Fetotomy in bovines by Dr Dushyant Yadav BASU, Patna INDIA

Fetotomy in bovines by Dr Dushyant Yadav BASU, Patna INDIA
in Anterior and Posterior Presentation

1. FETOTOMY
Prepared by-
Dr DushyantYadav
Assistant Professor cumJr. Scientist
Department of Livestock Farm Complex (VGO)
Bihar Veterinary College, BASU, Patna-800014
Prepared by Dr Dushyant Yadav

2. Fetotomy
Definition:-
“Fetotomy(originallyreferredtoasembryotomy)is
sectioningofafetusintotwoormorepartswithinthe
uterusandvaginatoreducethesizesuchthatdelivery
throughthebirthcanalbecomespossible”
Types:-
➢OntheBasisofDivisonofFetus---
❑Partial-dividingthepartsoffetus
❑Total-dividingthewholefetus
➢OntheBasisofMethodInvolved---
❑Subcutaneousfetotomy-amputationoffetalpartsbelowtheskin
❑Percutaneousfetotomy-amputationoffetalpartsencludingskin
Prepared by Dr Dushyant Yadav

3. Fig:SubcutaneousfetotomyA-incisionontheskinfromfetlocktoscapularcartilage,
B-Dissectionofskinfromunderlyingtissues,C-Amputationofextendedlimb
Fig:Percutaneousfetotomy;noneedtoanyincisionontheskinPrepared by Dr Dushyant Yadav

4. Advantages of fetotomy
✓Itreducesthesizeoffetus
✓Avoidcesareansection
✓Requirelittleassistance
✓Preventthetraumacausedbyexcessivetractionetc.
Disadvantages of fetotomy
✓Causesinjuriesorlacerationofuterusorbirthcanalbyinstrumentor
sharpedgeofbone
✓Exhaustiontodamandoperators
✓Pressurenecrosisofbirthcanal
✓Possibilitiesofinfectionwhendelayedcasesetc.
Prepared by Dr Dushyant Yadav

5. Equipments/Instruments
UsedinSubcutaneousFetotomy-
oKnife-
▪Canceledknife,Stalfer’sknife,Hallurckringknife,Colepatternguarded
knife,Robert’sknife
oAirInsufflator
oKaller’sSemisharpSpatulaetc.
UsedinSubcutaneousFetotomy-
oKnife
oBenischfetotome
oThygesen’sdoublebarrelfetotome
oThreaderandbrush
oWireSaw
oSnare
oWiresawhandles
oKreyhook-AKreyhookwithanobstetricchainorrope
oSawwireintroduceretc.
Prepared by Dr Dushyant Yadav

6. Fig:A-Robert’sguardedknife,B-Unsworth’sguardedknife,C-Kaller’sSpatulla,
D-Persson’schainsaw,E-Fetotomywireintroducer,F-Mutifilamentfetotome
wire,G-ModifiedThygesen’sfetotome,H-Fetotomewirehandgrips,J-Shriever’s
wireintroducer,K-Gattli’sspiraltubes(usedtoprotectthewiresaw)
Prepared by Dr Dushyant Yadav

7. Fig:Frombottomleftinclockwisedirection-Kreyhook
withattachedrope,Utrechtfetatomewithwirethreader
insertedthroughonebarrel,calvingchains,arolloffetotomy
wire,fetotomyhandles,andpliers
Prepared by Dr Dushyant Yadav

8. Indications for Fetotomy
✓Feto-pelvicdisproportion
✓Pathologicenlargementofthefetus(fetalgigantism)
✓Incompletecervicaldilatation
✓Fetalmal-postureandmal-presentation
✓Fetalmalformations(likemonster)etc.
Note:
❑Fetotomyisnotusefulwhenthebirthcanalisobstructedor
reducedinsize Prepared by Dr Dushyant Yadav

9. General Considerations/Pre-requisits
➢Instruments should be properly sterilized
➢Fetus should be dead (sacrificed only when dam is very high quality)
➢Perinealregion of dam should be cleaned properly with PP solution
➢Birth canal should be well dilated to introduce the fetotomeand operators
hand
➢Birth canal should be free from laceration
➢Restraint-StandingorLateralrecumbency
➢Anesthesia-Epiduralanesthesia(withlocalanaestheticagents)
➢Lubrication-PlentyoflubricantgenerallyPetroleum-basedwater
solublelubricants
➢Assistance-Atleastoneandpreferablytwoassistants.Iftwo;one
maintainspositionoffetotomeandotheronthesawingPrepared by Dr Dushyant Yadav

10. Precautions During Fetotomy
✓Properlubricationisnecessaryuptotheendofoperation
✓Knifeshouldbeusedcarefully
✓Sawingshouldbestartedafterfinalcheckingoffetotome
position
✓Wiresawshouldnotcrossedtoeachother
✓Sawingshouldbeginwithslow,shortstrokes,withonlylight
pressureonthewire
✓Afterthewireisseatedbeneaththefetalskin,strokesofthe
wirecanbelengthenedandheavierpressureapplied
✓Tensiononthesawwireshouldnotberelaxedduringthe
cuttingprocedure,becausethesawwiremaytangleandbreak
✓Changetheoperatorwhenfirstgettiredetc.
Prepared by Dr Dushyant Yadav

11. FetotomyinAnteriorPresentation
❖RequiresamaximumofSix(sometimesseven)cuts-
1.Decapitation(Amputationofhead)
2.Amputationofforelimb(Rt/Lt)
3.Amputationofotherforelimb(Rt/Lt)
4.Transversedissectionoffetaltrunkatanteriorpartofchest
5.Transversedissectionoffetaltrunkatposteriorpartofchest
(atlumbarregion)
6.Longitudinaldissectionofhindquarter(pelvisbisection)
Prepared by Dr Dushyant Yadav

12. 1. Decapitation (Amputation of the Head)
➢Aloopofsawwireispassedovertheheadofthefetus
immediatelycaudaltotheears
➢Headofthefetotomeispositionedbetweenthe
mandiblesandcaudaltotheirposteriorbordersorcaudal
totheramusofthemandible
Prepared by Dr Dushyant Yadav

13. Fig: Amputation of Head (Positioning of the FetotomeHead and
Loop of Saw Wire)Prepared by Dr Dushyant Yadav

14. Fig: Amputation of Head (Positioning of the FetotomeHead and
Loop of Saw Wire) (Original Photographs*)Prepared by Dr Dushyant Yadav

15. 2 & 3. Amputation of the Forelimbs
➢Beforebeingamputated,theforelimbsmustbeextended
➢Distalportionofthelimbprotrudedfromthevulva
Procedure
➢Anobstetricchainisfirstfixedtothelimb
➢Chainispassedthroughtheloopofthewiresaw
➢Placedthesawwireloopbetweentheclawsoftheforefoot
totemporarilyanchorit
➢Passedthefetotomealongthelateralsurfaceofthelimb
untiltheheadoffetotomerestsnearthemiddleofthe
scapulaandmoveuptoposteriorborderofscapula
Prepared by Dr Dushyant Yadav

16. ➢Givemoderatetractiontoextendtheleg
➢Sawwireloopisremovedfromtheinterdigitalspace
➢Movetheloopofsawwireupthemedialsurfaceofthe
limbuntilitliesmedialtothescapulaintheaxillary
space
➢Applythetractionwithobstetricchaintofullyextendthe
limb
➢Coverstheheadofthefetatomewithahandandamputate
thelimb
➢Amputatethesecondforelimbinsimilarmanner
Prepared by Dr Dushyant Yadav

17. Fig: Amputation of Forelimb (Positioning of the FetotomeHead and
Loop of Saw Wire)
Fig:Obstetricchainattachedtothe
limbispassedthroughthewireloop
Fig:Temporarypositioningofthe
fetotomewirebetweentheclawsofforelimb
Prepared by Dr Dushyant Yadav

18. Fig: Amputation of Forelimb (Positioning of the FetotomeHead and
Loop of Saw Wire) (Original Photographs*)
Fig: Amputated one Forelimb (Original Photographs*)
Prepared by Dr Dushyant Yadav

19. 4. Transverse Dissection of Fetal Trunk at
Anterior Part of Chest
➢FirstlyKreyhookisfixedtotheexposedcervicalvertebrae
➢Headoffetotomeplacedbehindtheposteriorborderof
scapula
➢Loopofsawwirepassedalongthedorsolateralsurfaceof
thefetalchestnearthescapularattachment
➢ChainfromtheKreyHookisthenanchoredtothefetotome
➢Fetotomemotioncanbeminimizedbypushingthe
fetotomeagainstthefetus
Prepared by Dr Dushyant Yadav

20. Fig:TransverseDissectionofFetalTrunkatAnteriorPartofChest
Prepared by Dr Dushyant Yadav

21. 5. Transverse Dissection of Fetal Trunk at
Posterior Part of Chest (at Lumbar Region)
➢Kreyhookisanchoredtothethoracicvertebrae
➢Headofthefetotomeispositionedonthedorsolateral
surfaceofthefetusimmediatelycaudaltothelastrib
➢Sawwireloopisatrightanglestothefetotomearound
theabdomen
Prepared by Dr Dushyant Yadav

22. Fig:TransverseDissectionofFetalTrunkatposteriorPartofChest
(atlumbarregion)
Prepared by Dr Dushyant Yadav

23. Fig:TransverseDissectionofFetalTrunkatPosteriorPartofChest
(atlumbarregion)(Originalphotograph*)
Prepared by Dr Dushyant Yadav

24. 6. Longitudinal Dissection of Hind Quarter
(Pelvis Bisection)
➢Itisfinallongitudinaldivisionofthefetusseparatesthe
hindquarters
➢Usinganintroducer,thesawwireispassedoverthe
dorsalaspectofthepelvisandtheintroducerretrieved
betweenthehindlimbs
➢Headofthefetotomeplacedanteriortolumbarvertebra
➢WireSawbetweenthetailandtuberischii(pinbone)
Prepared by Dr Dushyant Yadav

25. Fig: Pelvis Bisection
Fig: Pelvis Bisection
(Original Photograph*)
Prepared by Dr Dushyant Yadav

26. FetotomyinPosteriorPresentation
Itincludes:-
1.AmputationoftheHindlimb
2.SamefortheotherHindlimb
3.Transversedissectionofthefetaltrunkatthelumbarregion
(posteriorchest)
4.Transversedissectionofthefetaltrunkatthescapularregion
(anteriorchest)
5.Diagonallongitudinaldivisionoftheforepartsofthefetus
Prepared by Dr Dushyant Yadav

27. 1 & 2. Amputation of the Hind limbs
Procedure:-
➢Anobstetricchainisattachedtothelimbtobeamputated
➢Passedthechainthroughtheloopofsawwire
➢Anchoredthewirelooptemporarilybetweentheclaws
➢Introducethefetotomealongthelateralsurfaceofthelimbandmove
untilltheheadoffetotomerestsintheareaofthegreatertrochanterof
thefemur
➢Movethesawwireupthemedialsurfaceofthelimbuntilitliesmedial
andcranialtothestiflejoint(betweentuberischiiandtailhead)
➢Givethetractiononthechaintoextendallthejoints
➢AmputatedthelimbandSecondlimbcanbeamputatedsimilarly
Prepared by Dr Dushyant Yadav

28. Fig:AmputationofHindlimbinPosteriorPresentation(Acuteangle)
Fig:AmputationofSecondHind
limbinPosteriorPresentation
Fig:AmputationofSecondHindlimb
andCalf’sPelvisinPosterior
PresentationPrepared by Dr Dushyant Yadav

29. 3. Transverse dissection of the fetal trunk
at the lumbar region (posterior chest)
▪Headoffetotomeplacedjustcaudaltothelastrib
▪WireSawloopisplacedataroundthetrunkatrightangleto
fetotome
▪PelvisissecuredwithKreyhook
4. Transverse dissection of the fetal trunk
at the scapular region (anterior chest)
▪Positionoffetotomeheadonthedorsolateralsurfaceofthefetus
immediatelycaudaltothescapulae
▪Sawwireloopisthenpositionedaroundthechestatrightangle
tofetotome
Prepared by Dr Dushyant Yadav

30. Fig:Transversedissectionoffetaltrunkinposteriorpresentation
Prepared by Dr Dushyant Yadav

31. 5. Diagonal longitudinal division of the
foreparts of the fetus
▪Amputationofeachforelimbseparatelyorbydiagonal
divisionoftheforepart
▪Headoffetotomeispositionedatposteriortoscapular
attachmentofoppositelimb
▪Sawwirepassdorsallyoverfetus,guideventrallybelow
theforelimbinvolvingthebaseofneckandretrieveon
oppositesideoflimbsothatventrallypartofwirefaces
mediallytoelbowjoint
Prepared by Dr Dushyant Yadav

32. Fig:DiagonalBisectionofForequartersinposteriorpresentation
Prepared by Dr Dushyant Yadav

33. Modified Fetotomy
“AmodificationoftheUtrechtmethod(common)forcomplete
fetotomyhasbeendescribedthatreducesthenumberofcuts
requiredbutapplicableonlywhenthefetusisnotexcessively
oversized”
CranialPresentation
oTheheadoffetusisfirstamputatedbyencirclingtheneckwiththesaw
wire
oHeadoffetotomepositionedsimilartonormalfetotomybut,sawwireis
positionedbetweenthestumpoftheneckandtheoppositeforelimb
oResultsintoamputationofoneforelimb,theneck,andaportionofthe
thoraxwhichpermitseviscerationofthethoracicandabdominalcavities
oTractionontheremainingforelimbisthencontinueduntildeliveryis
complete
oIfnecessary,thefetalpelvisissectioned
Prepared by Dr Dushyant Yadav

34. CaudalPresentation
oFirsthindlimbisamputatedasinnormalfetotomy
oTheneviscerationisdonetoreducethesizeoffetus
oIfnotreducedsufficiently,atransversecutismadethrough
thethoraxcaudaltothescapula
oAfinalcutismadeobliquelythroughtheremaining
forepartofthefetus-
oOnesectioniscomposedofaforelimbandmostofthethorax
and
ootheriscomposedofthehead,neck,andremainingforelimb
Prepared by Dr Dushyant Yadav

35. Fig:Transversedissectionthrough
trunkafteramputationof
head/neckandrightforelimb
Fig:Analternateapproachtoamputate
theleftforelimbandneck
followingamputationofthehead
Prepared by Dr Dushyant Yadav

36. Fetotomyin Mal-positioning/
Abnormal of Fetus
Fig:PositionofFetotomeHeadandSawWireinCarpalFlexion
Fig:PositionofFetotomeHeadandSawWireinShoulderFlexion
Prepared by Dr Dushyant Yadav

37. Fig:PositionofFetotomeHead
andSawWireinLateral
DeviationofNeck
Fig:PositionofFetotomeHeadand
SawWireinBilateralHipFlexion
Fig:PositionofFetotomeHeadandSawWireinSchistosomaReflexusFetusPrepared by Dr Dushyant Yadav

38. Aftercare with Fetotomy
✓Uterusshouldberoutinelylavagedwithwarm(42°to45°C)
watertowhichisaddedasmallamountofanonirritating
disinfectant
✓Usetheecbolicagentsuchasoxytocinetc
✓Systemicantibiotics
✓Othersupportivetherapyetc.
Prepared by Dr Dushyant Yadav

39. THANK
YOU
Prepared by Dr Dushyant Yadav