FEMALE BOVINE INFERTILITY 0749-0720/93 $0.00 + .

20

ABNORMAL BOVINE
PARTURITION
Obstetrics and Fetotomy
Robert G. Mortimer, MS, DVM,
and Robert E. Toombs, DVM, MS

Calf losses due to dystocia can substantially affect the percentage

of calves weaned on most ranching operations. In fact, a 2-year
Colorado study of over 24,000 calvings on 73 ranches reported that 34%
of all calf losses were associated with dystocia/stillbirth (Wittum T,
Salman M, Odde K, et al: Submitted for publication, 1992). In a IS-year
study of a Montana research station, nearly SO% of all calf losses could
be directly or indirectly attributed to dystocia. 22 Death losses that occur
at the time or shortly after calving are easy to assess, but more subtle
losses exist. In cows that experience calving problems, researchers have
reported lighter weaning weights,7 an increased calving-to-breeding
interval, 15, 22 and a higher percentage of open COWS. 21 These losses could
be minimized if management addressed all the loss factors associated
with dystocia, and instituted calving management programs to reduce
the impact of calving problems on beef cattle operations. 3

FACTORS ASSOCIATED WITH DYSTOCIA

There are several genetic, environmental, nutritional, and manage-

ment factors that impact the dystocia rates seen in beef cattle. The
highest incidence of dystocia and calf death losses occur in heifers
calving for the first time/ with the most common cause being dispro-

Some portions of this text are adapted from Mortimer RG, Ball L, Olson JD: A
modified method for complete bovine fetotomy. J Am Vet Med Assoc 185:525, 1884; with
permission.

From the Department of Clinical Sciences, Colorado State University College of Veterinary
Medicine and Biomedical Sciences, Fort Collins, Colorado

VETERINARY CLINICS OF NORTH AMERICA: FOOD ANIMAL PRACTICE

VOLUME 9 • NUMBER 2 • JULY 1993 323

324 MORTIMER & TOOMBS

portionate in size between the fetus and the maternal pelvis. 3, 6, 10, 15, 19,
23-25, 28, 29 Dystocia rates are inversely correlated to age and size of
replacement heifers,4, 9, 20, 27, 29 which suggests that the larger the animal,
the less likely the chances of dystocia. Cow size can be correlated to
both a larger pelvic diameter and heavier birth weights (and similar or
reduced dystocia rates).4, 13, 17 Work completed in Montana, Nebraska,
and Colorado showed that, in first-calf heifers, the most severe dysto-
cias occurred in heifers with abnormally small pelvic canals. Unfortu-
nately, such heifers could not be identified by visual evaluation alone.
Selection of heifers based on pelvic measurements achieves some
reduction in dystocia rates,2, 13, 25 particularly when coupled with sire
selection. 1, 12, 16, 19
Hereditary factors may have a significant bearing on dystocia rates.
Certain sires (whether used in a cross-breeding program or not), along
with certain breeds of livestock, have higher rates of dystocia. 12, 16, 19
These are attributed primarily to birth weights of newborn calves.
Particular bulls within breeds have been identified as siring calves
with heavier birth weights and increased rates of dystocia as a conse-
quence.1, 12, 16, 17, 20, 26, 32
Prepartum energy levels can alter the incidence of dystocia. 5, 11, 14,
19,20,33 Cows and heifers on diets low in energy may fatigue prematurely
during delivery28 and have higher calf mortality 11, 15 and poor subsequent
reproductive performance. 5, 11, 15,33 Replacement heifers that have not
reached their optimum size at the time of calving also may experience
higher levels of dystocia. 4, 9,20,27,29 Calving heifers prior to mature cows
provides opportunity for better monitoring of the calving process,
allowing for early intervention when necessary, and the application of
correct procedures for dystocia management. 3, 4, 27 Better calving man-
agement, coupled with good colostral management in calves,20, 26 likely
will result in similar calf losses in heifers and mature cows.

GUIDELINES FOR INTERVENTION

An understanding of the three stages of labor is a prerequisite for

determining proper guidelines for intervention. Stage 1 labor is char-
acterized by restlessness and occasional signs of colic. This stage ends
when the cervix is dilated and fetal parts enter the birth canal, initiating
stage 2 labor. In stage 2, actual delivery of the fetus occurs, with the
most obvious early sign being passage of the unbroken amnionic sac
through the vulva. The presence of fetal parts in the birth canal in
stage 2 initiates the abdominal press, which increases in force and
frequency until the fetus is delivered. In stage 3, expulsion of the fetal
membranes is accomplished.
Even though the bovine fetus may live in utero for up to 8 hours
after the initiation of the second stage of labor,30 this is probably an
exception rather than the rule. It is unlikely that the calf will be
delivered alive after this duration of time. Any interruption in the
 ABNORMAL BOVINE PARTURITION 325

normal progress of labor should be considered abnormal. In such cases,

intervention is always indicated. 28, 30 In general, however, the following
guidelines can be used in deciding when to intervene in the calving
process: 30
1. The cow has been in first stage labor longer than 6 hours.
2. The cow has been in second stage labor for 2 hours and progress
is slow or absent.
3. The amniotic sac is observed hanging outside the vulva for 2
hours and delivery is not complete.
4. The fetal membranes are not passed within 8 to 12 hours
postdelivery .
From these guidelines, a maximum interval of 3 hours between
observations of cows and heifers at calving has been recommended. 30
Earlier intervention than suggested by these guidelines has been re-
ported to reduce calf losses, increase first service conception rates, and
increase overall pregnancy rates. 3 When adequate facilities and trained
personnel are available, early intervention may be considered a valuable
management tool.

ASSESSMENT OF DYSTOCIA

When an animal is presented in dystocia, a thorough history should

be obtained. The veterinarian should assess the cow's parity, determine
the stage and duration of labor, be inquisitive about any prior attempts
at delivery, and note both the duration of gestation and any pertinent
incidents occurring during the course of gestation.
Prior to examination of the cow, the perineal region should be
thoroughly cleaned and disinfected. The veterinarian should use copi-
ous amounts of lubrication during examination of the birth canal if it is
dry. The size of the pelvic opening, along with the amount of cervical
and vaginal dilation, should be evaluated. In addition, the obstetrician
should make a complete search of the pelvic canal, uterus, and mes-
entery to determine whether or not injuries are present, especially in
cows in prolonged labor or those that have had prior assistance. The
presentation, position, and posture of the fetus must be assessed. For
cattle, the presentation of the fetus is cranial, with both forefeet
presented into the birth canal. In cranial presentation, the fetal head is
presented nose-first atop the forelimbs. 28, 30 Calves may be delivered
without assistance in caudal presentation, but the likelihood of stillbirth
is increased. All other presentations, positions, and postures are con-
sidered abnormal. The caudal presentation means added risk to the
fetus because it may suffocate before delivery is complete.
The vital status of the fetus influences the selection of method for
resolution the dystocia. A live fetus exhibits a withdrawal reflex when
its feet are pinched between the toes or its tongue or mouth is pinched,
blinks when the eyes are palpated, or contracts its anal sphincter if a
326 MORTIMER & TOOMBS

finger is inserted into its rectum. If these reflexes are absent, when
possible, palpation of the fetal thorax for a heartbeat or the umbilicus
for a pulse is recommended. A live fetus should be delivered by
mutation or forced extraction or by Cesarean section, whereas a dead
fetus generally should be removed, in order of preference, by mutation
or forced extraction or by fetotomy.8, 18,28,30 Before the decision is made
to do a fetotomy, one should apply several of these techniques to
confirm lack of fetal viability. 8, 18, 30

DILATING THE BIRTH CANAL

The veterinarian often finds it necessary to dilate the maternal birth

canal manually before forced extraction is attempted. The maternal
birth canal should be well lubricated, then dilatation accomplished by
clasping both hands together, fingers interlocked and arms parallel,
and inserting them into the vulva and vagina. The arms form a wedge
and a persistent force is applied against the undilated birth canal until
dilatation occurs. It may take up to 20 minutes to adequately dilate the
vulva, vagina, and cervix of a cow so that damage to the reproductive
tract does not occur. 30 By completing this procedure, veterinarians
avoid the most common types of injuries incurred by the dam during
calving (vulvar, vaginal, and cervical tears; hematomas; postparturient
vaginal necrosis; and calving paralysis due to damage to the sixth
lumbar spinal root).28
With the calf in cranial presentation, the two points of greatest
resistance occur when the head passes through the vestibule and vulva,
and when the thorax is delivered through the pelvic canal. There is
little danger to the fetus because its umbilicus usually remains attached
and functional. If dilatation of the vestibule is necessary, inserting one's
hands around the head or thorax in the constricted area and gently
stretching the vestibule away from the fetus will allow the fetus to pass
safely.
A fetus in caudal presentation presents a more difficult problem.
Its umbilicus may be looped between the rear legs or impacted on the
pelvic brim, potentially compromising the fetal blood supply and
inducing asphyxiation. 28 Severe organic damage may occur if the fetal
blood flow is interrupted for as short as 5 minutes. Mechanical damage
also is more likely to occur to the fetus in caudal presentation, probably
because the fetal body conformation and traction are less compatible
with safe delivery than when a fetus is presented cranially. In addition,
the caudally presented fetus often is not pushed far enough into the
birth canal to adequately dilate the cervix and to apply point pressure
to the vagina and vulva. Consequently, the cow may not show signs
of stage 2 labor. In this situation, delivery should not be attempted
until full dilation of the birth canal is achieved, or fetal death or injury
may result.
 ABNORMAL BOVINE PARTURITION 327

CORRECTION OF COMMON DYSTOCIAS DUE TO

ABNORMAL PRESENTATION, POSITION, OR
POSTURE

Knowledge of procedures for efficiently correcting abnormal pres-

entation, position, and posture of the bovine fetus allows the obstetri-
cian to minimize losses associated with relief of dystocia. Corrective
procedures usually are less difficult to apply with the cow in the
standing position. A dystocia should be evaluated carefully before
correction is attempted. In many instances, Cesarean section is the
method of choice or, in those involving a dead fetus, a fetotomy may
be best. Once intervention is started, one should limit the amount of
time spent on mutation without any progress to 0.5 hour before
obtaining professional help. Efforts beyond this time usually are futile.
In many instances, special equipment and techniques available to the
veterinarian are required to deliver the fetus. Four types of mutations
can be applied to the fetus-repulsion, rotation, version, and reposition
of extremities. 28 Repulsion and reposition of extremities are self explan-
atory. Rotation is accomplished by turning the fetus on its longitudinal
axis, whereas version is by turning the fetus end-for-end on its trans-
verse axis.

Cranial Presentation

Dorso-llial and Dorso-Pubic Position

When the fetus is positioned on its side (dorso-ilial) or upside
down (dorso-pubic), correction is accomplished by rotating the fetus.
Rotation is easier to accomplish when traction or repulsion are applied
simultaneously to longitudinal movement of the fetus. Rotation some-
times can be accomplished by using the operator's arm and hand alone;
however, only a strong person can rotate the fetus in utero. The
procedure requires the operator to "scoop" the fetus into the dorso-
sacral position. Another useful method is that of crossing the fetal legs
and applying a rotational force. This is less effective than if the fetus is
in caudal presentation. While maintaining the rotational force, the fetus
is alternately repelled and extracted until the dorso-sacral position is
achieved. With more difficult dystocia, a detorsion rod may be required.
The same principles apply with use of the detorsion rod. Use of
excessive force may damage the dam or fetus, however. The rod or
chains may impact the cow's pelvic brim, tear the birth canal, or fracture
the fetal legs. 28

Retention of a Forelimb
Usually, one or both forelegs are retained, flexed at the carpal or
shoulder joints. To correct this posture, a "flexed carpus manipulation"
is used. 28 If the shoulder is flexed, the obstetrician must first convert it
328 MORTIMER & TOOMBS

to a flexed carpus posture by placing caudal traction on the upper

foreleg. Then the carpus is repelled in a cranial-dorso-Iateral direction
while simultaneous traction is applied to the hoof in a medial and
caudal direction. The fetal carpus thereby is moved laterally and the
fetlock and hoof medially so the leg can enter into the birth canal. The
hoof should be guarded to prevent damage to the uterus and birth
canal. Flexed carpus posture also can be corrected by placing a snare
below the fetlock, then applying traction on the snare while the fetal
carpus is repelled and the limb extended into the pelvic canal.

Elbow Lock Posture

One or both of the fetal elbows can be flexed and locked on the
pelvic brim as the head and legs extend into the pelvic canal. Correction
is achieved by repelling the fetal trunk while applying alternate traction
on the limbs until they are fully extended.

Foot-Nape Posture
One or both forelimbs can be crossed over the nape of the neck as
the fetus passes into the birth canal. This dystocia usually is not difficult
to correct, but persistent maternal abdominal pressing may force the
forelimbs through the dorsum of the birth canal, resulting in a recto-
vaginal fistula or a perineal laceration. To correct this dystocia, the fetal
head must be repelled slightly and elevated until each front leg can be
positioned beneath the head prior to placing traction upon the fetus.

Dog-Sitting Posture
This posture occurs when the rear legs are extended along the
abdomen of the fetus in cranial presentation. Careful examination is
required to detect this condition because the fetal head and front legs
often are presented normally into the pelvic canal and the malposture
of the rear legs may go undetected. If traction is applied, the fetus
impacts into the canal. If the fetus is small, this posture may be
corrected by repelling its rear legs as it is extracted. If care is not taken,
however, the feet, partly repelled, may perforate the uterus when
traction is applied. If the fetus is too large to be delivered by this
mutation, a Cesarean section may be indicated. 28

Deviation of the Head

The lateral deviation is the most common head deviation seen,
although deviations in any direction are possible. With this deviation,
room is obtained for manipulation of the head by repelling the body of
the fetus. Opposing forces usually are required, one repelling the fetus,
the other converting the head deviation to a normal posture by applying
traction to the head. For example, one may use head or jaw snares or
 ABNORMAL BOVINE PARTURITION 329

orbital hooks to apply traction to the head while repulsion is accom-

plished by pushing with the hand against the shoulder or brisket of
the fetus. Care should be taken when jaw snares are used because the
fetal jaw fractures easily. Repulsion may be accomplished with a fetal
repeller placed against the thorax or shoulder, then traction can be
applied by the obstetrician's fingers to the jaw or nose of the fetus. The
head should be maintained in an upright (dorso-sacral) posture. It is
easier to correct this malposture if head traction is applied with the
hand rather than with a snare because the fetal head can be controlled
more precisely. If adequate repulsion is obtained, the head can be
brought into the birth canal upside down, then rotated. Lateral head
deviation may be associated with axis rotation of the neck or ankylosis
of the cervical vertebrae or "wry neck." The obstetrician must perform
a fetotomy or Cesarean section to alleviate the dystocia caused by wry
neck. 28
The fetal head occasionally deviates ventrally between the forelegs
(head-breast posture). To correct this dystocia, one initially converts
the ventral into a lateral deviation. This is accomplished by repelling
one of the forelimbs into a flexed shoulder posture. The head is then
moved from a ventral to a lateral deviation by applying a laterally
directed force to the head and neck using the hand and arm. The flexed
shoulder is reconverted into a normal posture with both legs in the
birth canal. The lateral deviation is then corrected as previously de-
scribed.

Vertex Posture
In this dystocia, the fetal nose is impacted ventrally against the
maternal pubis, and the fetal poll is in the pelvic canal. This posture
usually is associated with a dead fetus because a live one usually moves
enough to prevent entrapment. Commonly, correction is accomplished
by repelling the fetus enough to allow conversion of the head to its
normal posture.

Caudal Presentations

Rear Umb Retention

One or both of the rear limbs may be retained in either hock or
hip flexion. With hip flexion (breech) presentation, there is little stim-
ulus to the birth canal; consequently, forceful second stage labor may
not be observed. These postures may be difficult to correct; in uncom-
plicated cases, however, the "flexed hock" manipulation can be used. 28
The obstetrician converts the "flexed hip" to a "flexed hock" posture.
This requires repulsion of the fetus by holding the metatarsus in one
hand then forcefully repelling the hock cranial-laterally while applying
traction on the foot in a caudal-medial direction. One hand should
guard the hoof as it is rotated medially into the birth canal to prevent
330 MORTIMER & TOOMBS

injury to the uterus and pelvic canal. A snare also can be used to help
correct this dystocia. The looped snare should be placed below the
fetlock joint and the standing part passed down the dorsal surface of
the foot and between the toes. Then the hock is repelled as previously
described while traction is applied with the snare. The hock and fetlock
joint flex when traction is applied to the snare, extending the retained
limb into the birth canal.

Transverse Presentations

The fetus may be transverse to the birth canal, with either the back
or all four feet and the belly presented. The cow mayor may not apply
the abdominal press in this presentation. Transverse presentation
commonly leaves very little room for mutation; consequently, the
method of choice for alleviating this dystocia usually is Cesarean
section. If room is available, however, the fetus may be converted to a
caudal presentation, dorsal-sacral position, and extracted.

FORCED EXTRACTION OF THE FETUS

The procedures that follow, in general, were developed by the

obstetricians at the University of Utrecht, The Netherlands. 3o Once
abnormal presentation, position, and/or posture are corrected, delivery
usually is uneventful. Following mutation or an oversized fetus, how-
ever, forced extraction may be necessary. In delivery of the fetus by
forced extraction, consideration must be given to three major points-
(1) position of the cow, (2) maximum amount of traction allowable, and
(3) the direction of traction. Failure to consider these factors carefully
prior to the delivery process results in greater fetal and maternal losses.
If the cow is to assist the operator in the delivery process, she should
not be given epidural anesthesia.

Cranial Presentation

The cow should be cast in right lateral recumbency to determine

whether or not the cranially presented fetus can be delivered. For
application of traction, a loop of chain can be placed above each fetlock
joint and a half-hitch taken below the fetlock in the pastern area.
Traction should come from the dorsal (cranial) surface of the leg. Figure
1 illustrates the direction for application of traction during various
phases of delivery. The shoulders of the calf often can be "walked"
through the maternal pelvis by first applying unilateral traction in a
caudal direction with the force of one man on the bottom (left) forelimb
of the fetus, followed by similar traction on the upper leg. The shoulder
will have passed the wings of the ilium when the fetal fetlock joint
 ABNORMAL BOVINE PARTURITION 331

A 8

Figure 1. Forced extraction of fetus in cranial presentation. Cow is in right lateral

recumbency. A, Unilateral traction is in a caudal direction initially using the force of one
person per forelimb; B, after fetal shoulders are through the maternal pelvis, the fetus is
rotated 45 to 90 degrees to a dorso-iliac position, and C, traction by force of two people or
equivalent can be applied bilaterally. Traction is then in a caudal or slightly dorsal direction
relative to the longitudinal axis of the cow. (Adapted from Schuijt G, Ball L: Delivery by
forced extraction and other aspects of bovine obstetrics. In Morrow DA (ed): Current
Therapy in Theriogenology, vol 1. Philadelphia, WB Saunders, 1980, pp 254-256.)

protrudes approximately 10 to 15 cm (or one hand's width) beyond the

lips of the vulva. Extraction is possible only if the second shoulder can
be extracted past the ilium into the birth canal. If not, Cesarean section
or fetotomy is indicated. Similar diagnostic steps may be used in the
standing cow but, if the fetus is oversized, its weight may prevent the
shoulders from coming through the pelvic inlet. 30 In addition, a standing
cow is not as capable of assisting the obstetrician with abdominal press
as the recumbent cow. The obstetrician should apply traction only
when the cow presses because this process pulls the cow's pelvic inlet
into a position more perpendicular to her spinal column. This has the
practical effect of making the pelvic inlet functionally (not literally)
larger in diameter, allowing easier delivery of the calf.
When its head, neck, and forelegs are through the vulva, the front
end of the fetus should be rotated about 45 to 90 degrees, converting
the caudal half of the fetus to a dorso-sacro-ilial position. This allows
the hips of the fetus to engage the maternal pelvic inlet at its widest
diameter, helping to prevent fetal hiplock (Fig. 2). Rotation can be
expedited by having the traction assistants exchange chains and apply
traction on the individual forelegs in slightly divergent directions.
Traction on the upper leg of the fetus should be more dorsal than the
bottom leg relative to the longitudinal axis of the calf. With large calves,
332 MORTIMER & TOOMBS

~; WIDTH
A B c
Figure 2. Relationship of maternal pelvis and fetal hips during delivery. A, Maternal pelvis
illustrating various diameters of the pelvic canal. The greatest diameter is the sacropubic.
a, Cross-section of fetal hips showing the widest section to be across the greater
trochanters. C, Maternal pelvis with rotated fetal hips demonstrating advantage of rotation
during delivery. (Adapted from Schuijt G, Ball L: Delivery by forced extraction and other
aspects of bovine obstetrics. In Morrow DA (ed): Current Therapy in Theriogenology, vol 1.
Philadelphia, WB Saunders, 1980, pp 252-254.)

it may be necessary to provide additional manual assistance in the

rotation process. The obstetrician can accomplish this by positioning
himself ventral to the calf and passing the hand and arm nearest the
cow between the forelegs of the fetus then over its neck. The other
hand and arm are passed beneath both fetal legs and under its neck.
The hands are then clasped together near the base of the fetal neck.
The obstetrician exerts a rotational force on the fetus as the traction
assistants maintain tension on the chain. 30 The calf can be stimulated
to breathe before the umbilicus is broken and while the rear legs are still
in the cow. The calf's nostrils should be cleared of mucus and it should
be stimulated to breathe, by tickling the nostrils with straw or a small
stick. Once a breathing pattern has been established, the assistants pull
only when the cow presses. The direction of traction should be caudal
and somewhat dorsal, relative to the cow, once rotation is accomplished
(see Fig. Ie), and should be exerted bilaterally.
In spite of using proper techniques, hiplock sometimes occurs.
Should it occur, traction should be discontinued, and the calf should
be allowed to breathe. In the authors' opinion, more calves die at this
point from not being allowed to breath than from excessive force. To
relieve the hiplock, the operator must palpate along the back of the calf
to determine whether its pelvis is rotated as far as necessary. If not,
the calf should be repelled and rotated to the dorso-sacro-ilial or dorso-
ilial position. Rotation is then maintained (preferably in the dorso-ilial
position) while up to three traction assistants deliver the hiplocked
fetus. Direction of traction is still caudal and somewhat dorsal (see Fig.
Ie). If efforts are still unsuccessful, the fetus should be pulled around
vigorously toward the cow's flank. In effect, this further rotates the
fetal pelvis, leads one hip through the pelvic opening ahead of the
other, and often breaks the hiplock. When the hiplock is broken,
the calf is usually delivered without further complications. If this
fails, fetotomy or maternal symphysiotomy may be indicated as a last
resort.8, 18, 28, 30
 ABNORMAL BOVINE PARTURITION 333

Caudal Presentation

More complications are likely to occur in forced extraction of a

fetus presented caudally than cranially. Forced extraction of the fetus
in caudal presentation is done essentially in reverse order to extraction
in cranial presentation (Fig. 3). Because the fetal hips are widest at the
greater trochanters and the cow's sacro-pubic diameter is greater than
her bis iliac diameter, the fetus should be rotated to a dorso-iliac or
dorso-sacro-iliac position before extraction. The fetus is rotated by first
crossing and then twisting the rear legs until the fetus is rotated 45 to
90 degrees to allow the fetal hips to enter the maternal pelvic inlet at
its widest diameter. When the cow is pressing, two assistants apply
bilateral traction to the fetus in a slightly dorsal and caudal direction to
extract the fetal hips through the pelvic inlet. If the hocks are extracted
about one hand's width beyond the vulva, extraction usually is possible
because the fetal hips have passed the maternal pelvic inlet. If not,
Cesarean section or fetotomy should be used for delivery. When
dilatation is adequate and the fetal hips have passed the maternal
pelvic inlet, the fetus is rotated back to a dorso-sacral position. A
caudal, slightly ventral traction is applied until the fetus is delivered
(Fig. 3C). Once the fetal hips are brought through the maternal pelvic

Figure 3. Delivery of fetus in caudal presentation. Cow can be lying on either side. A, Calf
is initially rotated 45 to 90 degrees to dorso-iliac position before starting delivery. B, Bilateral
traction is applied by two people or equivalent. Direction of traction is caudal and slightly
dorsal until hips of fetus pass the maternal pelvis. Calf is then rotated back to a dorso-
sacral position and delivery continued. C, Direction of traction is caudal until calf is delivered.
(Adapted from Schuijt G, Ball L: Delivery by forced extraction and other aspects of bovine
obstetrics. In Morrow DA (ed): Current Therapy in Theriogenology, vol 1. Philadelphia, WB
Saunders, 1980, pp 256-257.)
334 MORTIMER & TOOMBS

inlet, the fetus should be extracted as quickly as possible to prevent its

asphyxiation. Care should be taken when removing the caudally pre-
sented fetus using forced extraction. Excessive force has been associated
with joint and back injuries, diaphragmatic hernia, broken ribs, pul-
monary bleeding, liver rupture, and death of the fetus. 28

Fetal Extractors

This article has described the amount of traction that the obstetri-
cian should use in removing a fetus to prevent injuries to the cow or
calf. Three traction assistants can apply about 600 pounds of force, the
maximum amount recommended (Ball L, personal communication,
1982). Occasionally, sufficient labor is not available, so fetal extractors
must be used for traction. It is possible to apply an appropriate amount
of traction, but up to 2500 pounds of force can be applied with a fetal
extractor; this is excessive. In addition, improper placement of the fetal
extractor interferes with normal abdominal press and freedom of move-
ment of the maternal hind legs. The authors cannot overemphasize the
need for care when using fetal extractors in extraction efforts.

DYSTOCIA DUE TO OTHER CAUSES

Uterine Inertia

Roberts28 defines uterine inertia as a lack of normal physiologic

uterine contractions during or after parturition. Both primary and
secondary causes of uterine inertia are recognized. Primary uterine
inertia is associated with over distention of the uterus with conditions
such as twins or hydrops of fetal membranes. Exercise also seems to
playa role in development of uterine inertia in confined animals. Cows
with hypocalcemia may have weak or absent second stage labor.
Animals with uterine inertia have either prolonged onset or complete
lack of stage 2 labor. In many instances, incomplete cervical dilatation
accompanies the inertia. In these cases, Cesarean section is indicated.
Secondary uterine inertia most commonly is associated with prolonged
dystocia and fatigue, but also may be associated with hypocalcemia.
These cases usually can be delivered without complication by early
detection and proper handling procedures.

Torsion of the Uterus

Before corrective efforts are initiated, the obstetrician should rule

out uterine torsion, in which both the uterus and fetus rotate on their
longitudinal axis. If the fetus is presented in dorso-ilial or dorso-pubic
position, torsion of the uterus may be present. With uterine torsion,
 ABNORMAL BOVINE PARTURITION 335

spiral folding of the vagina is evident, often simulating incomplete

dilatation of the cervix. In torsion, the broad ligaments of the rotated
uterus are stretched across the cervix. If the torsion is clockwise, the
left broad ligament is stretched across the dorsal aspect of the cervix; if
counterclockwise, the right broad ligament is stretched across the
dorsum of the cervix. Either the Shaffer method of "plank in the flank"
or a detorsion rod may be used to correct the torsion. 28 Cesarean section
also is a viable option.

Monster Fetus

The most common fetal abnormalities encountered in cattle are

ankylosis, schistosomus reflexus, perosomus elumbis, and perosomus
horridus.28 Conjoined fetuses, asymmetric fetuses with extra append-
ages, and hydrocephalus occasionally are seen. An example of a rare
anomaly is the acardiac monster, which is twin to and a placental
parasite of a normal fetus. Even though many fetal monsters are small,
they often require Cesarean section or fetotomy for correction because
of fetal ankylosis and deformity. No general guidelines for handling
these dystocias can be presented because of their diverse nature.
However, the obstetrician should use sound obstetric principles in
relieving such dystocias to assure delivery without compromising re-
productive integrity and life of the dam.

FETOTOMY

Fetotomy can be defined as "section of the fetus." Its purpose is

to reduce the size of a fetus to allow delivery through the birth canal.
The "art" of fetotomy is more advanced in Europe than in the United
States. The main indications for doing fetotomy are either fetal oversize
or abnormal presentation, position, or posture that cannot be corrected
by mutation. A well-executed fetotomy is safer than a Cesarean section
when the fetus is emphysematous and the dam is toxic. 8 , 18,31 A fetotomy
certainly is more appropriate than a Cesarean section when the opera-
tion is simple and involves only one or two procedures. In general,
once a fetotomy is begun, it should be carried to completion. If done
properly, in a systematic manner, a complete fetotomy saves time over
a partial fetotomy because excessive time may be lost in attempting to
extract a still-oversized fetus following a partial fetotomy. In addition,
a properly executed complete fetotomy preserves the integrity of the
cow's birth canal and reproductive tract because excessively large parts
are not forced through it.

Instrumentation

Quality of fetotomy equipment has improved over the years.

Double-tubed fetatomes with hardened, smooth and rounded heads
336 MORTIMER & TOOMBS

and butts minimize problems with wire saw handling and cutting. A
fetatome cleaning brush is necessary for sanitizing the fetatome. Other
instruments that expedite fetotomy include a spool handle and a locking
handle for each end of the wire saw. Obstetric chains and a Krey's
hook with an obstetric chain attached are required for applying traction
to the fetus. In addition, a spool of wire saw, a wire saw introducer,
and a fetatome wire saw threader are essential items of equipment.
Side cutting pliers or tin snips can be used for cutting the wire saw.

Terminology

Understanding terminology is fundamental to learning good feto-

tomy techniques. Following is a list of terms to describe certain aspects
of fetotomy procedures. Even though simplified descriptions are not in
strict agreement with dictionary definitions, they allow the reader a
basic understanding of the procedures that are described hereafter.
1. Percutaneous section: Section through the skin.
2. Decollation: Section through the neck at the level of the cranial
thorax.
3. Decapitation: Section through the neck at the occiput.
4. Direct cut: Section of the fetus in which the fetotomy wire
extends forward from the fetatome head, forming an angle
greater than 90 degrees with the shaft of the fetatome. The cut
is toward the operator.
5. Indirect cut: Section of the fetus in which the fetotomy wire
forms an angle of 90 degrees or less with the shaft of the
fetatome. The cut is at least perpendicular to the fetatome shaft
and may be away from the operator.
6. Counterforce: Stabilization of the head of the fetatome by appli-
cation of a Krey's hook or obstetric chain from a fixed position
on the fetus to the butt plate of the fetatome. This assures
stabilization of the fetatome when performing indirect fetotomy.

Common Partial Fetotomy Procedures

Forelimb removal is indicated when one or more forelimbs are in

abnormal posture that cannot be corrected by mutation, or to reduce
size in over-large fetuses. If the leg is presented, the obstetric wire is
passed around the leg and the head of the fetatome is placed deep to
the scapula and the leg removed with an indirect cut. This procedure
reduces the diameter of the fetus, often allowing it to pass through the
pelvic canal.
Decollation is indicated for the removal of a deviated head or of
an oversized head and neck. Decollation decreases the size of the
thoracic girdle by allowing the shoulders, when traction is applied to
the legs, to occupy the space vacated by removal of the neck at its
 ABNORMAL BOVINE PARTURITION 337

base. This fetotomy therefore is corrective for the commonly occurring

shoulder lock condition. To perform the procedure, the fetatome wire
must be placed deeply around the neck of the fetus. If the head and
neck are deviated, the cut is direct; if the head is presented into the
birth canal, a snare or chain around the neck is used to apply counter-
force for performing an indirect cut.
Evisceration is indicated to increase the amount of space available
for additional mutation and fetotomy procedures. In the case of hiplock,
when bisection of the pelvis is indicated, the abdominal viscera first
must be removed. The exposed cranial half of the fetus is elevated
dorsally to expose its ventrum and a transverse cut is made into the
abdominal cavity, large enough to admit one hand at the level of the
xyphoid cartilage. All abdominal organs, except the kidneys, should be
removed. After abdominal evisceration, a wire introducer is used to
pass obstetric wire from a half threaded fetatome over the back then
between the rear legs of the fetus. The fetatome is then fully threaded
and the pelvis is bisected. The forelimb, torso, and one rear limb are
extracted, then the remaining leg is removed. An alternative to this
process is to perform a deep detruncation by making a transverse cut
just cranial to the fetal pelvis. A wire then is introduced over the back
and between the rear legs, as previously described, and pelvic bisection
is completed.

Utrecht Fetotomy

The Utrecht fetotomy was developed on the premise that by doing

a complete fetotomy in a systematic manner, less damage to the birth
canal of the dam would occur. The following discussion is only a
summary of the Utrecht method. For a more complete description of
this technique, the reader is referred to the original article. 8

Cranial Presentation
The fetus is decapitated, then the forelimbs, including the scapula,
are removed by indirect fetotomy. To accomplish this, the wire of a
fully threaded fetatome is passed along the medial side of the leg deep
into the axillary space and the head of the fetatome is positioned
approximately 4 inches deep to the caudal margin of the scapular
cartilage. Counterforce is applied between the ipsilateral leg and the
butt plate of the fetatome to maintain the deep position of the head of
the fetatome while the cut is being made. This procedure is easiest to
perform with the cow standing. If the cow is down, however, it usually
is unrewarding to attempt to get her up. If the cow is down, the easiest
limb to remove first is the uppermost limb. The cow then is rolled to
her opposite side and the second leg is removed.
From this point the use of a Krey's hook is mandatory to maintain
traction on the fetus and to apply counterforce when necessary. Two
 -
338 MORTIMER & TOOMBS

transverse cuts are made through the fetal trunk. The first is made
through the thoracic cavity at the mid sternal plane and the second just
cranial to the fetal pelvis. If necessary, a longitudinal cut may be made
through both trunk sections just lateral to the vertebral column. The
trunk sections can then be rolled into a compact mass for easy delivery.
The fetotomy is completed by bisecting the pelvis and removing the
rear legs, as previously described under partial fetotomy procedures.

Caudal Presentation
The essential cuts of the Utrecht method begin with the removal
of one rear presented limb by placing the head of a fully threaded
fetatome cranial to the pelvis, just beyond the trochanter major and
near the lumbar vertebrae. The wire is passed up the medial surface of
the leg, and counterforce is applied using a chain attached to the leg
above the hock and the butt plate of the fetatome. An oblique indirect
cut is made. If the leg is retained, a direct cut is made. To accomplish
this, the wire from a half-threaded fetatome is passed around the leg.
The head of the fetatome is then placed in the notch between the
trochanter major and the tuber ischium of the opposite leg and the cut
is made. The second leg may be removed by making a transverse cut
just cranial to the fetal pelvis. The torso of the fetus is then divided
transversely just behind the scapula, and the rear quarters and abdomen
are removed. Again, a longitudinal cut of the torso may be necessary
to reduce the size of the rib cage. The torso section can then be rolled
up and delivered through the birth canal. The final cut is an oblique
sagittal cut, dividing this leg and the thorax from the other leg and the
head. This allows removal of one front leg together with the major part
of the thorax. The head, with its attached forelimb, is then removed.

Modification to the Utrecht Fetotomy

More cuts are required with the Utrecht technique than are neces-
sary in many instances. In addition, difficulty may be encountered in
positioning the wire saw for each cut, particularly in placing the wire
saw over a previously cut surface. It is easier to work the wire saw
down over an uncut torso than to position it over the cut margin of
the rib cage as required by the Utrecht method. Last, the repeated use
of a Krey's hook, required by the Utrecht procedure, is difficult and
time consuming. Modified techniques therefore are less exhausting
than the Utrecht fetotomy and eliminate, with the exception of one
alternate cut, the necessity of using a Krey's hook. Modifications to the
Utrecht techniques have been described for both cranial and caudal
presentations. I8 The objectives of these modifications are to reduce fetal
size with fewer cuts and to improve the ease of wire placement. Both
cranial and caudal modified approaches can be completed with three
or four cuts and evisceration. The reader is referred to the original
 ABNORMAL BOVINE PARTURITION 339

article for a complete discussion. 18 The procedures are only summarized

in this text.

Cranial Presentation
In cranial presentation, the fetus is first decapitated. The second
cut is an oblique one separating the neck, part of the thorax, and one
forelimb from the torso. This is done by placing the head of a fully
threaded fetatome deep to one scapula, as with the Utrecht technique.
A counterforce chain is then applied between the ipsilateral forelimb to
be removed and the fetatome butt plate. The wire is then placed
between the neck stump and the opposite forelimb so that the indirect
cut runs obliquely across the fetal neck and thorax. This creates an
opening in the thorax through which complete evisceration of both
thoracic and abdominal contents is carried out. Following evisceration,
the fetus is partially or completely extracted, depending on its size, by
placing traction on the remaining forelimb. If the fetus is emphysema-
tous, this procedure releases the gases that preclude extraction. The
fetus is then extracted until it is delivered or until fetal hips impact the
maternal pelvis. If this occurs, the hips are bisected as previously
described in the section on hiplock bisection.

Caudal Presentation
In the caudal presentation, the fetal hips are the first obstruction
encountered. One fetal hindlimb is removed as in the Utrecht method.
If the leg that is to be removed is in the flexed position and retained,
the fetatome is half threaded and the wire saw passed around the leg
with the wire introducer. Threading is then completed and a direct cut
is made obliquely across the pelvis by holding the head of the fetatome
lateral to the ischial tuberosity on the ipsilateral side. If both legs are
retained, the second leg often can be delivered following removal of
the first because it creates more room for mutation. If not, the leg is
manipulated into the flexed hock posture and a cut is made through
the hock joint. The stump can then be extracted into the birth canal
after removal of the distal portion. Removal of the first leg allows
evisceration through an opening made by blunt dissection into the
abdomen in the flank area. Complete abdominal and thoracic eviscer-
ation are recommended, allowing for escape of trapped gases. The
fetus often may be delivered following evisceration. If not, a transverse
cut is made just caudal to the scapula. This requires counterforce to be
applied between the butt plate of the fetatome and a point above the
hock of the remaining leg. A third and final cut runs obliquely through
the remaining portion of the thorax, allowing for removal of most of
the thorax and one forelimb, as with the Utrecht technique. Occasion-
ally, second and third cuts may be combined, depending on the
anatomy of the obstetrician and the sizes of the fetus and cow.
340 MORTIMER & TOOMBS

SUMMARY

The veterinarian is in a unique position to assist and improve the

profitability of producers by educating clients on proper intervention
and delivery techniques. This paper describes some procedures for
intervention, evaluation, and management of dystocia by mutation,
forced extraction, and fetotomy. In addition, a brief summary of the
factors influencing dystocia is presented. When these techniques are
used properly, losses due to dystocia are minimized.

References

1. Arthur P, Makarchian M, Price M, et al: Heterosis, maternal and direct effects in

double-muscled and normal cattle. J Anim Sci 67:902, 1989
2. Belcher D, Frahm R: Effect of pelvic size on calving difficulty in percentage Limousin
heifers. J Anim Sci 49:152, 1979
3. Bellows R: Calving management. In Proceeding of the Annual Meeting of Society for
Theriogenology, Denver, 1984, p 145
4. Bellows R, Gibson R, Anderson D, et al: Precalving body size and pelvic area
relationships in Hereford heifers. J Anim Sci 33:455, 1971
5. Bellows R, Short R: Effects of precalving feed level on birthweight, calving difficulty
and subsequent fertility. J Anim Sci 46:1522, 1978
6. Bellows R, Short R, Anderson D, et al: Cause and effect relationships associated with
calving difficulty and calf birth weight. J Anim Sci 33:407, 1971
7. Bellows R, Short R, Staigmiller R, et al: Effects of induced parturition and early
obstetrical assistance in beef cattle. J Anim Sci 66:1073, 1980
8. Bierschwal C, deBois C: The Technique of Fetotomy in Large Animals. Bonner
Springs, KS, VM Publishing, 1972
9. Cadle J, Ruttle J: Dystocia in range beef heifers. J Anim Sci 43:227, 1976
10. Cain DV, Dennis SM: Perinatal calf mortality. Agri Pract 8:11, 1987
11. Corah L: Relationship of nutrition and dystocia. Agri Pract 8:26, 1987
12. Cunningham B, Magee W: Breed-direct, breed-maternal, and nonadditive genetic
effects for pre weaning traits in crossbred calves. Can J Anim Sci 68:83, 1988
13. Deutscher G: Using pelvic measurements to reduce dystocia in heifers. Mod Vet
Pract 66:751, 1985
14. Dunn T, Ingalls J, Zimmerman D, et al: Reproductive performance of 2-year-old
Hereford and Angus heifers as influenced in pre- and post-calving energy intake. J
Anim Sci 29:719, 1969
15. Laster D, Glimp H, Cundiff L, et al: Factors affecting dystocia and the effects of
dystocia on subsequent reproduction in beef cattle. J Anim Sci 36:695, 1973
16. Lawlor T, Kress D, Doornbos D, et al: Performance of crosses among Hereford,
Angus and Simmental cattle with different levels of Simmental breeding. J Anim Sci
58:1321, 1984
17. Morrison D, Humes P, Koonce K: Comparison of Brahman and continental European
crossbred cows for calving ease in a subtropical environment. J Anim Sci 67:1722,
1989
18. Mortimer R, Ball L, Olson J: A modified technique for complete bovine fetotomy. J
Am Vet Med Assoc 185:524, 1984
19. Neville W, Tucker S, Utley P: Reproduction and calf performance of Angus-sired and
polled Hereford cows bred to Angus and Brahman bulls for primiparous calving as
2- vs 3-year-old cows. J Anim Sci 66:1606, 1988
20. Odde KG: Survival of the neonatal calf. Vet Clin North Am Food Anim Pract 4:501,
1988
21. Patterson D, Bellows R, Burfening P, et al: Effects of Cesarean section, retained
placenta and vaginal or uterine prolapse on subsequent fertility in beef cattle. In
Proceed, West Sec, Am Soc of Ani Sci 30:223, 1979
 ABNORMAL BOVINE PARTURITION 341

22. Patterson D, Bellows R, Burfening P, et al: Occurrence of neonatal and postnatal

mortality in range beef cattle I. Calf loss incidence from birth to weaning, backward
and breech presentations and effects of calf loss on subsequent pregnancy rate of
dams. Theriogenology 28:557, 1987
23. Phillipson J: Studies on calving difficulty. Stillbirth and associated factors in Swedish
cattle. Upprola, Sweden, Department of Animal Breeding, The Swedish College of
Agriculture, 1976, p 5750
24. Price T, Wiltbank J: Dystocia in cattle. A review and implications. Theriogenology
9:195, 1978
25. Price T, Wiltbank J: Predicting dystocia in heifers. Theriogenology 9:221, 1978
26. Rice L: Perinatal management of calves. In Proceedings of Society for Theriogenology,
1979, p 138
27. Rice L, Wiltbank J: Dystocia in beef heifers. In Proceedings of the Western Section of
American Society of Animal Sciences, 1970
28. Roberts S: Veterinary Obstetrics and Genital Diseases. Woodstock, NY, the author,
1986
29. Rutter L, Ray D, Roubicek C: Factors affecting and prediction of dystocia in Charolais
heifers. J Anim Sci 51:157, 1980
30. Schuijt G, Ball L: Delivery by forced extraction and other aspects of bovine obstetrics.
In Morrow DA (ed): Current Therapy in Theriogenology. Philadelphia, WB Saunders,
1980, p 247
31. Sloss V: A clinical study of dystocia: 2. Complications. Aust Vet J 50:294, 1974
32. Stables J: Genetic selection for ease of calving. Bovine Pract 14:102, 1979
33. Wiltbank J, Remmenga E: Calving difficulty and calf survival in beef cows fed two
energy levels. Theriogenology 17:587, 1982

Address reprint requests to

Robert G. Mortimer, MS, DVM
Department of Clinical Sciences
Colorado State University
College of Veterinary Medicine and Biomedical Sciences
Fort Collins, CO 80523