Fetotomy

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Fetotomy (One of the most valuable obstetrical
technique) Presented by Dr. Alaa ELDin Zain
Mahmoud Dept. of Theriogenology Fac. Vet.
Medicine Assiut University Egypt EVET C-059-I0
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Basic Obstetrical Techniques to correct an
existing Dystocia 1) Traction (Fetus)
2) Correction (Fetus). 3) C. Section
(Dam) 4) Fetotomy (Fetus). 5)
Episiotomy (Dam) 6) Cervicotomy (Dam).
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• After trials of either manual correction of
  abnormal PPP or strong traction of the fetus and
  no progress is made.
• The Veterinary Surgeon must resort to
• C. Section if the fetus is live
• Fetotomy if the fetus is dead

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• The choice of obstetrical technique after manual
  correction have failed is determine by
• Economic value of female.
• Viability of fetus.
• Expertise of veterinarian.
• Equipments facilities available for
  veterinarian.
• Owners preference.

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• Fetotomy
• Definition Is the reduction in the size of the
  fetus by the removal or destruction of its parts
• in order to permit safe delivery.
• The fetotomy technique is indicated to preserve
  the life of dam for
• Future breeding.
• Fattening and slaughter.

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Aims of Fetotomy 1.Rapidly decrease the size of
fetus lead to safe extraction
process. 2.Avoids the stress injuries that
follow prolonged manipulation. 3.Avoids the
additional expenses risks from performing
C. section.
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• Indications
• Fetotomy is performed for
• Feto-pelvic disproportion. (Oversize).
• Irreducible/ or incorrect PPP.
• Fetal malformation.
• An emphysematous or edematous fetus.

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Fetotomy can be performed by two ways
Sub-cutaneous or intr-afetal method.
Per-cutaneous or extr-afetal method. The
method can be combined or modified according to
needs.
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Sub-cutaneous method Means Sufficient
skeletal, muscular structures and viscera were
removed or destroyed (by using guarded knife or
cutting hook) to reduce size of the fetus.
Disadvantage of method 1) Need a lot of
physical strength. 2) Time consuming.
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• Per-cutaneous method
• Means
• Sectioning of the fetus by cutting through skin,
  muscle and bone with a fetotome to remove the
  incorrect flexed parts or reduce the size of the
  fetus.
• Advantage of method
• Being faster and easy to perform.
• More adaptable to various situations.

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For Successful Fetotomy Certain considerations
must be undertaken at 1- Prior to initial
examination. 2- At initial examination. 3-
Epidural anaesthesia . 4- Preparation and
sterilization of instruments.
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• Prior to initial examination, the operator must
  be
• Restrained the animal very well (mare).
• Examined the animal clinically.
• Warped and tied the tail to one side.
• Thoroughly cleansed the perineal region.
• Wears a sterile rubber sleeves.

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At initial examination, the operator must
be 1.Determine the condition of genital tract.
1.Presence of any laceration
2.Presence of a pelvic mass (mare).
3.Degree of cervical relaxation.
4.Presence of uterine muscular spasms. 2.Suggest
what the number and where the cuts should be
made. 3.Application of copious
volume of lubricant. 4.Kill of a weak alive
fetus.
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• Epidural anaesthesia
• Is a single injection of 10 ml (2.0 2.5) of
  local anaesthetic solution (xylazine) into the
  epidural sac.
• The site of injection is the middle of the
  first intra-coccegeal space.
• Purposes for epidural anaesthesia
• Eliminate abdominal contraction during fetotomy.
• Provide analgesia to perineal region.
• Reduce reflex straining initiated by
  manipulations.

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Different Types of Fetotomy Cuts There are
three types of cuts Transverse cut (The
section is perpendicular to the long axis of
fetotome) Oblique cut (The section is oblique
to the long axis of fetotome) Longitudinal cut
(The section is parallel to the long axis to the
fetotome).
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Preparation of Fetotome for Different Types of
Cuts The wire saw pass through both channels
of fetotome and each end fix in metal handle.
Perform a loop of saw wire at the head of
fetotome (Transverse and Oblique cuts).
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The wire saw pass through one channel of
fetotome and the end is fix in handle. The other
end of wire is tied in wire director, which pass
around the part of fetus to be cut, then remove
the director. The wire passes by threader through
the other channel and fixes the end in other
handle. (Longitudinal cut).
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Application of different types of
cuts Transverse cut applied to remove forelimb,
hind limb, sectioning the trunk or cutting the
base of neck (extended head and neck). Oblique
cut applied to remove forelimb at point of axilla
or hind limb at point of hip joint. Longitudinal
cut applied to remove the base of neck (laterally
deviated head and neck) and bisection of the
pelvis.
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• General considerations at fetotomy procedure
• Careful thought should be given prior to all
  manipulations.
• Ensure that head of fetotome is in correct
  position on fetus body.
• 3.Hold the fetotome securely during cutting
  procedure.
• 4.Repeated in and out arm movements are
  contraindicated.
• 5.Minimize the number of cuts that need, can
  short the
• intervention time and permit a traumatic
  delivery of dead fetus.

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A. Sub-cutaneous fetotomy method (Using scalpel
or guarded knife) I. Removal of fore limb The
limb is snared and sustained traction. Small
incision with scalpel into skin in front of
fetlock joint. Long incision is made from
pastern to scapular cartilage. Finger
dissection of skin around limb to scapular
region. Broken down attachment of pectoral
muscles in the axilla area. Des-articulate the
fetlock joint. Traction is applied to the
denuded limb. (Photo).
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II. Removal of hind limb The limb is snared
and sustained traction. Small incision with
scalpel into skin in front of hook joint. Long
incision is made up to the hip joint of limb.
Finger dissection of skin around limb to gluteal
region. Broken down attachment of muscles and
ligaments. Vigorous traction the articulate
head of femur freed from acetabulum and removed.
(Photo).
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B. Per-cutaneous fetotomy method (Using
fetotome) I. Anterior presentation
Amputation of fore limb (in correct
malpostures). Amputation of the head neck
(lateral deviation). Amputation of the head
neck (extended) fore limb. Amputation of
trunk (include other fore limb). Bisection of
hind limbs. (Photo)
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II. Posterior presentation Amputation of
hind limb (in correct malpostures). Amputation
of one hind limb at hip joint. Amputation of
both hind limbs (one operation). Section of
lumber and thoracic areas. Bisection of
anterior part of fetus. (Photo)
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III. Fetal abnormality Hydrocephalus case
(Single fetotomy cut from behind the ear
across the eyes will permit removal half of fetal
head, thereby permitting assisted vaginal
delivery of fetus). (Photo)
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• Care of the dam after fetotomy
• Try to remove the remnants of placenta.
• Wash the uterus with mild antiseptic solution.
• Inject oxytocin (20-30 IU) to enhance the uterine
  involution.
• 4.A local antibiotic doses (2-4 gm).
• 5.Systemic antibiotics (infected cases).

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Conclusions 1.The veterinarian owner consider
a dead fetus to be an indication of
fetotomy. 2.Results from fetotomy can vary,
depending on a level of expertise offered by
the veterinarian facilities available. 3.A
common fault to chose fetotomy only after the
birth canal have already been traumatized by
unproductive attempts at manual correction. 4.The
good veterinarian should be skilled in the
former, but have recourse to the latter and
should use both techniquesat appropriate time.
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Do not ask me about what had happened
Never go to a crazy vet.