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Dystocia is an abnormal and difficult birth in which the first or the second stage of labour is markedly prolonged and subsequently found impossible for the dam to deliver without artificial aid. In cattle, it can be relieved by different obstetric methods, including the cesarean operation and fetotomy. Caesarean section is the extraction of the fetus or foeti from the dam, through a surgical opening in the abdominal wall and the uterus. This surgical method can be performed by about eight alternative surgical approaches in bovines with its advantages and disadvantages. However, the selection is dependent on many factors like the type of dystocia, the cows and environmental conditions, the availability of assistants, and the surgeon's preference. For cows, most surgeons use a standing left paralumbar celiotomy. However, the left oblique approach is also preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Besides, alternative approaches are also available that will further limit the potential for contamination but many junior surgeons perform the left paralumbar celiotomy using the same approach each time due to their comfort with one specific approach or lack of familiarity with other available options. Therefore, the objective of this review is to provide basic insights and highlight the cesarean section incision approaches with their relative advantages and disadvantages in cows., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

OBJECTIVE To characterize signalment, clinical signs, reproductive history, surgical management, and outcomes of beef cattle undergoing cesarean section because of dystocia at a veterinary teaching hospital. DESIGN Retrospective case series with nested cohort study. ANIMALS 173 beef cattle admitted to a veterinary teaching hospital from 2001 through 2010 that underwent cesarean section because of dystocia. PROCEDURES Medical records were reviewed and information collected on cattle signalment; reproductive history; cause of dystocia; anesthetic protocol; surgical management; number, sex, and body weight of calves delivered (alive or dead); perioperative treatment; duration of hospitalization; and discharge status. A questionnaire regarding postoperative fertility was mailed to all owners, and owners who did not respond were contacted via telephone. RESULTS Overall mortality rate for calves was high, with 37.6% (62/165) of calves delivered dead or dying ≤ 24 hours after cesarean section. Mortality rate was higher for female versus male calves and for calves from dams with signs of labor for ≥ 3 hours versus < 3 hours before hospital admission. Overall mortality rate for dams was low, with only 10 of 161 (6.2%) dams failing to survive for ≥ 21 days after hospital discharge. Postoperative fertility rate was acceptable, with 75% (44/59) of dams that were rebred after cesarean section giving birth to ≥ 1 live calf. CONCLUSIONS AND CLINICAL RELEVANCE Cesarean section was a clinically useful method for resolving dystocia in beef cattle, providing a high dam survival rate and an acceptable postoperative fertility rate. Beef cattle producers should seek veterinary assistance whenever clinical signs of dystocia are noticed, preferably within 6 hours after onset of parturition.

The aim of the present study was to determine the level of serum liver enzymes, triglyceride and some metabolites in cows with or without difficulties during parturition. The second goal was to compare between the possible effects of caesarian section and fetotomy on these parameters. A total number of 24 native breed cows at full term were included in this study. Out of them, 8 gave normal parturition, 16 cows were admitted with dystocia. The group of dystocia was subdivided into two groups; fetotomy (n=8) and caesarian (n=8) group. In the caesarian group, 4 cows were with uterine torsion. Five blood samples were collected from each cow: directly pre-partum, during and just after delivery and at, 24, 48 and 72 h post-partum. Serum samples were used for determination of aspartate amino transferase (AST), glutamate dehydrogenase (GLDH), gamma glutamyl transferase (gamma-GT), creatine phosphokinase (CK), glucose, total bilirubin, cholesterol and triglyceride. The results showed that AST, GGT, GLDH and CK activities were significantly increased in the group with caesarian sections due to uterine torsion than the control and fetotomy groups. There were insignificant changes in serum GGT and GLDH activities between control, fetotomy and dystocia group without uterine torsion at pre-partum and at 24 and 48 h post-partum. At 72 h post-partum, there was a significant increase in GLDH activity without significant increase in serum GGT activity. The concentrations of cholesterol and triglycerides did not differ in cows with dystocia compared to normal cows. In conclusion, cattle subjected to caesarian section and especially those with uterine torsion are associated with hepatic dysfunction. On the other hand, fetotomy has no effect on hepatocellular damage. The type of parturition has no effect on the bilirubin, cholesterol and triglyceride concentrations just before parturition to the 3rd day post-partum. It is recommended to supply cows with liver supportive therapy after caesarian section with uterine torsion.

Evaluating the possibility of performing a caesarean section on a cow with dystocia, the economic value of the animal usually plays a central role. The aim of this retrospective study was to analyse and to determine possible factors influencing the fertility. In 1998, 1999 and the first half-year of 2000 a total of 207 cows had a caesarean section. 68% of the inseminated cows which gave birth to a living calf became pregnant again, whereas only 46% of the cows with a dead calf were successfully reinseminated. Thus, 59% of all inseminated cows became pregnant, 2.5% of them had an abortion. The occurrence of retained fetal membranes or of endometritis has been shown to have negative effects on fertility. Only 30% of subsequent inseminations were successful in cows which had suffered from endometritis. The probability of being affected by endometritis was twice as high after birth of a dead calf than after a living calf.

In the course of this retrospective study on fetotomy of cattle 131 operations were evaluated. The case studies put the cattle 2 to 96 hours into labour (average 13 hours). The cows that exhibited post-operative complications were on average 19.2 hours into labour prior to the operation. Those which had a normal puerperium however were only 8.4 hours, on average, in labour. 79% of the animals showed depressed general health on admission, 8% of which were unable to stand. The main cause of the dystocia was the incorrect position/orientation of the dead foetus (38.9%) as well as relative or absolutely too large calves (25.2%). In 14.5% of the cases the offspring were malformed causing the dystocia. 28 of the protracted births were due to both maternal as well as foetal causes. Mortality of the cows lay by 6.9%, irregularities in the puerperal period ran at 67.2%. The age of the mother did not seem to influence the post operative events. The most common complication was retained placenta (n = 49; 37.4%) followed by lochiometra (n = 21; 16%), vaginal wounds and pelvic phlegmons (each n = 16; 12.2%) and neurotripsy (n = 6; 12.2%). Of these puerperal complications the pelvic phlegmon required the longest post-operative care (14.3 days, retention secundinarum was cured in 13 days, lochiometra in 8.8, cows without complaint were treated for 3.8 days after the operation). The most important factors for the post-operative prognosis are the time in labour and any trauma of the soft birth canal which influence the forming of pelvic phlegmons.

Ninety-seven dairy cows suffering from traumatic reticuloperitonitis, abomasal displacement, and other gastrointestinal disorders or dystocia were referred for abdominal surgery. Plasma protein concentrations, including plasma fibrinogen and haptoglobin, and conventional haematological variables were determined both pre- and postoperatively. The examined variables were not of value in predicting the outcome of the abdominal disorders in general, but fibrinogen concentrations may be helpful in postoperative monitoring of infectious complications, such as peritonitis. Fifty-five per cent of the cows had increased haptoglobin concentrations preoperatively and abdominal surgery led to an additional haptoglobin increase for a further 2-3 days. It is recommended that pre- and postoperative haptoglobin values should be compared when monitoring infectious complications. Non-parametric receiver operating characteristics (ROC) analysis suggested that plasma haptoglobin concentration was the most accurate parameter for differentiating traumatic reticuloperitonitis from other gastrointestinal disorders, but plasma fibrinogen and globulin concentrations were also of value in this respect.

A left oblique celiotomy approach was used for cesarean section in 18 standing cows (15 beef cows and 3 dairy cows). Indications for cesarean section included oversized or emphysematous fetus and uterine inertia. Poor body condition was identified as a contributing factor for dystocia in 4 cows. Abdominal wall hernias did not develop in any of the cows. Because the incision in this approach extends further cranial and ventral than in the standard left celiotomy approach, the left oblique celiotomy readily permitted manipulation and exteriorization of the gravid uterine horn. Additionally, apposition of the transversus abdominis and internal abdominal oblique muscles was facilitated by use of this technique. Closure of the incision was readily accomplished in all cows.

Cesarean section has become a common surgical procedure and there is a tendency for both veterinarians and their clients to regard it as routine. It is important to remember, however, that a cesarean section entails major abdominal surgery, with inherent risks, irrespective of the prevailing conditions or personnel involved.

A retrospective study on 159 cesareans on dairy cows referred between 1985 and 1989 to the veterinary teaching hospital is reported. The objective of the study was to evaluate the probability and the factors associated with survival and subsequent calving. The risk of dying for the cows was 24% following surgery. The risk of dying differed if the cow had an emphysematous, dead, or live calf; it was 63%, 21%, and 14%, respectively. Of all the cows returned to the farm and for which there was a breeding recorded, 64% calved again. But only 28% of all the cows returned home and, therefore, only 17% of all the referred cases calved again. We used multivariate analysis to obtain a predictive model on prognosis following surgery. The prognosis was only influenced by the calf condition at admission.

A case of congenital peritoneal mesotheliosis in a calf which caused hindrance of parturition necessitating partial fetotomy is described; patho-anatomical, -histological and environmental findings are given.

Rupture of the urinary bladder of a cow occurred secondary to prolonged dystocia. Primary surgical closure of the tear was performed after drainage of the uroperitoneum, and the cow recovered without complications.

The results of 77 caesarean sections in cattle carried out in a seven-person practice over a period of 16 months are described and evaluated. The standardisation of the surgical technique, the speed of decision making in dealing with dystocia, and the education of the farmers contributed to the 84 per cent calf survival rate, and post surgical complications were few. There was only one fatality in a dam.

A case of dystocia in a cow delivered by Caesarean section, complicated by haemorrhages and a dying calf, is reported. The heifer had to be slaughtered and only then the clinical findings could be accounted for by close examination of the uterus. This case was very likely one of spontaneously reduced uterine torsion.

The animal most frequently requiring operation for dystocia in this survey of 133 cases was the Friesian/Holstein heifer. In 38 per cent of cases the reason for surgery was an oversized calf and in 84 per cent the operation was performed on the farm of origin. The majority of the dams were operated on while standing, using a left flank incision, and under paravertebral or field infiltration with local anaesthetic solution. Exteriorisation of the uterus did not appear to be essential except when the calf was dead. Ninety-five per cent of the calves alive in utero and 91 per cent of the dams survived, although 30 per cent of the dams suffered ill-health afterwards. In nine cases neither dam nor calf survived. The fertility indices of those which were rebred were not markedly affected, but milk production was reduced by an estimated 12 per cent of the potential yield.