Ali Abbas Ajeel et al., (2019); 8 (3):11-22.

ORIGINAL ARTICLE Mirror of Research in Veterinary Sciences and Animals

Mirror of Research in Veterinary Sciences and Animals
MRVSA/ Open Access DOAJ

Caesarean Section in Ruminants Referred to the AL-Muthanna

Veterinary Hospital
Ali Abbas Ajeel 1*; Fadhil abbas mezeal; Aayed jassim khiad & Nuhaia alewi abbidan
1
Department of Surgery/ College of Veterinary Medicine/ Al Muthanna University/ Iraq

ARTICLE INFO be performed with the animal, either standing or lying down.
__________________ Sheep and goats are restrained in right lateral recumbency
Received: 13.09.2019 with both fore legs and both hind legs tied separately in the left
Revised: 20.10. 2019 oblique ventrolateral approaches. In cow performed with
Accepted: 13.12. 2019 standing position. Sedation may be required in anxious cows.
Publish online: 05.01.2020 Although two %xylazine hydrochlorides 0.03 to 0.1 mg/kg IM
_______________________ (Knight, 1980), is the most widely used sedative in bovine
*Corresponding author: practice. A local anaesthetic line block of the flank with 2%
Ali Abbas Ajeel lidocaine hydrochloride. Animals were operated with left flank
Email address: oblique incision approach of caesarean section has been
draliabbas1972@yahoo.com successful with moderate operative haemorrhage, the
________________________ exteriorization of the uterus was facile in all cases, and
abdominal closure was easy. They are considered by a few
surgeons as a better operative site due to lesser postoperative
Abstract complications and minimum contamination of the operative
site during sternal recumbency. The commonest cause of
Caesarean section operations dystocia was incomplete dilation of the cervix (2 cows, 4 ewes
were carried out on twenty clinical and 3 does). The second important cause of dystocia was
cases of dystocia in ruminants at AL- uterine torsion (1cow, 2 ewes, and 2 does).The third cause was
Muthanna Veterinary Hospital (4 emphysematous (1cow, 2 ewes, and 2 does), also there was
cows, 9 ewes and 7 does) between case of foetus anomaly. The study concluded the commonest
July 2016, and March 2017. Average cause of dystocia was incomplete dilatation of cervix as well as
age, ewe and doe 2-3 years and cow irreducible uterine torsion. Caesarean section in dystocia
3-5 years. The restraint of animals affected ruminants could be successfully carried out in lateral
depends upon the operative site used recumbent surgical restraint and left ventrolateral oblique
and animal species. The surgery can incision.

To Cite this article: Ali Abbas Ajeel; Fadhil abbas mezeal; Aayed jassim khiad &
Nuhaia alewi abbidan. (2019). Caesarean Section in Ruminants Referred to the
AL-Muthanna Veterinary Hospital. MRVSA. 8 (2): 30-41.
Doi: http://dx.doi.org/10.22428/mrvsa-2019-0082-04.
__________________________________________________________________________
Keywords: Caesarean section, doe ,ewe, ventrolateral oblique incision.

Introduction

Cesarean section is a widely used emergency operative technique for surgical delivery. The
fetotomy/caesarean section has been based on poor dam survival rates and poor fertility (Singh
et al., 2013). Dystocia in cattle can be relieved by different obstetric methods, including the
caesarean operation and fetotomy. Nowadays, the caesarean operation is one of the most
common surgical procedures performed by veterinarians in cattle practice and is considered as

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a routine obstetric technique. It has high maternal and foetal survival rates and often is less
exhausting, speedier and safer than fetotomy.
There are three main goals:
(1) survival of the cow
(2) survival of the calf
(3) maintenance of fertility
A prompt decision to perform a caesarean operation is essential for optimum success. Ideally,
it is carried out when a live calf cannot be delivered after 15-20 minutes of manipulation. The
cow is a good surgical risk, provided that the environment is suitable for aseptic abdominal
surgery. The need for urgent intervention is indicated if there is evidence of foetal hypoxia, as
shown by hyperactive movements of the foetus and expulsion of the meconium, identifiable in
the amniotic fluid. A successful prognosis depends on several factors, such as the skill and
speed of the surgeon, duration of dystocia, the physical condition of the dam, surgical
environment, concurrent disease, and presence of a live calf (Jos, 2008). There are several
indications for doing the caesarean section; these are including maternal and foetal indications.
The maternal indications include immature heifers, pelvic deformities, failure of cervical
dilation, uncorrectable uterine torsion, uterine tear, hydrops, and prepartum paralysis (Campbell
and Fubini, 1990). Risk factors in cattle are increased by heifer’s age less than 2 years compared
with multiparous cows, and previous cesarean section calving compared with dams having
previous normal calving (Barkema et al., 1992)
Foetal indicators include normal and pathologic foetal conditions. Normal foetal conditions
consist of absolute foetal oversize (relative to a normal maternal pelvis size) and malposition.
A high-value calf, such as an embryo transfer, may be an indication for an elective caesarean
section. Pathologic foetal conditions include foetal anasarca (generalized foetal body edema),
hydrocephalus, conjoined twins, emphysematous, mummification, and prolonged gestation.
Depending on the circumstances, including the availability of a fetotome and the practitioner’s
experience, a fetotomy is not always a viable option. Attempting a fetotomy on an
emphysematous foetus when the uterus is tightly contracted, little uterine fluid is present, cervix
is incompletely dilated, or uterus is friable is inadvisable (Campbell and Fubini, 1990)
The traditional approaches have been well described in the literature (Noorsdy, 1979). Restraint
(appropriately based on the breed); space; light; help available; location; and the veterinarian’s
training, experience, and confidence (Campbell and Fubini, 1990).
The two main options are whether to do a caesarean section on standing or a recumbent cow.
Depending on the demeanour of the dam, a recumbent approached using sedation and tying
the legs forward and back. If the cow may not remain standing for the duration of the surgery,
it may easier to start with her recumbent rather than having her fall down during the operation.
The recumbent approach, because it facilitates the exteriorization of the uterus, especially when
an oversized foetus is present, reduces the opportunity to contaminate the abdominal cavity.
The recumbent approach can be midline or over the pregnant horn using a paramedian, low-
flank (Noorsdy, 1979), or paramammary approach ( Figure. 1).
The paramammary approach, located between the udder and the fold of the flank, is useful in
dairy cows because it is more likely to avoid the caudal epigastric veins and ventral edema
located on the paramedian and midline areas. The midline approach likely requires the longest
incision because the linea alba is relatively inflexible. The standing flank approach may be done
from either the left or the right; it is more commonly performed from the left (Frazer and
Perkins, 1995).

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Figure. 1. The preoperative ventral view shows the locations of the midline (top line), right
paramedian (middle line), and the right low oblique or paramammary approaches (bottom line).

The primary advantage of the left approach is that the rumen prevents evisceration of the small
intestines, but rumen prolapse may occur if straining during surgery. When the pregnancy is
located in the right horn, some practitioners find it easier to use the right approach, especially
if the calf is big. The primary disadvantage of this approach is retaining the small intestines
within the abdominal cavity. In cases in which the left approach has been used exclusively to
perform several caesarean sections over time in the same cow, the practitioner may find it easier
to use the right approach. More recently, a left oblique flank approach in standing cows has
been described (Figure. 2) (Parish et al., 1995). An incision is started 10 cm cranial and 8 to 10
cm ventral to the cranial aspect of the tuber coxae. The incision is extended cranioventrally at
a 45_ angle, ending 3 cm caudal to the last rib. The apex of the uterine horn is more readily
accessible, facilitating the manipulation and exteriorization of the uterus. This incision is larger
and extends more cranioventrally compared with the traditional vertical flank incision. This
technique may be useful to remove large calves or when the uterine contents are contaminated.
The internal abdominal oblique muscle is incised parallel to the muscle fibers; the abdominal
viscera apply tension to this muscle, facilitating apposition during the closure.

Figure. 2. The postoperative photograph shows the location of the left oblique approach for
caesarean section. (Courtesy of Dr. Matt Miesner, The Ohio State University, Columbus, OH.)

Sedation may be required in anxious cows. Although xylazine hydrochloride (Rompum), 0.03
to 0.1 mg/kg intravenously (Knight, 1980), is the most widely used sedative in bovine practice,
it also increases uterine tone, making manipulation and exteriorization of the gravid uterus more
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difficult (Frazer and Perkins, 1995). A study using endoscopy showed that xylazine alters
laryngeal and pharyngeal anatomy and impairs sensation in adult dairy cattle (Anderson et al.,
1994), which likely increases the risk of aspiration pneumonia if the cow is positioned in either
lateral or dorsal recumbency. Xylazine also may induce ataxia—an undesirable effect while
doing a standing caesarean section. When a halter is the sole means of restraint in dairy heifers,
the combination of 7.5 mg of acepromazine maleate and 10 mg of butorphanol tartrate
(Torbugesic) administered intravenously provides adequate sedation (unless the cow is already
in a highly excitable state) for standing surgery without causing either ataxia or increased
uterine tone. The surgical approach determines which local anaesthesia technique is used.
Techniques for local anaesthesia using 2% lidocaine hydrochloride are well documented in the
literature (Turner and McIlwraith, 1989; Muir et al., 2000).
The most common techniques are the proximal paravertebral and distal paravertebral, inverted
‘‘L,’’ and line blocks. The technique used reflects the surgeon’s preference. The proximal
paravertebral block is technically more challenging because the needle is inserted just adjacent
to the vertebral body, and the tip of the needle should be close to the nerve roots exiting the
vertebral foramen, requiring more restraint and a long needle (18G, 10 cm long). Extremely
muscular or fat beef cows may require a longer needle. An easier technique is the ‘‘modified’’
proximal paravertebral block, in which the needle is inserted midway between the spinous
process and the tip of the transverse process (Figure. 3). This block uses the smallest dose of
local anaesthetic, provides the maximal anaesthetic region, and induces maximal relaxation of
flank musculature.

Figure. 3. The modified proximal paravertebral block, shown on this dorsal view of the left
lateral aspect. T13, L1, L2, and L3 are the spinous processes of the last thoracic and first,
second, and third lumbar vertebrae. Note the location of T13 (13), L1 (1), and L2 (2) nerves
and the placement of needles.

The distal block requires less skill and may be performed using an 18G, 3.75-cm needle; this
block works well, provided that the local anaesthetic injections are fanned above and below the
edge of the transverse processes (Figure. 4). Although the line block is the least technically
challenging, it requires the greatest amount of local anaesthetic. Lidocaine is available with or
without epinephrine. Epinephrine reportedly increases the duration of the local anaesthesia by
causing vasoconstriction; however, incisional complications, such as delayed healing and skin

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slough, have been associated with the use of lidocaine with epinephrine for line blocks (Muir
et al., 2000).

Figure. 4. The distal paravertebral block, shown on the left lateral aspect. T13, L1, L2, L3,
and L4 are the spinous processes of the last thoracic and first, second, third, and fourth lumbar
vertebrae. Note the location of T13 (13), L1 (1), and L2 (2) nerves and the placement of needles.

Caudal epidural anaesthesia, which desensitizes the caudal nerve roots as they emerge from the
dura, often is indicated if the calf or obstetric manipulations have initiated strong abdominal
contractions. An 18G, the 1.5-inch needle can be used to give 2% lidocaine hydrochloride
(Lidocaine 2% Injection), 0.2 to 0.4 mg/kg (Turner and McIlwraith, 1989). Provided that the
recommended maximal volume of 0.5 mL/50 kg is not exceeded, the caudal epidural should
not affect motor control of the hind limbs. The onset of a properly placed epidural is usually
within minutes. An anterior epidural anaesthesia can be used as an alternative that provides
flank anaesthesia and may be administered using one of three techniques: at the lumbosacral
(L6–S1) position (1 mL/4.5 kg) or either the sacral-coccygeal (S5–Co1) or the first
intercoccygeal (Co1–2) space (40–150 mL for an adult cow) (Skarda, 1996).
When performing local anesthesia with small ruminants, the accumulation of a toxic dose of
lidocaine (5 mg/kg) should be avoided. The clinical signs of systemic toxicity are
predominantly central nervous system signs, including drowsiness, convulsions, respiratory
depression, and cardiovascular collapse, potentially leading to death (Muir et al., 2000).

Toxicity is treated with intravenous fluids and supportive care. The volume of 2% lidocaine
required to elicit systemic toxicity is approximately 0.2 mL/kg or 9 mL/45kg. In small
ruminants, safest first to draw up the maximal lidocaine dose for the patient in a syringe and
dilute the lidocaine with 0.9% sodium chloride to achieve a final concentration of 1% lidocaine
before administering the local block.

There are several surgical preparations including hair removal by clipping alone has been
reported to incite fewer skin reactions with no significant difference in incisional infections
compared with clipping and shaving (Bedard et al., 2001). No significant difference was
observed between chlorhexidine gluconate and povidone-iodine. When isopropyl alcohol was
used after washing, there was significantly fewer colony forming units and more negative
cultures when chlorhexidine gluconate was used compared with povidone-iodine (Desrochers
et al., 1996).
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Details of the surgical techniques for performing a caesarean section are well described in the
literature. The abdominal wall incision should be sufficiently large to remove the foetus safely
through the abdominal wall. A small abdominal incision tends to increase the level of difficulty
in removing the foetus and increases the risk of subcutaneous emphysema or seroma formation
or both. After identifying the uterus, the portion of the uterus containing a hind leg is pulled up
into the abdominal incision. Placing one hand under the hock or hocks and the other on the
dorsal aspect of the pastern facilitates ‘‘locking’’ the foot into the abdominal incision (Lee et
al., 2004; Turner and McIlwraith, 1989).
With breech or posterior presentations, the front limb is grasped. This presentation increases
the level of difficulty of exteriorizing the uterus and may require a larger incision. During
ventral approaches, the greater omentum often must be retracted cranially when the uterus is
located within the omental sling. The greater curvature of the uterus should be partially
exteriorized, and an incision made along the greater curvature of the uterus. This incision avoids
most blood vessels and caruncles. A small uterine incision increases the risk of tearing the
uterus during foetal extraction. Uterine tears most often occur at angles to the uterine incision;
this increases the difficulty in closing the uterus. Under ideal circumstances, spillage of uterine
contents into the abdomen should be avoided. When both legs are exteriorized, the calf is being
extracted; the uterus needs to be held in place to prevent spillage of uterine contents into the
abdomen. Large beef calves often are extracted without uterine exteriorization without affected
morbidity or mortality in the cows because obstetric manipulations have been minimized, and
the calf is usually alive. The umbilical cord should be stretched and ruptured in a controlled
fashion by holding it adjacent to the abdominal wall. Normal retraction and contraction of the
umbilical arteries may be impaired by surgical excision of the umbilical cord. If the elective
caesarean section is performed, careful attention is paid to the umbilical vessels, as there is an
increased likelihood of excess haemorrhage because the umbilical vessels are not prepared for
spontaneous rupture. Temporary clamping of the umbilical arteries and vein may be required.
After the calf is removed, the veterinarian should always check for a second calf. If the placenta
readily detaches from the caruncles, it should be removed; otherwise, the veterinarian should
trim the portion that is hanging outside the uterus to prevent its inclusion into the closure of the
uterus.
If the calf is alive and the uterus is healthy (i.e., an elective procedure), one layer of closure
with absorbable suture material, such as 2 chromic catgut. Two-layer closure is recommended
if the calf is dead or contaminated uterine fluids are suspected to be present (i.e., an emergency
or emphysematous procedure), or the uterine wall is compromised or torn during fetal
extraction. Continuous inverting suture patterns, such as the Cushing and Lembert, should be
used because they provide a tight seal, minimize suture exposure, and promote healing, as the
uterus heals initially by serosal-to-serosal contact. The blood clots should be teased away gently
using irrigation and a gloved hand because these clots may give rise to adhesions that can affect
future fertility adversely. Gauze sponges should not be used to wipe the uterus clean because
this causes serosal abrasion, which increases the likelihood of detrimental uterine adhesions.
Changing to new surgical gloves after the uterus is closed potentially reduces the risk of
abdominal contamination. The abdominal wall usually requires two to three layers of closure.
The peritoneum and transversus are usually closed in one layer, using absorbable suture
material (e.g., 3 chromic catgut) in a simple continuous pattern. The internal and external
abdominal oblique muscles are closed together using absorbable suture material (e.g., 3 chromic
gut) in a simple continuous pattern. The internal abdominal oblique may be incorporated into
the first layer when peritoneum and transversus are tearing in thin or excessively straining cows;
the external abdominal oblique is then sutured alone. Excessive straining may be minimized
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using sedation, using an epidural, and or placing a nasotracheal tube. A nasotracheal tube
prevents closure of the glottis, preventing positive thoracic pressure against the diaphragm,
which restricts abdominal straining. To reduce dead space and potential seroma formation, the
layers can be periodically tacked down to the preceding layer. The skin can be closed using
either a continuous ford interlocking, simple interrupted cruciate, or simple interrupted sutures
using 3 polyamides.
There are variations in the postoperative care such as the use, type, and frequency of antibiotics.
The most commonly used antibiotics are penicillin G procaine; 22,000 U/kg intramuscularly
every 24 hours for 3–5 days), oxytetracycline; 19.8 mg/kg intravenously, intramuscularly, or
subcutaneously every 1–3 days), or ceftiofur 1 mg/kg intravenously, intramuscularly, or
subcutaneously every 12–24 hours for 3–5 days). Flunixin meglumine (Banamine) (1 mg/kg
intravenously or intramuscularly every 12 hours for 2 days) may be useful to prevent abdominal
adhesion formation. Elective or uncomplicated caesarean sections in which there is a live calf,
healthy cow, healthy uterus, minimal obstetric manipulation preoperatively, and minimal
abdominal contamination during calf extraction likely do not require antibiotics. Antibiotics are
indicated when the calf is dead when there is prolonged dystocia when there is a compromised
uterus, when extensive obstetric manipulations occurred preoperatively, and when abdominal
contamination has occurred. In the authors’ experience, intravenous oxytetracycline for 5 to 7
days is the antibiotic of choice when the concern for postoperative peritonitis is deep (i.e., an
emphysematous foetus). Standing flank incisions require little postoperative care and attention
compared with ventral approaches. Cows with flank incisions often do not require stall rest that
provides restricted activity and can be rebred using a bull without undue concern regarding
abdominal wall herniation. In contrast, ventral approaches require strict stall rest for 6 weeks.
Different types of complications such as the preoperative, operative, postoperative, and long-
term were reported previously (Dehghani and Ferguson, 1982). Preoperative complications
include delayed delivery, anorexia, fetal death, emphysematous fetus, forced extraction, fetal
abnormalities, fetal limb fractures, uterine inertia, uterine trauma, uterine rupture,
obturator/sciatic nerve damage, and severe trauma during manipulation. Operative
complications include excessive uterine trauma, peritoneal cavity contamination,
gastrointestinal trauma, excessive trauma to the abdominal wall, and inadequate uterine closure.
Postoperative complications include peritonitis, seroma formation, retained placenta, metritis,
endometritis, skin suture dehiscence, subcutaneous emphysema, adhesions, mastitis, straining
cow, and calf death. Long-term complications include downer cow, debilitated cows,
production losses, spontaneous abortions (Cattell and Dobson, 1992).
The retained fetal membranes are one of the complication. The bovine placenta typically is shed
within 24 hours after surgery (Dawson and Murray, 1992) a retained fetal membrane is the
failure to shed the placenta within this period. In cases when the placenta was not removed
during surgery, low doses (20–40 IU) of oxytocin frequently may be administered
intramuscularly postoperatively, provided that the cervix is open. Administering oxytocin when
the cervix is closed increases the pressure on the suture line and likely would increase the risk
of uterine incisional dehiscence(Frazer and Perkins, 1995). Cows may become recumbent
during surgery. It is believed that cows are more likely to become recumbent during attempts
to exteriorize the uterus. Falling during surgery is believed to a consequence of pain that arises
from traction on the broad ligament during difficult uterine manipulations. Administration of
xylazine epidural preoperatively may reduce painful stimuli. Cows that remain standing during
the procedure have a better chance of survival (Hoeben et al., 1997).
In Iraq, a review of the literature revealed scarce publications regarding caesarean section
operations in ruminants. Consequently, this study was designed to investigate the caesarean
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section operations in ruminants suffered from dystocia that referred to Al Muthanna veterinary.

Materials and methods

Preoperative preparation

Animals
This research of caesarean section operations was carried out on twenty clinical cases of
dystocia in ruminants at AL-Muthanna Veterinary Hospital (4 cows, 9 ewes, and 7 does)
between July 2016 and March 2017. Average age, ewe and doe 2-3 years and cow 3-5 years.

Preoperative preparation

Included administration of sufficient fluid replacements, antibiotics is strongly recommended.

Commonly, 10 mg/kg each of an antibiotic mixture of procaine penicillin and
dihydrostreptomycin intramuscular.

Restraint

The restraint of animals depends upon the operative site used and animal species. The surgery
can be performed with the animal, either standing or lying down. Sheep and goats are restrained
in right lateral recumbency with both fore legs and both hind legs tied separately in the left
oblique ventrolateral approaches. In cow performed with standing position.

Approach

Two surgical approaches have been used for the caesarean operation:
1. Standing the cow (left or right paralumbar fossa (flank approach).
2. Lateral recumbency in ewe and doe (ventrolateral and low-flank approach).

Surgical preparation

Clipping, shaving, cleaning, and disinfected the operative site with alcohol 70% and providing
iodine 5%.

Anaesthesia

Sedation may be required in anxious cows. Although xylazine hydrochloride 0.03 to 0.1 mg/kg
IM (Knight, 1980), is the most widely used sedative in bovine practice. A local anaesthetic line
block of the flank with 2% lidocaine hydrochloride.

Surgical technique

A skin incision of 25 -30 cm long was taken at the respective site of the incision after checking
the bleeding points, subcutaneous tissues and muscles were incised in the direction of their lay(
Figure.5 ).

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Figure.5: Skin and subcutaneous tissues and muscles were incised in the direction of their lay.

The peritoneum was incised, and omentum was pushed anteriorly. Every attempt was made to
exteriorize the uterus outside the surgical wound in each case of caesarean (Figure.6). The
incision was given from ovarian end and extended towards the cervix, avoiding the cotyledons,
and every attempt was made to prevent an uneven tear of uterus and hemorrhage. The incised
uterine wall was pulled out and was grasped firmly on either side by the assistant until the fetus
and fluid were removed. The fetus was exteriorized by grasping both legs (fore or hind) and
was removed gently, avoiding uterine tear (Figure.7).

Figure.6: exteriorize the uterus outside the surgical wound.

Figure.7: The fetus was exteriorized by grasping both fore legs.

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The placenta was removed, and the uterine cavity was cleaned thoroughly with normal saline.
Blood clots and any debris of the placenta were removed during caesarean in all the cases. Two-
layer closure was used for uterus suturing. Continuous inverting suture patterns, such as the
Shmedin and Cushing, were used because they provide a tight seal, minimize suture exposure,
and promote healing (Figure.8).
The abdominal wall usually requires two to three layers of closure (Figure.9). The peritoneum
and transversus are usually closed in one layer, using absorbable suture material (e.g., 2 chromic
catgut) in a simple continuous pattern. The internal and external abdominal oblique muscles
are closed together using absorbable suture material (e.g., 2 chromic gut) in a simple continuous
pattern. The skin can be closed using a horizontal mattress interrupted sutures using 2 silk.

Figure.8: Two-layer closure was used for uterus suturing.

Figure.9: The abdominal wall usually requires two to three layers of closure.

Post-operative care

The success of the operation depends upon the post-operative care. Antibiotics and anti-
inflammatory drugs are given for 3-5 days. The operative site cleaned daily with spirit. The
sutures can be removed 8-10days post-operative.

Results and Discussion

The commonest cause of dystocia was incomplete dilation of the cervix (2 cows, 4 ewes and 3
does) these agree with Saxena et al., (1989) and Shiv Prasad et al., (2000). The second important

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cause of dystocia was uterine torsion (1cow, 2 ewes, and 2 does). Third cause was
emphysematous (1cow, 2 ewes, and 2 does), also there was case of fetus anomaly (doe). Similar
observations were also recorded by Iyer et al., (1987). Animals were operated with left flank
oblique incision approach of caesarean section has been successfully carried out by Saxena et
al., (1989), and Shiv Prasad et al., (2000) with moderate operative hemorrhage, the
exteriorization of the uterus was facile in all cases, and abdominal closure was easy. Considered
by a few surgeons as a better operative site due to lesser postoperative complications and
minimum contamination of the operative site during sternal recumbency. (Purohit et al., 2006).
Only one retrospective clinical study on buffalo caesarean sections compared the complications
of caesarean sections performed employing different operative sites, and suggested that the
midline and paramedian operative sites resulted in more postoperative complications like
wound dehiscence and hernia due to the heavyweight of abdomen resting on the suture line
(Verma et al., 1974).

Conclusions

1- The commonest cause of dystocia was incomplete dilatation of the cervix as well as
irreducible uterine torsion.
2- Caesarean section in dystocia affected ruminants could be successfully carried out in lateral
recumbent surgical restraint and left ventrolateral oblique incision.

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