in cows rather than heifers.

Excessive foetal weight and foetal movements during 1st stage of labour in response to myometrial contractions may be significant, lack of uterine tone or indeed conditions that might affect these aforementioned conditions are likely to prove significant.

There have been discrepancies in the literature regarding whether cows are more at risk if at pasture or housed, to my mind this could be related to risk of slipping, falling, or moving between pasture to concrete surfaces, but group changes with aggressive social interactions either physically or affecting feed intake and rumen volume might be just as significant. There are thoughts that housed or confined cattle may suffer from lack of exercise leading to decreased abdominal musculature which could inadvertently lead to increased space and slackness in the abdomen. Interestingly in discussion, some of my colleagues from Pakistan suggested swimming as a significant risk factor in buffalo, however not many cattle regularly partake in this pastime here in South Eastern England! Given the severity of some torsions we encounter beyond 180 degrees, I think it likely there is more to be understood in the aetiopathogenesis of this condition.

2. After correcting a uterine torsion, incomplete cervical dilatation is commonly encountered. Are the panel members in favour of waiting to see if dilatation occurs, or to try and proceed with pulling the calf as soon as possible?

Steve Borsberry replies:

Incomplete cervical dilation is a problem for the attending veterinary surgeon. I have found that in heifers, complete dilation does not occur and a caesarean is performed.

No matter what procedure is being undertaken, especially dystocia, I prefer to provide a running commentary on the progress or lack of in order that the client is fully aware of what is happening. Once the torsion has been corrected an examination of the ‘texture’ of the cervix will aid the decision as to whether to apply traction now, later or discuss other options. Where the cervix appears moist and soft, with what appears to be an average size calf I will attempt traction; alternatively if the cervix is not of sufficient dilation I advise re-examination in two to three hours. When the os of the cervix feels ‘tough’ and fibrous (similar to a true ring womb), unless the calf is small, I am against traction. I have even cut these bands with a guarded blade and still not been able to create enough room for a calf delivery. I do not administer oxytocin unless there is a fully dilated cervix and I am of the opinion that the calf is of a size that can be delivered without excessive traction.

Colin Lindsay replies:

As the author stated, if the foetal membranes are intact then waiting is definitely an option. If the foetal membranes are broken then the process of delivery has to continue. If the decision is to wait for further dilation to occur the veterinarian must always warn the owner that this does increase the risk of foetal mortality. As a rough rule of thumb if the dilation is large enough to allow both feet and the nose to partially come through the cervix I would continue with the delivery and apply gentle traction.

John Macfarlane replies:

After uterine torsions are corrected, it is my normal policy to attempt to deliver the calf by traction straight away. I can only recall one occasion when I revisited a couple of hours later to deliver the calf. In general, I find that cows left because of incomplete dilation of the cervix almost always need further veterinary attention.

Jon Mouncey replies:

Early attempts to deliver a calf with failure of the cervix to dilate can result in cervical laceration. In addition, in most instances where I am able to perform manual correction per vaginum and the calf is live, I will attempt to deliver the calf there and then after an assessment of how friable the cervix may be. There have been hypotheses that manipulations through the cervix to correct the torsion can help to effectively dilate the cervix. If the calf is alive and cervical dilatation is incomplete waiting a few hours to see if labour will proceed to 2nd stage is an option. However if the foetal membranes have already ruptured I would not delay undertaking a caesarean. Equally holding your nerve for two hours with a live pedigree calf waiting to be born into the world or efforts to restrain a fractious cow for a second time might have a bearing on one's decision! In my experience the cervix rarely dilates if the foetus is already dead in which case a decision as to whether to perform a caesarean, embryotomy or euthanasia should be made.

3. What factors do the panel consider in deciding whether to perform a caesarean section on cases of uterine torsion?

Steve Borsberry replies:

Value of the calf may influence the decision to perform a caesarean; however, welfare considerations are important. Many clients are influenced by previous surgical success on their premises and staff availability. Uterine torsion in heifers, provided there is no abnormal uterine discharge, is corrected surgically prior to uterine incision.

A farm's recent history of dystocia due to relative foetal oversize will often sway a client into requesting a caesarean immediately preferring surgical correction to vaginal manipulation and/or casting and rolling.

Attempting to suture a friable oedematous uterus is challenging. If foetid uterine discharge is discovered with incomplete cervical dilation a frank discussion needs to occur. These animals will not calve, thus require euthanasia or caesarean section. It may be that euthanasia may be required in the midst of the surgical intervention.

My experience with dystocias, including uterine torsion, is that, if there is any doubt at all that the calf cannot be delivered without excessive traction either due to relative maternal undersize, relative foetal oversize and/or incomplete dilation of the birth canal and it indicates a caesarean then the sooner the better.

In my opinion, traumatising the cervix and/or vagina has a more deleterious affect on future fertility compared to a caesarean.

Colin Lindsay replies:

There are numerous factors which must all be taken into account. Some of the factors which would be indicators to perform a caesarean would be, as the author stated, if it is a suckler cow or pedigree then the intervention point will be earlier, the duration of stages 1 and 2, foetal stress (kicking), inability to rectify the torsion, foetal mortality prior to autolysis. Factors which would be negative indicators would be poor facilities, hygiene conditions, manpower, and foetal autolysis.

John Macfarlane replies:

As the only annual production from a beef cow is its offspring, our priority is the delivery of a good, viable calf. Consequently, attempts at correction are seldom prolonged, especially with the larger beef breeds. Sound surgical technique, careful hygiene and pre-operative antibiosis produce a successful long-term outcome in the vast majority of cases. Postoperative NSAIDs are essential in the short term and help improve future breeding success.

In my experience, complications arising from tissue friability can be overcome by careful handling of the uterus.

Jon Mouncey replies:

In the case of a live calf, if the torsion is irreducible or the cervix refuses to dilate, I would consider performing a caesarean section with intra-abdominal correction prior to hysterotomy. The client must however be aware of the significant risk of uterine rupture and post-operative peritonitis, metritis and perimetritis, especially if the uterine wall is found to be oedematous or with symptoms of vascular compromise. In some instances closure of the uterus may not be possible, resulting in a decision to euthanize the dam. Uterine torsion is the most common cause of uterine rupture in which case euthanasia is indicated in my opinion. If the calf is dead and it was possible, I would opt for an embryotomy over a caesarean or dependant on clinical examination of the dam, euthanasia may be the best option – e.g. dam in toxic shock with a dry emphysematous calf and uterus clamped down around it.

Ultimately prognosis will depend on the duration of the torsion, degree of severity and extent of vascular compromise within the uterus and the client should be warned about this prior to surgery. Thereafter first and foremost, a thorough clinical examination of the dam is indicated prior to lifting your surgical blade!

REFERENCES

  1. Top of page
  2. ABSTRACT:
  3. AETIOLOGY
  4. RISK FACTORS
  5. CLINICAL SIGNS
  6. DIAGNOSIS
  7. TREATMENT
  8. POST CORRECTION MANAGEMENT
  9. PROGNOSIS
  10. CONCLUSION
  11. QUESTIONS
  12. REFERENCES
  • AUBRY, P, WARNICK L.D., DESCOTEAUX, L. and BOUCHARD, E. 2008. A study of 55 field cases of uterine torsion in dairy cattle Canadian Veterinary Journal 49(4):366372.
  • DROST, M. 2007. Complications during gestation in the cow Theriogenology 68(3):48791.
  • FRAZER, G. S., PERKINS, N. R. and CONSTABLE, P D. 1996. Bovine uterine torsion: 164 hospital referral cases. Theriogenology 46(5):739758.
  • LAVEN, R. and HOWE, M. 2005. Uterine torsion in cattle in the UK Veterinary Record 157(3):96.
  • LYONS, N. A., KNIGHT-JONES, T. J. D., ALDRIDGE, B. M. and GORDON, P. J. 2012. Incidence, Management and Outcomes of Uterine Torsion in Dairy Cows. Cattle Practice (Accepted).
  • MANNING, J., MARSH, P., MARSHALL, F., McCORKELL, R., MUZYKA, B. and NAGEL, D. 1982. Bovine uterine torsion: a review illustrated by cases from the Western College of Veterinary Medicine Large Animal Clinic Bovine Practitioner 17:9498.
  • NANDA, A. S., BRAR, P. S. and PRABHAKAR, S. 2003. Enhancing reproductive performance in dairy buffalo: major constraints and achievements Reproduction 61:2736.
  • NOAKES, D. E. 2009. Maternal dystocia: causes and treatment. In Veterinary Reproduction and Obstetrics, ed. D E Noakes, T. J. Parkinson, and G. C. W. England, 232246. 9th ed. Elsevier.
  • PEARSON, H. 1971. Uterine torsion in cattle: a review of 168 cases Veterinary Record 89(23):597603.
  • PRABHAKAR, S., SINGH, P, NANDA, A. S. and SHARMA, R. D. 1994. Clinico-Obstetrical Observations on Uterine Torsion in Bovines Indian Veterinary Journal 71(8):822824.
  • ROBIN, G.W. 2005. Uterine torsion in cattle in the UK Veterinary Record 157(4):124.
  • SLOSS, V. and DUFTY J. H. 1980. Dystocia. In Handbook of Bovine Obstetrics, 108111. Baltimore ; London : Williams & Wilkins.