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Fetotomy: An obstetrical operation to resolve the dystocia in the domestic

animals: A review

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 The Pharma Innovation Journal 2020; 9(5): 139-143

ISSN (E): 2277- 7695

ISSN (P): 2349-8242
NAAS Rating: 5.03 Fetotomy: An obstetrical operation to resolve the
TPI 2020; 9(5): 139-143
© 2020 TPI dystocia in the domestic animals: A review
www.thepharmajournal.com
Received: 16-03-2020
Accepted: 18-04-2020 Pramod Kumar, Dharmveer Singh, Sivendra Kumar Bhalothia,
Dr. Pramod Kumar Tapendra Kumar, KS Nehra, Ashok Kumar and Talluri T Rao
Assistant Professor, Department
of Veterinary Gynecology and
Obstetrics, College of Veterinary
and Animal Science, RAJUVAS, Abstract
Bikaner, Rajasthan, India The principle purpose of obstetrical operations is to deliver a viable fetus as far as possible without injury
to the dam. In most cases of dystocia, one or more combinations of the different obstetrical operations are
Dr. Dharmveer Singh performed. The obstetrical operations have been divided into four major groups’ viz. mutation, forced
Teaching associate, Livestock extraction, fetotomy and caesarean section. The plan of the choice of the procedures to be used for a safe
Research Station (LRS), Nohar, delivery depends not only on the condition of the case but also on the time since dystocia and assistance
Hanuman Garh, Rajasthan, available. The present paper detailed about the indications, procedure, merits and demerits of fetotomy in
India domestic animals.
Dr. Sivendra Kumar Bhalothia
Keywords: Dystocia, fetotomy, percutaneous fetotomy, subcutaneous fetotomy
Bhalothia Department of
Veterinary Gynecology and
Obstetrics, College of Veterinary Introduction
and Animal Science, RAJUVAS, Fetotomy operations performed on the dead fetus for the purpose of reducing its size by either
Bikaner, Rajasthan, India
its division or the removal of certain parts of dead fetus (Kebede et al., 2017) [1]. In most cases
Dr. Tapendra Kumar these operations are performed within the uterus of the dam in order to remove the fetus per
Department of Veterinary vaginum (Benesch and Wright, 2001) [2]. If the fetus is dead and accessible fetotomy should be
Gynecology and Obstetrics, the first choice of relieving dystocia when mutation fails to correct it (Bierschwal and deBois,
College of Veterinary and Animal 1972; Harvey and Vailancourt, 1989; Rusch and Berchtold, 1978; Mortimer et al., 1984) [3-6].
Science, RAJUVAS, Bikaner,
A fetotomy can be performed under the following conditions to save the life of the dam:
Rajasthan, India
1. The fetus is lifeless.
Dr. KS Nehra 2. If the fetus is emphysematous, this decreases the survival rate of the dam after a C-section.
Officer Incharge, Livestock 3. The fetus is big to be delivered or the dam’s pelvis is narrow (i.e., feto-maternal
Research Station (LRS), Nohar, disproportion/size mismatch). Fetopelvic discrepancy includes
HanumanGarh, Rajasthan,
(a) Fetal oversize due to prolonged gestation or fetal muscular hypertrophy
India
(b) Narrow pelvic cavity due to pelvic fractures/ exocytoses
Dr. Ashok Kumar (c) Emphysematous fetus
Scientist, ICAR-Central Sheep (d) Fetal monsters like hydrocephalus, schistosoma reflexus (Herr, 1979) [7], perosomus
and Wool Research Institute elumbis, fetal anasarca or fetal duplication.
(CSWRI), Arid Region Campus
4. The fetus has an abnormality that will not allow it to be delivered (such as schistosomus
(ARC), Bikaner, Rajasthan,
India reflexus, perosomus horridus or perosomus elumbis).
5. Uncorrectable fetal malpresentation
Dr. Talluri T Rao 6. The fetus and the dam are in a hip-lock (breech presentation) that cannot be
Senior Scientist, National corrected by fetal rotation.
Research Center on Equine
(NRCC), Equine Production
Center (EPC), ICAR, Bikaner, General consideration for fetotomy
Rajasthan, India 1. The general condition of the patient (Temperature, pulse and respiratory rate) must be
assessed and appropriate therapy (Fluid therapy and life saving drugs) must be instituted
before any handling efforts. The condition should be assessed early to decide on the type
and extent of fetotomy.
Corresponding Author: 2. Fetus must to be dead and accessibility of the fetus examines per vaginally.
Dr. Pramod Kumar 3. Fetotomy should never be delayed too long. The mare is more sensitive to excessive
Assistant Professor, Department fetotomy and hence manipulative attempts should first be done.
of Veterinary Gynecology and 4. The animal should be restraining perferably in a standing position. If the patient is
Obstetrics, College of Veterinary recumbent it must be restrain in lateral recumbency (Benesch and Wright, 2001) [2].
and Animal Science, RAJUVAS,
Bikaner, Rajasthan, India 5. For removal of a limb by subcutaneous fetotomy in a recently died fetus, artificial
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emphysema can be induced by subcutaneous injection fetotomy can be attempted using small surgical blades or
of air. simple knives or even shaving blades. Subcutaneous fetotomy
6. Manipulations in a dry birth canal predispose it to can also be done for removal of one or both limbs in the dairy
injuries. Sufficient lubrication of the birth canal should goat and ewes using a surgical blade and the fingers of the
be done if it is not well lubricated than infuse liquid operators (Kumar et al., 2014; Ruhel et al., 2018) [15, 16].
paraffin with hot water or non-irritant sweet oil or
obstetric cream or jelly. Percutaneous fetotomy
7. Good clean and sterile instruments should be used in the The animal is restrained either in standing condition in a
fetotomy operation. travis or in a sternal recumbency in sitting position. The hind
8. Epidural anaesthesia is indicated in most of cases but portion of the animal is washed with soap and water and then
not all cases by injecting 5-10 ml of 2% lignocaine or with a mild antiseptic. Epidural anaesthesia is administered
xylocaine. when required. Percutaneous fetotomy is done using different
9. The cervix is only partially (two or three finger) types of commercially available fetotomes (Dadarwal, 2004)
[17]
dilated—introduction of fetotomes are difficult than put . Fetotomes are double barrel stainless steel equipment
the animal for C-section (Thangamani et al., 2018) [8]. through which a wire saw is passed to make a loop of wire at
10. To perform Fetotomy veterinarian should also make one end. The other end of wire saw is tied to a wire saw
sure if there is adequate space in the birth canal for holder. The wire saw is threaded in advance when a fetal limb
introduction and alignment of the fetotome, the patient is to be cut while, the wire is first passed though one barrel of
can be restrained in an area that allows adequate space the fetotome and after passing through the fetal part the wire
for operating the wire saw, adequate help is available is passed through the other barrel of the fetotome and tied up
(Schultz et al., 2008) [9]. in the wire saw holder. The birth canal should be well
lubricated before inserting the fetotome. The fetotome is
Equipment inserted in the birth canal. The free end of the wire saw is tied
Apart from having the technical knowledge and proficiency, a to the wire saw holder and by sawing action the part intended
veterinarian must have the correct equipment to optimize the to be removed is cut. This part is taken out and the fetotome is
chances for a successful fetotomy (Bierschwal and de Bois, introduced to another part if that also has to be cut or the
1972) [10]. Following equipment’s and accessories are listed as fetotome is removed and following mutation the fetus is
below: removed by traction. Sufficient care must be exercised to
1. Thygesons embryotome: this is a double-barrelled avoid any part of the birth canal to be imposed between the
instrument with a hand grip and notched oval plate. fetus and the wire saw. In lateral deviation of the head,
2. Fetotomy (palm) knife: this is used to seat the wire for amputation of the limb opposite to the side of flexion or the
some cuts. It is beneficial for removing bone fragments amputation of the entire head may create sufficient space for
prior to fetal extraction. correction of fetal maldisposition and/or delivery of the fetus.
3. Krey hook: expandable, two-armed hook Uncorrectable carpal flexion or hock flexion posture warrants
4. Fetotome saw wire the amputation of one or both limbs below the knee or hock
5. Wire saw handles joint to preserve some traction point. Likewise, in shoulder
6. Wire introducer: this is a curved instrument for passing flexion posture amputation of the head or one or both limbs
the wire over or around a fetal part. creates plenty of workable space to correct the maldisposition.
7. Fetotomy wire and disinfected wire cutters are required. In hip flexion posture which is considered to be one of the
8. Lubricants, cotton ropes, obstetrical sleeves or gloves etc. toughest malpresentation, amputation of one of the hind limbs
. or pelvic bisection is necessary to create space in the birth
Procedure of Fetotomy canal (Sharma et al., 1992a) [18].
Subcutaneous fetotomy Using complete percutaneous fetotomy, the fetus can be cut
Subcutaneous fetotomy is cutting of fetal parts usually the into pieces and delivered. The maximum number of cuts that
limbs without removal of the skin. It is usually done in are suggested are six (Dadarwal, 2004) [17], however, many
emphysematous fetuses, employing different types of knives. times only partial fetotomy would be sufficient to deliver a
Epidural anesthesia using 5-8 mL of 2% xylocaine may be maldisposed fetus per vaginum. A low incidence of post-
given in some cases (Hall, 1971; Bhokre and Deshpande, operative complications (vulvo vaginal laceration or edema)
1979) [11, 12]. Tocolytic drugs are also helpful as they relax the and a high dam survival are seen in cows and buffaloes with
birth canal (De Nooij, 1984; Balla and Tschiru, 1985) [13, 14] the use of percutaneous fetotomy. In general, it is considered
especially in mares. After proper lubrication the knife is by many clinicians that the dam survival and future fertility of
introduced in the birth canal and the skin is incised from the the dam are high when fetotomy is used as a means of fetal
scapular point to metacarpal bone in anterior presentation and delivery in dystocia affected animals (Franz and Kramer,
from hip joint to metatarsal bone in posterior presentation. 1970; Mortimer et al., 1984; Purohit and Mehta, 2006;
The skin is detached from the muscles and other attachments Purohit, 2006) [19-22]. However, it much depends on the
by the operator's fingers and/or blunt instruments. The hygienic conditions, time since dystocia onset and the post
pectoral muscles and the muscles nearby the scapula or hip handling care. The detailed procedures of fetotomy for
are broken. Traction is then applied on the limb under the skin different fetal maldispositions in the mare have been
using ropes or chains. The limb breaks off from the scapular described (Frazer, 1997; Frazer et al., 1997) [23, 24].
or hip joint and is taken out. The other limb is removed
similarly when required. To avoid injury both to the operator Merits of fetotomy
and the birth canal care should be taken. At many locations 1. It reduces the size of the fetus which create more space
where the obstetrician has limited access to instruments or for manipulation in birth canal.
technical help and the fetus is emphysematous, subcutaneous 2. It avoids traumatic surgical procedures and prevents

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trauma to the birth canal by use of excessive traction. In assist dam to expel fetus.
subcutaneous fetotomy, skin loop of legs provides more 3. Fetotomy to reduce the size of dead fetus inside the
option for traction. uterus, the main indication of fetotomy in sheep and goat
3. Avoids the major abdominal surgery of caesarean section, is postmortal fetal edema and emphysema (Sobiraj, 1994)
[35]
less assistance required than caesarean section, shorter .
recovery time/less aftercare and less cost (Newman and 4. Caesarean section by delivering fetus through
Anderson, 2005) [25]. laparohysterotomy preferred in relative fetal oversize or
4. It maintains future fertility of the animal when carefully narrow and small pelvis of the dam (Hussain and Zaid,
performed (Franz and Kramer, 1970; Purohit and Mehta, 2010) [36].
2006) [19, 21].
Fetotomy in mare
Demerits of fetotomy The incidence of dystocia in mare has been much less
1. It may be dangerous, causing injuries or lacerations to the documented than bovines (Frazer, 2007 and Singh et al.,
uterus or birth canal by instruments or sharp edges of 2019) [37, 38]. Dystocia in mare is perhaps one of the most
bone when performed roughly; and also it may take a challenging conditions faced by equine practitioners (Purohit,
long time causing exhausting of both the dam and the 2011) [39]. The obvious goal is not only to deliver a live foal
operator (Elits, 2007) [26]. whenever possible, but also to preserve life and fertility of
2. It prompts the obstetrician to infections of the arm when mare (Carluccio et al., 2007) [40]. Therefore duration of
the fetus is emphysematous. vaginal intervention should be kept to a minimum even if
3. Cervical adhesions are almost inevitable in the mare after fetus is dead. Procedure of fetotomy isn’t easy as in cow than
prolonged intervention. to longer equine birth passage and therefore the impediment
posed by rapidly detaching foetal membranes (Fraser, 1997)
[23]
Fetotomy in cattle and buffalo . In the mare maldisposed dead fetuses can be safely
Fetotomy is commonly used to correct dystocia due to resolute for vaginal delivery through fetotomy performed by
fetomaternal disproportionation in cattle and buffalo (Noakes skilled persons; otherwise, it is potentially dangerous (Frazer,
et al., 2009) [27] and must be given first concern if the fetus is 1997; Higgins and Wright, 1999; Frazer, 2001; Al-Dahash et
dead, especially when it is emphysematous (Wehrend et al., al., 2013 and Singh et al., 2019) [23, 41-43, 38]. One or two well
2002; Noakes et al., 2009; Purohit et al., 2012; Gupta et al., placed fetotomy cuts can radically shorten intervention time
2017) [28-30]. Fetotomy may be unsafe causing injuries or and permit the atraumatic delivery of non-viable fetus (Frazer,
lacerations to birth canal by instruments or sharp edges of 1997, Nimmo et al., 2007 and Sutaria et al., 2014) [23, 44, 45].
bone. It may take long time, fatiguing both the dam and
operator and possibly cause pressure necrosis of the birth Fetotomy in camel
canal and if fetus is emphysematous there is a possibility of The common causes of dystocia in the camelids are the
infection to operator’s arm (Roberts, 1986) [31]. After fetotomy extremely long neck and fetal extremities predispose to
following precaution should be kept in mind: flexion (Tibary and Anouassi, 1997) [46]. Fetotomy using
 Make sure you remove every piece of the fetus ordinary bovine techniques can be used in camel dystocia
 Examine the uterus for any tears, cuts, or the presence of cases where the fetus is known to be dead and the uterus is
another calf readily accessible (Jackson, 1995) [47]. Partial fetotomy of the
If the calf does not present any anomaly like schistosomus head or limbs is possible in camels using a Thygesons or
refelxus or perosomus elumbis to be delivered vaginally, and other fetotomes used in cattle. Fetotomy reduces the size of
if the calf is in a caudal presentation and is just too large to be fetus and creates space for manipulation and correction of the
delivered vaginally, a fetotomy should be escaped because abnormality. Dead foetuses can deliver by Fetotomies (Kumar
after cutting one or both hindmost limbs the thorax will be too et al., 2012; Tejpal et al., 2015; Dudi et al., 2016) [48-50] and
large to be delivered and usually the calf cannot be rotated. A forced extraction, but, may sometimes lead to a fatal uterine
C-section would be indicated for these cases (Schultz et al., hemorrhage due to injury to the birth canal and hence
2008) [9]. cesarean section must be performed (Van Starten, 2000 and
Purohit et al., 2000; Purohit et al., 2011, purohit, 2012) [51-54].
Fetotomy in sheep & goat
Fetal maldisposition is major contributing factor of causing Conclusions
dystocia in sheep and goat (Thomas, 1990; Ismail, 2017) [32, 1. A dead fetus either oversized/monster or abnormalities in
33]
. The most common maldispositions are lateral deviation of presentation, position, or posture or a combination of
head and neck, flexion of carpus and shoulder (Purohit et al., these which cannot be corrected by mutation is
2012) [29]. The incidence of postural abnormalities has been considering an indication of fetotomy.
reported between 65 to 70% in sheep and goat. Deviation of 2. Results from fetotomy can vary, reliant on a level of
fetal head in sheep and goat may vary in degree. It is most expertise offered by the veterinarian and the facilities
commonly deviated slightly but sometimes it may be deviated available.
laterally to the fetal body (Purohit, 2006, Kumar et al., 2014; 3. A mutual fault to choose fetotomy only after the birth
Ruhil et al., 2018) [22, 15, 16]. There are a few obstetrical passage has already been traumatized by unproductive
procedures can be done to remove the fetus (Majeed et al., attempts at manual correction.
1995) [34]. These obstetrical procedures includes following 4. The great veterinarian should be skilled within the
processes- former, but have recourse to the latter and will use both
1. Mutation- correction of abnormal presentation, position techniques at appropriate time.
and posture of fetus by manipulation. 5. In general fetotomy shouldn’t be attempted unless: proper
2. Forceful traction- application of outside force used to fetotomy instruments and adequate space within the birth

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passage for manipulation. Percutaneous fetotomy in management of dystocia in

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