8/12/2019 Surgical removal of a macerated bovine fetus

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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

Fetal maceration may occur at any stage of gestation and has been reported to occur in all species(Purohit, 2012) following fetal death, regression 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 encounteredin mares (Burns and Card, 2000), small ruminants(M ehta et al , 2005; Ajitkumar et al , 2007) andcompanion animals. In rare instances the disintegratedfetus parts and bones may be retained in the uterus forprolonged 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 bredcow was referred to the Veterinary College Hospital,Bikaner with the history of reddish brown watery foulsmelling discharge from the vagina, since five days withno progress in parturition. The animal evidenced severetenesmus and was treated with prostaglandin F 2 alphafor inducing parturition by the local veterinarian. Theanimal was depressed and evidenced rectal temperatureof 102 0F. Vaginal examination revealed a hard andpartially dilated cervix. Rectal examination revealed acontracted uterus lying on the pelvic brim, distendedwith fluid, a thickened uterine wall and a crepitatingmass of fetus. Transrectal ultrasonography was done and

the bony pieces (hyperechogenic) were observed withinthe echogenic pus (Fig 1). Based on clinical examinationthe case was diagnosed as fetal maceration.Treatment

To improve the general condition and to combattoxemia the animal was administered intravenous fluidsand antibiotics. An attempt was made to evacuate theuterus by the administration of prostaglandin (Inj-Repregna Vet Mankind, 2 ml I M) and estradiol (Inj-Progynon depot German Remedies 2 ml IM). On thesecond and third day stilboesterol (Inj- Haristrol 10mlIM) was administered. There was no change in the

condition of the birth canal and an effort to deliver thefetus per vaginum was futile due to improper cervicaldilation. It was, therefore, decided to perform alaparohysterotomy by left flank site under localinfilteration anaesthesia as described previously (Purohit,

2012). After removal of the fetal bones and decomposedmuscles (Fig 2), the uterus was cleaned with normalsaline and diluted povidone iodine solution. The uteruswas subsequently sutured with cushings sutures usingChromic catgut no. 2 followed by closure of theabdominal incision as per the standard method.

Post operative care included infusion of fluids,antihistaminics and parentral antibiotics for 5 days. Therewas an uneventful recovery. The skin sutures wereremoved after 10 days post operative.Discussion

Fetal maceration is the disintegration of a fetusthat has died after formation of the fetal bones (after 4months 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 theabnormal presentation of a fairly dry fetus which causesit to be retained in the uterus (Drost, 2007). Bacterialinvasion of the fetus leads to fetal emphysema andmaceration (3 to 4 days). There is formation of plenty of

(24-48 h) pus and the bones of the fetus separate out.Theanimal discharges plenty of foul smelling, reddish grayvulvar discharge and strains frequently (Purohit and Gaur,2011). Fever and anorexia may develop due to infection.The condition is noticed by the owners when foulsmelling 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, rectalpalpation (free fetal bones palpable in crepitating pusand doughy thick uterine wall) radiography (especiallyin small animals) and ultrasonography (finding of

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8/12/2019 Surgical removal of a macerated bovine fetus

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Fig 1 . Sonogram of a bovine macerated fetus. Thehyperechogenic bones are visible in echogenicpus.

Fig 2. The bones and disintegrated tissues of a maceratedfetus removed from the uterus of a cow bylaparohysterotomy.

hyperechogenic scattered bones in an echogenic or nonechogenic fluid with echogenic floating pus) (Kumar andPurohit, 2009). Sonographic and palpable findingsduring the present case were similar to previouslydescribed findings characteristics to fetal maceration.

ReferencesAjitkumar G, Kuriakose AM, Ghosh KNA and Sreekumaran

T (2007). Fetal maceration in a goat. Indian Journalof Animal Reproduction 28:107-108.

Art hur GH , N oakes 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 bones in a mare. Journal of AmericanVeterinary Medical Association 217:878-880.

Drost M (2007). Complications during gestation in thecow. Theriogenology 68:487-491.

Kumar V and Purohit GN (2009). Ultrasonographicdiagnosis of the bovine genital tract disorders.Vet Scan 4: Article 43 (1-11).

Mehta V, Sharma MK and Bhatt L (2005). Maceratedfetus in goat. Indian Journal of AnimalReproduction 26:75.

Purohit GN and Gaur M (2011). Etiology, antenataldiagnosis and therapy of fetal complications of gestation in large and small domestic ruminants.Theriogenology Insight 1:45-63.

Purohit GN (2012). Domestic Animal Obstetrics. EdsPurohit GN, Lambert Academic Publishers,Germany.

Sood P, Vasistha NK and Singh M (2009). Use of a novelsurgical approach to manage macerated fetus ina crossbred cow. Veterinary Record 165:347-48.

The animal should be examined per vaginumand any pieces of bones lodged in the vagina or cervixmust be removed manually if the cervix is dilated.Infusion of large quantities of normal saline in the uterusis useful in removing the pus and bone pieces 24 hrslater (Drost, 2007). When the cervix is not openprostaglandins or estrogens can be given to regress thepartially regressed CL and/or increase the uterinecontractions (Purohit and Gaur, 2011). Sufficientlubrication and gentle removal of the bones is necessary.In the present case all these approaches were unsuccessfulhence laparohysterotomy had to be performed.

Laparohysterotomy to remove the maceratedfetus is potentially dangerous and must be considered asa last resort (Sood et al , 2009). The prognosis is alwayspoor. Rarely long standing cases may develop peritonitissubsequent to uterine rupture. In multiparous animalshysterectomy may be suggested. In the present casehowever hysterotomy could be successfully performedwithout any complication. It was concluded thatmacerated fetus can be removed by laparohysterotomyand with sufficient care the clinical outcome is good.

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