D. E. Larsen,DVM
The barn was cold, but there was steam rising from the back of young heifer. A dusting of snow on her back was melting fast. Bill and Connie Wolfenbarger had called with a heifer in labor. They were not regular large animal clients but did visit the clinic with their small dogs. I had been to their place several times to treat cows belonging to the Gilbert’s.
When they discovered a tail hanging from the heifer’s vulva, they knew they had a problem. This meant the calf was in a true breech presentation and almost certainly dead. In a true breech position, the calf does not engage the cervix, and the cow doesn’t go into hard labor. Most people will not notice a problem until the calf has been dead for a day or two.
Tomorrow was Thanksgiving, I would miss some of the prep for the family dinner. The evening snowfall was light but continuing. Hopefully, I could make it home before the roads became a problem. Sandy’s folks were already at the house, so we didn’t have to worry about anybody traveling tomorrow.
I tied the tail out of the way and started to wash the heifer’s rear end. The hair on the tail would come off with the slightest touch. I pulled on a plastic OB sleeve onto my left arm. With a little lube on my hand, I eased into her vulva to explore the birth canal. She strained hard when I reached the butt of the calf. No fluid was expelled with the strain. I pushed the rear of the calf with a couple of fingers. There was a spongy consistency under the skin and some crackling like I was popping air bubbles. The calf filled the entire birth canal, I could not advance my hand into the uterus, and I could not move the calf, it was wedged solidly into the birth canal. I withdrew my hand, the sleeve was covered with hair from the calf and the odor was slightly pungent.
“This calf has been dead for over a week,” I said as I removed the sleeve. “It is emphysematous, blown up with gas, I am not sure I am going to be able to get it out of her.”
“What are our options?” Bill asked. I knew their daughter was a small animal veterinarian, maybe in California. I did not know her, but I would assume they would be a little more knowledgeable than most clients.
“Options are not many, the calf is in a breech position. That means its’ hind legs are retained and only the rump is presented. It is blown up so much that I cannot even insert my hand into the uterus. We are not going to be able to deliver this calf vaginally. I try not to do a C-Section on a dead calf, but with all the emphysema I won’t be able to do a fetotomy. That leaves us with two viable options. Option one is a C-Section, which will be with risk and will be difficult.”
“And the second option?” Bill asked.
“The second option is to get your rifle and shot her now. It would not be fair to her to leave her in this situation,” I said.
“Let’s do the C-Section,” Bill said.
I double checked her halter to make sure she would not be choked if she went down. Then I change the tail, tying it to the right side. I placed a rope around her neck with a bowline and ran it along her side and tied it to ally fence, holding her against the fence. With her in a reasonably secure position, I clipped a wide area on her left flank, from her dorsal midline to her bottom of her flank.
I prepped her flank with Betadine Surgical Scrub. The with 90 ccs of 2% Lidocaine, I did a large inverted ‘L’ block of her left flank. I blocked a wider area than usual because I may need to make a longer incision than is usually required. This was not going to an easy procedure. I repeated the prep after the block.
After laying out the surgical pack and supplies, I pulled on a pair of surgical gloves, more to keep my hands clean than to pretend that this was going to be a sterile procedure.
“We have a couple of major risks with this surgery,” I explained as I prepared to make my incision. “The first one is that it is going be difficult to pull this uterus to the incision and second when I open the uterus, there is going to be no way to prevent the contamination of the incision and the abdomen. We are just going to have to depend on antibiotics.”
Bill nodded, and I made a long incision down her flank, starting a few inches below her transverse processes and extending about 15 inches down her flank. The skin and subcutaneous tissues parted easily. This I incised the muscles of the flank, they quivered as the blade divided them. When I incised the peritoneum, the abdominal content did not sink away from the incision with a characteristic rush of air into the abdomen. The distended uterus filled the entire abdomen. There was no trouble finding it or worry about moving the rumen to externalize the uterus. The abdomen was filled with the uterus.
I reached into the abdomen to the tip of the uterus. Cupping my hand around the tip of the uterine horn, I pulled. The uterus did not move. I tried to rock the uterus in the abdomen. Sometimes you could swing the uterus enough to make it easier to bring it to the incision. This uterus did not budge. Again and again, I tried to bring the uterus to the incision. I searched and found a hoof, I could not move the hoof.
I pulled out, stretched and changed gloves. It this cold barn, I was sweating profusely.
“Do you think I could give you a hand?” Bill asked.
“We might try that, if we could both get a hand under the end of the uterus, we might be able to make it move,” I replied.
Bill stripped down to his waist and washed his hands and arms thoroughly. I stood on the head side of the incision and ran my left hand down to the tip of the uterus. Bill on the other side of the incision inserted his right arm. I guided his hand to the correct position. We pulled, we pushed, we tried almost every maneuver. The uterus did not budge.
Bill and I were almost nose to nose. Bill had sweat on his brow and sweat dripping off the tip of his nose. He looked me square in the eye.
“A woman couldn’t this,” he said.
I smiled, “If you haven’t noticed, I haven’t got it done myself, yet.”
We pulled out, and I rethought the situation.
“I am going to try one more thing,” I explained. “I am going to open the uterus up here without externalizing it. I will then try to get a hold of the calf’s hoof and turn it up to the incision. The risks in doing this are many. I could spill content into the abdomen, I could tear the uterus, and even with a grip on a foot, I might not be able to budge this uterus.”
“And then, if this fails, we are going back to option two. We will get your rifle and put this girl out of her misery.”
That said, I incised the uterus in the middle of the flank incision. With a surgical glove and an OB sleeve on, I ran by right hand down the inside of the uterus. There was a front foot, I grabbed the leg just above the hoof and pulled as hard as I could. The uterus rolled and the hoof popped out of the incision. With my left hand, I incised the uterus over the hoof, then slipped an OB strap onto the hoof. I handed the strap to Bill and told him to keep it there.
Pulling my arm out of the upper incision, I enlarged the incision over the exposed hoof. Bill was able to pull the entire front leg out of the incision. I reached in and found the other leg. It came out quickly, and we attached it to the other end of the OB strap.
With both front legs out, I enlarged both the flank incision and the uterine incision. Now I was able to pull the head out of the incision. Then putting things down, I helped Bill put a hard pull on the calf. It was sort like pulling a basketball through a knothole but when gas-filled abdomen of the calf finally cleared the incision both Bill and I almost fell as the rest of the calf followed with a swoosh.
The membranes and the calf landed on the barn floor in a splat. Then the odor hit us. Bill and Connie both gagged and had to turn back to the side door. When they opened that door, things were better, or maybe we were just adjusted. Bill grabbed the OB strap and pulled the calf out the barn door, and I returned my attention back to closing up this mess.
I washed and changed gloves. I put 5 grams of Tetracycline powder into the uterus and pulled the open incision to the outside. This was a long incision in the uterus, and then there was the small incision higher on the horn. I elected to close the upper incision first, just in case the uterus would start to involute, and I would not be able to reach this incision. I closed It with a simple continuous suture of #2 Dexon.
The larger incision I closed with my standard Utrecht closure using #2 Dexon. After closing, I returned the uterus to the abdomen. I was concerned that there was probably a lot of leakage into the abdomen and pondered how best to deal with that event. There was no option to lavage the abdomen in the middle of this barn, so I just dumped another 5 grams of Tetracycline powder into the abdomen.
I closed the flank incision with 4 layers, all the deep layers with #2 Dexon. I used simple continuous in the peritoneum, interrupted mattress in the muscles and simple continuous in the subcutaneous tissues. I used #4 Vetafil in the skin with an interrupted mattress pattern. No need to spray for flies in this weather.
The heifer had to feel tremendous relief getting that mess out of her. She was going to need some additional antibiotics to keep her incision from falling apart. The easiest thing was to use some long-acting sulfa boluses. I gave her 4 boluses of Albon SR. That would give her 5 days of protection.
I untied her tail rope and the sideline. She was as calm as could be expected. I loosened the halter and slipped it over her head. She turned slowly and headed to the door, sniffing the floor a little as she passed.
“She should be okay for tomorrow, but I will check with you on Friday,” I said to Bill as I was cleaning myself up.
“She will be just fine,” Connie said. “Our daughter will be home for a week or two. She can check her tomorrow. We will let you know how she is doing. You go home and rest for dinner tomorrow.”
At least I was going to have a few days to rest up with the holiday. I stopped at the clinic and cleaned all the equipment. I would be a real mess if I left it for the girls on Monday. I stripped down to the waist and washed thoroughly. The one mistake I made with the clinic was not putting in a shower. I thought I would wash here and go home for a shower. Then probably have to start working on dinner for tomorrow.