College of Veterinary and Animal Science, RAJUVAS, Bikaner Rajasthan, INDIA
. Department of Veterinary Gynecology and Obstetrics *gnpobs@gmail.com SURGICAL MANAGEMENT OF A MACERATED BOVINE FETUS Pramod Kumar, GN Purohit* and JS Mehta Fet al macerat i on may occur at any st age of gestation and has been reported to occur in all species (Purohi t, 2012) followi ng fetal death, regressi on of corpus luteum and failure of abortion (Arthur et al, 1989). The condition is common in cattle and buffaloes (Purohit and Gaur, 2011) but may be rarely encountered i n mares (Burns and Card, 2000), small rumi nants (Meht a et al, 2005; Aj i t kumar et al, 2007) and companion animals. In rare instances the disintegrated fetus parts and bones may be retained in the uterus for prolonged periods necessitating surgical removal (Drost, 2007) which is reported for the present case. History and clinical examination A seven years old full term pregnant cross bred cow was referred to the Veterinary College Hospital, Bikaner with the history of reddish brown watery foul smelling discharge from the vagina, since five days with no progress in parturition. The animal evidenced severe tenesmus and was treated with prostaglandin F 2 alpha for inducing parturition by the local veterinarian. The animal was depressed and evidenced rectal temperature of 102 0 F. Vagi nal exami nati on reveal ed a hard and partially dilated cervix. Rectal examination revealed a contracted uterus lying on the pelvic brim, distended with fluid, a thickened uterine wall and a crepitating mass of fetus. Transrectal ultrasonography was done and the bony pieces (hyperechogenic) were observed within the echogenic pus (Fig 1). Based on clinical examination the case was diagnosed as fetal maceration. Treatment To improve the general condition and to combat toxemia the animal was administered intravenous fluids and antibiotics. An attempt was made to evacuate the uterus by the admi ni strati on of prostaglandi n (I nj - Repregna Vet Mankind, 2 ml IM) and estradiol (Inj- Progynon depot German Remedies 2 ml IM). On the second and third day stilboesterol (Inj- Haristrol 10ml I M) was admi ni stered. There was no change i n the condition of the birth canal and an effort to deliver the fetus per vaginum was futile due to improper cervical di l at i on. I t was, t herefore, deci ded t o perform a l aparohyst erot omy by l eft fl ank si t e under l ocal infilteration anaesthesia as described previously (Purohit, 2012). After removal of the fetal bones and decomposed muscles (Fig 2), the uterus was cleaned with normal saline and diluted povidone iodine solution. The uterus was subsequently sutured with cushings sutures using Chromi c cat gut no. 2 fol l owed by cl osure of t he abdominal incision as per the standard method. Post operative care included infusion of fluids, antihistaminics and parentral antibiotics for 5 days. There was an uneventful recovery. The ski n sutures were removed after 10 days post operative. Discussion Fetal maceration is the disintegration of a fetus that has died after formation of the fetal bones (after 4 months of pregnancy in cattle) and has failed to abort, although the cervix is open (Purohit and Gaur, 2011). Although uncommon, the reason for the non delivery of a dead fetus could be a partially dilated cervix, or the abnormal presentation of a fairly dry fetus which causes it to be retained in the uterus (Drost, 2007). Bacterial i nvasi on of the fetus l eads to fetal emphysema and maceration (3 to 4 days). There is formation of plenty of (24-48 h) pus and the bones of the fetus separate out.The animal discharges plenty of foul smelling, reddish gray vulvar discharge and strains frequently (Purohit and Gaur, 2011). Fever and anorexia may develop due to infection. The condi ti on i s noti ced by the owners when foul smelling pus is discharged by a pregnant animal. Rarely, it may be diagnosed during pregnancy examination. The condition can also be diagnosed by the history, finding of a piece of bone lodged in the cervix, rectal palpation (free fetal bones palpable in crepitating pus and doughy thick uterine wall) radiography (especially in small animals) and ultrasonography (finding of Vol 2 No 1, p 107-108 Ruminant Science June 2013/107 2 Fig 1. Sonogram of a bovi ne macerated fetus. The hyperechogenic bones are visible in echogenic pus. Fig 2. The bones and disintegrated tissues of a macerated fet us removed from t he ut erus of a cow by laparohysterotomy. hyperechogenic scattered bones in an echogenic or non echogenic fluid with echogenic floating pus) (Kumar and Purohi t, 2009). Sonographi c and pal pabl e fi ndi ngs duri ng the present case were si mi l ar to previ ousl y described findings characteristics to fetal maceration. References Ajitkumar G, Kuriakose AM, Ghosh KNA and Sreekumaran T (2007). Fetal maceration in a goat. Indian Journal of Animal Reproduction 28:107-108. Art hur GH, Noakes DE and Pearson H (1989). Veterinary Reproduction and Obstetrics. 6 th Edn, ELBS Publication, Britain. Burns TE and Card EE (2000). Fetal maceration and retention of fetal bonesin a mare. Journal of American Veterinary Medical Association 217:878-880. Drost M (2007). Complications during gestation in the cow. Theriogenology 68:487-491. Kumar V and Purohit GN (2009). Ultrasonographic diagnosis of the bovine genital tract disorders. Vet Scan 4: Article 43 (1-11). Mehta V, Sharma MK and Bhatt L (2005). Macerated fet us i n goat . I ndi an Journal of Ani mal Reproduction 26:75. Purohit GN and Gaur M (2011). Etiology, antenatal diagnosis and therapy of fetal complications of gestation in large and small domestic ruminants. Theriogenology Insight 1:45-63. Purohit GN (2012). Domestic Animal Obstetrics. Eds Purohi t GN, Lambert Academi c Publi shers, Germany. Sood P, Vasistha NK and Singh M (2009). Use of a novel surgical approach to manage macerated fetus in a crossbred cow. Veterinary Record 165:347-48. The animal should be examined per vaginum and any pieces of bones lodged in the vagina or cervix must be removed manual l y i f the cervi x i s di l ated. Infusion of large quantities of normal saline in the uterus is useful in removing the pus and bone pieces 24 hrs l at er (Drost , 2007). When t he cervi x i s not open prostaglandins or estrogens can be given to regress the part i al l y regressed CL and/ or i ncrease t he ut eri ne contracti ons (Purohi t and Gaur, 2011). Suffi ci ent lubrication and gentle removal of the bones is necessary. In the present case all these approaches were unsuccessful hence laparohysterotomy had to be performed. Laparohysterotomy to remove the macerated fetus is potentially dangerous and must be considered as a last resort (Sood et al, 2009). The prognosis is always poor. Rarely long standing cases may develop peritonitis subsequent to uterine rupture. In multiparous animals hysterectomy may be suggested. I n the present case however hysterotomy could be successfully performed wi t hout any compl i cat i on. I t was concl uded t hat macerated fetus can be removed by laparohysterotomy and with sufficient care the clinical outcome is good. Ruminant Science June 2013/108
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