Prolonged co-twin foetal retention in a sheep: caused by ... · Prolonged co-twin foetal retention...

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Prolonged co-twin foetal retention in a sheep: caused by hysterocele? SUMMARY Prolonged foetal retention is a birth complication and its clinical signs usually appear in early puerperium with systemic ill- ness. This case report describes a case of co-twin foetal retention and its pre/intraoperative clinical findings. A sheep was re- ferred to our clinic suffering from a ventral mass and loss of appetite in the previous three days. She had given birth to one healthy lamb 33 days before. After haematological tests, neutropenia and anaemia were detected. Ultrasonic and radiologic exa- minations revealed a dead foetus in this mass. Following clinical examination the preliminary diagnosis was a prolonged foe- tal retention related to a ventral hysterocele. During surgery no findings related to ventral hysterocele was observed but utero- peritoneal adhesions were detected. A dead but otherwise intact foetus was removed from the uterus. Following surgery the sheep recovered uneventfully. This is a rare case of prolonged co-twin ovine foetal retention in an adhere uterus, and for as long as 30 days asymptomatic. KEY WORDS Adhered uterus, pregnancy abnormality, sheep. G. ERDOGAN 1 , E. HAKAN UÇAR 1 , C. PEKER 1 , N. KILIÇ 2 1 Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey 2 Department of Surgery, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey INTRODUCTION Dystocia in multiple pregnant small ruminants increases the risk of perinatal lamb mortality and it is related to important economic losses 10 . It is more frequent in twin ovine pre- gnancies than singletons, except when singletons are oversi- zed 8 . Moreover, some maternal dysfunctions (uterine inertia, uterine rupture and ectopic pregnancies) are reported as de- livery problems in does 11 . Foetal retention resulting from dystocia is a rare complica- tion, and usually suspected in early puerperium with syste- mic illness such as high temperature, anorexia, lethargy etc. 4 . It has been recorded in cases of multiple lamb births and ute- rine torsion 2,17 . Foetal retention caused by prolonged ovine dystocia causes necrotic metritis and is usually fatal 5,13 . This short communication describes a rare case of delayed interval delivery of co-twin foetus with pre/intraoperative clinical findings in a sheep. The dead but also intact foetus which was not delivered due to utero-peritoneal adhesion had caused no maternal systemic clinical signs after 30 days from the co-twin’s birth. CASE DESCRIPTION A 2-year-old, Chios-Kivircik crossbred sheep was presented to the Clinics of Adnan Menderes University, Faculty of Ve- terinary Medicine, with a large mass palpated in the ventral abdomen and a 72-hour history of in appetence. The sheep had given birth to one healthy lamb at term -33 earlier days. Parturition was performed without assistance and no genital disorders (retention secundinarum and/or metritis were ob- served in the postpartum period. Primary examination revealed that the sheep was in good condition and normothermic. The only abnormal external clinical finding was a painless and compressible mass locali- zed on the left ventroabdominal region (Figure 1). No vagi- nal discharge was observed. Vaginal examination revealed that the cervical canal was closed. In contrast to her good physical condition, haematological tests showed that White Blood Cell (WBC), Red Blood Cell (RBC) and haematocrit (HCT) values were lower and 5.62 x 10 9 ; 4.04 x 10 12 and 14.28%, respectively. At abdominal palpation, fluctuation was noted on the region where the mass was located. A foetus localized in this mass was identified by trans-abdominal ultrasonography. During the foetal ultrasonography, an increase in echogenity was de- tected in the foetal fluids (Figure 2A). Moreover, a radio- graph was taken in lateral projection to examine the locali- zation of the dead foetus (Figure 2B). Following all patient’s data obtained from clinical and laboratory examinations, the preliminary diagnosis was a prolonged foetal retention due to ventral hysterocele (gravid). The treatment of choice was tha surgical removal of the dead foetus from the uterus and to repair of ventral hernia surgi- cally. The sheep was sedated with an intramuscular injection of 0.2 mg/kg Xylazine hydrochloride (Xylazinbio 2%® - Bio- veta, Turkey) and placed in right recumbency and the ventral abdomen was aseptically prepared in a standard fashion. The surgical area was desensitized with a linear infiltration of 2% lidocaine hydrochloride (Adokain® - Sanovel, Turkey). Du- ring the linear /over the swelling surgical incision of the abdo- minal wall, no hernial sac formation could be observed. After G. Erdogan et al. Large Animal Review 2015; 21: 87-89 87 l Autore per la corrispondenza: Günes ¸ Erdogan ([email protected]).

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Prolonged co-twin foetal retention in a sheep: caused by hysterocele?

SUMMARYProlonged foetal retention is a birth complication and its clinical signs usually appear in early puerperium with systemic ill-ness. This case report describes a case of co-twin foetal retention and its pre/intraoperative clinical findings. A sheep was re-ferred to our clinic suffering from a ventral mass and loss of appetite in the previous three days. She had given birth to onehealthy lamb 33 days before. After haematological tests, neutropenia and anaemia were detected. Ultrasonic and radiologic exa-minations revealed a dead foetus in this mass. Following clinical examination the preliminary diagnosis was a prolonged foe-tal retention related to a ventral hysterocele. During surgery no findings related to ventral hysterocele was observed but utero-peritoneal adhesions were detected. A dead but otherwise intact foetus was removed from the uterus. Following surgery thesheep recovered uneventfully. This is a rare case of prolonged co-twin ovine foetal retention in an adhere uterus, and for aslong as 30 days asymptomatic.

KEY WORDSAdhered uterus, pregnancy abnormality, sheep.

G. ERDOGAN1, E. HAKAN UÇAR1, C. PEKER1, N. KILIÇ2

1 Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Adnan Menderes University,Aydin, Turkey

2 Department of Surgery, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey

INTRODUCTIONDystocia in multiple pregnant small ruminants increases therisk of perinatal lamb mortality and it is related to importanteconomic losses10. It is more frequent in twin ovine pre-gnancies than singletons, except when singletons are oversi-zed8. Moreover, some maternal dysfunctions (uterine inertia,uterine rupture and ectopic pregnancies) are reported as de-livery problems in does11.Foetal retention resulting from dystocia is a rare complica-tion, and usually suspected in early puerperium with syste-mic illness such as high temperature, anorexia, lethargy etc.4.It has been recorded in cases of multiple lamb births and ute-rine torsion2,17. Foetal retention caused by prolonged ovinedystocia causes necrotic metritis and is usually fatal5,13.This short communication describes a rare case of delayedinterval delivery of co-twin foetus with pre/intraoperativeclinical findings in a sheep. The dead but also intact foetuswhich was not delivered due to utero-peritoneal adhesionhad caused no maternal systemic clinical signs after 30 daysfrom the co-twin’s birth.

CASE DESCRIPTION

A 2-year-old, Chios-Kivircik crossbred sheep was presentedto the Clinics of Adnan Menderes University, Faculty of Ve-terinary Medicine, with a large mass palpated in the ventralabdomen and a 72-hour history of in appetence. The sheephad given birth to one healthy lamb at term -33 earlier days.

Parturition was performed without assistance and no genitaldisorders (retention secundinarum and/or metritis were ob-served in the postpartum period.Primary examination revealed that the sheep was in goodcondition and normothermic. The only abnormal externalclinical finding was a painless and compressible mass locali-zed on the left ventroabdominal region (Figure 1). No vagi-nal discharge was observed. Vaginal examination revealedthat the cervical canal was closed. In contrast to her goodphysical condition, haematological tests showed that WhiteBlood Cell (WBC), Red Blood Cell (RBC) and haematocrit(HCT) values were lower and 5.62 x 109; 4.04 x 1012 and14.28%, respectively. At abdominal palpation, fluctuation was noted on the regionwhere the mass was located. A foetus localized in this masswas identified by trans-abdominal ultrasonography. Duringthe foetal ultrasonography, an increase in echogenity was de-tected in the foetal fluids (Figure 2A). Moreover, a radio-graph was taken in lateral projection to examine the locali-zation of the dead foetus (Figure 2B). Following all patient’sdata obtained from clinical and laboratory examinations, thepreliminary diagnosis was a prolonged foetal retention dueto ventral hysterocele (gravid).The treatment of choice was tha surgical removal of the deadfoetus from the uterus and to repair of ventral hernia surgi-cally. The sheep was sedated with an intramuscular injectionof 0.2 mg/kg Xylazine hydrochloride (Xylazinbio 2%® - Bio-veta, Turkey) and placed in right recumbency and the ventralabdomen was aseptically prepared in a standard fashion. Thesurgical area was desensitized with a linear infiltration of 2%lidocaine hydrochloride (Adokain® - Sanovel, Turkey). Du-ring the linear /over the swelling surgical incision of the abdo-minal wall, no hernial sac formation could be observed. After

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Autore per la corrispondenza:Günes Erdogan ([email protected]).

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opening of the abdominal cavity, it was clearly seen that the la-teral surface of the left gravid horn was tightly adhered to theabdominal viscera. The gravid horn was localized in front ofanulus inguinalis. The abdominal wall was intact. The lefthorn was detached carefully from the abdominal wall. Theadhered gravid horn - viable appeared - and the only abnor-mal physical finding was a localized circumscribed purulentarea on the external surface of the uterus (white arrows, Figu-re 3). When lancing the uterine wall the foul-smelling, puru-lent foetal fluid was aspirated to avoid intra-abdominal conta-mination. A dead but intact foetus at full term was removed.On partial post-mortem exam of dead foetus, neither conge-nital nor acquired abnormalities were recorded (Figure 4).Following closing the uterus with Lembert and Schmieden su-tures, to prevent the development of abdominal adhesions 50to 100 ml of a solution of 6% dextran 70 was dripped into theperitoneal cavity and the abdominal wall was closed with acontinuous suture by using 2-0 polyglactin 910 (Vicryl®, Ethi-con). Postoperatively, antibacterial therapy was given with 2.5mg/kg enrofloxacine (Baytril-K® 5%, Bayer IE Ulagay) dailyfor five days. A week after surgery, the sheep was clinically nor-mal and appeared healthy. No complications were recordedthroughout the four weeks following the surgery.

DISCUSSION

The delivery of a dead foetus depends on the extent of foe-tomaternal signalling mechanisms operative between theuterus, ovaries and pituitary gland. A foetus when it dies inthe uterus is usually expelled within 24-72 hours after itsdeath12. Although long-term retention of a dead foetus caseshave also been reported in elephants7,14, the causes andpathogenesis of prolonged foetal retention in the elephantare unknown.It is well known that in domestic animals species an healthyfoetus can develop beside a mummified co-twin. The deadbovine foetus can remain in the uterus for between 150 or200 days or a normal gestation period6. A live calf with amummified co-twin foetus was recorded in a heifer1. Mum-mified foetus/es present in the uterus with normal healthyfoetuses are reported in small ruminants3,9. Moreover Tutt,(1997) reported that a mummified co-twin foetus was de-scribed in a doe after two months from the normal birth ofa healthy kid. In this case report non mummified, intact foe-tus covered with purulent foetal fluid was observed.Brozos et al., (2012) reported - an emphysematous embryo re-moved from infected and necrotised uterus in a Chios ewe

Figure 1 - Macroscopic appearance of ventro-abdominal mass.

Figure 2 - A) Ultrasonographic image at the mass, increased echo-genity of foetal fluid (a), foetal body (b). B) Lateral radiograph of thesheep showing the dead foetus in the ventro-abdominal mass.

Figure 3 - Green colour - localized circumscribed purulent area(arrows) on the adhered uterus horn surface.

Figure 4 - The dead intact foetus delivered via caesarean opera-tion 33 days after the co-twin birth.

A

B

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References1. Anderson, G.B., Cupps, P.T., Drost, M. (1979) Inductions of twins in cattle with

bilateral and unilateral embryo transfer. J Anim Sci, 49:1037-1042.2. Brozos C.N., Lazaridis L., Karagiannis I., Kiossis E., Tsousis G., Psychas V., Gia-

nidis N.D. (2012) Prolonged dystocia, uterine necrosis, and ovariohysterec-tomy in a Chios ewe. Turk J Vet Anim Sci, 36: 211-213.

3. Dadarwal D., Duggal G.P., Gupta A.K., Purohit G.N., Pareek P.K. (2000) Rarecase of abortion of mummified fetus in a goat. Vet Pract, 1: 139-140.

4. Günzel-Apel A.R., Fehr M., Seefeldt A., Reischauer A., Schoon H.A. (2008) Pro-longed foetal retention in a bitch resulting in Trichogranulomatuous panme-tritis and re-establishment of fertility after unilateral ovariohysterectomy. Re-prod Dom Anim, 43: 117-120.

5. Hindson J.C., Winter A.C. (2007) Genital abnormalities, obstetrical problemsand birth injuries. In: Diseases of Sheep, Ed. Aitken I.D.,75-80, Blackwell Pu-blishing, London.

6. Johnson WH, Manns JG, Adams WM, Maplefot RJ (1981): Termination of pre-gnancy with cloprostenol and dexamethasone in intact or ovariectomizedcows. Canadian Veterinary Journal 22, 288-290.

7. Lange A., Hildebrandt T.B., Strauss G., Czupalla O., Goeritz F., Schaftenaar W.(1999) Moeglichkeiten und Grenzen für Geburtshilfe bei Elefanten. Verh BerErkrg Zootiere, 39: 47-58.

8. Majeed A.F., Taha M.B., (1989) Dystocia in local goats in Iraq Small Rum Res,2: 375-381.

9. Ogbu E.O., Omamegbe J.O., Ukara R., Njoku U.N., Nnakwe K., Nwoha R.I.O.(2011) Dystocia and foetal mummification in a West African Dwarf Doe (A ca-se report). Nigerian Vet J, 32: 357-361.

10. Østerås O., Gjestvang M.S., Vatn S., Sølverød L. (2007) Perinatal death in produc-tion animals in the Nordic countries - incidence and costs. Acta Vet Scand, 49: 14.

11. Purohit GN. (2006) Proceedings National Seminar on Innovations and RecentAdvances in Small Ruminants Production. Avikanagar, Jaipuri, India, p: 227-231.

12. Purohit G.N., Gaur M. (2011) Etiology, antenatal diagnosis and therapy of fe-tal complications of gestation in large and small domestic ruminants. Therio-genology Insights, 1: 43-62.

13. Scott P.R. (2005) The management and welfare of some common ovine obste-trical problems in the United Kingdom. Vet J, 170: 33-40.

14. Thitaram C., Pongsopawijit P., Thongtip N., Angkavanich T., Chansittivej S.,Wongkalasin W., Somgird C., Suwankong N., Prachsilpchai W., Suchit K., Clau-sen B., Boonthong P., Nimtrakul K., Niponkit C., Siritepsongklod S., RoongsriR., Mahasavankul S. (2006) Dystocia following prolonged retention of a deadfetus in an Asian elephant (Elephas maximus). Theriogenology, 66: 1284-1291.

15. Tutt C.L.C. (1997) Postpartum mummification of a co-twin fetus in a Came-roon dwarf goat more. Vet Rec, 140: 229-231.

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which had given birth to 2 lambs, 2 days earlier. Similarly, thecase of a foetal retention about 5-month-old resulting in Tri-chogranulomatuous panmetritis was observed in a bitch4. De-spite the presence of foul-smell and purulent foetal fluids inthe gravid horn, no findings related to necrotising of the ute-rine wall was seen except the small purulent area localized inits dorsal surface. The left adhered gravid horn was viable andsutured successfully after uterine lavage. Regarding to the in-tact foetus, non-necrotized uterine wall, and low haematologi-cal values, it can be assumed that foetal death has occurred inbefore the 2-3 days. This is the most plausible explanation forthe first quiescent postparturient 30 days, without any foetaldegeneration and maternal systemic illness. To the authors’knowledge, this is a rather unique case of prolonged retentionof a co-twin caused by utero-abdominal adhesion in a sheep.Intraperitoneal adhesions are fibrous bands of connectivetissue with blood vessels and neurons in some cases. Adhe-sions usually are formed after surgical trauma, inflamma-tion, ischemia and/or infection of the peritoneum, leading toabnormal connections among serosa surfaces due to imba-lance between fibrin deposition and fibrinolysis16. Althoughit was not possible to establish the cause of the utero-perito-neal adhesion in this case, it is likely that the retained foetuswas not normally delivered because of reduces and/or absentmyometrial contractions.The foetal counting and monitoring of single and multiplepregnancies by using ultrasonography is important for ma-ternal health and also foetal outcome. Having divided thepregnant ewes into single- and multiple foetuses groups, atparturition of the multiple foetuses carrying-sheep it shouldbe established by manual trans-vaginal examination that allfoetuses have been delivered. The early diagnosis of the foe-tal-maternal problems may help to reduce the lamb morta-lity and economic losses in the flock.

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