Chapter 5

DYSTOCIA IN THE MARE

Parturition in the mare is normally a rapid and quite examination should be performed at 28-35 days to
violent process. Once the birth process is under way, minimize the risk of missing twin conceptions and to
placental separation or functional deterioration is likely check that the fetus is alive. Triplet pregnancies can
to occur much more quickly than in other species. Fetal oceur in the mare and a thorough examination of the
death or damage — including development of the neo- uterine body and horns is advised to avoid missing
natal maladjustment syndrome — due to hypoxia may them. Most equine twin pregnancies end in abortion,
occur. Any reported case of equine dystocia must be treated often at about 7 months of gestation. Premature lacta-
as an emergency and attended immediately. Fetal maldis- tion may be seen in such animals. Restlessness, sweat-
position is an important cause of equine dystocia pre- ing, and mild colic may precede the passage of the twin
disposed to and complicated by the long head, neck, foals. One is often mummified and the other may be liv-
and limbs of the foal. If recognized early in the birth ing but non-viable. Rare cases of twin pregnancy per-
process it can often be corrected without difficulty, sist to term when two small foals may be born and
sometimes by an experienced stud groom. Where such dystocia through simultaneous presentation, fetal mal-
experienced help is not available the obstetrician must disposition, or uterine inertia may be a complication.
be called without delay. For these reasons, early diagnosis of equine twins is
If not identified quickly the maldisposed fetus may desirable. If equine twins are diagnosed one conceptus
become impacted in the maternal pelvis by strong can be destroyed by crushing per rectum. Alternatively,
abdominal straining and uterine contractions. Correc- the whole pregnancy may be terminated by an intra-
tion of the abnormality —often now complicated by fetal muscular injection of prostaglandin F2a (500 pg clo-
death - is much more difficult in such circumstances. prostenol or 5mg dinoprost). This should be carried
Supervision of equine birth must be quiet and unob- out before day 35 of pregnancy, when the endometrial
trusive because any disturbance may delay initiation of cups form and prostaglandin F2a is not effective. After
parturition. In many studs use is made of remote con- termination the mare may be served again.
trol video cameras, one-way windows, and observation A further confirmation of pregnancy may be carried
points allowing good observation of the parturient mare out at 6-10 weeks of gestation to ensure that unex-
without disturbance. Assistance may be given quickly pected fetal loss has not occurred since the original pos-
if there is the slightest suspicion of any abnormality itive pregnancy diagnosis was made. In many mares no
likely to compromise birth. further veterinary attention is given unless it is needed
at the birth of the foal.
Novice breeders should be advised about the care of
ANTENATAL CARE their mare during pregnancy. Normal feeding should
continue with grazing in the summer and concentrates
Pregnancy diagnosis by rectal ultrasonography of the and hay in the winter. Mares in poor condition on a
uterus is performed in many mares at 14—18 days after low-protein diet and with a heavy parasite burden may
covering and before the mare is likely to return to fail to maintain their pregnancy. Moderate exercise
estrus. Twin pregnancy can often be detected at this throughout gestation is beneficial but strenuous riding
stage by the identification of two separate vesicles each should be avoided in the last trimester of pregnancy.
containing a conceptus. A further ultrasonographic Novice breeders should also be given details of normal
82 Dystocia in the Mare

birth and the signs of dystocia, and told to seek help progestagen altronogest: 2.2 mg altronogest/50 kg
immediately if the mare shows any signs of abnormality. body weight are given orally each day. The efficacy of
Mares with a history of previous abortion should this treatment has not been scientifically evaluated
be subjected to special care during a subsequent preg- but obstetricians may be under great pressure from
nancy. Thoroughbred mares will have been screened owners to use it. If used, the drug should be
for evidence of infections such as equine viral arteritis, withdrawn slowly before parturition is due.
contagious equine metritis, Klebsiella, and Pseudomonas
before covering, Vaccination against equine herpesvirus-1
INCIDENCE OF DYSTOCIA
is used on some studs. The uterine health of problem
mares is carefully checked before service at an appro-
The incidence of dystocta in mares has been much less
priate time by a stallion whose venereal health has also
well documented than in cattle. However, a very com-
been checked. prehensive survey involving over 600 cases of equine
Once pregnancy is confirmed, problem mares should
dystocia was carried out by Vanderplassche (1993) at
be checked at intervals throughout pregnancy. Monthly
Ghent Veterinary School in Belgium.
or more frequent examinations are carried out depend-
Dystocia occurs in about 4% of Thoroughbred mares,
ing on the history of the mare. A general health check
with a higher incidence (in the above survey) in Belgian
and the following procedures are carried out on each
Draft horses, in which double-muscling of the fetus may
occasion:
cause problems with fetopelvic disproportion. Dystocia
may be also more common in Shetland ponies. The
« Rectal examination: to ensure uterine enlargement
incidence of elbow flexion as a cause of dystocia in this
and fetal growth are normal. The ovaries are also
breed is quite high. Fetopelvic disproportion is occasion-
palpated as they move forward out of reach as
ally seen in this and other small breeds. The Shetland
pregnancy progresses. As birth approaches the
foal has a relatively large head and this may prevent
presentation, position, and posture of the fetus are
the forelegs from becoming fully extended as they enter
checked. The fetus is usually in anterior presentation,
the birth canal. This may predispose to dystocia due to
ventral position with the head and forelegs extended
incomplete extension of the elbow joints. Dealing with
towards the pelvic inlet as birth approaches.
dystocia in such small breeds can be difficult because of
« Ultrasonographic examination: of the uterus, the
the lack of space in the birth canal.
placenta, the fetus, and its fetal fluids. Fetal growth
The fetus is in anterior presentation in nearly 99% of
and movement are monitored. The fetal heart rate
normal equine births, in posterior presentation in only
should be reasonably steady and faster than that of
0.9%, and in transverse presentation in 0.1%. Although
the mare. The chorion should be closely applied to
the foal is in a ventral position during late gestation,
the endometrium. Areas of separation or thickening
it normally assumes a dorsal position during delivery.
of the chorion may indicate that placental function
The foal may occasionally fail to move completely into
is suboptimal and the risk of pregnancy loss is
the dorsal position and may be presented in a lateral
increased. Fetal fluids should be non-echogenic and
position. All the maldispositions described in the calf
free from any solid material.
also occur in the foal.
Vaginal examination: is carried out with strict
The incidence of dystocia is higher in mares foaling
attention to hygiene. The cervix is observed through
for the first time but may increase again as the mare
a vaginal speculum and is checked for closure and
becomes older. In general it may be advisable not to
the absence of an abnormal discharge. Any
breed from mares below the age of 4 years or over the
purulent material should be cultured and antibiotic
age of 20.
therapy may be required.
Plasma progesterone: may be monitored each time the
mare is examined. A decrease in plasma CAUSES OF DYSTOCIA
progesterone, especially at a stage of pregnancy at
which previous abortion has occurred, may indicate Published details of the survey by Vanderplassche (1993)
that the pregnancy is at risk. In such cases natural are insufficient to provide an exact breakdown of the
progestin production by the placenta may be component causes. The survey related to mares seen in
supplemented by the administration of the synthetic a referral clinic and thus reflects the more serious
 Handbook of Veterinary Obstetrics 83

disturbed that she continues to inhibit parturition. In

Table 5.1 Causes of dystocia in the mare
such cases birth should be induced with an intravenous
No.of cases % injection of oxytocin. Although this can be incorpo-
rated in a drip and be given over a period of 1 hour an
Foal in anterior presentation 408 68 intravenous bolus injection appears equally satisfactory
Lateral deviation of the head 237 40
and is more easily managed. A dose of 2.5-15IU oxy-
Other postural abnormalities, 7 28
malpositions, and fetal monsters tocin is used, depending on the size of the mare. The
Foal in posterior presentation 95 16 mare should go into labor within 15 minutes of injection
Breech presentation a7 8 and may show signs of sweating and mild colicky pain.
Hock flexion 24 4 For further details concerning induction of birth in the
Other abnormality 24 4 mare see Chapter 15.
Foal in transverse presentation 98 16 The induced birth should be carefully supervised and
Complete bicornual pregnancy 47 8 fetal delivery assisted by moderate traction if necessary.
Partial bicornual pregnancy 51 8
Total 601 100 Secondary uterine inertia
Secondary uterine inertia follows another primary cause
of dystocia such as fetal maldisposition. In such cases
causes of dystocia referred for specialist assistance.
the primary dystocia is corrected and fetal delivery
Some causes of dystocia such as uterine inertia, which
assisted by traction.
may mostly be dealt with in practice, are not listed.
Following delivery in both categories of uterine inertia,
Table 5.1 shows the broad categories into which the
uterine involution after the birth of the foal should be
causes of dystocia fell.
encouraged by administration of 10-301U oxytocin
given by intramuscular injection.
SPECIFIC CAUSES OF EQUINE Failure of the abdominal expulsive forces
DYSTOCIA
This usually results from damage to the integrity of the
Details of the more important causes of dystocia are abdominal musculature, which compromises its ability
described below. to assist in straining to expel the fetus. Ventral hernia
may occur in older multiparous mares as a result of senile
changes and increasing fetal weight in late pregnancy.
FAILURE OF THE EXPULSIVE FORCES It may also arise as a result of injury. The ability of
affected mares to foal unaided is compromised and assis-
Uterine inertia tance (by traction applied to the foal) when parturition
commences may be necessary. In severe cases of ventral
Primary uterine inertia hernia downward deviation of the uterus may occur. The
This is mostly the result of voluntary suppression of foal's exit from the displaced uterus is obstructed and
parturition caused by disturbance of the mare as foaling assisted delivery is necessary to bring the foal up into, and
approaches. In nervous mares even the slightest sound then through, the maternal pelvis (for details of fetal
or movement may be sufficient to inhibit birth and delivery, see Downward deviation of the uterus, p. 86).
hence the need for totally unobtrusive observation in
this species. The mare is restless and uneasy and birth Rupture of the prepubic tendon in mares
appears imminent but foaling does not commence. The Rupture of the prepubic tendon should always be sus-
cervix is usually partially open and can be manually pected if severe painful edema is seen on the ventral
dilated without difficulty. The chorioallantois is normally surface of the abdomen of the mare in late gestation.
intact. The edema forms a plaque-like layer up to 15 cm deep
Treatment If the chorioallantois is intact and there in some mares (see Fig. 2.4). The edema pits on pressure
is no evidence of fetal distress the mare may be left and digital pressure causes evidence of pain. The con-
completely alone for up to 20 minutes. In some cases, dition may be more common in heavy breeds of horse.
parturition will recommence spontaneously in the Note: non-painful edema is frequently seen in mares
now undisturbed patient. In other cases the mare is so in late gestation. It is thought that the presence of the
84 Dystocia in the Mare

growing fetus causes partial obstruction of maternal Vaginal obstruction

lymphatic and venous drainage. This latter type of edema This is relatively uncommon in mares. In older mares a
usually disappears completely without treatment within squamous cell carcinoma may involve the caudal vagina
48 hours of foaling. and vulva. Melanomas may be found in the vagina of
Treatment The development of painful edema may gray mares and may also occasionally interfere with
initially indicate threatened rather than actual rupture fetal delivery. In neither case should such mares be bred
of the tendon. An ulirasonographic scan of the tendon from again but, providing the tumor is not too large,
may help assess the degree of damage. In any case, the it may be possible to guide the lubricated foal past the
ventral abdominal floor should be supported by strong obstruction during delivery. If problems are encountered
canvas strapping fixed round the abdomen. The abdomi- or anticipated, cesarean section may be required.
nal floor and the damaged or threatened tendon are Varicose veins occur in the vaginal wall of some
thus supported indirectly by the vertebral column. Sur- older mares and may project into the lumen. Physical
gical repair of the tendon and its insertion into the obstruction to the passage of the foal is seldom a prob-
pubis — where the rupture usually occurs — is not nor- lem. Hemorrhage can occur spontaneously during preg-
mally feasible. The mare is kept under observation and nancy or at parturition. Such hemorrhage is rarely
assistance given with foaling if required. life-threatening and is dealt with by standard hemosta-
Rupture of the tendon may cause displacement of tic measures. These include packing the vagina with
one of the mare's teats but lactation and access by the damp toweling or coagulation of the vessels using a
foal are not normally affected. In many cases the foal is gauze pad soaked in 10% formol saline. If these methods
reared normally but after weaning the mare should be fail, the vessels should be ligated under epidural or gen-
retired from further breeding. eral anesthesia. Hemorrhage from the uterine arteries
is described in Chapter 13.

OBSTRUCTION OF THE BIRTH CANAL The cervix

Obstruction of the cervix of the mare is rarely a cause
Bony tissue obstruction of dystocia unless the cervix has suffered damage and
Pelvic injury compromising the patency of the pelvic scar tissue formation at an earlier birth. The normal
canal is uncommon in horses. If such injury had been equine cervix can be dilated manually with relative
sustained the mare should not be bred. If she is found ease at any stage of pregnancy or parturition. Scar dam-
to be in foal after injury, arrangements should be made age from a previous foaling should have been noted
for an elective cesarean section. If the problem is undis- during inspection of the cervix at the previous postnatal
covered until dystocia occurs, attempts should be made check. Severe damage may compromise conception
to guide the fetus past any obstruction. If this is not and may necessitate cesarean section if dystocia occurs
possible then immediate cesarean section might allow and manual dilation proves impossible.
delivery of a living foal. Fetotomy can be used to divide
and deliver a dead foal.
Torsion of the uterus
Uterine torsion can occur during pregnancy or as a
Soft tissue obstruction cause of dystocia at parturition. The condition is rela-
As in other species, soft tissue obstruction of the birth tively uncommon, with approximately 50% of cases
canal may affect any part from the vulva to the uterus. occurring after 7 months of pregnancy and 50% at
Many Thoroughbred mares have had the dorsal two- term. The two forms of uterine torsion will be considered
thirds of their vulval orifice stitched by Caslick's opera- separately.
tion as an aid to conception. The stitched tissues should
be opened with scissors up to a week before foaling to 1. Torsion of the uterus during
prevent tearing at birth. On some studs, an experienced pregnancy
stud groom opens the stitched vulval lips during the Clinical signs Uterine torsion should always be con-
first stage of labor. The vulval lips are normally sutured sidered when signs of colic occur in mares during late
again shortly after birth of the foal and passage of the gestation, Mild colic can occur in any pregnant mare
placenta if it is intended to breed from the mare again. and may be associated with fetal movements and
 Handbook of Veterinary Obstetrics 85

pressure on pelvic nerves and blood vessels. Such colics is the quality of the surgical facilities available. Three
are non-progressive and usually resolve rapidly without methods of treatment may be considered:
treatment. Occasionally, analgesia may be required.
Any more serious or persistent colic should be fully 1. Replacement of the uterus by manual manipulation: an
investigated. In summary, a full history is taken and the attempt is made to grasp the uterine wall per rectum,
mare subjected to a complete clinical examination in rock the uterus from side to side, and then swing it
case a serious gastrointestinal problem has developed back into the correct position. Great care must be
incidentally in the pregnant mare. A rectal examination taken to avoid damaging the rectal and vaginal walls
is performed to examine the accessible parts of the and this method is only likely to be successful if the
abdomen for signs of abnormality involving the gas- uterine torsion is recent and the fetus small. If
trointestinal tract. A stomach tube is passed to check successful, the uterus resumes its midline position
for evidence of gastric reflux and the abdomen is aus- and the signs of colic rapidly resolve.
cultated to assess bowel activity. An abdominal paracen- 2. Rolling the mare under general anesthesia: this can be
tesis is performed to obtain a sample of peritoneal fluid. attempted if the previous method fails, but should
The latter technique is often unproductive in late preg- not be used in late gestation. The mare is placed on
nancy because paracentesis at this time usually results the side to which the torsion is directed and then
in the collection of allantoic rather than peritoneal fluid. sharply rolled over in the direction of the twist. It
Specific findings with uterine torsion during preg- may be necessary to repeat the procedure and
nancy include: external pressure on the uterus and fetus may be
supplied using a board — on which an assistant
« mild to quite severe unremitting colic
stands — as in the cow. The procedure is not
« slight elevation of the pulse; packed cell volume is
without risk but may be considered if laparotomy
usually normal
is not possible for economic or other reasons.
+ normal bowel activity and sounds
3. Replacement of the uterus via laparotomy: this can be
scant but normal peritoneal {luid
attempted in the standing or recumbent mare.
rectal examination: reveals displacement of the
Standing flank laparotomy in the sedated mare
uterus and its broad ligaments. The pregnant
and under local infiltration anesthesia is performed
uterus lies laterally and is displaced from its normal
on the side towards which the torsion is directed.
midline position
A small incision is made in the center of the
« vaginal examination: usually no abnormality. Most
sublumbar fossa initially to allow the obstetrician’s
cases during pregnancy are precervical and have
hand to grasp the uterus. The uterus is rocked
little effect upon the vagina.
backwards and forwards away from and towards
During rectal examination the uterus may be felt to the operator and then turned back into its correct
deviate sharply laterally and downwards instead of position. Occasionally, bilateral incisions may be
being readily palpable in the midline. The fetus may not required.
be palpable and the uterus is immobile. The broad liga- Ventral midline laparotomy is performed under
ments are displaced and may be tense, especially on the general anesthesia and allows better access to the
side of the animal towards which the uterus is rotated. abdomen and uterus. Good surgical facilities are
Thus if the uterus is rotated to the right the right broad mandatory. The direction of the torsion is checked
ligament may be palpated per rectum as a tense band and an attempt made to rock or replace the uterus
running from the right sublumbar region down to and into its correct position. If satisfactorily replaced,
under the uterus. The left broad ligament runs from the the uterus and its broad ligaments should be in
dorsal aspect of the displaced uterus to the left sublumbar their correct position and under normal tension.
area. Right and left uterine displacement occur with The abdomen may be more readily checked for
equal frequency. gastrointestinal abnormalities during a ventral
Treatment The state of the uterine wall must be midline laparotomy. If the uterine wall is
taken into account: it may have been compromised if compromised it may be possible to repair damage
the torsion has been present for some time. Fetal com- and if there is clear evidence of fetal death then
promise may have also occurred if the placenta has been cesarean section can be employed to remove it.
damaged. Fetal death may occur in cases of prolonged Severe damage or disruption of the blood supply to
torsion. Economic considerations are also important, as the uterine wall carries a grave prognosis.
86 Dystocia in the Mare

Preoperative antibiotic and non-steroidal to the torsion. Several attempts may be necessary to
anti-inflammatory therapy are recommended. correct the problem. Once the torsion has been dealt
with the fetus should be delivered manually. Great care
Management of the mare and fetus after correc-
must be taken as the viability of the uterine and possi-
tion of uterine torsion The prognosis following
bly vaginal walls may have been compromised or more
treatment — especially rolling or surgery — must be
severely damaged by interference with the blood supply
guarded. There is arisk of placental separation with fetal
during the period of torsion. Gentle massage of accessible
death, uterine rupture, peritonitis, or other postproce-
tissues may encourage relaxation and facilitate delivery.
dure complications. In one survey, 70% of foals known
If rotation of the uterus per vaginam is not success-
to be alive at surgery were born alive at term.
ful a ventral midline approach to the uterus should be
Following correction of uterine torsion, the foal
made at surgery. At laparotomy the uterus is inspected
should be monitored carefully after treatment. A trans-
and rotated into its correct position. It may be advisable
abdominal ultrasonographic scan should be performed
to deliver the foal by cesarean section to avoid further
daily to monitor the fetal heart beat and the clarity of
complications. Standard postoperative care and manage-
the amniotic fluid. The scan should be carried out daily
ment are required.
for the first week and weekly after that until term. Fetal
Rolling the mare at term is accompanied by grave risks of
survival will depend on whether there has been any
uterine rupture and should not be attempted.
compromise of placental function. It has been suggested
that a compromised placenta produces insufficient prog-
estins to maintain pregnancy: 2.2 mg/50 kg body weight Downward deviation of the uterus
daily of the synthetic progestagen altrenogest can be
This may be a problem in mares that have suffered a
given orally to the mare in such cases in an attempt to
ventral hernia. If the pregnant uterus passes into the
support maintenance of pregnancy. The drug is with-
sac of the hernia the fetus may hang almost vertically
drawn slowly and with reducing dose towards the end
down from the pelvis. Exit from the uterus may be
of pregnancy. The efficacy of the drug therapy has not
occluded and fetal delivery is compromised. The start of
been scientifically proven.
parturition should be closely monitored and manual
assistance given with delivery of the foal. The severity
2. Torsion of the uterus as a cause of of the hernia may be reduced and fetal delivery assisted
dystocia at term by support for the ventral abdominal wall. A canvas
Clinical signs Suspicions of uterine torsion may sling passing around the abdomen and supported by
arise if there are signs of colic and delay in the early the mare's spine may be found useful as in cases of rup-
stages of birth. In parturient mares the point of torsion ture of the prepubic tendon (see p. 83). Fetal delivery
is normally anterior to the cervix. Vaginal examination is more easily completed in the recumbent mare. The
may reveal some constriction of the birth canal and abdominal floor may be raised in the quiet standing
displacement of the broad ligaments may be confirmed mare by using a sack under the abdomen held and
on rectal examination. The fetus may be displaced ante- lifted by two assistants one on either side of the patient.
riorly and not as easily palpated as in other forms of In a nervous mare, sedation or casting may be neces-
dystocia. In some cases the uterine torsion is associated sary to cause her to lie down. Traction is applied to the
with an abnormal disposition of the foal, which may be foal to bring it up into and through the maternal pelvis.
found in a lateral or ventral position.
Treatment If good surgical facilities are available an
immediate cesarean section is advisable to deal with FETOPELVIC DISPROPORTION
this abnormality. If immediate surgery is not contem-
plated and access can be gained to the fetus an attempt This is seldom a problem in mares although it has been
should be made to correct the torsion by rotating reported in Belgian Draft mares where double-muscling,
the fetus and surrounding uterus back into its normal which greatly increases fetal size, occurs. It is occasion-
position. The obstetrician's hand is fully inserted into ally seen in other breeds including ponies. Prolonged
the birth canal and the fetus is grasped by the neck or gestation in mares, in total contrast to the position in
shoulder. The fetus and uterus are rocked from side to cattle, does not result in fetal oversize. In fact, quite the
side and then sharply turned in the opposite direction reverse. Foals are quite frequently carried for 4 weeks
 Handbook of Veterinary Obstetrics 87

or more past the expected delivery date (330 days

post-service) and it is possible that their foals may be FETAL MALDISPOSITION
smaller rather than larger than normal. Fetal maturity
and size are usually related to placental competence This category comprises the major causes of equine
and prolonged gestation may be an indication that the dystocia. The long neck and limbs of the foal predispose
placenta is not functioning as well as normal. Fetal life it to maldisposition and the violent expulsive efforts of
in such circumstances is seldom at risk. The rarity of the parturient mare rapidly and irreversibly compound
fetopelvic disproportion in mares means that vaginal the problem. The length of the extremities may make
delivery should be possible in cases where fetal disposi- correction of maldispositions more difficult in the mare
tion and the birth canal are normal. In those rare cases than in the cow. The risk of uterine rupture by the long
where it is believed (and confirmed by trial traction) that extremities or during attempts to correct their position
the fetus will not pass through the pelvis it may be is also high.
delivered by cesarean section or fetotomy. The fetus Many of the maldispositions that affect the foal
may be larger than normal in cases of transverse pres- are also seen in the calf. They are considered in great
entation with the foal having developed as a 'bicor- detail in Chapter 4. Their treatment is summarized
nual’ pregnancy (see p. 88). in this section and the reader is advised to consult
Chapter 4 if more detail is required. Those maldisposi-
tions more commonly seen in the horse, such as the
‘dog sitting’ position of the fetus, will be considered
Fetal monsters
here in detail.
Fetal monsters are less common in horses than in cattle Treatment The principles of treatment of fetal mal-
but their presence should be suspected if the delivery of disposition are broadly the same in mares as in cows.
what appears to be a normal fetus does not proceed as The nature of the fetal maldisposition is diagnosed by
expected. At all cases of dystocia those parts of the foal inspection of visible fetal parts and methodical palpa-
that are palpable should be examined for evidence of tion of the fetus per vaginam. Before delivery can be
abnormality. achieved the fetus must be restored, where possible,
Cases of hydrocephalus with gross enlargement of the into the correct presentation, position, and posture for
cranium have been reported. The deformed head may birth. The fetus must be repelled back into the uterus to
be too large to pass through the pelvis. allow the obstetrician space to correct abnormalities of
Ankylosis of one or more limb joints may interfere head or limb posture. Generous application of obstetric
with delivery. In some foals a persistent lateral deviation lubricant will aid manipulation of the fetus, includ-
of the neck (‘wry neck’) may make delivery difficult as ing repulsion. In quiet mares fetal repulsion may be
the neck tends to spring back into its abnormal position achieved by firmly pushing the fetal head, chest, or
when the head is released. Such foals may show slow hindquarters away from the pelvic inlet. If maternal
improvement after birth although help with sucking straining makes this maneuver difficult, an epidural
the mare may be required. The occurrence of other anesthetic may be administered: 10-15 mL of 2% lido-
monsters such as schistosomus reflexus in horses is caine (lignocaine) may be given into sacrococcygeal space
very rare. or the first intercoccygeal space. Pulling the mare's
Treatment of cases of dystocia caused by fetal tongue out of the side of her mouth sometimes helps to
monsters This depends on the extent and nature of reduce straining and may be used before an epidural
the abnormality. In a case of hydrocephalus in which anesthetic is given. Relaxation of the uterine muscles may
the foal is dead, the abnormal cranium may sometimes also assist in the correction of maldispositions and can
be removed using the embryotome. In cases of wry be achieved by the use of 200-300 g clenbuterol given
neck, which cannot be manually corrected, the embry- by intravenous or intramuscular injection, Correction
otome may also be used to remove the head and allow of maldispositions may be more readily performed in
delivery of the dead fetus. If the fetus is known to be the standing mare. The recumbent mare should be
alive and manual correction of the maldisposition has encouraged to rise if manipulation of the fetus is prov-
proved impossible, cesarean section might be indicated. ing difficult.
Partial fetotomy is extremely useful to assist delivery of Deviated extremities are identified and if possible
adead foal in cases of ankylosis of limb joints. returned to their correct anatomical position.
88 Dystocia in the Mare

Damage to the uterine wall may be minimized by the 16% of cases of dystocia in the Ghent survey
obstetrician cupping the sharp points of the deviated were associated with the fetus in this presentation.
extremity in the hand as it is returned to its normal Cesarean section is required to deliver the fetus in most
position. Once the maldisposition has been corrected cases.
the mare should be assisted to deliver the foal as quickly Etiology In normal equine pregnancy the fetus
as possible. commences its development in one uterine horn. After
If manual correction is impossible, the alternatives 6 months gestation it also occupies part of the uterine
are to proceed to cesarean section or fetotomy. If facili- body. The placenta also extends into the nonpregnant
ties for cesarean section are not available or if the foal uterine horn.
is dead, fetotomy (often partial) may provide the only In transverse presentation, fetal occupancy of the
course of action. The foal will not usually survive for uterus is abnormal and is almost always associated
more than an hour in second-stage labor and thus in with a bicornual pregnancy. Fetal development com-
many cases of dystocia it may already be dead. If there mences in one uterine horn and as the fetus grows it
are any doubts concerning the living state of the foal enters the other uterine horn rather than the body of
when fetotomy is to be performed it can be destroyed by the uterus. The placenta develops fully in both horns
intrathoracic injection of 40-50 mL pentobarbitone and, as a result, some fetuses become larger than nor-
sodium. mal. Fetal movement is somewhat restricted and a
degree of joint ankylosis may occur. A further compli-
cation is that the unoccupied uterine body does not
FETAL MALPRESENTATION AND grow and expand as much as it does in a normal preg-
MALPOSITION nancy. The exit from the uterus at the cervical end of
the uterine body may therefore be smaller than normal
Malpresentation and the fetus poorly accessible to the obstetrician.
Natural birth is quite impossible.
Posterior presentation
Clinical signs Although the birth process starts it
This condition occurs in only about 1% of normal equine makes no progress because the uterine contractions
births but accounted for 16% of dystocia cases seen of first-stage labor do not move the fetus towards the
in the Ghent survey (Vanderplassche 1993). Posterior pelvis but impact it further into the two uterine horns.
presentation of the foal apparently predisposes to diffi- Vaginal examination may reveal a poorly developed
culty at birth. Fifty per cent of the foals in posterior pres- uterine body, the fetus far forward in the uterus and
entation were also in lateral position as they entered only just palpable through its fetal membranes by the
the birth canal. This caused the fetus to be impacted obstetrician's finger tips. In most transverse pregnan-
against the pelvic brim or wing of ilium. cies the fetus is in a ventral position and the feet are
Before the fetus is delivered it should be repelled and, directed towards the maternal pelvis. Other parts of the
when necessary. rotated back into a dorsal position. As fetus are not palpable (Fig. 5.1).
in other species, delivery of the fetus in posterior pres- A ventrotransverse presentation not associated with
entation is generally more hazardous than when the bicornual pregnancy has also been described in the
fetus is in anterior presentation. If the fetus becomes mare. In this abnormality the fetus is thought to have
hypoxic it may attempt to breath and inhale amniotic developed chiefly in the uterine body. At birth all four
fluid. This problem is exacerbated by premature rupture fetal legs enter the birth canal and the fetus becomes
or by compression of the umbilical cord, which is likely impacted with both head and hindquarters away from
to occur during delivery in this presentation. Once the pelvic inlet.
delivery in posterior presentation is started it should be Occasionally, a dorsotransverse ~presentation is
completed as quickly as possible. For this reason the encountered, in which case the obstetrician may be able
obstetrician must ensure that adequate assistance is to palpate the spinal column of the fetus and possibly
available before attempting to deliver the fetus. its neck or croup (Fig. 5.2).
Treatment If the fetus is alive, immediate cesarean
Transverse presentation section is advisable, and even if the fetus is dead this
This rare presentation — occurring in only 0.1% of may be the best course of action. Fetotomy may be pos-
natural births — is always associated with dystocia; sible but the fetus is normally so far forward from the
 Handbook of Veterinary Obstetrics 89

Figure 5.1 Bicornual pregnancy in the mare. The foal is in a ventrotransverse presentation. The uterine body is poorly developed
and vaginal delivery is impossible.

Figure 5.2 Foal in dorsotransverse position.

cervix that access Is extremely difficult. Very occasionally Vertical presentation

it may be possible to reach one end of the fetal body, A form of dystocia seen very occasionally in the horse
bring it to the pelvic inlet and deliver the fetus per (and extremely rarely in the cow) is sometimes described
vaginam. as being a ‘vertical presentation’. This is the ‘dog sitting
90 Dystocia in the Mare

position” in which the fetal head. neck. and forelimbs floor and placed back in the uterus. The hindlimbs
are in the vagina accompanied by the distal extremities are placed as far forward from the pelvic inlet as space
of both hind limbs. will allow. Traction is applied to the head and forelegs
Clinical signs Initially, birth may appear normal with of the fetus and it is delivered. There is still a risk that
the fetal forelegs and head appearing at the vulva. the hindfeet may damage the uterine floor.
Unproductive straining follows and no progressis made. If the hindfeet cannot be reached or dislodged it has
Vaginal examination reveals that the forelegs are less been suggested that the anterior end of the fetus could
advanced in the birth canal than normal (this may also be repelled into the uterus. Traction is applied to the
be seen in cases of elbow flexion, see p. 93). In some hindlimbs to convert the presentation into a poste-
cases the head and part of the thorax pass through rior presentation in a ventral position. The fetus is
the vulva. The fetus cannot be moved caudally even rotated into a dorsal position and delivered by traction.
when modest traction is applied. even though it appears Although possible, this complex manipulation is likely
that delivery is underway and should now be easy and to be difficult.
uncomplicated. Cesarean section would be difficult unless the fetus
This lack of progress — being abnormal and unex- could be repelled into the uterus enabling it to be
pected — should indicate an unusual situation requiring removed at laparotomy. Correction of the maldisposition
further careful vaginal examination, Such examina-~ by laparotomy and hysterotomy may be an alternative
tion is not easy because the presence of the fetus in the to full cesarean section. A small opening in the uterus
birth canal makes access difficult. The lubricated hand is made. The obstetrician reaches forward in the uterus
is advanced into the vagina beside or beneath the fetus to identify the displaced limbs, which are lifted from
and towards the pelvic brim. In cases of the dog sitting the pelvic floor and carefully extended back into the
position the hindfeet are found resting on the pelvic uterus. The fetus is delivered by traction and the small
floor (Fig. 5.3) The position of the hindlimbs — with opening in the uterus and the laparotomy wound are
hips flexed and hocks extended — prevents any further closed.
advance of the fetus into the birth canal. If manipulative delivery is impossible, fetotomy may
Treatment If the problem is diagnosed at an early present the only method of resolving the problem if the
stage it may be possible for the hindfeet to be cupped fetus is dead. Using the embryotome with the wire
in the obstetrician's hands and lifted off the pelvic looped over the fetal head and neck the fetus should be

Figure 5.3 Fetal malposture— foal in the ‘dog sitting’ position.

 Handbook of Veterinary Obstetrics 91

sectioned in the lumbar region. The front end of the fetus Hock and hip flexion may complicate delivery of the
is delivered by traction. Fetal viscera should be removed fetus in posterior presentation. Natural movements by
manually. The caudal part of the spinal column is the foal during birth help it to assume the correct pos-
repelled converting the fetal remnants into a posterior ture for delivery. If the foal is dead, unwell, or deformed,
presentation. Traction applied to the hindlegs should these natural movements do not occur and the risk
allow delivery to be achieved preceded if possible by of dystocia is increased. In most cases, non-productive
rotation to place the fetus into the dorsal position. straining is seen, sometimes combined with an abnor-
mal appearance of fetal parts at the vulva. For example,
the head and a single forelimb or two forelimbs without
Malposition the head.
The foal is normally born in the dorsal position but
during gestation it lies in the uterus in a ventral posi- Lateral deviation of the head
tion. The fetus starts to rotate into the dorsal position
This abnormality was the single most common cause of
during the first stage of labor. The hindquarters and
dystocia in the Ghent survey. being responsible for 40%
legs of the foal usually rotate from ventral to dorsal
of all the equine dystocia cases. The deviation may arise
position during the second stage of labor as the foal is
sporadically or may be caused by the condition of wry
born. Failure of this rotation to occur will lead to a mal-
neck, in which the fetal neck is ‘permanently’ deviated
position, which may be left or right lateral or ventral - in
laterally.
the latter case the foal being ‘upside down’ in the birth
Clinical signs The fetal forelegs are found within the
canal. The dorsal surface of the foal's body is rather
vagina or protrude through the vulval lips. Intense
more pointed than that of the calf and its shape is
maternal straining fails to move the fetus. Vaginal
accommodated by the contour of the inner dorsal
examination confirms the absence of the fetal head in
surface of the maternal pelvis. Any malposition may
the pelvis but the base of the neck is palpable and deviates
interfere with the delivery of the foal. Malposition
sharply to the right or left (Fig. 5.4).
may occur in the foal in either anterior or posterior
Treatment The long neck and head of the foal may
presentation.
mean that the fetal muzzle may be lying near its
The malposition is diagnosed by examination of the
hindquarters. Space is required to accommodate cor-
foal's position in relation to that of its mother. It must
rection of the abnormality and the fetus must be
be corrected by obstetric rotation whereby the foal is
repelled as far back into the uterus as possible. This may
turned on its long axis into the dorsal position. This is
be assisted by standing the mare on a sloping surface
achieved repelling the fetus and then applying lateral
with her hindquarters raised and the use of epidural
direct pressure to the shoulder region of the fetus assisted
anesthesia. Generous lubrication is mandatory.
if appropriate by a rocking movement. The maneuver
The base of the neck is located and followed forwards
is greatly assisted by generous application of obstetric
until the head is located. The head is brought towards
lubricant to the fetus and the birth canal.
the pelvis, initially by pulling the skin of the neck, an ear
Strong uterine contractions and straining may impact
or inserting the finger into an eye socket or the mouth
the malpositioned fetus and make repulsion and rotation
until the head is brought closer to the obstetrician.
difficult. In this case, a degree of rotation can often be
If possible, the obstetrician encloses the fetal muzzle to
achieved during delivery by applying traction combined
protect the uterus and the head is guided round and
with rotation. Downward pressure is exerted on one
up into the pelvis.
fetal limb and upward pressure on the other as traction
The head of the foal is much longer than that of the
is applied.
calf and bringing it round into the pelvis is proportion-
ately more difficult (Fig. 5.5).
Once the head has been located, ventral flexion of
Malposture
the fetal neck will provide more space to correct the
This extremely important category of equine dystocia displacement of the head.
is caused by displacement of the fetal head and/or If correction of the abnormality is impossible, cesarean
forelegs with the fetus in anterior presentation. section or fetotomy may be required.
92 Dystocia in the Mare

Figure 5.4 Fetal malposture — lateral deviation of the head.

Figure 5.5 The head of the foal (right) is much longer than the head of the calf (left) and manipulation into the correct posture is
more difficult.

Downward deviation of the head deviation it may be necessary to repel a forelimb into the
Clinical signs Varying degrees of this abnormality are uterus to permit access to the head and to allow it to be
seen. The long nose of the foal can quite easily catch on the retrieved and brought up into the pelvis. The foreleg is
maternal pelvic brim causing the fetus to be presented in brought back up into the pelvis and delivery by traction
the vertex posture. In severe cases the head may be pushed follows. If manual correction proves impossible, deliv-
down between the forelegs in the breast-head posture. ery must be by cesarean section or fetotomy.
Treatment Slight downward displacements such as
in the vertex posture may be corrected by repelling the Dystocia in the mare caused by the
fetus and lifting the fetal muzzle up onto the pelvic floor. foot-nape malposture in the foal
The long fetal head may require the poll of the head This rare dystocia is not believed to occur in cattle and
to be further repelled to allow space for the muzzle to is caused partly by displacement of the fetal head and
be lifted into the pelvis. In cases of severe downward partly by displacement of the forelegs.
 Handbook of Veterinary Obstetrics 93

Figure 5.6 Foal malposture — incomplete extension of the eloow.

Clinical signs Attention is drawn to the case by is palpable and the long slender limbs of the foal may
severe non-productive straining by the mare. Vaginal allow the flexed carpus to enter the vagina and come
examination reveals the fetal head in a normal extended almost up to the vulva.
position in the vagina. The fetal forefeet are found rest- Treatment The fetus must be repelled as far as possi-
ing on the dorsal surface of the fetal head or neck, The legs ble. The flexed carpus is repelled. pushed upwards and
may cross over each other and the tips of the hooves forwards into the uterus to bring the fetal foot within
may be directed towards the roof of the vagina. If the reach of the obstetrician. The foot is cupped in the
dystocia is not rapidly corrected there is a grave risk hand and brought up into the pelvis. If both legs are in
that the hooves may penetrate the vaginal roof possibly carpal flexion, both must be retrieved and brought into
producing a rectovaginal fistula. the pelvis. In some cases a calving rope may be used
Treatment The foal is repelled and the upper limb is to help correct the abnormality (see Carpal flexion in
lifted from its position across the fetal neck and placed Chapter 4, p. 53). If the foal is dead and the deviated
alongside the head. The second limb is dealt with in limb impacted, it can be sectioned just below the carpus
a similar manner. The fetal head is lifted upwards and with the embryotome to allow fetal delivery.
the legs placed just underneath the head. Both legs are
extended and the fetus is delivered by traction. 2. Incomplete extension of the elbow
Retention of a forelimb This condition may be more common if the fetal head is
This may involve carpal flexion, incomplete extension larger than normal and appears to be seen more fre-
of the elbow, or shoulder flexion involving one or both quently in Shetland ponies than in other breeds.
forelimbs. Clinical signs The fetal nose and the tips of the feet
may appear together at the vulval lips. The feet are not
1. Carpal flexion in advance of the nose as they are in normal birth. The
Clinical signs [n many cases when only one limb is fetus appears to be completely impacted and does not
affected, the fetal nose and the distal extremity of one move even when the mare strains vigorously. Vaginal
foreleg are visible at the vulva but, despite straining, examination — if space permits — reveals that the fetal
the mare makes no progress. Vaginal examination will elbows are flexed and the olecranon process of each is
normally reveal the other limb either at the pelvic inlet impacted against the anterior edge of the maternal
or in the vagina. The anterior surface of the flexed carpus pelvic brim (Fig. 5.6).
94 Dystocia in the Mare

Treatment The problem is normally easy to correct. If the foal is dead and the malposture cannot be cor-
The fetus is repelled and, after lubrication, one limb rected manually, the lower part of the limb may be
is pulled into an extended position. The second limb is removed by fetotomy.
extended in a similar fashion and the foal delivered by
traction.
2. Hip flexion (breech presentation)
Clinical signs Only the tail of the foal may be visible
3. Shoulder flexion at the vulva and sometimes — if the tail lies alongside
Bilateral shoulder flexion in the foal is rare and more the fetal body — nothing is visible, despite intense non-
commonly one limb only is involved. productive straining. Vaginal examination reveals the
Clinical signs The fetal head and one limb protrude hindquarters of the foal either engaged in the maternal
from the vulva. The second forelimb is absent but the pelvis or lying in front of or below the pelvis. Occasionally,
shoulder joint on that side is palpable. The proximal only one limb is flexed and the other is extended into
portions of the retained forelimb can be felt in a flexed the birth canal.
posttion lying alongside the fetal thorax. Treatment The fetus is repelled from the pelvic inlet
Treatment The fetus s repelled and an attempt made and an attempt made to locate one of the hocks. This is
to retrieve the retained limb. The limb is grasped around gently raised up to the pelvic inlet. Once there it is dealt
the humerus and the shoulder joint is extended. The with as a case of hock flexion (see above). If the second
obstetrician’s hand is transferred to the radius as soon limb is involved it is dealt with in a similar manner.
as possible and the carpus is brought up to the pelvic inlet. A calving rope may be used to assist in retrieving the
The carpal flexion is corrected by the method described hock (see Chapter 4).
above. If manipulative delivery is impossible, cesarean sec-
If the foal is dead and it is impossible to retrieve the tion or fetotomy may be used.
deviated limb it can be removed by fetotomy. The feto- Delivery of an equine breech presentation in an
tomy wire attached to an introducer is dropped between uncorrected malposture If the fetus is small and
the upper forelimb of the foal and its thoracic wall. the mare’s pelvis capacious, it may be possible to deli-
The wire is threaded through the embryotome and the ver the foal without attempting to retrieve the retained
muscular attachments of the limb are readily sawn hindlimbs. Ropes are passed (using the introducer of
through allowing removal of the limb and fetal delivery. an embryotome) between the thigh and the body wall
of the fetus on both sides. Traction is applied and the
Retention of a hindlimb fetus is guided rump first into the pelvis. Further trac-
Hock flexion and hip flexion involving one or both hind- tion is applied and the foal delivered. This is a potentially
limbs can occur in the fetus in posterior presentation. hazardous procedure with severe consequences if the fetus
become impacted in the maternal pelvis during delivery.
1. Hock flexion Severe damage to the cervix will probably be sustained
Clinical signs The tip of the fetal tail may be seen at by the mare, making her unfit for future breeding. The
the vulva and the flexed hocks are palpable at the pelvic technique is not recommended unless all other methods
inlet. If one limb only is involved the other leg can be fail or are unavailable.
extended and protruding through the vulva.
Treatment The long legs of the foal make this a
DYSTOCIA DUE TO MULTIPLE BIRTH
potentially difficult and hazardous procedure. Great care
must be taken to avoid damage to the uterine floor by
Every effort is made — at least in Thoroughbred and
the sharp hoof of the foal during the process of correc-
other controlled breeding establishments — to avoid
tion. The fetus is repelled into the uterus as far forward
twin pregnancy. In many cases the twin pregnancy —
as possible. Using plenty of lubrication, the hock is
through placental insufficiency — will end in abortion
pushed upwards and forwards. The obstetrician’s hand
at about 7 months gestation. Occasionally the pregnancy
slides down the metatarsus to seek the fetal foot. The foot
goes on to term, when two small foals are born. Dystocia
is cupped in the hand and is lifted into the pelvic canal,
can occur if:
thus allowing the limb to be extended and delivery to pro-
ceed. For further details of alternative manipulation used « either fetus is malpresented
in the calf and applicable to the foal, see Chapter 4, p. 94. « simultaneous presentation of the fetuses occurs
 Handbook of Veterinary Obstetrics 95

» uterine inertia, which is rare in mares, occurs as a without supervision. Prediction of the time of birth in
result of overstretching of the uterus. the horse is notoriously difficult. Gestation length is
very variable and even the same mare may show con-
Clinical signs and treatment The presence of twin
siderable variation in the length of her gestation dur-
foals may have been discovered after formation of the
ing different pregnancies. Mares prefer to give birth in
endometrial cups at 35 days and a decision made to
conditions of quiet and solitude. Observation by stable
allow the pregnancy to continue to term. Such a foaling
staff for approaching foaling may itself disturb the
should be carefully supervised and assisted as required.
mare and delay birth for many hours or even days.
Early vaginal examination should be performed and
Such observation must be very discreet but must none-
action taken to deliver the foals manually if uterine inertia
theless be thorough because, if dystocia is thought
is present. If two fetuses are presented simultaneously
to be present, it must be dealt with as a matter of
at the pelvic inlet or within the vagina, one is repelled
urgency.
and the other delivered by traction. Maldispositions are
Specific signs of dystocia include:
dealt with in the manner described for singleton foals
suffering this abnormality.
Prolonged first-stage labor: the mare is restless for
much longer than normal.
Straining without any progress being made.
DYSTOCIA CAUSED BY FETAL DEATH The presence at the vulva of an abnormal
combination of extremities — two forefeet alone may
Petal death during pregnancy in the mare is normally indicate that the head is deviated laterally. The fetal
followed by abortion. If the foal dies at term dystocia head and one forelimb may indicate that one limb is
may arise through: (1) failure of the foal to adopt the abnormally disposed in shoulder or carpal flexion.
normal birth posture; (2) loss of fetal fluids, which A more subtle abnormality - but a serious one - is
impedes normal delivery through lack of natural lubri- that observed in cases of elbow flexion. In this
cation. Failure of the cervix to dilate (as may occur in abnormality the fetal forefeet are level with the nose
similar circumstances in cattle) is seldom a problem in instead of beingin front of it (Fig. 5.6).
mares, in which the cervix can normally be manually Any abnormal vaginal discharge or odor. which
dilated without difficulty. might indicate signs of fetal death.
Treatment This is attempted by manually dilating
the cervix, introducing generous amounts of lubricant
into the uterus, correcting any maldisposition, and
attempting to deliver the foal by traction. Before treat- APPROACH TO A CASE OF DYSTOCIA
ment in cases in which the fetus is thought to have IN THE MARE
been dead for some time, a full evaluation of the mare
should be performed. Antibiotic and non-steroidal anti- Speed of attendance
inflammatory therapy is advisable before delivery is The importance of rapid attendance to foaling cases
commenced. If the mare looks unwell and shows signs has already been mentioned but is so important that
of abdominal pain, a peritoneal tap is useful to check it is repeated here. While waiting for the arrival of
for the presence of early peritonitis, which would worsen the obstetrician the owner could be advised to keep
the prognosis of the case. Ultrasonographic guidance the mare standing and walking to minimize non-
may assist in obtaining peritoneal rather than allantoic productive straining. Clean, warm water and help should
fluid. be arranged. Separation of the chorion from the endo-
For further discussion on additional methods of deal- metrium occurs in some cases of dystocia and also
ing with the emphysematous fetus, see Chapter 4, p. 56. after induced birth. The red-colored velvety chorion
may appear unruptured at the vulva, with fetal
parts palpable through it and the amnion. This is some-
SIGNS OF DYSTOCIA IN THE MARE times termed a ‘red bag foaling'. Experienced owners
and grooms should be advised to open the chorion
Thoroughbred mares are very closely supervised as quickly, but carefully, with scissors while awaiting the
birth approaches. Many pony mares foal in the open obstetrician.
96 Dystocia in the Mare

shoes. If the mare has had her vulval lips sutured by

[ OBSTETRICIAN'S CHECK LIST
Caslick's operation before breeding the sutured area
Call received should be snipped open with a pair of scissors.

Brief history taken

l Position of the mare, assistance,
Advice to owner re immediate treatment and restraint
1 A reliable assistant holding the mare's head is essential.
Keep mare walking/reduce straining If she is already lying down and her hindquarters are
1 accessible she may be approached quietly and a prelim-
Open vulva if sutured inary vaginal examination may be carried out without
i the mare rising. If she is nervous or standing it is advis-
Open chorion if ‘red bag foaling’ able to have a second assistant holding her tail and steady-
1 ing her hindquarters. Two persons may be required to
Obstetrician — check equipment apply traction to the foal. If only one assistant is available
to hold the mare's head the use of a calf puller to apply
{ careful traction during fetal delivery can be helpful. A calf
Attend mare urgently
puller should be used only in exceptional circumstances,
and then only by the obstetrician. This is not likely to be
On Thoroughbred stud farms an experienced head necessary in Thoroughbred establishments. If the mare
groom is sometimes instructed to perform a vaginal is lying in a corner where her hindquarters are not
examination of the mare as she enters second-stage accessible to the obstetrician she must be encouraged to
labor. If both forefeet and the head of the fetus are pres- rise and moved round so that such access is possible.
ent the mare is left to foal without assistance, although
her progress is monitored carefully. If the fetal presen- Sedation
tation is not normal, the head groom may make minor
adjustments to the fetal posture and, if necessary, the This is advisable in nervous mares but the level of
obstetrician is called immediately. sedation must be such that the ability to stand can be
maintained. Detomidine hydrochloride provides effec-
tive sedation at a dose of 10-20 p.g/kg given by intra-
Preparations for foaling venous or intramuscular injection.
In case problems occur the owner should be encouraged
to have the mare in an accessible, roomy box. Light,
Epidural anesthesia
electricity, and a good supply of warm water should be
readily available. Foaling outside is possibleif the weather This is not necessary for routine equine obstetric work.
is good but observation in such circumstances can be If straining makes examination or manipulation difficult,
difficult and the lack of facilities, should help be required, orif fetotomy is required, epidural anesthesia will be bene-
is a disadvantage. The mare should wear a head collar ficial; 10-15 mL of 2% lidocaine (lignocaine) hydrochlo-
at all times so that she can be caught with ease in any ride is injected via the sacrococcygeal space or the first
circumstances. intercoccygeal space using strict aseptic technique. It is
Even normally quiet mares can become agitated and sometimes less easy to locate the injection site in mares
violent as birth approaches. They may lie down or get than in cows, Careful palpation for the depression between
up very quickly and lash out with their hindlegs or adjoining dorsal spines of vertebrae and locating the point
strike out with their forelegs during foaling, and such of maximum flexibility of the tail base is often helpful.
behavior may become more violent if dystocia occurs.
A foaling mare should be approached with great caution
Protective clothing
and the obstetrician should always be alert and ready to take
evasive action if violent behavior — often unpredicted— occurs. Unless the mare is very quiet it is not advisable for
A tail bandage should be fitted and changed daily and the obstetrician to wear a long parturition garment.
it is advisable, for safety reasons, to remove the mare's The rustling of the garment may frighten the mare and
 Handbook of Veterinary Obstetrics 97

its length may inhibit the obstetrician taking rapid eva- acute hypocalcemia and acute mastitis (quite common
sive action if the mare becomes suddenly violent. Nor- in the cow) are very seldom seen in the parturient mare.
mal washable clothing and waterproof overtrousers The presence of visible fetal parts and placental tissue
will be useful. is observed. The outer surface of the chorion is a deep
red color and has a velvety appearance. Occasionally,
Equipment especially in induced birth, the chorion does not rupture
as the foal enters the pelvic inlet. In such rare cases
« Three nylon ropes (such as calving ropes),
(‘red bag delivery’ or ‘red bag foaling’) the chorion
preferably of different colors and with cylindrical
appears as a conical red projection emerging from
wooden handles with which to apply traction.
the vulval lips. If it does not rupture spontaneously it
« A mechanical puller, such as the HK calving aid.
should be opened carefully using a pair of scissors.
is useful in professional hands (only) if little skilled
In most cases, any fetal parts are covered by the
help is available.
amnion, which is more fibrous and less transparent
« Afetotomy kit if available.
than in the cow. If the amnion is very opaque it may be
« Asupply of obstetric lubricant, oxytocin, tetanus
difficult to identify any fetal parts visually. Palpation of
antitoxin, local anesthetic, clenbuterol, antibiotics, a
the fetal parts usually allows them to be readily identified.
sedative (such as detomidine hydrochloride].
If there is still doubt concerning the identity of fetal
Doxapram hydrochloride and oxygen may be
parts, the amnion can be opened by tearing or the careful
required for the foal.
use of scissors.

OBSTETRICIAN'S CHECK LIST

OBSTETRICIAN'S CHECK LIST
Arrival at stables
Clinical examination of mare
|
Further history taken briefly
Appraisal of mare for signs of ill-health
1 1
i Expected foaling date? Sedate mare if necessary
) {
Management during pregnancy? Inspect the vulva
{
Problems during pregnancy? Identify any fetal parts
4 {
Duration of labor? Identify and assess visible fetal membranes
{ {
What has been observed so far? Open amnion if required to confirm
1 identity of fetal parts
Discuss restraint of mare
1
Assess available assistance Vaginal examination
{ The genital tract of the mare is susceptible to infection
Seek further assistance if required and available and the obstetrician must pay very strict attention to
1 hygiene. The whole perineal region is washed thor-
Approach mare with caution oughly and the obstetrician’s lubricated hand is passed
through the vulva into the vagina. Once the obstetri-
cian's hand is within the vagina the mare does not nor-
General examination of the mare mally kick out behind herself.
A brief appraisal of the mare is required and more If the vulva is not easily dilated the obstetrician
detailed examination is made if she appears unwell. should check again that the upper parts of the vulval
Heavy sweating at foaling is quite normal, as are signs lips are not constricted by an earlier Caslick’s operation.
of colicky discomfort and groaning. The problems of If such constrictions remain they should be removed
98 Dystocia in the Mare

by carefully cutting between the vulval lips up to the compare the size of the fetus with the soft and bony tissue
dorsal commissure to restore the full vulval orifice. dimensions of the birth canal. The hand is passed back
The vagina and its contents are explored systemati- past the long head of the fetus and along the neck to the
cally, as in other species. The mare has a large external shoulders. If the lubricated hand can be moved com-
urethral orifice (with no diverticulum) lying on the pelvic fortably between the fetus and the maternal pelvis vaginal
floor. In some mares foaling for the first time a hymenal delivery is likely to be possible. Trial traction is certainly
remnant may be present just in front of the external justified. The presence of more than one fetus is also
urethral orifice. In most cases it causes no problem but it very uncommon but care must be taken to ensure that
can occasionally obstruct the vagina. It may be possible any fetal parts palpable belong to the same foal.
to push it to one side or gently tear through its thin non- If the presentation, position, or posture of the foal is
vascular structure with the fingers. Occasionally, it may abnormal the amnion must be opened to enable the
be necessary to carefully incise the hymen with a scalpel. obstetrician to examine the fetus more directly, confirm
The cervix of the mare is usually level with the brim the maldisposition, and attempt corrective action. Firm
of the pelvis. The external os protrudes caudally into finger pressure is required to penetrate the equine amnion
the vagina and distinct dorsal and ventral frenulae are and, occasionally, it may have to be opened carefully with
palpable when the cervix is closed. The equine cervix is scissors.
much softer and less fibrous than that of the cow and If there is evidence of fetal maldisposition, this must
can in most cases be readily dilated with expanding be corrected before delivery can take place, Repulsion
digital pressure. If fully dilated the cervix blends with of the fetus is necessary in most cases and is achieved
the vaginal wall and cannot be recognized. by applying pressure to the fetal head. In cases of elbow
The fetus is usually enclosed within the amnion, flexion, repulsion is followed by extension of the limbs
which in horses seems particularly closely applied to to enable the elbows to enter the birth canal. In more
the fetus and tightly stretched by the head and forelegs severe malpostures, considerable fetal repulsion is nec-
as they enter the birth canal. The fetus, still enclosed in essary to provide room to manipulate the misplaced
the amnion, is palpated with care to establish its pres- extremities into their correct position. Encouraging the
entation, position. and posture and also whether there recumbent mare to stand may facilitate the correction
is evidence of fetal life. This examination is performed of fetal maldispositions. Great care must be taken to
exactly as in the calf. Although fetopelvic disproportion protect the uterine and vaginal walls from damage
is a rare cause of equine dystocia, an attempt ismade to during fetal manipulation.

OBSTETRICIAN'S CHECK LIST

Vaginal examination: (open sutured vulva)
Consider epidural anesthesia

Commence vaginal examination

Fetus absent ~ \ Fetus present

N {
Assess vulval relaxation Methodical palpation

Assess vaginal relaxation Confirm identity of fetal parts

1
Check for vaginal damage Presentation, position, and
3 posture of fetus
Check for vaginal obstruction
{ {
Palpate cervix Diagnose cause of dystocia
1 ~
 Handbook of Veterinary Obstetrics 99

! i 0
Cervix closed Cervix dilated Correct any fetal maldisposition

I Explore uterus Plan fetal delivery

|| {
| Locate fetus Attempt fetal delivery
I -
Fetus at pelvic inlet Fetus in both horns

Manipulate into vagina ?Bicornual pregnancy

{
. Attempt fetal delivery Cesarean section
Further assessment of cervix
—
Cervix tightly closed/membranes intact Cervix dilatable/chorioallantois ruptured
|
i Mare not ready to foal? Attempt manual dilation of cervix
|
|
Successful g Unsuccessful
%
} Attempt fetal delivery Consider cesarean section

MANIPULATIVE DELIVERY by two persons each grasping a fetal leg just above the
fetlock. As the mare strains, each leg is pulled in turn
The obstetrician should check that the foal is in the cor- under the obstetrician's instructions. The direction of
rect presentation and that there appears to be space pull is initially backwards and then downwards
between the foal and the pelvis. Generous amounts of towards the mare’s hocks. If a little more traction is
obstetric lubricant should be introduced into the birth required, ropes may be applied to the foal’s legs just
canal. Ideally, help should be given to the mare when above the fetlock joints. They may be tied onto cylindri-
she is lying down. If she is standing she may be left cal wooden handles and traction applied to alternate
for a short time until she lies down, but prolonged delay forelegs with the aid of ropes and handles (see also Figs
is not justified in case the foal is already becoming 4.18and 4.19).
hypoxic. Sometimes fetal maldispositions can be cor- In cases where the foal's head has not engaged in the
rected more easily in the standing mare. pelvis, an additional rope should be applied to the head —
If the mare foals — or is assisted to foal — in the standing using the same technique as in the calf - before the leg
position the foal’s umbilical cord may rupture prematurely. ropes are placed in position. Traction is applied in
In such circumstances, flow of blood from the placenta sequence to each foreleg and then the head, with the
back into the fetal circulation may be impaired and greatest effort coinciding with the mare's straining.
there may be resultant tissue hypoxia. If only one person is available to help with delivery,
Sometimes, the mare does not lie down to foal - either the HK calf puller — or similar instrument — may be used
when being assisted or when foaling naturally. Premature in exceptional circumstances to apply traction. This is
rupture of the umbtlical cord can occur in such circum- used in the same way as it is used in the cow and can
stances and does not always have serious consequences. be equally effective. It should be used only by the
If the foal is of normal size, has entered the birth obstetrician and with the same limitations on the degree
canal and the mare is straining, delivery may be achieved of traction exerted as in the cow (see Chapter 4, p. 72).
100 Dystocia in the Mare

Slow but steady progress should be made and the umbilicus and the cord is pulled steadily away from the
head and shoulders are steadily brought through foal's abdomen. The cord separates at its natural break
the vulva. Once the thorax has been delivered. traction point. Alternatively. the cord should be ligated and
should stop with the hindlimbs of the foal still inside sectioned about 5 cm from the umbilicus.
the mare’s vagina. Amniotic remnants are removed If traction fails to move the foal after 5 minutes, fur-
from the foal's head. The nose and muzzle are cleared ther pulling should cease and the obstetrician should
and breathing is monitored. The foal should be left like check the foal's presentation once again. In particular,
this for 5-10 minutes while the uterus contracts and a careful check should be made to ensure that the foal
squeezes the blood circulating in the placenta back into is not in the dog sitting position, with its hindfeet resting
the foal's circulation. In many cases, the mare will sud- on the pelvic floor preventing further advance through
denly get up and the foal's umbilical cord ruptures. If the birth canal.
the cord does not rupture spontaneously it should be If a further attempt at delivery by traction fails the case
severed. The obstetrician's hand is placed against the should be reassessed. If the foal is alive and facilities are

OBSTETRICIAN'S CHECK LIST

Fetal delivery

Open amnion

Correct any fetal maldisposition

Note signs of fetal life

Compare size of fetus and birth canal

Is vaginal delivery possible?

Possible / \ Impossible

Apply [urllller lubricant Cesarean sec:ion/ fetotomy

Check presentation, position, and posture

1
Apply traction to forelegs, coordinating with mare’s straining

Fetus delivered / \ Fetus not delivered

1 1
Monitor foal/do not sever Further check of presentation, position,
umbilical cord and posture
$
Apply ropes to head and legs
{
Apply traction

e S
Fetus delivered Fetus not delivered
1 1
Monitor foal/do not sever Cesarean section/fetotomy
umbilical cord
 Handbook of Veterinary Obstetrics 101

available, delivery by cesarean section may be used. If the

FURTHER CARE OF THE MARE AND
foal is dead but readily accessible, fetotomy may be used.
FOAL
RESUSCITATION OF THE FOAL The foal's navel should be dipped in a weak iodine solu-
tion or 2% chlorhexidine solution: alternatively, it may
If the foal fails to breath at birth, the thorax is palpated be sprayed with an antibiotic aerosol. The mare's teats
for evidence of an apex heart beat. If the heart is beating. are checked for patency. Mare and foal are best left
respiration may be stimulated by administration of alone to enable bonding to take place. Discreet observa-
40-100mg of doxapram hydrochloride given intra- tion should continue in case the mare becomes mildly
venously or sublingually. The pharynx and larynx should colicky and uncomfortable as she attempts to expel
also be cleared by suction and oxygen given by face mask. her placenta. There is also a small risk that she may
Should breathing fail to commence, artificial respiration accidentally tread on the foal. The foal may need assis-
should be given. A Cox foal resuscitator can also be used tance to stand if it has not spontaneously gained its feet
at this point. This has a resuscitator pump through within 2 hours of birth.
which additional oxygen can be supplied via a face mask. The foal may need help finding the teats and learning
In this serious situation, concern about premature rup- to suck, especially if. as quite often occurs, the mare's
ture of the cord is less important than starting the foal udder is uncomfortable as milk builds up in the udder.
breathing, Positioning the foal safely for artificial respira- Meconium production and passage should be observed
tion may entail rupturing and temporarily applying artery carefully. Meconium is usually passed within 12 hours
forceps to the cord. The foal is laid on its side with head of birth and retention is associated with colic. Resolution
and neck extended. The upper chest wall is raised and low- of the problem usually follows careful administration of
ered holding the uppermost humerus and the last rib. If an enema.
spontaneous respiration still fails to occur, an attempt Urine production and passage should also be moni-
should be made to intubate the foal (if suitable equipment tored. Urachal patency with leakage of urine through
is available) and provide positive-pressure ventilation. For the umbilical stump may occur. In colt foals. discomfort
further details of fetal resuscitation see Chapter 4, p. 75. may arise through inability to pass urine through the

‘ OBSTETRICIAN'S CHECK LIST

Postnatal care of the foal
A: Visible signs of life
Do not sever umbilical cord intentionally

Clear fetal airway

Attempt to stimulate first gasp: cold water on head/needle in filtrum

Administer doxapram HCI IV or under tongue

Artificial respiration: manual/foal resuscitator

Inflate lungs and apply fqu:ther artificial respiration

Monitor pulseland blood Po,

Apply pulsoximeter to ear or tongue

102 Dystocia in the Mare

1
Watch for spontaneous respiration

Monitor respiration and patient's recovery

B: No visible sign of life
Check fetus for heart beat

Observe and palpate chest wall

1
Auscultate heart

Heart beat detected

~ No heart beat detected
{ 13
Clear airway Clear airway
{ {
Commence artificial respiration Check for clear signs of fetal death
{
Apply pulsoximeter to ear or tongue
e
Signs present
NSigns absent
! { 4
Watch for spontaneous respiration Abandon resuscitation Intracardiac adrenaline
(epinephrine)
1 {
Monitor respiration and patient’s recovery Commence artificial respiration
4
Check for heart beat
e \
Heart beat present Heart beat absent
{ {
Continue respiration Abandon resuscitation

penis. The clinical signs may closely resemble those of signs. The general health of the foal must be closely
meconium retention. The history of observed meconium observed because neonatal septicemia and the neonatal
passage and a digital rectal examination reveal no maladjustment syndrome may develop at an early stage.
abnormality. Very occasionally, the penis is apparently The mare should stand within 15 minutes of foaling
stuck within the prepuce by smegma-like material and if she has not done so spontaneously should be
that prevents its extrusion. Penile extrusion is essential encouraged to rise. Occasionally, a foaling mare will
to allow comfortable passage of urine in colt foals. If become cast by getting herself in an awkward position
untreated the condition might progress to a ruptured in the stable from which she cannot easily rise. She
bladder. The problem is readily resolved by washing the may have her head so close to a wall or corner that she
prepuce and penis with a mild soapy solution and cannot extend her forelegs in the normal way before
introducing obstetric lubricant into the prepuce. The rising, In many cases she does not seem able to move
penis is then gently but firmly drawn out from the herself into a sunitable position. She may appear dis-
prepuce using the fingers — a procedure normally tressed and ill but in many cases is simply cast. In such
followed by immediate urination and relief of colicky cases the head should be pulled round away from the
 Handbook of Veterinary Obstetrics 103

obstruction and the mare stimulated by knee pressure of viability in foals is narrow and premature induction
from the obstetrician over her ribs. Most mares will rise of birth can result in the loss of the foal. Birth should
easily and with apparent relief. not be induced in mares with prolonged gestation until
The mare normally passes her placenta within the obstetrician is sure that the fetus is mature.
3 hours of the foal's birth. The presence of the placenta, Cases of suspected prolonged gestation should always
especially if parts hang down onto the mare's hocks be examined without delay. The mare's service date is
may cause irritation and restlessness. The placenta is checked and the possibility of later services investi-
normally passed with its gray-blue allantoic surface gated. The mare should be given a full clinical exami-
outermost. The placenta has the gross appearance of a nation to check her general health. Signs of approaching
pair of bloomers with one large leg — from the pregnant parturition, including relaxation of the pelvic ligaments,
horn — and a smaller leg from the non-pregnant horn. vulval lengthening, and mammary development may
After the placenta is passed it should be removed from be present. These signs are not always reliable indica-
the foaling box immediately. The problem of retained tors of approaching birth. Pregnancy diagnosis should
placenta is dealt with in Chapter 13. In mares that have be performed to check that she is pregnant. Rectal
had a previous Caslick's operation, the vulval lips are examination enables the uterus and fetus to be pal-
cleaned, freshened and resutured in preparation for the pated and the approximate stage of pregnancy deter-
next breeding season. mined. The viability of the fetus can also be determined.
The cervix should be inspected or palpated to ensure
OBSTETRICIAN'S CHECK LIST that it is closed and that there is no abnormal discharge
coming from the uterus. Ultrasonographic scan per
Postnatal care of the mare rectum and transabdominally will enable the viability
Check uterus I'ir afurther foal and pulse rate of the fetus to be observed. The placenta
should be examined carefully to see if areas of pla-
Check birth canal for damage cental separation from the endometrium or placental
thickening are present. The fetal fluids are also viewed
Check uterine involution ultrasonographically to ensure that they are non-
echogenic.
Administer oxytocin if poor uterine involution If milk is present in the udder a sample can be taken
for calcium, sodium, and potassium assay. Milk calcium
Advise owner about placental retention levels of over 40 mg/dL are indicative of fetal maturity;
levels below 12 mg/dL are indicative of fetal dysmaturity.
Arrange to replace Caslick sutures Assessment of fetal maturity and the induction of birth
is discussed in greater detail in Chapter 15.
If birth does not appear imminent and the fetus is
considered dysmature, the mare should be examined
at intervals of 14 days to monitor the progress of her
PROLONGED GESTATION - THE pregnancy. The owner should be advised to keep a close
OVERDUE MARE eye on her for signs of foaling.

Pregnancy lasting over 330 days is not uncommon in

mares. Fortunately it is not normally followed by the OBSTETRICIAN'S CHECK LIST
birth of a very large foal and dystocia caused by feto-
Management of the overdue mare
pelvic disproportion. The cause of prolonged gestation
in mares is usually that the fetal placenta s either small Check service date(s)
or its function compromised. Local areas of chorionic 1
necrosis or detachment may be present, restricting the Check details of antenatal care
area of efficient placenta available to the foal. Ges- i
tation may be prolonged by several weeks, and occa- Full clinical examination
sionally up to 2 months. Fetal maturity in the mare
1
cannot be predicted by gestational length. The window
104 Dystocia in the Mare

4 REFERENCE
Vaginal examination — check cervix Vanderplassche M (1993) Dystocia. In: McKinnon AO, Voss L (eds) Equine
reproduction. Lea & Febiger, Philadelphia, p 578-587
1
Rectal examination — check uterus and fetus
{
Ultrasound scan of fetus, fluids, and placenta
{
Milk in the udder? - assay calcium, sodium, and
potassium
1
Advise re monitoring mare
1
Arrange follow-up visit
Chapter 6

DYSTOCIA IN THE EWE

Lambing time and the periods that precede and follow

Table 6.1 Causes of dystocia in the ewe
it are the times of greatest veterinary activity within
most sheep flocks. Obstetric work forms a substantial Cause %
part of a flock’s veterinary care. It is essential that the
obstetrician has a good understanding of both normal Fetal maldisposition 50
Obstruction of the birth canal 35
and abnormal parturition in sheep. Treatment of simple
Fetopelvic disproportion 5
dystocia cases is often undertaken by the shepherd, with Fetal monsters/abnormalities 3
more serious cases being brought to the veterinary sur- Others 7
gery for professional care.
Data from: Blackmore DK 1960 Some observations on dys-
tocia in the ewe. Veterinary Record 72:631-636, Hughes-
INCIDENCE Ellis T 1958 Observations on some aspects of dystocia in the
ewe. Veterinary Record 70:952-959, Jackson PGG 2003
Unpublished data, Thomas JO 1990 Survey of the causes of
A number of surveys have suggested that the incidence dystocia in sheep. Veterinary Record 127:574-575.
of dystocia in ewes is approximately 3%, although the
level of assistance at lambing given in closely supervised
flocks may be much higher. The incidence of dystocia
may be higher in ewe lambs carrying a single fetus and All surveys have shown that fetal maldisposition
also in the heavier lowland breeds. The tendency to (especially lateral deviation of the head) and obstruc-
use large breeds for commercial crossing has, in some tion of the birth canal (especially failure of the cervix
surveys, resulted in a higher incidence of dystocia due to dilate — ringwomb — are the most common causes of
to fetopelvic disproportion. Little dystocia is seen in dystocia in sheep. These and other causes of dystocia
highland breeds or among feral sheep. Problems that are discussed in greater detail below.
may have a hereditary predisposition to dystocia, such
as a small pelvic size, tend to be naturally eliminated
in such groups. Over 90% of lambs are delivered in
anterior presentation but the incidence of dystocia is SPECIFIC CAUSES OF DYSTOCIA IN
proportionally and significantly higher in lambs in pos- THE EWE
terior presentation. In one survey, over 80% of lambs
in posterior presentations had one or both fetal hind- Details of the more important causes of dystocia in
limbs flexed. the ewe follow below.

CAUSES OF DYSTOCIA FAILURE OF THE EXPULSIVE FORCES

Analysis of a number of surveys suggests that the inci-
dence of the various causes of ovine dystocia presented
Uterine inertia
for veterinary attention is as shown in Table 6.1. This is relatively uncommon in sheep.
106 Dystocia in the Ewe

Primary uterine inertia in the perineal region. These are scldom life threaten-
Birth may be inhibited or delayed through fear, such as ing unless the urinary bladder becomes trapped, but
they can compromise the ability of the ewe to strain.
may occur through worrying of sheep by dogs. Primary
uterine inertia is occasionally seen in young, inexperi- Assisted delivery of the lambs may be required.
enced ewe lambs who, through apparent anxiety, do
not actually get on with lambing. Assisted delivery and
supervision of the establishment of mothering may be OBSTRUCTION OF THE BIRTH CANAL
all that is required. Although hypocalcemia can occur
both before and after lambing, it is rarely associated As in other species, this may be caused by either bony
with uterine inertia in sheep. Primary uterine inertia or soft tissue obstruction.
may occasionally occur in severe cases of pregnancy
toxemia,
Bony obstruction
Secondary uterine inertia This is uncommon, although the pelvis may be small in
This may develop as a result of another cause of some ewe lambs (see Fetopelvic disproportion, p. 111). In
dystocia, such as an uncorrected fetal maldisposition. some sheep. including Scottish Blackface ewes, the dorsal
Its presence may be noted during the correction of the surface of the pubic symphysis is both sharp and promi-
primary cause of dystocia. Sometimes after a first mal- nent. In some cases this may partially obstruct the pas-
disposed fetus has been delivered the tone of the uter- sage of the fetus. It may also cause damage to the vaginal
ine wall is found on palpation to be very low. Specific or uterine floor as the obstetrician is manipulating the
treatment of such secondary inertia is seldom required fetus prior to delivery. Great care should be taken to avoid
because further fetuses are normally manually deliv- accidentally exerting downward pressure on this sharp
ered. However, postdelivery administration of oxytocin prominence if soft tissue damage is to be avoided.
will encourage uterine contraction, encourage passage
of the placenta, and help prevent uterine prolapse. Soft tissue obstruction
Failure of abdominal expulsive forces This may involve any section of the birth canal from
the vulva to the cervix.
This may occur as a result of disease or previous
injury. In cases of severe debility through poor feeding,
Vulval obstruction
or in advanced cases of pregnancy toxemia, the ewe
may be too weak or ill to lamb spontaneously. The This can result from injury at a previous lambing or
cervix may open at term, there is some evidence of occasionally through lack of normal prelambing
uterine contraction, but fetal delivery does not take relaxation. In most cases, gentle stretching of the vulva
place. Manual delivery is normally possible and the ewe with the well-lubricated fingers will result in sufficient
is supported by intensive nursing and medical care. relaxation to permit passage of the obstetrician’s
Abdominal wall ruptures or hernias are occasionally hands and fetal delivery.
seen in ewes. Ventral rupture may occur as a result of
rough handling during pregnancy. A tear occurs in the Vaginal obstruction
ventral abdominal wall musculature allowing the gravid This is uncommon, especially in parturient ewes. It
uterus to pass through the abdominal wall and lie may result from either failure of normal tissue relax-
subcutaneously. The risk of complete breakdown of the ation or from previous injury, including scars from the
abdominal wall is small but the ability of the animal to insertion of sutures to retain a vaginal prolapse. In
strain is compromised. Assistance with fetal delivery many cases gentle stretching will overcome the problem
in affected ewes should be anticipated and planned. The but where this fails cesarean section may be required.
udder may be displaced in such cases, making access Obstruction of the birth canal by vaginal
to one of the teats by the lamb difficult. prolapse Vaginal prolapse is a common complication
Less common are umbilical and perineal hernias in of late pregnancy in sheep. In the majority of cases the
ewes. Perineal hernias are either unilateral or bilateral prolapse does not prevent spontaneous delivery of the
and are recognized by the presence of reducible swellings fetus, especially if the prolapse has been secured with a
 Handbook of Veterinary Obstetrics 107

T-shaped plastic retainer. If sutures have been used they body. preventing passage of the lamb. Uterine torsion
must be removed before birth to prevent tearing of the usually occurs (as in cattle) at the beginning of first-stage
vulval lips. Occasionally, and especially if the prolapse labor. It is usually detected when a vaginal examina-
has been damaged, the vagina is severely edematous tion is carried out to determine why an expected birth
and swollen, with resultant occlusion of its lumen. In has not proceeded at the anticipated rate. An internal
most cases, and using generous amounts of lubricant, examination reveals that the vagina is obstructed caudal
the obstetrician is able to guide the fetus through the to the cervix. Displaced folds of vaginal mucosa con-
prolapsed organ without causing further damage. Very verge conically as the hand is advanced. If the degree
occasionally, if severe laceration has occurred, delivery of torsion is less than 180° it may be possible to pass
by cesarean section might be necessary. the hand beyond the obstruction and past the dilated
cervix to palpate the lamb. Complete obstruction may
The cervix occur if the degree of torsion is greater than 180°.
Obstruction of the cervix (often termed ringwomb) is a Torsion may be clockwise or anticlockwise.
major cause of ovine dystocia. The cervix fails to dilate If the obstetrician’s hand can reach the lamb, cor-
sufficiently to allow fetal delivery per vaginam, or it may rection of the torsion may be achieved by rotating the
show only partial dilation. The exact etiology of the lamb and surrounding uterus back into its correct
condition is not known but studies have suggested a position. Rotation in such cases is greatly facilitated by
number of predisposing factors. These include a failure raising the hind end of the ewe to allow gravitational
of the normal complex process of cervical relaxation, forces to move the uterine contents away from the
induration of the cervix through previous injury, uter- pelvic inlet. If the vagina is completely obstructed, rolling
ine inertia, and fetal maldisposition - especially breech the ewe may be attempted as in the cow but in most
presentation. Abnormally high levels of estrogen in cases cesarean section is performed.
the diet have also been blamed for ‘outbreaks' of cases of
ringwomb. In some cases this is associated with the
presence of estrogenic Fusarium spp. molds in the food
or bedding, The incidence of ringwomb on farms varies
Downward deviation of the uterus
considerably. Numerous cases may occur in one season This may be seen in cases of ventral hernia or rupture
but the following year, although management is osten- of the prepubic tendon. These abnormalities occur
sibly the same, the incidence may be much lower. mainly in older ewes heavily pregnant but often in poor
It has also been suggested that in neglected cases of bodily condition. Muscular damage — spontaneous or
dystocia the cervix may open normally and then close as the result of trauma — allows the gravid uterus to
again before fetal delivery, thus producing what might fall into the hernia sac and to come to lie under the
be described as secondary obstruction of the cervix. In ventral abdominal skin. Death through hemorrhage and
some cases it may be possible to gently dilate the closed shock may occur acutely in some cases immediately after
cervix manually, and this should always be attempted trauma. In other cases, pregnancy continues to term.
first. If manual dilation fails, cesarean section is usually Spontaneous birth may not be possible in such cases
required. A number of drugs, including estradiol, vita- for two reasons: The abdominal straining required for
min D, calcium borogluconate, prostaglandin E, and a fetal expulsion is absent or very inefficient and the exit
range of ‘uterine relaxants' have been used in an from the uterus may be obstructed by the uterine devi-
attempt to open the cervix. Evaluation of such treat- ation. The commencement of birth in such cases can
ments is difficult and none has been found to be entirely easily be overlooked and supervision should be espe-
reliable. If the cervix is genuinely obstructed, fetal life cially vigilant as assistance will almost certainly be
will be at risk and delivery by cesarean section should required. Vaginal examination will reveal that the uter-
not be delayed. Further details about the evaluation and ine body deviates sharply downwards just beyond the
treatment of the closed cervix are given below (p. 115). pelvic brim. The weight of the gravid uterus may cause
the cervical region of the uterus to be pulled tightly
downwards, occluding its lumen. The obstetrician's
Torsion of the uterus lubricated hand can normally be introduced beyond
Uterine torsion is rare in sheep and results in partial or the obstruction with comparative ease and the fetus(es)
complete obstruction of the caudal part of the uterine delivered manually. Delivery is easier if the ewe is lying
108 Dystocia in the Ewe

down or if an assistant gently raises her ventral head are presented (ventrotransverse presentation).
abdominal wall. Transverse presentation is treated by repelling the
fetus and applying further repulsion to one end of the
fetus and easing the other end towards the pelvic inlet.
(Ideally the hind end of the lamb should be pulled
FETAL MALDISPOSITION towards the pelvic inlet as only two extremities have
to be guided into position.) The transverse presentation
This is the most common cause of ovine dystocia.
is converted into a longitudinal presentation, the fetus
Abnormalities of posture are particularly common and
and birth canal are lubricated and delivery is completed
an analysis of a number of surveys of dystocia suggests
by gentle traction.
the following broad distribution of this type of abnor-
mality shown in Table 6.2,
In many cases of fetal maldiposition in ewes, abnor- Malposition
malities of presentation, position and posture may be
seen at the same time, often involving more than one Lambs in ventral or lateral position are quite frequently
fetus in the litter. In most cases, repulsion of the mal- seen. Malposition is often complicated by malposture
disposed fetus is required before postural defects can be and simultaneous presentation. Where possible cases
corrected. The presence of other fetuses within the of fetal malposition should be converted into the nor-
uterus may limit the amount of repulsion possible. mal dorsal position before delivery is attempted. This is
achieved by repulsion of the fetus and lubrication of
the fetus and birth canal. The fetus is then rotated around
Malpresentation its long axis into the dorsal position and delivery is
completed by careful traction.
Over 95% of lambs are born in anterior presentation.
Posterior presentation does not always result in dystocia.
Delay in the delivery of lambs in this malpresentation
Malposture
may result in their asphyxiation through inhalation of
fetal fluids. Assisted delivery by traction is advisable. Fetal malposture is the most common cause of dystocia
Malposture due to hock or hip flexion frequently com- in the ewe. Nearly 70% of the causes of dystocia listed
plicates this posterior presentation. Such malpostures in Table 6.2 are in this category. Multiple birth is very
must be corrected before delivery is attempted. common in sheep and in cases of dystocia more than one
Transverse presentation is seen chiefly in cases member of the litter may have an abnormal posture.
where more than one fetus is present in the uterus. The
fetus lies across the pelvic inlet unable to be delivered Lateral deviation of the head
without assistance and obstructing the delivery of other This is the most common single cause of dystocia in
fetuses in the litter. In some cases the back of the fetus ewes. The degree of displacement of the head varies
is presented at the pelvic inlet (dorsotransverse presen- greatly. It may be slightly displaced from being able to
tation). In other cases the limbs and possibly the fetal enter the maternal pelvis normally or the head and
neck may lie back against the lamb’s body. If the case
has been untreated for some time fetal fluids will pro-
Table 6.2 Fetal maldisposition in sheep bably be lost and the uterine wall may be tightly applied
to the fetus. Correction of the maldisposition may be
Type % of maldispositions difficult in such cases and great care must be taken to
avoid damaging the uterine wall. Lubrication is intro-
| Lateral deviation of the head a
and neck duced into the uterus and the fetus is repelled by exerting
Shoulder flexion 6 pressure on the base of its neck. The deviated head is
Carpal flexion 10 cupped in the obstetrician's hand and brought round
Bilateral hip flexion (breech) 8 and up into the pelvis (see Fig. 7.1). In some horned
| Hock flexion 4 breeds the fetus has prominent horn buds and these
| Simuitaneous presentation 17
Transverse presentation 14 and the fetal mouth should be covered by the obstetri-
cian’s hand to prevent uterine damage.
 Handbook of Veterinary Obstetrics 109

In some cases access to the deviated head may be dif- Occasionally the fetal head obstructs the passage of
ficult because of the presence of the fetal forelegs in the the obstetrician's hand into the uterus to retrieve the
pelvis. To gain access to the head one fetal foreleg can be retained forelimbs. In such cases the head should be
flexed and repelled back into the uterus. Once the devi- repelled slightly to allow access to the forelimbs. Before
ated head has been correctly positioned the flexed fore- repulsion a cord snare or the loop of a lambing instru-
leg can be retrieved and the lamb delivered by traction. ment (Fig. 6.2) should be placed to secure the head for
later retrieval. Once the malposture is corrected the
Retention of a forelimb lamb is delivered by gentle traction.
This is quite frequently seen and results from either
shoulder or carpal flexion; 16% of the cases listed in Retention of a hindlimb
Table 6.2 were in this category. One or both limbs may Although posterior presentation is relatively uncom-
be involved (Fig. 6.1). If both limbs are retained the fetal mon in sheep assistance with delivery is often required.
head may pass through the vulva without the legs. In Cases of unilateral or bilateral hip or hock flexion are
this position the head may become enlarged and edema- encountered and require assistance. In bilateral hip
tous and fetal life may be compromised unless prompt flexion (breech presentation) the fetal tail may be seen
delivery is achieved. In a very small fetus it may be possi- protruding from the vulva. Breech presentation may
ble to deliver the lamb with one shoulder flexed without also be complicated by. and predispose to, failure of the
correcting the malposture. It is better obstetric practice, cervix to dilate. If the lamb is very small, spontaneous
however, to correct all maldispositions before attempted or assisted delivery of the uncorrected breech presen-
delivery. The fetus is repelled, lubrication is applied and tation may occur. Whenever possible the malpresenta-
the retained forelimbs are identified. Shoulder flexion is tion should be corrected into a posterior presentation
first converted into a carpal flexion posture. The fetal with extended hindlimbs before delivery.
foot is cupped in the hand and brought up into the In cases of hock flexion (Fig. 6.3) the fetal hocks are
pelvis. The second leg (if affected) is retrieved and its presented at the pelvic inlet obstructing the passage of
malposture is corrected in a similar manner. thelamb into the pelvis. To allow delivery, the fetus is first

Figure 6.1 Fetal maldisposition — lamb with carpal flexion. The second lamb has a similar malposture.
110 Dystocia in the Ewe

Figure 6.2 A lambing snare can be used to apply traction to the fetal head when space is limited

Figure 6.3 Fetal maldisposition — lamb with bilateral hock flexion

repelled by exerting pressure (after the application of pelvis. The procedure is repeated for the second limb if
lubrication) on the hindquarters. The obstetrician's this is also in malposture.
hand follows each limb in turn down to the fetal foot. The If the fetus is presented in hip flexion the fetus is first
foot is enclosed in the hand, the hock is further flexed, repelled and lifted slightly within the aterus by apply-
and the foot is lifted over the pubis into the maternal ing pressure to its hindquarters. The obstetrician’s
 Handbook of Veterinary Obstetrics 111

hand follows one hindlimb down until the hock is be guided into the pelvis compared with three in the
reached. The hock is gently flexed and brought towards case of the lamb in anterior presentation. For further
the pelvic inlet and is now in a hock flexion position. discussion, see the section Approach to a case of dysto-
The foot is cupped in the obstetrician's hand and is ciain the ewe, p. 112.
brought back and extended into the pelvis. The second
leg is retrieved in a similar fashion and the lubricated
FETOPELVIC DISPROPORTION
lamb is delivered by traction. If the lamb has very long
legs there is a risk that, during conversion of the hip
This problem is more common when litter size is small
flexion to hock flexion, the fetal foot might damage the
but the size of the individual lamb is large. Many ewe
uterus. In such cases the obstetrician should attempt to
lambs produce only a single lamb in their first litter. Such
reach the fetal foot and cup it in the hand and flex the
animals are themselves not fully grown and their pelvic
hock. The foot should be retained in the hand as fur-
size may also be quite small. This type of dystocia may be
ther correction of the dystocia is carried out by lifting
further predisposed by the increasing use of heavier
the foot and extending it into the maternal pelvis.
breeds of ram, e.g. the Texel to produce a large, rapidly
growing commercial lamb. The lamb — especially a male
Simultaneous presentation lamb — may be simply too big to pass with ease through
the maternal pelvis. Assisted delivery with generous
The presence of multiple fetuses is very common in sheep
lubrication may be required and in some cases, if the dis-
and should be anticipated at all times. Although many
proportion is severe, cesarean section will be necessary.
litters with multiple fetuses are delivered spontaneously;
17% of the cases of dystocia in Table 6.2 were caused
by simultaneous presentation. In most cases two fetuses FETAL MONSTERS
are involved in dystocia cases in this category. I indi-
vidual lambs are very small three lambs or very occa- These are occasionally seen and if large in size or
sionally more may be involved. diameter may cause dystocia. Most of the monsters des-
Dystocia from simultaneous presentation may arise cribed in cattle also occur in sheep. In addition, lambs
in a number of ways: with one or more accessory limbs are sometimes seen.
Dystocia associated with edematous lambs has been
Uterine inertia: caused by overstretching of the
reported in Beulah speckle-faced sheep. In all cases
myometrium, especially in debilitated animals.
an attempt at vaginal delivery is made. If this proves
Simultaneous presentation of two or more fetuses: the
impossible the abnormal fetus is delivered by cesarean
lambs may be in the same presentation or, more
section or fetotomy.
frequently, one is in anterior presentation and the
other in posterior presentation.
Maldisposition: of the first, second, or subsequent
DYSTOCIA CAUSED BY FETAL DEATH
fetuses.
Initial vaginal examination of such cases can be con- Death of one lamb or all the lambs in the litter in late
fusing. A number of extremities are found within the pregnancy or at term may arise from a number of
pelvis or at the pelvic inlet. There is little space available causes. Lack of space in the uterus may compromise
for the obstetrician’s hand. Examination is aided if the placental function as fetal demands increase. Infections
ewe is standing so that her uterine contents fall away such as Chlamydia psittaci may cause abortion and also
slightly from the pelvic inlet. The hindquarters of the the death of one or all of the lambs in late pregnancy.
ewe may be raised slightly but this should be for a short Exposure to toxic agents, severe metabolic disease, and
period only. With the aid of generous lubrication the stress can also result in fetal death. In some cases fetal
presenting parts are examined methodically to identify death results in failure of initiation of birth. Cervical
individual lambs and their presentation, position, and opening in such cases may be incomplete and ascend-
posture. A mental picture is built up of the lambs and ing infection gains access to the uterus. No signs of
how delivery will be attempted. If two lambs are pre- first- or second-stage labor may be seen and the ewe
sented with one in posterior presentation the latter is examined only when an abnormal vaginal discharge
should be delivered first. Only two extremities have to or decaying placenta is seen at the vulva.
112 Dystocia in the Ewe

In many cases, pregnancy may have been con-

A number of the infectious agents that cause fetal
firmed by ultrasonic scanning and those ewes known to
death are zoonotic and animals in which fetal death is
be carrying two or more lambs have been identified.
suspected should be examined with gloved hands and
Specific signs of dystocia include:
strict attention to hygiene. If the ewe is in very poor
condition or moribund, attempted treatment may The presence of a foul vaginal discharge or
compromise her welfare and euthanasia may be pref- decaying placenta at the vulva. This is a serious
erable to treatment. Vaginal examination is carried out sign, which may indicate fetal death or attempted
with generous lubrication. The fleece of dead lambs, abortion and must be investigated without delay.
together with the lack of uterine fluid, makes internal An abnormal disposition of the fetus seen at the
examination difficult. Warm water can be introduced vulva. For example, a fetal head but no forelegs is
into the uterus by stomach tube. Great care must be seen at or protrudes between the vulval lips. Such
used as the uterine wall may be in poor condition and an appearance suggests gross fetal maldisposition,
easily ruptured. The dead lambs are frequently malpre- e.g. the forelegs being in shoulder flexion.
sented having been unable to adopt the correct posture A prolonged non-progressive first stage of labor.
for birth. Access to the uterus may be compromised by The ewe may have separated herself from the rest of
incomplete cervical opening. An attempt is made to the flock and may appear uneasy. She may stand for
identify the presentation, position, and posture of the short periods and then lie down. Some straining
lamb or lambs. It may be possible in some cases to gen- may occur but the vigorous straining that is
tly dilate the cervix but this is often not possible. After characteristic of second-stage labor does not occur.
the introduction of additional lubrication an attempt is Such signs may suggest that the ewe has ringwomb
made to deliver the lambs by careful traction. If a lamb or is suffering from uterine inertia.
is severely decomposed it can sometimes be delivered The ewe strains vigorously for 20-30 minutes or
by removing small portions of it from the uterus. intermittently for 30-60 minutes but no fetus is seen.
If vaginal delivery is impossible, cesarean section, This suggests the possibility of a fetusin a
fetotomy, or euthanasia should be considered. The eco- maldisposition, fetopelvic disproportion, or the
nomics of the case must be discussed with the owner. simultaneous presentation of two or more fetuses. The
Cesarean section has a poor prognosis in such cases. second stage of normal birth in sheep may take up to
Access to the uterus by a paramedian incision may be an hour but obvious progress is seen during this time.
best (see Chapter 11). Fetotomy is only possibleif access
As in other species, the dividing line between normal
to the uterus via the cervix is possible. The ewe should
birth and dystocia is not clear cut. Dystocia may be
be euthanized if other methods of treatment prove
suspected in a ewe that is in fact lambing normally
impossible, compromise her welfare, or are uneconomic.
but slowly. As in other species it is better to examine
Good aftercare of the ewe is important in such cases.
cases that raise even slight suspicions of abnormality
Antibiotic and non-steroidal anti-inflammatory treat-
to ensure that no true case of dystocia is overlooked.
ment is given. Fluid therapy is beneficial in cases in
which signs of shock are present.
APPROACH TO A CASE OF
DYSTOCIA IN THE EWE
SIGNS OF DYSTOCIA IN THE EWE
Many cases will be examined in the surgery in a clean
Sheep are normally and advisedly closely supervised at room prepared for the purpose. Such a room should
lambing time so that any departure from normal can be designed in such a way that thorough cleaning
be observed and investigated without delay. Approximate and disinfection between cases is possible (for general
dates of lambing for groups of ewes served during a details, see also Chapter 3).
particular time are normally known and these animals
are subject to careful scrutiny as their time for lambing
Equipment
approaches. Some of the signs of dystocia are quite
subtle and may easily be missed if supervision is not Minimum equipment is required — the obstetrician’s
very good. hands being the most effective instruments. Parturient
 Handbook of Veterinary Obstetrics 113

sheep are a possible source of zoonotic disease. which Assessment of her condition score should indicate how
may be particularly dangerous to female obstetricians. well she has been managed during pregnancy, and in
For this reason the wearing of long-sleeved plastic particular if her dietary energy levels have been satis-
gloves for lambing work may be advisable. A lambing factory. If her dystocia is recognized and presented
snare (see Fig. 6.3) is occasionally useful but if this early she should be in good condition unless her preg-
is not available then three lightweight lambing cords nancy has been complicated by pregnancy toxemia. If
may be used. Handles for the cords are seldom neces- she has been left untreated for some time, or if treat-
sary and it is unusual for more than one cord to be used ment was attempted by unskilled hands, she may be
at a time. Adequate supplies of obstetric lubricant will in very poor condition. If the uterus has been ruptured
be needed, especially if the case has been in labor for and dirty hands used to investigate the dystocia it is
a long time. In such cases, natural lubricants are lost possibile that clostridial disease with overwhelming
and the birth canal and fetus become very dry. A sterile endotoxemia may be developing. In such cases the
cesarean surgical kit should be available, together with ewe may show signs of severe depression, toxic mucous
supplies of suture materials, antibiotics, etc. membranes, and a degree of dehydration.
Additional equipment may be needed if the case is Occasionally, her condition may be such that she
to be attended on the farm. If lighting is known to be is unlikely to withstand further treatment and eutha-
poor, a good torch or lantern is a valuable aid. If sup- nasia is indicated. If she is suffering from severe life-
plies of hot water are limited, 5 liters taken in a plastic threatening pregnancy toxemia supportive therapy
container along with soap and towel from the surgery may be necessary before fetal delivery can begin. Mastitis
can make working conditions much better for both is uncommon in the parturient ewe but the udder
obstetrician and patient. should be checked for the presence of milk and the
patency of both teats. Milk (initially thick colostrum)
is usually present in the udder 12-24 hours before
OBSTETRICIAN'S CHECK LIST
lambing. Absence of milk may suggest that the ewe is
Call received not quite ready to lamb, especially if her cervix is found
to be closed.
Brief history taken
Close inspection of the vulva and vagina may reveal
{ an intact amnion in early cases. In cases of longer
Check drugs and equipment
duration a detached chorioallantois, ruptured amnion
{
and possibly vulval damage may be seen. Any visible
See patient as quickly as possible
fetal parts should be identified.
on the farm or at the surgery
L

Case history OBSTETRICIAN’S CHECK LIST

A brief history of the case is taken. Was the patient Evaluation of the ewe
unwell in late pregnancy? What was the nature of her Further hiitory taken
illness? Has she experienced previous dystocia? Have
any lambs been born already? How many and were Problems during pmgfancy in ewe or flock?
they alive or dead? How long has she been attempting
to lamb? Has anyone else attempted to treat the case? Details of recent management
Have any other ewes in the flock suffered from
dystocia recently? In many cases the shepherd will have Pregnancy scanning result?
examined the ewe and will report any abnormalities
or damage found or caused accidentally. Previous dystocia (if known)?

General examination of the ewe Recent dystocia problems in flock?

It is very important to check the ewe's health sta- Help already given by shepherd?
tus before commencing to deal with her dystocia.
114 Dystocia in the Ewe

OBSTETRICIAN'S CHECK LIST

Clinical examination of the ewe

—
Ewe bright and well
T
Ewe dull Ewe moribund

Brief hez*lh check Detailed clinical examination Consider euilanasia and

retrieval of lambs
Check udder for milk and mastitis Evaluate existing disease
Pregnancy toxemia/uterine
infection. Treat immediately.
Proceed to evaluate dystocia
if ewe's health permits

accidental latrogenic rupture of the uterus is to be

OBSTETRICIAN'S CHECK LIST .
avoided.
Visual inspection of vulva 2. Itisnot necessary or desirable to routinely raise
N the hind end of the ewe before internal
Presence of placenta?
examination or manipulation is carried out. This
procedure is stressful and potentially dangerous.
Which membranes are visible?
It may compromise the ewe's respiration and
predispose to uterine rupture. Raising the hind end
Condition of fetal membranes?
of the ewe may occasionally be necessary to
correct uterine torsion or to deal with a fetal
Presence of fetal parts?
maldisposition that is impacted at the pelvic inlet.
In such cases the time the ewe is held in this
Identification of fetal parts
position should be kept to a minimum.
Most internal manipulations can be carried out
with the ewe in the standing position.
Restraint 3. The genital tract of the ewe Is quite susceptible to
The ewe may be held in a standing position by an assis- infection. The highest standards of hygiene and
tant but if she is in a small pen she can be examined cleanliness must be practiced at all times. It is also
and restrained by the obstetrician alone (Fig. 6.4). She extremely important that the veterinary
should not be held by her fleece, which is easily pulled obstetrician sets a very good example, which
out in late pregnancy. If the parturient ewe is lying may be emulated by the shepherd.
down she may be approached quietly from behind and
an internal examination carried without her getting up. I the perineal arca is surrounded by dirty flecce, this
should be removed using dagging shears before com-
mencing the internal examination. Preferably, all ewes
Vaginal examination should be dagged before lambing time.
After washing the perineal region thoroughly, the
Before commencing this examination in a ewe, three
obstetrician's lubricated hand is carefully inserted into
important points must always be borne in mind:
the vagina. In most cases this can be done with ease
1. The obstetrician must constantly be aware of the and, unless the cervix is closed or a fetus occupies the
potentially extreme fragility of the ovine uterus. caudal birth canal, the hand can readily be passed on
Internal examinations and manipulations must through the bony pelvis into the uterus. In small ewes
alwaysbe carried out with the utmost care if the passage of the hand through the pelvis may only
 Handbook of Veterinary Obstetrics 115

Figure 6.4 Restraint of the ewe for vaginal examination.

just be possible. The presence of the obstetrician’s cases where the cervix does not appear to be fully
hand in the birth canal usually provokes straining in the opened.
ewe. Gentle persistence and moving the hand forward
between bouts of maternal straining will allow the birth
canal and its contents to be explored and evaluated. Further assessment of the cervix
The caudal birth canal is carefully palpated for signs of The cervix should be gently palpated for evidence of
damage, such as tears in the vaginal mucosa. previous scar tissue, which may have formed at an
earlier lambing and is now preventing the cervix from
opening. If firm scar tissue is found, the chances of
Evaluation of the cervix
further cervical dilation are small but even in such cases
The frequency of ringwomb as a cause of dystocia an attempt at manual dilation should be made.
means that the ewe's cervix should always be carefully Manual dilation of the partly closed cervix should
evaluated. If the cervix is fully dilated it is not palpable — always be attempted and in many cases will be success-
the vaginal and uterine walls appear to be continuous. ful. The obstetrician's lubricated finger is introduced
Sometimes the cervix is not fully dilated and all degrees into the partially opened cervix and is moved around
of incomplete dilation may be seen. The cervix may be with centrifugal action exerting lateral pressure on the
completely closed and careful exploration of the anterior rim of the cervix. Sometimes the cervix will be felt to
vagina will encounter and identify the external os. If the open like the shutter in a camera in response to pres-
cervix is completely and tightly closed the ewe may not, sure and further fingers — initially forming a cone — and
in fact, be really ready to lamb. Apparent signs of dis- eventually the whole hand may be inserted. Further
comfort may be seen in ewes that have suffered an earlier pressure will allow complete dilation of the cervix and
vaginal prolapse — such animals may appear to be try- access to the lamb(s) in the uterus. Complete manual
ing to lamb when they are not ready. On palpation the dilation may require 10 minutes or more to complete.
cervix is found to be closed. Once the cervix is open it is advisable to deliver the lambs
If partially dilated, one, two, or three fingers can be immediately — reports of the cervix closing before the
inserted into the cervix, which is palpable as a circular fetuses could be delivered by the ewe make this action
ring around the circumference of the vagina/uterine advisable. If there has been genuine delay in cervical
junction. The problem with the partially dilated cervix opening the lambs may be becoming hypoxic and
is deciding whether it is likely to open further and immediate delivery is in any case advisable.
how healthy the lambs are on the other side. If the partially opened cervix cannot immediately be
A number of factors involving the cervix, the unborn dilated manually a further period of time may be allowed
lamb(s), the duration of parturition, and the readiness to see if natural dilation will occur. If the ewe is healthy
of the ewe to lamb must be taken into account in all and the lambs are not believed to be at immediate risk
116 Dystocia in the Ewe

Figure 6.5 Assessment of ewe with ‘ringwomb’. The fetal membranes are intact, fetal fluids are present, and the fetus is alive
(see also Figure 6.6).

the ewe may be left quietly in comfortable surroundings (Pig. 6.5). If the lamb is dead the placenta may feel
for a further 30 minutes. Drug therapy may be given at leathery to the touch, has probably lost its fluid
the start of this period. contents, and has a foul smell. Separated cotyledons
of the chorioallantois may be palpable and
occasionally portions of the unhealthy placenta are
Drug therapy
protruding through the cervix (Fig. 6.6).
As mentioned above, a number of drugs have been Is the lamb alive? The restricted access to the lamb
claimed to encourage cervical dilation. These include again makes this difficult to ascertain. If the lamb is
parenteral calcium borogluconate, vetrabutine hydro- alive, spontaneous fetal movements may be palpable
chloride, vitamin D, estradiol, and the local application through the cervix. If the fetal muzzle is touched the
to the cervix of prostaglandin E. None has been fully fetus may demonstrate a sucking reflex. If access to
evaluated but on some farms a response to one or more afetal foot is possible, pinching the toes will produce
of these treatments has been seen. After 30 minutes the the pedal withdrawal reflex in the living lamb.
ewe is re-examined and a further attempt is made to Further evidence of fetal life This may also be
dilate the cervix. If this is not possible the lambs should demonstrated by palpating the ewe externally
be delivered by cesarean section. through the flanks and resting the flat of the hands
against the body wall. Spontaneous intrauterine
movements will indicate fetal life. Hyperactivity within
Assessment of the lamb(s) through
the uterus may indicate threatened fetal hypoxia.
the partially dilated cervix
Doppler or B-mode ultrasonographic evaluation of the
In such cases the Jamb(s) may be alive and well or lamb(s) through the ewe's abdominal wall can provide
dead and decaying. Access to the lambs is restricted but further definite evidence of fetal life by demonstrating
even palpation by the finger may reveal useful infor- fetal movement, including a beating heart.
mation about the lamb and placenta.
If the above positive signs of life are absent the lamb is
« Is the lamb surrounded by healthy placenta? Healthy probably dead. If it has been dead for several days it will
placenta is soft, fluid filled, and does not have an probably not have instigated the birth process includ-
unpleasant smell. Fetal movements may be palpated ing a possible role in cervical dilation.
 Handbook of Veterinary Obstetrics 117

Figure 6.6 Assessment of ewe with ‘ringwomb’. The fetal membranes are ruptured, fetal fluids have been lost, and the fetus is
dead (see also Figure 6.5).

The readiness of the ewe to lamb must be assessed « Has the vulva lengthened?
whenever there are problems of non-dilation or partial
If the answer to all the questions is ‘yes' then the ewe
dilation of the cervix. If the ewe is not really ready to give
is probably ready to give birth and the lambs should be
birth, the lambs are unlikely to survive. The following
delivered without delay. If the cervix cannot be further
questions should be posed and, if possible, answered:
dilated in such cases by hand or with the aid of drugs,
« Do the ewe’s service dates suggest that lambing is cesarean section is indicated. If the lambs are thought
really imminent and have other animals in her to be dead the prognosis for the case is not good, espe-
service group lambed already? cially if the ewe is depressed and toxemic. For details
« Is milk (colostrum) present in the udder and teats? of the management of the ewe prior to cesarean sec-
« Are the sacrosciatic ligaments, which run between tion if fetal dysmaturity is suspected or is possible, see
the tuber ischii and the sacrum, fully relaxed? Chapter 11.

OBSTETRICIAN'S CHECK LIST

Vaginal examination

Strict attention to hygiene

Dag perineum if soiled

L= Apply and introduce lubrication

\
Fetus absent Fetus(es) present

Assess vulval relaxation Methodical pxpation of lambs

 118 Dystocia in the Ewe

| Assess vaginal relaxation Presentation, position and posture of

| palpable fetus(es)

: Further evaluation of fetal membranes Compare size of fetus(es) and birth canal
i
} Check for vaginal damage/obstruction Attempt check cervical dilation

|| Palpate cervix 3 Cervix open

! Cervix tightly closed Cervix partially open Correct any fetal maldisposition

Monitor her progress See box below Attempt fetal delivery

Fig. 4.15). A mental picture of each lamb is built up

OBSTETRICIAN‘S CHECK LIST and a plan made of what is needed to place it into a
; Evaluation of partially dilated cervix normal presentation for delivery.

| Fetal membranes Fetal membranes

! intact ruptured Correction of malpresentations
‘ Lamb(s) alive Lamb(s) dead — Treatment Most lambs are born naturally in anterior presentation
with their head extended and resting on their extended
i uneconomic?
forelimbs. A few lambs are born in posterior presenta-
| Attempt manual dilation of cervix
tion with their extended hindlimbs passing through the
birth canal first. The malpresented, malpositioned, or
l Consider drug therapy
malpostured lamb should be moved into a correct ante-
rior or posterior presentation. The obstetrician should
Check cervix after 30 minutes
always introduce plenty of lubricant into the uterus
before attempting to correct any abnormalities. Each
displaced extremity is located and brought into its cor-
Cervix open(ing) Cervix unchanged
rect position, taking great care to ensure that the fragile
uterus is not damaged in the process. It is usually neces-
Manual delivery of lambs Cesarean section
sary to repel the fetus gently back into the uterus during
a break in the ewe's straining efforts to allow room for
the extremity to be replaced into its correct position.
MANUAL DELIVERY OF THE LAMB(S)
Lamb in anterior presentation
As the obstetrician's hand enters the vagina or passes If the fetal head is being brought round and into the
through the cervix it usually encounters one or more pelvis, the muzzle and horn buds (if any) should be
lambs. Each lamb must be carefully and systematically enclosed in the obstetrician’s hand to protect the uterus
examined to determine its presentation, position, and from possible damage. If the legs are being brought into
posture. As multiple birth is very common in sheep, the pelvis, the feet and prominences such as the hocks
great care must be taken to identify which head and should be enclosed in the hand for the same reasons.
fetal legs belong to the same lamb. Each presenting If both head and forelegs are displaced it is advis-
leg is examined from the foot upwards to determine able to correct the posture of the head before dealing
whether it is a forelimb or a hindlimb as in the calf (see with the legs. The head is brought round to the pelvic
 Handbook of Veterinary Obstetrics 119

inlet. Each leg is then retrieved, its posture corrected, and in turn back towards the vulva. As soon as the legs are
brought into the pelvis. Retrieving the second leg may within reach the obstetrician grips them with his or
be difficult as the pelvis is now occupied by both the head her other hand. Gentle traction is applied in a back-
and the other forelimb. In such cases the lamb may have wards and downwards direction to the fetal legs while
to be gently repelled to provide a little more room. If the the obstetrician applies traction using the other hand
legs are corrected first there may be insufficient room to the head (Fig. 6.7). If the lamb is quite large, traction
to bring the head round and up into the pelvis. is initially applied alternatively to each forelimb. The
Occasionally with this manipulation the head will not head is eased along the birth canal as the legs are
remain in the pelvis but falls back as an attempt is made moved. If the lamb is small and the delivery is pro-
to retrieve the legs. If this happens the head should be ceeding well, traction can be applied to both forelegs
held in the pelvis before the legs are retrieved. If the simultaneously. Traction should always coincide with
head is close to the vulva the obstetrician may hold it straining efforts by the ewe. The head may be gripped
with one hand while the other hand locates and deals by placing the fingers over the back of the lamb's
with the forelegs in turn. Alternatively, the head can be head and the thumb between the mandibles. If space is
held by the lambing snare (see Fig. 6.2) or by using a restricted, the lamb can be gripped carefully using the
light-weight lambing cord secured around the head eye socket hold. Alternatively, traction may be applied
and through the mouth as in the calf (see Fig. 4.18). to the head using the lambing snare. Traction should
be applied — carefully — only by the obstetrician, with-
Lamb in posterior presentation out the help of an assistant.
Correction of malposture in this presentation is nor- Once the head and thorax of the lamb have been
mally less complex as only two extremities (instead of delivered the hindquarters should follow with further
three in anterior presentation) must be brought into the moderate traction. Moving the trunk of the lamb from
pelvis. The obstetrician must take particular care to side to side and rotating it slightly on its long axis aid
ensure that the uterus is not damaged by the fetal feet the passage of its hindquarters through the maternal
as they are brought into the pelvis, especially following pelvis.
correction of a bilateral hip flexion malposture. Fetus in posterior presentation The fetal hindlimbs
Although very small maldisposed lambs can be are brought into the pelvis and, using one hand, the
delivered without correction of their abnormal posture — obstetrician gently but firmly pulls both towards the
this is especially true of the small lamb with unilateral vulva. At this stage one leg is held in each hand - the leg
shoulder flexion or in breech presentation - it is not being gripped around or just below the hocks. Traction
good obstetric practice to to do this. is applied to each leg alternately until the fetal hips are
engaged in the pelvis. Both legs are now pulled in a
backwards and downwards direction until the fetus is
Delivery of the lamb by traction delivered. When the fetal hindquarters pass through
the maternal vulva, the dorsal commissure and caudal
Once any malpostures have been corrected, the lamb vaginal roof should be protected by the obstetrician's
is ready for delivery. hand.
Fetopelvic disproportion is less common in sheep than As in other species, posterior presentation increases
in cattle. Before delivery is attempted the size of the the risk of fetal asphyxia through early rupture of the
lamb should be compared manually with the diameters umbilical cord and the risk of inhalation of amniotic
of the pelvis through which it must pass. If there is any fluid. Once traction is commenced it should be com-
doubt, trial traction should be employed. If this is not pleted with all possible speed. Adequate lubrication of
successful, cesarean section may be required. the birth canal and the fetus are essential and greatly
aid the passage of the fetus.
Application of traction If moderate traction fails to deliver the lamb, its
Fetus in anterior presentation Once the fetus is presentation should be checked again carefully, together
correctly presented at the pelvic inlet it is ready for with its size in relation to that of its mother's pelvis.
delivery. Plenty of obstetric lubricant is placed around Further generous lubrication is applied and traction
the lamb and in the caudal birth canal. Using one hand, tried again. If the lamb does not move cesarean section
the obstetrician eases the head and then each foreleg will be necessary.
120 Dystocia in the Ewe

%
Figure 6.7 Delivery of a lamb in anterior presentation by traction.

OBSTETRICIAN'S CHECK LIST

Manual delivery of lambs

Confirm presentation, position, and posture of lamb(s)

Compare size of fetus(es) and birth canal

Apply further lubrication

Decide which lamb to deliver first

Correct maldisposition of first lamb

Vaginal delivery ?possible \Vagina’»deliiery 2imposstble

Apply manual traction ?Trial manual traction

Delivery possible Delivery impossible Successful Unsuccessful

Deliver lamb Cesarean stction Deliver lamb Cesarean section

Check for and deliver subsequent lambs

 Handbook of Veterinary Obstetrics 121

RESUSCITATION AND CARE OF to enrich any air being breathed in. Alternatively, air
THE LAMBS may be pumped into the lungs using a Cox lamb resus-
citator, which supplies approximately 100mL of air
As soon as the lamb is delivered it is held up by the with each pump through a face mask.
back legs and gently shaken to allow fetal fluids and Great care must be taken when compressing the lamb’s
mucus to drain from the mouth, nasal passages, and chest — the ribs are very easily broken and severe dam-
lungs. Remnants of amnion are removed from the lamb's age can unknowingly be done to both the lungs and the
face. Cardiac function is identified by the presence of an liver. Very occasionally the lamb's ribs may be damaged
apex beat in the chest. In most cases, breathing will start during assisted delivery. If slight rib damage is discov-
spontaneously but if not the lamb should be swung ered analgesia should be provided in the form of an
carefully but more vigorously backwards and forwards. injection of flunixin and antibiotic cover prescribed.
During such swinging the lamb should be firmly gripped Mouth-to-mouth respiration is highly risky for zoonotic
by its back legs just above the hocks because— as it is reasons and should never be employed in lambs.
often covered in natural and artificial lubricant — it As soon as the lamb is breathing, the navel should be
may be accidentally dropped. sprayed with antibiotic (e.g. oxytetracycline) or dipped
If breathing has not started, the lamb is Jaid on its in a weak iodine solution. It is then placed near the
side and artificial respiration is started. This is best ewe's head to encourage mothering and the firm estab-
achieved by gently lifting the thoracic wall with one lishment of the fetomaternal bond. Subsequent lambs
hand and the shoulder joint with the other and then are treated in the same way. Colostrum should be taken
releasing the grip. Negative pressure in the chest is in by the lamb within 6 hours of birth and on many
achieved by this method and the lungs should be farms its intake is ensured by administering 60 mL by
encouraged to inflate allowing air to enter the lungs. small stomach tube to each lamb shortly after birth, A
Commencement of respiration can be further encour- further 60 mL is given later unless it is known that the
aged by administration of 5-10 mg of doxapram hydro- lambs have sucked. On farms where losses through
chloride, either intravenously or under the tongue. watery mouth have occurred, lambs may be given a
A small oxygen cylinder with face mask is very useful routine dose of an oral antibiotic, such as spectinomycin.

OBSTETRICIAN'S CHECK LIST

Postnatal care of lambs

Open amnion if still sealed

Clear airway

Lift lamb by hindlegs

Swing gently - allow fluids and mucus to drain

Check breathing

Lamb breathing Lamb not breathing

Monitor breathing Heart beat present No heart beat

Stimulate gasp Signs of death No signs of death

122 Dystocia in the Ewe

Administer doxapram Abandon Intracardiac

resuscitation adrenaline
(epinephrine)
Artificial respiration
Continue
Manual/resuscitator/esophageal tube technique resuscitation

‘Watch for spontaneous respiration

Monitor respiration

Place lamb near ewe's head

After an assisted lambing, antibiotic cover is usually

DELIVERY OF THE REST OF THE LITTER
provided for the ewe. An intramuscular injection of one
of the long-acting preparations of penicillin or oxytetra-
After the first lamb has been delivered the uterus is
cycline is given. If the risk of infection is considered
again examined for the presence of further offspring.
high, antibiotics may be given daily for up to 5 days
The second lamb is delivered manually and the uterus
after the lambing. Antibiotic pessaries may be placed in
checked again. This process is repeated until it is ascer-
the uterus. The perineal region of the ewe should be
tained that the uterus is completely empty. The lambs
washed with a mild antiseptic solution. Most ewes will
may occupy both horns or one horn may be pregnant
have received a booster injection of clostridial vaccine
and the other non-pregnant. Both horns should be
4-6 weeks before lambing.
identified — one on either side of the septum — and
Before releasing the ewe her milk supply should be
examined for the presence of further lambs.
checked — the patency and function of each teat and its
The last lamb in the litter can easily be overlooked —
associated mammary gland should be checked. Sup-
especially if the litter size is large. The last lamb often
plementary feeding for the lamb(s) is provided where
occupies the tip of one uterine horn and the coiled shape
necessary.
of the ovine uterus can make it difficult to reach (Fig.
If uterine tone is considered poor after assisted
6.8) unless the obstetrician carefully searches actively to
lambing uterine involution may be encouraged by the
the tip of each horn, however deep that may be.
administration of 201U oxytocin given by intra-
muscular injection.
AFTERCARE OF THE EWE The ewe is watched closely after lambing for signs of
postparturient problems (for details, see Chapter 13).
After the lambs have been born they should be left quiet Once the placenta has been passed it should be
and undisturbed with the ewe. The ewe licks and stimu- removed from the lambing pen to prevent the ewe
lates the lambs, making chuckling sounds with her from choking when trying to consume it.
voice, which enable the lambs to recognize their mother.
Some ewes seem very rough with their lambs, paw-
ing them vigorously with their forefeet to encourage
OBSTETRICIAN'S CHECK LIST
them to move and rise. Little damage seems to be done
by this action but small weak lambs must be protected Postnatal care of the ewe
from possible injury.
Check the uterus for further lamb(s)
1t is advisable to move the ewe and her lambs into a
small pen for 24 hours or so to keep the lambs warm and
Check the birth canal for damage
to further establish the family relationship and make it
less likely that the ewe and her lambs become separated.
{
 Handbook of Veterinary Obstetrics 123

Figure 6.8 The entire uterus must be searched carefully to ensure that the last lamb has not been overlooked.

pregnant. An earlier unobserved abortion is the most

4 likely cause of this.
Assess uwmie involution Any ewe found to be pregnant after the end of the
lambing season should be examined carefully. The
If deficient administer oxytocin possibility of a later service date should be investigated,
helped by knowledge of the date that the rams were
Consider anull;louc therapy removed from the flock. If a ewe is found to be preg-
nant more than 150 days after ram removal the possi-
Considcrtmlges&a bility of a true prolonged gestation increases. In some
cases the fetus may be mummified. Abdominal palpation
Check patency of te}ts and milk supply may reveal a hard, irregular mass just anterior to the
pelvic inlet. Ultrasonographic scan reveals an echogenic
Advice re further management mass but no evidence of fetal fluids. the placental coty-
ledons. or of fetal life. Ewes found to be carrying one
or more mummified fetuses are often culled. Their
THE OVERDUE BIRTH — PROLONGED abnormal pregnancy may be terminated by an intra-
GESTATION muscular injection of 125 ug of the prostaglandin
F2a analog cloprostenol. The mummified fetus is
Prolonged gestation is not always recognized in the ewe normally expelled from the uterus within 48 hours.
because the exact service date of many ewes is not Manual removal from the vagina may be necessary.
known. At the end of the lambing season the obstetri- Ewes in which fetal maceration has occurred are
cian may be asked to examine ewes that were known to likely to have been detected at an earlier stage. An
be pregnant when scanned but which have not lambed. unpleasant vaginal discharge containing fetal rem-
In most cases, abdominal palpation and ultrasonog- nants may have been seen. Treatment of such animals
raphic scan will reveal that such animals are no longer (see also Chapter 2) is often unsatisfactory and affected
124 Dystocia in the Ewe

animals are usually culled. The cause of fetal death is unable to produce sufficient ACTH and cortisol to ini-
may be detected by laboratory examination of the tiate its birth process. Pregnancy may be prolonged
placenta and vaginal discharges. Other ewes in the beyond 200 days.
flock may have aborted and a firm diagnosis of an infec- Ultrasonographic examination of affected animals
tious cause obtained. may demonstrate cranial defects in the living fetus within
True prolonged gestation with a living fetus is usually the uterus. Affected lambs are unlikely to be viable and
associated with a defect in the hypothalamic-anterior- are of no economic value. Their ewes may be culled or an
pituitary—adrenal axis in the developing lamb. Viral attempt can be made to induce parturition. Birth can be
causes include border disease virus in Europe and aka- induced in such animals by an intramuscular injection
bane virus in other parts of the world. Exposure to these of dexamethasone (16mg) and cloprostenol (125 pg).
and other viruses in pregnancy may result in pituitary Parturition normally commences 24-72 hours later.
aplasia and hydranencephaly. Similar fetal lesions are Assistance with fetal delivery is sometimes required and
produced by a number of plant toxins. The affected fetus the ewe receives normal postparturient care.

OBSTETRICIAN'S CHECK LIST

Management of the overdue ewe
Check service date(s) if known

Check the possibility of later service(s)

Clinical examination of ewe

Pregnancy diagnosis — ultrasonographic scan

—
Ewe pregnant Ewe non-pregnant — cull/retain?

Pregnancy normal /mnancy abnorm\

Estimate stage of pregnancy Mummified fetus Macemttd fetus Fetus alive

Retain Induce birth ?Surgical removal ?Cranial defect

Assist delivery Induce birth

Assist delivery
Chapter 7

DYSTOCIA IN THE DOE GOAT

The goat is a small ruminant and in many ways the

Table 7.1 Causes of dystocia in the doe goat
problems of dystocia encountered and their treatment
resemble those seen in the ewe. The more important Cause %
differences are discussed below but the overall approach
to the investigation and treatment of dystocia is the Fetal maldisposition 56
Fetopelvic disproportion 20
same in the two species. Experienced goat owners may
Obstruction of the birth canal 12
be unhappy to have the two species discussed asone and Uterine inertia 10
the obstetrician should, if possible, avoid comparisons Uterine torsion 2
between the species during obstetric work.
Although a number of large surveys of parturient Modified from Rahim & Arthur 1982.
ewes have noted the relative incidences of the different.
causes of ovine dystocia there are few accounts concern-
ing goats. Failure of the cervix to dilate — ringwomb — uterine inertia was a frequent complication of cervical
appears to be less common than in the ewe. obstruction. In cases of uterine inertia the presenting
fetus shouldbe delivered manually. Further fetuses in the
uterus should also be delivered. Postparturient uterine
INCIDENCE contraction should be stimulated by the intramuscular
administration of 5-10 IU oxytocin.
The exact incidence of dystocia in goats is not known.
In general they are kept in smaller herds than sheep and
problems at parturition are less concentrated over a
short period. Many goat herds are quite small and are OBSTRUCTION OF THE BIRTH CANAL
not supervised by an experienced shepherd.
Although obstruction may involve any part of the birth
canal the failure of the cervix to dilate (ringwomb) was
the most common problem encountered in the Saudi
CAUSES OF DYSTOCIA Arabian survey. Five cases of ringwomb were seen and,
of these, four required cesarean section to achieve deliv-
In a survey of 51 cases of dystocia in doe goats treated
ery, as did the single case of uterine torsion. Treatment
in Saudi Arabia {(Rahim and Arthur 1982) the causes
of ringwomb by drug therapy can also be attempted
were found to be as shown in Table 7.1.
(Matthews 1999). Prostaglandin F2a (10 mg dinoprost
or 125 pg cloprostenol) given by intramuscular injec-
tion has been used successfully and may be followed by
Uterine inertia kidding in 4 hours. Vetrabutine hydrochloride (2 mg/kg
This condition is rarely seen as a primary cause of caprine body weight) given by intramuscular injection may pro-
dystocia. Periparturient hypocalcemia in goats may, mote cervical dilation. The cervix and kids should be
however, lead to primary uterine inertia. In the Saudi carefully evaluated as in the ewe (see Chapter 6) before
Arabian survey (Rahim & Arthur 1982), secondary treatment is commenced. Cesarean section should be
126 Dystocia in the Doe Goat

performed if fetal life is thought to be at risk and in cases

SIGNS OF DYSTOCIA
in which drug therapy has been unsuccessful.
Any departure from the normal pattern of parturition
FETAL MALDISPOSITION can indicate the existence of dystocia and should be
investigated. Non-productive straining is also a frequent
This s the most common cause of dystocia in the goat. In sign. This may be accompanied by loud bleating, which
the Saudi Arabian survey by Rahim & Arthur, deviation often coincides with straining. The doe quickly tires and
of the head and carpal flexion were the most frequently may appear exhausted quite rapidly if her attempts at
seen maldispositions. Shoulder flexion was seen in five fetal delivery are unsuccessful. The appearance at the
animals but only one case of posterior presentation with vulva of a single fetal extremity, such as a head without
hock flexion was seen. either foreleg or a single hindlimb is - as in the ewe —an
Simultaneous presentation was a complication of indication of possible fetal maldisposition.
11 cases of dystocia and the proportion of animals car- The escape of allantoic fluid - if observed — may indi-
rying twins and triplets was high. One or more of the cate the commencement of birth but in goats sudden
simultaneously presented kids may also have amalpos- loss of watery fluid (or ‘cloudburst’) may also indicate
ture involving the head or limbs (Fig. 7.1). the end of pseudopregnancy. The presence of pseudo-
The majority of cases in the Saudi Arabian survey pregnancy (hydrometra) rather than pregnancy may
were dealt with by manual correction of the maldisposi- have been detected earlier by ultrasonographic scan or
tion and then delivery by traction. Partial fetotomy was the presence (from day 45 of pregnancy) of estrone sul-
required in a few cases in which the maldisposed fetus fate in the blood or milk of the genuinely pregnant doe.
was dead and not readily moveable. Cesarean section was In some cases, however. no pregnancy diagnosis will
performed in one case of shoulder {lexion that could not have been performed and the obstetrician should bear
pseudopregnancy in mind. The occasional doe showing
be corrected manually.
signs of restlessness, mild straining, and the loss of quan-
tities of watery fluid from the vagina may not actually be
FETOPELVIC DISPROPORTION kidding, or indeed be pregnant at all. In the pseudopreg-
nant doe there will be no placenta and no fetus. The
This abnormality was seen in nine cases in the Saudi fluid-filled uterus is readily detectable when a trans-
Arabian survey. Pelvic size was considered small in two- abdominal scan is performed. Echogenic lines caused by
thirds of the cases and fetal size excessively large in the the superimposition of the uterine horns cross the non-
remaining third. Two of the large kids were single males. echogenic fluid and are visible in the pseudopregnant doe

Figure 7.1 One or more simultaneously presented kids may have a malposture involving the head or limbos.
 Handbook of Veterinary Obstetrics 127

when the uterus is scanned. These lines are caused it should be delivered by traction. Traction is applied
by superimposition of the image of one uterine horn on in a caudal direction initially, and then downwards
the other. towards the maternal hocks. One leg should be advanced
Some goat owners are very inexperienced and, where before the other and the fetus is eased through the
possible, advice concerning normal kidding and the signs birth canal. Help from the obstetrician aids the natural
of dystocia should be discussed in advance of the event. expulsive forces.
Multiple birth, especially of twins and triplets, is
extremely common in goats. Great care must be taken
APPROACH TO A CASE OF to ensure that the uterus is searched methodically for
DYSTOCIA IN THE DOE GOAT further kids after each delivery.
Retention of a kid after the apparent cessation of kid-
The basic approach is as in the ewe. History taking may ding should be suspected in does in which the placenta is
be unrewarding if the owner is inexperienced. A gen- retained (Matthews 1999). Some animals give birth to
eral clinical examination should always be carried out a kid unaided up to several days after kidding appears
before the obstetric evaluation. Some does may be in to have been completed. In other cases of fetal retention
poor condition if feeding and management during preg- the doe is lethargic and anorexic as she becomes pro-
nancy has not been satisfactory. The patient is normally gressively more toxemic and septicemic. A careful vagi-
examined in the standing position being restrained by a nal examination should be made in such cases. If a kid is
collar held by the owner. Many does will lie down when found in the uterus it should be removed manually after
vaginal examination is attempted. The caprine uterus is generous application of lubrication. The doe should
very fragile and easily damaged by the fetal horn buds receive supportive therapy including antibiotic and non-
and displaced extremities. steroidal anti-inflammatory treatment.
Vaginal examination of the doe seems to cause great Resuscitation of the kids (using the same techniques
discomfort, even when the utmost gentleness is employed. recommended for lambs) may be necessary, especially if
The owner should be warned of this in advance. The there has been any delay in recognizing and dealing
apparently piteous cries of the doe are very unpleasant with the dystocia.
for owner and obstetrician. They probably do not indi-
cate the severe discomfort that their volume suggests.
Routine sedation of the doe is not necessary or advisable. AFTERCARE OF THE KID AND DOE
The vagina should be explored carefully to determine
whether the cervix is open and whether one or more Alfter delivery, each kid should be placed near its mother’s
fetuses are palpable. Additional lubrication greatly facil- head. Navel hygiene and supervision of colostral uptake
itates the examination. If the cervix is not fully dilated, are very important. Does kidding for the first time may be
an attempt should be made to dilate it manually. If fur- aggressive with, or apparently frightened of, their off-
ther dilation proves difficult or impossible, the cervix spring. Patient assistance may be required to help estab-
and uterine contents should be assessed in detail as in lish the fetomaternal bond. The milk supply and teat
the ewe (see Chapter 6). In many such cases a cesarean patency of the doe should also be checked.
section to deliver the litter will be necessary. The opera- The risk of postparturient infection in goats is quite
tion in the doe goat is discussed in detail in Chapter 11. high, especially if there has been much lay interference
The presentation, position, and posture of any pal- or if the case has been neglected. Antibiotic cover for
pable fetuses should be ascertained, along with their 5 days (with a broad-spectrum agent such as ampicillin)
living state. The size of the bony pelvis should be is advisable in all cases of assisted delivery.
assessed and a decision made as to whether vaginal
delivery is likely to be possible. If fetal maldisposition
is present this should be corrected manually after THE OVERDUE BIRTH — PROLONGED
repelling the fetus if necessary. In cases of simultane- GESTATION
ous presentation it is easier to deliver a fetus in poste-
rior presentation first as only two extremities (rather This condition is less well documented in the doe than
than three in anterior presentation) have to be dealt it is in the ewe. The general approach to the problem is
with. Once a fetus is in the correct posture for delivery the same in both species (see Chapter 6 for a detailed
128 Dystocia in the Doe Goat

account of the management of prolonged gestation in be kept in mind. Pseudopregnancy does not normally
the ewe). Although the date of service may have been persist beyond the length of a normal pregnancy.
recorded it is not uncommon for a doe to be served
again. A later service may not have been observed but REFERENCES
anew later kidding date is now in prospect.
Matthews JG 1999 Discases of the goat, 2nd edn. Blackwell Science,
Asin the ewe, it is essential to determine by pregnancy Oxford, p 48-50
diagnosis if the overdue doe is in fact pregnant. In goats, Rahim AT, Arthur GH 1982 Obstetrical conditions in goats. Cornell
the quite common condition of pseudopregnancy should Veterinarian 72:279-284