Vol.1, No.2, 41-53 (2011)
doi:10.4236/ojas.2011.12006
C
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
Open Journal of Animal Sciences
Maternal dystocia in cows and buffaloes: a review
Govind Narayan Purohit*, Yogesh Barolia, Chandra Shekhar, Pramod Kumar
Department of Veterinary Obstetrics and Gynecology, College of Veterinary and Animal Science, Rajasthan University of Veterinary
and Animal Science, Bikaner Rajasthan, India; *Corresponding Author:
Received 20 April 2011; revised 3 May 2011; accepted 29 June 2011.
ABSTRACT
The maternal causes of dystocia in cattle and
buffaloes are analyzed. Uterine torsion appears
to be the most frequent maternal cause of dys-
tocia in buffaloes whereas improper cervical
dilation appears to be more frequent maternal
cause of dystocia in cattle. Failure of uterine
expulsive forces (Uterine Inertia) and neo-
plasm’s of vagina, vulva and uterus are com
monly seen in cows but less frequent in buffa-
loes. The various maternal causes of dy stocia in
cattle and buffaloes and their management are
described.
Keywords: Dystocia; Maternal; Uterine Torsion;
Inertia; Neoplasms
1. INTRODUCTION
Amongst all domestic animals, cattle and buffalo are
considered the species in which the incidence of dystocia
appears to be highest. Although cattle and buffaloes ap-
pear to be similar in the parturition process but subtle
differences are known to be existent in the anatomy and
physiology of the birth canal between cows and buffa-
loes. The anatomic differences in the pelvis [1] and geni-
tal structures have been described. The differences in the
pelvis between cow and buffalo include more capacious
pelvis, larger area of ilium and the free and easily sepa-
rable fifth sacral vertebra in the buffalo [1]. The differ-
ences in the genital structures include tightly downward
curled uterine horns, less conspicuous shorter and nar-
rower cervix, smaller and less tight vagina and elongated
and wide apart vulvar lips in the buffalo [2].
Physiologic differences between cattle and buffalo
pregnancy and parturition include a longer gestation
period in the buffalo (305 to 320 days for the river
and 320 to 340 days for the swamp buffalo [3], com-
pared to 280 days in cattle [2], lesser time required for
completion of first and second stages of labor[1,4,5]
(70 and 20 minutes in buffalo compared to 2 to 6 and
0.5 - 1 hours in cows), a preponderance for parturition
during night hours [6], and an absence of physiologi-
cal cervical hypertrophy with consecutive calvings in
the buffalo [2].
All the above differences between cows and buffa-
loes point out that the parturition process is much
easier in the river buffalo compared to cows and
therefore, Jainudeen [3], considers that dystocia is not
a serious problem in the water buffalo. The incidence
of dystocia is considered to be higher in river than in
swamp buffalo (in which it has not been described)
and also in primipara than in pleuripara [3] however, a
few studies consider higher incidence of dystocia in
pleuriparous buffaloes [7]. In cows the incidence of
dystocia is higher compared to that in heifers [8-10].
1.1. Causes of Dystocia in Cows and Buf-
faloes
The causes of dystocia are generally classified into
the maternal and fetal causes [11-14]. Buffaloes are
known to have greater incidence of maternal dystocia
[15,16], however, in many other studies; a higher in-
cidence of fetal dystocia was recorded [7,17-19].
In the authors’ experience buffalo generally have
fewer problems in dilation of the birth canal com-
pared to cattle and there is a greater incidence of
uterine torsion in buffaloes. The incidence of fetal
monstrosities is higher in the buffalo.
1.2. Maternal Causes of Dystocia
The maternal causes of dystocia are considered to be
arising either because of the constriction/obstruction of
the birth canal or due to a deficiency of the maternal
expulsive force [13,14,20-22]. Each of the cause is de-
scribed in detail.
2. CONSTRICTION/OBSTRUCTION OF
THE BIRTH CANAL
The constriction/obstruction of the birth canal can
result in maternal dystocia and can be due to pelvic

G. N. Purohit et al. / Open Jour nal of Animal Sciences 1 (2011) 41-53
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42
abnormalities, vulvar or vaginal stenosis, neoplasms
of the vagina and vulva, vaginal cystocoele, incom-
plete cervical dilation, uterine torsion and ventral dis-
placement of the uterus. An uncommon cause of con-
striction of birth canal is carcinoma of urinary bladder
[23,24] with metastasis in cervix.
2.1. Pelvic Abnormalities
Pelvic abnormalities of the mother that can result in
dystocia include small size of the pelvis [13], pelvic
deformities or exostoses [11], osteomalacia and hy-
poplasia of vagina and vulva [1].
Breeding of heifers at too young an age, breeding of
poorly grown heifers, or breeding of heifers and cows
that had pelvic fractures can result in a smaller pelvis of
the mother culminating in dystocia at parturition.
Breeding of small sized breeds of cattle or buffaloes
with breeds of larger size can result in fetuses of bigger
size being obstructed at the small sized pelvis of the
mother.
Rarely, the cause of small bony pelvis is sacral luxa-
tion or displacement [13]. Other causes described in-
clude twins and intra pelvic hemorrhage [20]. However,
pelvic fractures and exostoses are considered to be un-
common as a cause of dystocia in large animals [11]. An
inadequate sized pelvis is a frequent cause of dystocia in
the bovine primipara [14,21]. Narrow pelvis is known to
be a cause of dystocia in the buffalo [25]. The incidence
of narrow pelvis has been recorded to be 7.79 percent
[7].
2.1.1. Incidence
The incidence of pelvic deformities as a cause of dys-
tocia in buffaloes is described to be 1.2 percent [26]. In
cows and buffaloes, the incidence of narrow pelvis is
known to be 9.2 percent [18].
2.1.2. Clinical Signs
Usually, there is a lack of progress in the second stage
of labor. If the fetus is able to enter the pelvis partially,
severe non-progressive straining occurs. If the fetus is
too large, then there is no progress in delivery subse-
quent to first stage of labor. Vaginal examination must be
done to compare the fetal and pelvic size. Any previous
fractures can be ascertained by the presence of calluses.
2.1.3. Management of Dystocia
If by palpation, it is felt that the fetus can pass
through the birth canal with assistance, traction must
be applied on the fetus after plenty of lubrication.
However, excessive traction in a narrow birth canal is
not advisable. It is better to opt for a caesarean section
if the birth canal is too narrow, or it is coupled with
fetal postural abnormality.
2.2. Vulvar or Vaginal
Stesis/Stricture/Rupture
Formation of scar tissue due to injuries sustained at
previous calving in aged animals [13], improper relaxa-
tion during parturition, congenital stenosis of the vagina
[13], vaginal obstruction by fibrous bands [27,28],
perivaginal abscess or cysts can occlude the genital pas-
sage and hinder with the delivery of the fetus. Dystocia
due to an infantile vulva has been recorded in a Jersey
heifer [29]. In the authors experience improper relaxa-
tion of the vulva/vagina is less common in the buffalo
[21]. Fetal parts may get stuck up in a ruptured vagina
and result in dystocia [30], or the gravid horn may some-
times prolapse through the vaginal rupture [31]. Post
partum vaginal ruptures can sometimes result in prolapse
of abdominal organs [32].
2.2.1. Clinical Signs
Improper vulvar relaxation may be evident clinically
and there may be difficulty sometimes in inserting the
lubricated hand into the birth canal. The vulva may have
a hard consistency in some cows; however, due to the
anatomic structure vulvar relaxation is less a problem in
the buffalo.
Improper vaginal relaxation is evident on internal
examination of the vagina. Perivaginal abscesses or
haematoma may be palpable as soft or firm fluctuating
masses pressing the vaginal walls inwardly. Vaginal
ruptures can be located by careful palpation.
2.2.2. Management of Dystocia
The usual management of a constricted vulva sug-
gested is gentle manipulation with or without an episi-
otomy cut, about one third down the lateral wall of the
vulva through the skin mucosa junction [33]. Surgical
correction of the vaginal stricture has been suggested
[34].
Mucosal folds in the vagina caudal to cervix obstruct-
ing the passage of fetus can be broken manually. Creams
containing prostaglandins E2 are in common practice in
medical obstetrics and can be tried in functional
non-dilation however, in large sized perivaginal ab-
scesses or hematomas, it is a wise decision to opt for a
caesarean section rather then to apply undue traction.
The fetus must be delivered by traction in the presence
of vaginal ruptures which must then be sutured. Like-
wise, the prolapsed part must be replaced and the vagina
sutured in mid gestation vaginal ruptures.
2.3. Neoplasms of Vagina, Vulva, Uterus

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4343
Tumours of the vulva, commonly seen in cows in-
clude papillomata, sarcomata, fibroma and squamous
cell carcinoma [35,36]. Cryosurgery of squamous cell
carcinoma of vulva has been suggested. Submucus
vaginal tumours are uncommon in cattle and buffaloes,
however, leiomyomas [37,13], sqamous cell carcinoma
[38,13], perivaginal granuloma [39], lipoma [40], fi-
broma [38] and fibroleiomyoma of vagina [41], have
been reported but seldom seen clinically during dystocia.
Tumours of the cervix include fibroma [42-45], ademona
[46] fibro leiomyoma [47-49] and squamous cell carci-
noma [50] or nebothean cyst [51]. Carcinoma of the cer-
vix has been recorded in the buffalo [23,24]. The tumor
masses in cervix and vagina seldom obstruct the birth
canal and are usually noticed subsequent to parturition
when they prolapse out. Tumours of the uterus are re-
corded from genitalia usually obtained post slaughter
and include adenoma [52], lipoma [52] and fibroma [38]
or polyps [53] noticed subsequent to calving. When no-
ticed clinically, they either prevent a pregnancy or cul-
minate in abortion [54]. The incidence of uterine tu-
mours in the buffaloes is known to vary from 0.3 to 0.7
percent [55].
2.4. Vaginal Cystocoele
Vaginal cystocoele has been described to be occurring
in the mare and cow [56,57] and also in the buffalo [58]
and can result in dystocia. The condition involves the
protruding of the urinary bladder either through the
aversion of the organ through the urethra [56] or
prolapse through a rupture on the vaginal floor [32].
Prolapse through a rupture on the vaginal floor is more
likely in the cow and buffalo. Since the prolapsed blad-
der may obstruct the birth canal it is suggested to iden-
tify the organ and replace it back after repelling the parts
of the fetus under epidural anaesthesia and ample lubri-
cation. The vaginal rupture must be sutured after re-
placement of the urinary bladder. The fetus can then be
delivered.
2.5. Incomplete Cervical Dilation
The dilation of the cervix at the time of delivery of
fetus is essential for the easy passage of the fetus. A wide
variety of changes in the hormonal milieu [59,18] enzy-
matic loosening of fibrous strands by elevated colla-
genase [60] and the physical forces of the uterine con-
tractions and fetal mass are considered to be responsible
to effect sufficient dilatation of the cervix during parturi-
tion in the cow [61] and buffalo [62,63]. An activation of
inflammatory network is considered to play an important
role in the progress of cervical dilation [64)]. An in-
crease in inflammatory cytokines during parturition is
known to effect dilation [65] as is the interplay of hor-
mones. In buffaloes, however, cervical non-dilation is
rare. Only sporadic cases have been reported [66]. Ani-
mals with delivery problems associated with the cervix
are those that had already delivered many calves [67].
Cervical non-dilation can occur because of the failure of
any of the mechanisms responsible for dilation described
above or spasm of the cervical muscles [3] or some other
poorly understood mechanisms and results in dystocia.
2.5.1. Incidence
The incidence of cervical dystocia was seen to be
from 11.1 to 16.7 percent [67] in cows. The collective
incidence of incomplete cervical dilation in cattle and
buffaloes is described to be 5.1 percent [18].
2.5.2. Clinical Signs
When the cervix is fully dilated, it is not palpable as a
separate structure and is continuous with the vagina.
Incompletely dilated or undilated cervix is palpable
through per rectum examination. By examination per
vaginum only a finger or two can be inserted in a par-
tially dilated cervix. Parts of fetus or the water bags can
sometimes be palpated at the cervix.
2.5.3. Management of Dystocia
Attempts can be made to dilate the cervix manually if
possible using sponge tents and local anesthetics [1], but
because the cervix has many annular rings it is often not
possible to dilate the bovine cervix manually. If the fetus
is present in the birth canal gentle traction over long pe-
riods can sometimes dilate the cervix, but excessive trac-
tion is not advisable. It sometimes happens that a mald-
isposed fetus present in a previously dilated birth canal
becomes tightly impacted because of continued uterine
contractions without fetal delivery. An obstetrician must
differentiate such a case from incomplete cervical dila-
tion. If the cervix remains closed, the fetus is live and its
fetal membranes are intact, it is suggested to wait for 30
minutes to allow time for natural dilation.
A deficiency of estrogen is considered to be one im-
portant cause of failure of cervical dilation [68], hence,
injection of estrogens like estradiol valerate 20 - 30 mg
im can be helpful, however, estrogen should be given
with care in a completely closed cervix because of the
dangers of uterine rupture that may follow because of
violent contractions. Likewise, injections of oxytocin 20
- 40 IU, iv or im can be given to promote uterine con-
traction to effect cervical dilation when it is partially
dilated. When the legs of a putrefied dead, fetus are pre-
sent in the birth canal and the fetus cannot come out be-
cause of incompletely dilated cervix, the authors suggest

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44
partial cervicotomy instead of a cesarean. One or two
cuts applied on the cervix are usually sufficient to de-
liver the calf. In the authors experience potent analgesics
like valethamate bromide (Inj. Epidosin TTK Pharma,
India) at the dose rate of up to 500 mg im or iv is of lim-
ited value in dilating a closed bovine cervix at term. β2
adrenergic drugs like isoxsuprine at doses of 200 - 300 mg
iv or 0.3 mg iv clenbuterol have been suggested to relax
the entire genital tract including the cervix but may not
be always helpful because of the complex mechanism
that is responsible for cervical dilation which largely
remains poorly understood. Moreover, the β2 adrenergic
drugs would reduce uterine contractions and hence delay
parturition. Caesarean section appears to be the best re-
sort when all attempts at cervical dilation have failed.
Use of relaxin as a cervical ripening agent and its use for
inducing labor in human subjects still remain unclear [69]
and hence, its use in animal therapy is out of question
because of the high cost.
2.6. Uterine Torsion
Torsion of uterus usually occurs in a pregnant uterine
horn and is defined as the twisting of the uterus on its
longitudinal axis [58]. The pregnant uterus rotates about
its long axis, with the point of torsion being the anterior
vagina just caudal to the cervix [13] (post cervical tor-
sion). Less commonly the point of torsion is cranial to
the cervix [13] (pre-cervical torsion). Uterine torsion
during pregnancy [70,71], at parturition [72-75], or
post-partum [66,67] is one of the complicated cause of
maternal dystocia both in cows and buffaloes culminat-
ing in death of both the fetus and the dam if not treated
early. There exists a difference of opinion as to the fre-
quent side of uterine torsion in cows. While Arthur et al.
1996 and few other workers concluded that the side of
torsion is generally left side in cows, a few reports
[78,79] and the authors are of the view that because of
presence of rumen on the left side, the side of torsion
should usually be the right side in cows. For buffaloes,
right sided torsion is mostly reported [62,80-82]. It is
probable that pregnancies occurring in the left horn may
be rotating towards the left side especially when rumen
is partially filled. The degree of torsion is generally 90˚
to 180˚ although it can occur up to 360˚ or even more.
Torsions up to 540˚ [75] or 760˚ [83] have been recorded.
Because of the rapidity of fetal death that ensues fol-
lowing torsion and the uterine adhesions with visceral
organs that develop, uterine torsion must be considered
an emergency. Torsion has been reported from a cow
with didelphic uterus [84,85] and along with uterine
prolapse [86]. Torsion can result into haemoperitoenum
if it results from horn butting between animals [87]. A
rare case of uterine torsion in a buffalo carrying twin
fetus has been reported [88].
2.6.1. Incidence
The incidence of uterine torsion is considered to be
higher in buffaloes compared to cows. The reasons for
such a discrepancy are poorly explained. Uterine torsion
is considered to be the single largest condition contrib-
uting to dystocia in buffaloes with incidence as high as
56% to 67% [25,81,89] and up to 70% [16]. Uterine tor-
sion has been reported mostly in dairy type buffaloes of
India, Pakistan [90] and Egypt [91,92], but reports on its
occurrence in the swamp buffalo are not seen. In the
authors experience uterine torsion is predominantly seen
in dairy cows and dairy buffaloes [81]. In cows the inci-
dence is comparatively lower although at various loca-
tions it is known to vary between 7% to 30% [92-94].
The incidence is known to be higher in pleuriparous cows
[72,75,79] and buffaloes [25,75,94,95] with maximum
frequency during second and third calvings [96,62].
Although a seasonal incidence [25,80] has been de-
scribed in buffaloes but it appears to be because of
higher calvings during that season. The usual age (years)
of animals that suffer from uterine torsion is 4 - 12 for
buffaloes and 5 - 7 for cows [72]. The incidence is
known to be more in cows maintained on mountainous
areas [97].
2.6.2. Etiology
The exact etiology of uterine torsion is poorly under
stood. It appears that instability of the uterus during a
single horn pregnancy and inordinate fetal or dam
movements probably are the basic reasons for rotation of
the uterus on its own axis. The bovine amnion is fused at
many places to the surrounding allantois, which is at-
tached to the uterine wall [98]. Rotatory fetal move-
ments during the second stage of labour or late gestation
would rotate the uterus. The uterus lies on the abdominal
floor during mid and late gestation with no stabilizing
attachments. A large number of predisposing causes have
been described [58,103] for uterine torsion and include
anatomical factors, close confinement, hilly tracts, and
wallowing habits of the buffaloes and the lowering of
front legs by the animal first, when lying down. The
higher occurrence of the problem in buffaloes is hy-
pothesized to be because of a deep capacious and pen-
dulous abdomen of buffalo [97], inherently weaker mus-
cles of the broad ligaments [99,100] and the wallowing
habits of the buffalo [97]. However, daily forceful wal-
lowing of pregnant buffaloes failed to induce uterine
torsion in one study [101]. Some exciting causes for the
occurrence of uterine torsion have been described [58]
and include external injury, lack of exercise and irregular
movement of animals. Uterus didelphus has been de-

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4545
scribed as one of the cause of uterine torsion in the buf-
falo [97]. Slight rotations (below 90˚) are symptom less
clinically and may be corrected spontaneously but rota-
tions of higher degree usually do not detort spontane-
ously.
2.6.3. Nature of Uterine Torsion
A pregnant uterine horn may rotate at mid to late ges-
tation, at normal parturition time, or sometimes post
partum. The horn may rotate to its right (clock-wise) or
left side (anti-clockwise) with degree of rotation from
90˚ to 720˚. The point of rotation can be caudal to the
cervix (post cervical) [102] or just cranial to the cervix
(pre-cervical). The percentage of frequencies of the na-
ture of torsion in terms of its relation with gestation, side
of torsion, point of rotation and degree of rotation re-
ported in some of reports are mentioned in Table 1. It is
clear that uterine torsion generally occurs at parturition
in cows and buffaloes, on the right side of the abdomen
at a point just caudal to cervix and usually rotates to
180˚ or more from its axis.
2.6.4. Clinical Signs
The usual clinical signs are the onset of labor without
delivery of fetus and/or fetal membranes [13] and later
regression of parturition signs [25]. The cow may show
signs of mild discomfort. The animal may adopt a rock-
ing horse stance [13,103] and show mild colic pain. Par-
tial anorexia, dullness and depression may be evident
[94]. Restlessness and arching of back and colic may be
seen in buffaloes [71]. One or both lips of the vulva are
pulled in because of torsion of the birth canal. Vaginal
examination reveals twisting of the vaginal mucous
membranes and the hand cannot be passed deeper into
the anterior vagina which has a conical end in torsion
with a degree of 180˚ or more. In lesser degree torsions
however, the fetus can be sometimes felt. The direction
of the vaginal fold twisting shows the direction of tor-
sion. On rectal examination, the twisted horn can be felt
and the broad ligament on the side of torsion is rotated
downwards sometimes palpable under the uterus and the
ligament on the opposite side is tense and stretched and
crossing to the opposite side. The positive diagnosis of
uterine torsion should thus, be based on the location of
broad ligaments palpated per rectum. Animals at many
locations may be presented to the obstetrician after
varying times since the first onset of labour; hence, the
clinical signs of shock, toxaemia may be evident de-
pending upon the severity of torsion, previous handling,
death of fetus and post-torsion complications. Clinical
studies on the hematology and blood biochemistry of
torsion affected buffaloes have shown marginal differ-
ences [105,106].
2.6.5. Management of Dystocia
Cases of uterine torsion must be considered an emer-
gency and therapy must be instituted early. It is impera-
tive to precisely evaluate the patient for the general con-
dition before any handling efforts. The patient must be
evaluated for presence of toxaemia and shock as cases
presented to the obstetrician after 36 hours are likely to
have one or more of these conditions. The authors sug-
gest infusion of plenty of fluid therapy along with corti-
costeroids and antibiotics whenever necessary to combat
toxaemia and shock before handling of cases presented
beyond 36 hours of delay. It is also usual to assess the
type of previous handling or therapies provided includ-
ing previous rolling given. Cases presented beyond 36 -
72 hours are likely to have plenty of toxaemia set in,
fetal death coupled with loss of fluid and uterine inertia.
Table 1. Percent frequencies of the nature of torsion in cows and buffaloes.
Buffaloes Cows Reference
Age (Year) 4 - 12 5 - 7 72
1 - 5 2 - 3 72
Pleuriparous Pluriparous 103
1st-16% - 54
2nd-24% - 62
3rd & above-56%- 62
1st-31.9% - 62
2nd 20.5% - 54
No. of Calving
2nd-6th-79% - 108
Stage of gestation
18.0% - 62
2.0% - 39
2.63% - 103
16.52% 22.8% 72
Pre-term
5 - 60 days 2 - 5 days 72

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25.5% - 54
78% - 62
81.3% - 81
100% 100% 103
98% - 39
83.4% 77.20% 78
100% - 54
At parturition
100% - 92
Prolonged gestation 9.1% - 49
Post partum - 2 to 4 weeks post partum77
Nature of torsion
Side of torsion
94.0% - 54
Right 6.0% - 62
79 116
87.0% - 39
63.8% 100% 72
87.0% - 81
97.79% 82.26% 78
8.5% - 72
12.9% - 39
2.21% 17.14% 78
Left
- 75% 6
Place of torsion
8.5% - 72
19.82% - 103
- 27% 39
- 4.17 73
Pre cervical
50% - 108
18
63.8% 100% 72
100% 99% 103
95% - 81
94.8% - 62
95% - 54
50% - 108
Post cervical
92.86% - 49
Degree of torsion
8.06% - 81
90˚ 21.28% - 54
64.0% - 81
64.6% - 62
46.8% - 54
41.2% - 108
180˚
- 98˚ - 180˚ most common104
270˚ 20.9% - 81
6.4% 81
- 82% 73
19.15% - 54
360˚
38.2% - 108
540˚ 4.6% - 108
720˚ 6.1% - 108
Single case 83

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The incidence of uterine rupture is fairly high and there-
fore an examination should be made for this before
treatment. Rarely uterine torsion can result into problems
like jejunal incarceration [107].The histamine levels are
known to be high in buffaloes suffering from uterine
torsion [108], hence, antihistaminics should be given.
The management techniques in cows and buffaloes sug-
gested for detorting the rotated uterus include rotation of
the fetus and uterus per vaginum [13], rolling of the
animal, laparotomy with manual intra-abdominal ma
nipulation and laparohysterotomy [21].
The choice of the method to be adopted depends on
the nature and intensity of the torsion, the viability of the
fetus and the time lapse since dystocia onset.
Rotation of the fetus per vaginum is possible only in
mild degrees of torsion where the obstetricians hand can
touch the fetus and sufficient fluids are present in the
uterus [13]. The fetus is grasped by a bony prominence
such as elbow, sternum or thigh and swung from side to
side before being pushed right over in the opposite di-
rection of torsion. If both fetal limbs are palpable they
can be tied in the cuffs of caemmerer’s torsion fork or a
Kuenhs crutch and an assistant can rotate them. If the
manipulation is successful, the torsion will disappear and
the vaginal folds will regain normal shape and the fetus
can be delivered with little difficulty. However, suffi-
cient lubrication must be available in the birth canal and
uterus before attempts at rotating the fetus are made us-
ing instruments. When sufficient time has passed since
the onset of such a problem, the uterus will tightly con-
tract around the fetus and detortion with this method is
not possible.
Rolling the cow or buffalo utilizes the principle to roll
the animal around its uterus while the uterus remains
static. It is one of the oldest and simple methods to re-
lieve uterine torsion in cows and buffaloes. The animal
must be rolled preferably on grass with its head lower
than the rear quarters. Vicious animals must be given a
sedative. The animal is laid down in lateral recumbency
on the same side to which the torsion is directed. The
two hind legs are tied together by a rope. Both the fore
legs are also tied together using a separate rope. The
animal is rolled suddenly in the same direction as the
torsion of the uterus to the other side. The rapidly rotat-
ing body of the cow/buffalo overtakes the more slowly
rotating gravid uterus. After the animal has been rolled
to 180˚ her body must be brought back to the original
position slowly so that she can be rolled once again. Af-
ter two rolling, the birth canal should be examined to
determine whether the torsion is corrected or not. If cor-
rected properly, the spiral folds and stenosis of the birth
canal would disappear and if the cervix is dilated, the
fetus can be palpated with ease. Plenty of blood stained
fluid comes out of the birth canal if the cervix is open
and this is sufficient evidence of torsion correction. If
the torsion is not corrected, the rolling procedure should
be repeated 3 or 4 times. If after 4 attempts, the torsion is
not corrected, then other procedures for correction of
torsion must be considered as uterine rupture can result
due to violent rollings [109,110]. Although, torsion may
be corrected by rolling in patients of not more than 36
hours duration, the potential dangers of uterine rupture
with continuous rolling must always be kept in mind. If
the vaginal folds are increasing after a rolling, the rolling
must be done on the opposite side. Sometimes, after the
correction of torsion, it may take 12 hours or more for
the cervix to dilate and hence one should not take rapid
action of removing the fetus after torsion correction
without proper cervical dilation. Prostaglandin injections
are suggested subsequent to torsion correction if the cer-
vix is not dilated. Fetuses are delivered 12 - 24 h later in
such cases.
A modification of the rolling technique called
Schaffer’s method, has been described by Arthur, [111]
and recommended widely [58,79] for detorsion of uterus
in cows and buffaloes. In this method, a slightly flexible
wooden plank of 9 to 12 feet long and 8 to 12 inches
wide is placed on the recumbent cows flank with the
lower end of the plank on the ground. An assistant stands
on the plank while the cow/buffalo is slowly turned over
by pulling the ropes. A slight modification of this
method has been suggested for the buffalo [112]. The
advantages of this technique are that the plank fixes the
uterus while the cow’s body is turned and that, because
the cow/buffalo is turned slowly less assistance is re-
quired and it is easier for the veterinary surgeon to check
the correct direction of the rolling by vaginal palpation
[21]. Usually, the first rolling is successful [14]. Similar
methods have been used with varying degrees of success
in the buffalo [74,75,95]. It is considered that since buf-
faloes have a capacious abdomen more pressure is re-
quired on the free end of the plank that is being modu-
lated by an assistant resulting in better detorsion com-
pared to the Schaffer’s method [113].
The number of turns required in buffaloes are more
(2.5) compared to cattle (1.0) [95] and vaginal delivery
takes a longer time after detorsion. Buffaloes with fully
dilated cervix at detorsion had maximum survival [89,75]
and detorsion failure occurs in 20% of the cases [66]. In
the authors experience, detorsion failure is common in
cases presented beyond 36 hours of delay and in animals

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Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
48
where dead emphysematous fetus is present or uterine
adhesions or uterine rupture is present. Similar views
have been expressed by other workers [114,115]. It is
known that detorsion is difficult in the presence of a
dead fetus [78]. Myometrial degeneration and endo-
metrial damage is more in cases of uterine torsion that
are delayed for treatment [116].
Laparotomy with manual intraabdominal detorsion is
suggested in cases of torsion during mid or late gestation,
or when the cervix is closed [79]. The procedure de-
scribed involves laparotomy through the left or right
paralumbar fossa under paravertebral or local infiltration
anaesthesia in a standing lightly tranquilized animal. The
hand is passed between the uterus and abdominal wall or
rumen and uterus, the fetal extremity is grasped and by
rocking movements the uterus is lifted and detorted. The
fetus may be removed if it is dead. Otherwise, it is left
for completion of gestation. The abdominal would is
closed routinely.
Laparohysterotomy is suggested in cases of uterine
torsion that fail to be corrected by rolling or in long
standing cases where fetus is dead and uterine adhe-
sions/rupture are likely. The outcome of a caesarean
when the fetus is dead and emphysematous can be grave.
It is advisable to take care of the patient for the general
condition before deciding to operate. Caesarean is a
method of choice in cases presented with a closed cervix,
dead fetus with subsided symptoms of parturition [114].
It is better to administer plenty of fluid therapy, antibiot-
ics and corticosteroids before starting the operation.
Different operative sites for caesarean are suggested
including the right [84,114] or left flank, midline (on or
parallel to linea alba), horizontal incision above arcus
cruralis [25], or appropriate incision in the right [94] or
left lower flank [71,74,117] or an oblique ventrolateral
approach with the animal in right lateral recumbency
[21]. The authors and few other workers [95,118] con-
sider the left oblique ventro lateral approach with the
animal in right lateral recumbency as a better operative
site as it results into minimum post operative complica-
tions. The anesthesia usually required is mild sedation
with local infiltration. The anesthetic management of
cattle has been reviewed recently [119] and detomidine
is suggested as the drug of choice when sedation is
needed in pregnant cattle. An iv dose of 2.5 - 10µg/Kg
produces standing sedation for 30- 45 min [120]. Higher
dose (40 µg/Kg, iv) will produce profound sedation and
recumbency [16]. General anesthesia using xylazine (0.1
- 0.2 mg/kg im) can be given to cattle followed by keta-
mine (10-15 mg/kg im). Such anaesthesia lasts for 45
minutes and can be prolonged by use of additional keta-
mine (1 - 2 mg/kg iv). Inhalation anaesthesia with halo-
thane and isoflurane with tracheal intubations using
conventional human anaesthetic machines are sufficient
for animal’s upto 200 kg [119] and are now becoming
increasingly common for bovine anaesthesia because
cows seldom experience emergence delirium, with inha-
lation anesthetics.
During the laparohysterotomy, the uterus is brought to
the site of incision by holding a fetal extremity and in-
cised. The fetus is removed with due care. Because of
the fetal death and the consequent uterine adhesions that
develop in cases operated beyond 36 hours it is not many
times possible to detort the uterus before the removal of
the fetus. Rarely if the animal had uterine torsion, rup-
ture of uterus can occur subsequent to attempts at cor-
rection of torsion by rolling. Such ruptures must be
searched during the operation and if possible repaired.
If the tear is not within approach, the best option is to
inject 20 - 40 IU oxytocin within the uterine wall at 3 - 4
or more locations to contract the uterus. The abdominal
wound is closed routinely.
A few of other less commonly used methods, have
been described for correction of uterine torsion [57] in-
cluding suspension of the cow’s body, abdominal bal-
lotment, and stimulation of vigorous fetal movements.
If the cow’s hind parts are raised with her ventral ab-
dominal wall uppermost, gravity will cause the uterus to
fall back into its normal position [93]. The cow is raised
until its back forms an angle of atleast 45 degree with
the floor. However, the method appears to be difficult
and not used widely.
Abdominal ballottement [121] is performed with the
animal standing. Two assistants one on the right side
with clenched fist pushes downwards and inwards and
the other on the left pushes upwards and inwards low
down on the flank. The push is given alternatively each
at a rate of about one per second, so as to make the
uterus swing and being corrected because of the fetal
movements. The method however, appears to be work-
ing in fresh cases of uterine torsion of less than 180˚.
Likewise, stimulation of fetal movements by rectogenital
pressure on fetal parts can sometimes correct the uterine
torsion of smaller degree.
It is considered that abdominal ballotment is not pos-
sible in the buffalo due to a heavy abdominal muscula-
ture [97].
The major complications that can occur following
uterine torsion are fetal and maternal death [66], uterine
rupture, vaginal rupture [32,33] and poor fertility fol-
lowing correction of a long standing case of torsion.
Sometimes fatal peritonitis or expulsion of fetus in the
abdominal cavity from a uterine rupture is possible.
2.7. Downward (Ventral) Displacement of
the Uterus

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4949
Ventral displacement of the uterus is an uncommon
cause of dystocia in cows [13] and buffaloes [21]. It is
seen in animals with a ventral hernia or rupture of the
prepublic tendon where the pregnant uterus passes
downward into the point of the hernia.
2.7.1. Clinical Sings
If the herniation is large enough, a herniated uterus
can be recognized externally with ease. The uterus may
herniate on the left or the right side of the abdomen. Af-
fected animals have difficulty in lying down and getting
up. Large left side herniation of the uterus may be asso-
ciated with mild degree torsion of the uterus and would
displace the rumen cranially with resultant rumen func-
tion disorders. Herniations of a lesser degree result in a
first stage labor without fetal delivery. The birth canal
may be sometimes occluded.
2.7.2. Management of Dystocia
In mid gestation herniations, support must be given to
the abdominal floor by tying strong canvas around the
abdomen. Such pregnancies would continue to term with
support except, when the herniations are large sized. In
herniations at or around parturition, it is better to restrain
the animal in dorsal or lateral recumbency to assist the
delivery of the fetus because the fetus may be beyond
reach in a standing animal. An alternative is to raise the
abdominal floor using a wooden plank or a strong can-
vas held and lifted by two assistants. If vaginal delivery
is not possible, then caesarean section must be per-
formed. Further breeding from such animals should be
discouraged.
2.8. Carcinoma of Urinary Bladder
Carcinoma of the urinary bladder are extremely rare in
the bovine species The transitional type cell carcinoma
[85] seldom cause dystocia but result in dysuria, how-
ever, squamous cell carcinoma are associated with ex-
tensive fibrosis with metastasis in the wall of cervix,
vagina and perivaginal adipose tissue resulting in
marked constriction of the birth canal and dystocia.
Clinically hard polypoid growths are palpable over many
places in the birth canal. The affected animals show dy-
suria and futile efforts to deliver the fetus [32]. Attempts
to dilate the birth canal and deliver the fetuses by inject-
ing estrogens and oxytocin usually fail and fetus can be
delivered by caesarean section [32]. The dysuria contin-
ues even after fetal deliveries and animals usually die or
must be euthanized.
3. FAILURE OF THE EXPULSIVE
FORCES
Failure of expulsive forces could result because of the
failure of abdominal or uterine expulsive forces. The
condition where the uterine expulsive forces fail to de-
liver a fetus is known as uterine inertia. The uterus qui-
etens and the progression of the fetus out of the birth
canal does not follow because of lack of contractions in
the uterus. Uterine inertia is classified conventionally
into primary and secondary uterine inertia [13,14,93].
3.1. Primary Uterine Inertia
In this condition, although the cervical dilation occurs
and the fetus is in normal presentation, position and
posture but it is not delivered due to lack of uterine con-
tractions. The process of birth begins but do not continue
into second sage labor.
The most common cause of primary uterine inertia in
dairy cows [13] and buffaloes [122] is considered to be
hypocalcaemia, with the animal showing signs of milk
fever as calving is about to begin. Over distension of the
uterus because of dropsical fetal conditions, general de-
bility and environmental disturbances are other causes. A
few of the less common causes described [86] include
inherited weakness of uterine muscle, toxic infections,
myometrial degeneration, senility and nervousness. The
incidence of uterine inertia is known to be 5.9 percent
[7].
Therapy for dystocia management includes intrave-
nous therapy with calcium borogluconate and 15 - 20 I.U
of oxytocin IM or IV. When the cause is calcium defi-
ciency animals will respond favorably and parturition
process would begin. The fetus can be delivered after
some time spontaneously or with little assistance. An
injection of oxytocin must be given after removal of
fetus to aid in uterine involution and placental expulsion.
3.2. Secondary Uterine Inertia
Secondary uterine inertia occurs due to exhaustion as
a result of dystocia [14]. When the uterine musculature
becomes exhausted subsequent to failure of delivery of a
maldisposed or oversized fetus or due to obstruction in
the birth canal, then the condition is known as secondary
uterine inertia. The contractions in the uterus then stop
or become weak and transient. The animal shows no
progress in parturition after the second stage of labor.
The fetal membranes are ruptured and the cervix dilated.
If dystocia is prolonged without fetal delivery, the fetal
fluids are expelled out and the uterus contracts tightly
around the fetus. It is necessary to correct the primary
cause of dystocia and deliver the fetus. Doses of oxyto-
cin must be given after fetal delivery to regain uterine
contractility. Secondary uterine inertia invariably results
in retention of the placenta.

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50
3.3. Uterine Rupture
Rupture of the uterine wall can occur as a result of ac-
cidental traumatic injuries, the presence of some weak
points [13], or subsequent to severe uterine torsion, both
in cows [123,124] and buffaloes [67,114, 125]. Uterine
rupture is considered the result rather than the cause of
dystocia [126] the predisposing causes being uterine tor-
sion, breech presentation and abnormal fetal movement.
Small tears are insignificant and the fetus may be deliv-
ered without much difficulty. Large tears can result into
passage of the fetus into the peritoneal cavity [108,127].
The resultant severe haemorrhage can result into mater-
nal death. Loops of intestines or other visceral organs
can prolapse through the vulva if the tear occurs at a
time when the birth canal is sufficiently dilated. The
general condition of the patient in such cases would be
extremely poor. Such patients must be managed early
with fluid therapy and laparotomy must be performed
immediately. The fetuses whether present in the abdo-
men or uterus must be removed and the uterine tear re-
paired. Parts of the fetus may sometimes project into the
peritoneum from the tear and the fetus develops nor-
mally for some time, but such cases are rare. Examina-
tions of such patients reveal the extra uterine presence of
the fetus [128] and such animals may evidence colic or
other clinical signs. The vaginal delivery of such fetus is
extremely difficult and unrewarding and hence a laparo-
tomy is suggested.
3.4. Failure of Abdominal Expulsive Forces
The abdominal musculature plays an important part in
the second stage of labour to expel the fetus. Failure of
abdominal expulsive forces can occur due to painful
conditions, tears in the muscles, or weak muscles as are
seen in old and weak animals. Conditions like traumatic
reticulitis/pericarditis, painful conditions of diaphragm
or chest may cause voluntary inhibition of attempts to
strain [13]. The birth fails to occur in such causes despite
the presence of normal preparatory signs and first stage
labor. In cases of abdominal distension fetus must be
delivered with assistance with the patient in recumbent
position. In conditions, like traumatic pericarditis a cae-
sarean is suggested.
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