Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study

The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the "dystocic pain", that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS.

A Case Report of Uterine Body Constriction Precluding Normal Parturition Leading to Dystocia in a Mare

A 13-year-old multiparous Quarter Horse mare was presented to the Michigan State University's, Large Animal Emergency service for dystocia. Clinical evaluation revealed a minimally dilated cervix on vaginal examination, with a palpable deceased fetus. Postmortem evaluation following owner-elected humane euthanasia revealed a circumferential, tan, fibrous band at the base of the uterine body that constricted the uterus and was adhered to the left and right ovaries. A routine histologic section of the incarcerating cord attached to the ovary consisted predominately of dense fibrous connective tissue, large blood vessels, and a central oviduct suggestive of a rent in the broad ligament. To the authors' knowledge, this is the first case report to describe uterine body constriction that precluded vaginal delivery of a fetus in a late gestation mare.

Pharmacological Interventions in Labor and Delivery

While there is not a wide range of pregnancy-specific drugs, there are some very specific high-risk areas of obstetric care for which unique pharmacological approaches have been established. In preterm birth, labor induction and augmentation, and the management of postpartum hemorrhage, these pharmacological approaches have become the bedrock in managing some of the most common and problematic areas of antenatal and intrapartum care. In this review, we summarize the existing established and emerging evidence that supports and broadens these pharmacological approaches to obstetric management and its impact on clinical practice. It is clear that existing therapeutics are limited. They have largely been developed from our knowledge of the physiology of the myometrium and act on hormonal receptors and their signaling pathways or on ion channels influencing excitability. Newer drugs in development are mostly refinements of these two approaches, but novel agents from plants and improved formulations are also discussed.

Impact of Dystocia on Milk Production, Somatic Cell Count, Reproduction and Culling in Holstein Dairy Cows

This study investigated the effects of dystocia on milk production, somatic cell count, reproductivity, disease, and milk production. A total of 2159 cows across 21 dairy farms in Alberta, Canada were enrolled in this study. Multivariable models were created to explore associations between outcome variables and calving ease score. In total, 89.5% of calvings were unassisted, 6.1% were an easy pull, and 4.3% were a moderate-hard pull. Cows that had a moderate-hard pull produced 4.01 kg less milk, 0.12 kg less volume of milk fat, and 0.12 kg less milk protein per day than those that had an unassisted calving. No difference was found between calving ease groups with respect to SCC. Cows with a moderate or hard pull produced 510 kg less milk per lactation than unassisted cows. Cows with a moderate to high level of assistance at birth had a higher hazard of being culled over the duration of their lactation. Cows with an easy pull had increased odds of developing a retained placenta. It is evident that assistance at calving, particularly a moderate-hard pull, is associated with significant impacts on future milk production and risk of being culled; therefore, efforts should be made to minimize dystocia and prevent these impacts.

Do Calving-Related Injuries of the Vestibulum Vaginae and the Vagina Affect the Reproductive Performance in Primiparous Dairy Cows?

The aim of this study was to investigate the influence of calving-related injuries of the vestibulum vaginae and the vagina on fertility measures in heifers. German Holstein heifers (n = 236) were checked for vestibulum vaginae and vaginal injuries. These were scored according to localization, depth and length. The healing process was assessed until day 42 post partum. Calving ease and the occurrence of metritis and endometritis were evaluated. In 160 heifers, the following fertility measures were calculated to assess the reproductive performance of heifers: mean interval from calving to first insemination, mean days open, mean interval from first insemination to conception, mean calving interval, mean pregnancy index, percentage of animals pregnant at 200 days p.p., and first service conception rate. On the one hand, dystocia was a risk factor for injuries of the soft birth canal, and, on the other hand, those injuries were a risk factor for metritis and endometritis. In this study, calving-related injuries of the vestibulum vaginae and the vagina had no statistically significant effect on the reproductive performance of heifers. One reason for this outcome was probably the overall good healing tendencies of those injuries in heifers.

Impact of age at first calving on performance traits in Irish beef herds

Reducing age at first calving (AFC) has been a challenge in beef herds. There is anecdotal evidence that herd owners choose to calve heifers older because of the perceived consequences of calving heifers at 24 mo of age compared to 36 mo on performance traits in beef herds. The objective of this study was to estimate the association of calving heifers at younger ages on subsequent performance traits, calving interval, longevity, cow weight, dystocia, and progeny weaning weight for parities 1 to 5. Available to the study after data edits were 219,818 calving interval records, 219,818 longevity records, 118,504 cow live-weight records, 230,998 dystocia records, and 230,998 weaning weight records. Linear mixed models were used to quantify performance of each trait in AFC groups for each parity. As parity increased, there was a favorable reduction in calving interval and dystocia (P < 0.001), while the likelihood of cows surviving reduced (P < 0.001). Both cow live weight and progeny weaning weight increased as parity increased. Age at first calving only had a significant association with dystocia within parity 1 (P < 0.001), where older heifers at first calving subsequently had lower risk of calving. Calving interval for parity 1 cows was observed to be longer by 6 d in cows that calved for the first time at 33 to 36 mo compared to cows calved for the first time at 22 to 24 mo (P < 0.001). No statistical difference was observed for longevity between cows with an AFC of 22 to 24 mo compared to cows with an AFC of 33 to 36 mo (P > 0.05). Cows that calved at a younger age did wean lighter calves for their first three lactations (P < 0.01) but had no association with weaning weight for parity 4 and 5 cows (P > 0.05). Cows with a lower AFC were lighter for parity 1 to 4 (P < 0.001); at parity 5, AFC had no association with cow live weight (P > 0.05). The performance of mature cows for calving interval, longevity, calving difficulty, cow live weight, and weaning weight was not impacted by AFC. In conclusion, calving cows for the first time at younger ages do pose risks and associated performance loss but this risk and loss should be minimized by good management.

Associations between polymorphisms in the myostatin gene with calving difficulty and carcass merit in cattle

A fully functional myostatin gene inhibits muscle fiber growth. The objective of the present study was to quantify the association between 21 known myostatin mutations with both calving and carcass traits in 12 cattle breeds. The myostatin genotypes of 32,770 dam-progeny combinations were used in the association analysis of calving dystocia, with the genotypes of 129,803 animals used in the mixed model association analyses of carcass weight, conformation, and fat score. The mixed model included additive genetic, maternal, and permanent environmental effects where appropriate. The mutant genotypes of nt821, Q204X, and F94L were all associated (P < 0.01) with more calving difficulty when present in either the dam or the progeny. The nt821 deletion had the greatest association with calving difficulty when the homozygous deletion was present in either the calf (0.37 points greater calving difficulty score relative to calves carrying no copies of the deletion based on a one to four scale) or the dam (1.30 points greater calving difficulty score relative to dams carrying no copies of the deletion), although the association between the calf's nt821 genotype and calving difficulty differed depending on the nt821 genotype of the dam. With the exception of nt748_78, nt414, and nt374_51, all other seven segregating myostatin variants were associated (range of allele substitution effect size relative to animals with no copies of the mutant allele) with carcass weight (2.36 kg lighter to 15.56 kg heavier), all 10 segregating variants with conformation (0.15 units less conformed to 2.24 units more conformed assessed on a scale of 1 to 15), and all segregating variants other than E226X with carcass fat (0.23 units less carcass fat cover to 3.85 units more carcass fat cover assessed on a scale of 1 to 15). Of these, the F94L, Q204X, and nt821 mutations generally had the greatest association with all three carcass traits, giving rise to heavier and more conformed carcasses. Despite the antagonistic genetic relationship between calving difficulty and carcass traits, the nt374_51, F94L, and E226X mutations were all associated with improved carcass merit while having minimal expected consequences on calving difficulty. Thus, animals carrying these mutation(s) may have favorable genetic merit for calving difficulty and carcass merit. Furthermore, depending on the dam genotype, a bull with two copies of the nt821 mutation can produce progeny with improved carcass merit while minimizing calving problems.

An intrapartum calculator for predicting cesarean birth due to dystocia: Preliminary findings from a single-center study in Korea

BACKGROUND

Previous calculators based on antepartum or pre-labor factors preclude intrapartum counseling. We aimed to develop a reliable, programmable, intrapartum calculator to predict the risk of cesarean birth (CB) due to dystocia and to increase the discriminatory accuracy of the predictive model.

METHODS

Data were obtained retrospectively for 1326 singleton term deliveries with cephalic presentation. Two predictive multivariable logistic regression analysis models were constructed using pre-active labor variables alone (model A) or with active labor variables (model B). The discriminatory accuracies and goodness-of-fit of the models were compared using receiver operating characteristic (ROC) curves or -2log-likelihood ratios, Akaike information criterion (AIC), and Bayesian information criterion (BIC), respectively. Both models were internally validated using a bootstrapping procedure.

RESULTS

Model A yielded an area under the curve (AUC) of 0.859 and adequate goodness of fit (P = 0.970). Model B yielded a significantly higher AUC of 0.887 and adequate goodness of fit (P = 0.624), as well as a significantly lower AIC and BIC (P &lt; 0.001). Internal validation revealed a minimal optimism of 0.0070491 and 0.0068976 for models A and B, respectively. Finally, the logistic regression equations were converted into programmable calculators to yield easy-to-understand basic (model A) and additional intrapartum CB calculators (model B).

CONCLUSIONS

The programmable calculators developed herein can augment intrapartum counseling. Our findings suggest that the risk of CB due to dystocia during labor should be estimated using a calculator that corresponds to labor progression. Further studies should explore external validation of these statistical models before translation to a clinical setting.

Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.

Defining "Normal" in Pig Parturition

Simple Summary

The dual considerations of efficient food production and good animal welfare have never been so important nor under such strong public scrutiny as they are in current times. Intensive animal production industries play an important role in feeding an ever-growing, increasingly affluent population that is hungry for animal proteins. The efforts to improve efficiency in these production systems must not come at the cost of animal welfare. One pain point in pig production is that of parturition, where factors such as litter size and sow-housing type have been shown to influence the process and outcome. However, there are still many gaps in knowledge surrounding the normal physiology and endocrinology in a farrowing and this review seeks to summarise what is known and highlight areas where further work is required.

Abstract

Animal production industries rely on efficient and successful reproductive outcomes, with pigs being no exception. The process of parturition in pigs (farrowing) can be especially prolonged, due to the large numbers of piglets being born (on average, approximately 13 piglets per litter in Australian conditions). Difficulties in farrowing (dystocia) lead to poor piglet outcomes and health problems in sows, in turn, causing economic loss for producers and welfare concerns for the animals. Despite the importance of this topic and publications in the area stretching back nearly 50 years, there is still no consensus on the prevalence of dystocia in pigs nor on how to identify a pig experiencing the condition. Understanding the process of parturition and the factors that influence its success is a crucial step towards the early identification of sows undergoing dystocia and development of best practices to assist them. This article describes the key factors that contribute to successful farrowing and identifies areas in which more research is required before the parturition process in the pig can be fully understood.

Birth traits of Holstein calves compared with Holstein, Jersey, Montbéliarde, Normande, and Viking Red-sired crossbred calves

Holstein (HO) calves, 3-breed crossbred calves of Montbéliarde, Viking Red, and HO (MVH), and 3-breed crossbred calves of Normande, Jersey, and Viking Red (NJV) were compared for gestation length (GL), calf weight at birth (CW), calving difficulty (CD), and stillbirth (SB) in 2 research herds at the University of Minnesota. Calves were born from January 2009 to December 2019. For the St. Paul and Morris herds, HO calves (n = 1,121) were compared with MVH calves (n = 1,393) from primiparous and multiparous cows. For the single herd analysis at Morris, HO calves (n = 476), MVH calves (n = 922), and NJV calves (n = 405) were compared from primiparous and multiparous cows. Primiparous and multiparous births were analyzed separately because multiparous cows had multiple births, and CD and SB are likely different traits for primiparous and multiparous cows. Statistical analysis of GL, CW, CD, and SB included fixed effects of sex of calf, herd, breed group of calf, and year-season of calving. For the St. Paul and Morris herds, HO calves from primiparous (278 d) and multiparous (279 d) HO cows had shorter GL compared with MVH calves from primiparous (280 d) and multiparous (282 d) crossbred cows. The HO calves (39.4 and 43.2 kg, respectively) from primiparous and multiparous HO cows had lower CW compared with MVH calves (40.3 and 44.3 kg, respectively) from primiparous and multiparous crossbred cows. Calving difficulty and SB were not different for HO and MVH calves from primiparous and multiparous cows. For the single herd analysis at Morris, HO calves (278 and 279 d, respectively) from primiparous and multiparous HO cows had shorter GL compared with MVH calves (281 and 282 d, respectively) and NJV calves (282 and 282 d, respectively) from primiparous and multiparous crossbred cows. The CW of HO calves (38.6 and 42.0 kg, respectively) from primiparous and multiparous HO cows was lower compared with MVH calves (39.7 and 42.9 kg, respectively), but higher compared with NJV calves (35.1 and 38.0 kg, respectively) from primiparous and multiparous crossbred cows. Calving difficulty and SB did not differ for HO, MVH, and NJV calves from primiparous and multiparous cows. The longer GL for crossbred calves and higher CW for MVH calves did not increase CD and SB for primiparous and multiparous cows. Dairy producers may implement 3-breed rotational crossbreeding systems that include the HO, Jersey, Normande, Montbéliarde, and Viking Red breeds, and some breeds may increase GL and CW without an increase in CD and SB.

Study on NGF and VEGF during the Equine Perinatal Period-Part 2: Foals Affected by Neonatal Encephalopathy

Neonatal Encephalopathy (NE) may be caused by hypoxic ischemic insults or inflammatory insults and modified by innate protective or excitatory mechanisms. Understanding the underlying pathophysiology is important in formulating a rational approach to diagnosis. The preliminary aim was to clinically characterize a population of foals spontaneously affected by NE. The study aimed to: (i) evaluate nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) levels in plasma samples obtained in the affected population at parturition from the mare’s jugular vein, umbilical cord vein and foal’s jugular vein, as well as in amniotic fluid; (ii) evaluate the NGF and VEGF content in the plasma of foals affected by NE during the first 72 h of life/hospitalization; (iii) evaluate NGF and VEGF levels at birth/admission in relation to selected mare’s and foal’s clinical parameters; (iv) evaluate the relationship between the two trophic factors and thyroid hormone levels (TT3 and TT4) in the first 72 h of life/hospitalization; and (v) assess the mRNA expression of NGF, VEGF and brain-derived neurotrophic factor (BDNF), and their cell surface receptors, in the placenta of mares that delivered foals affected by NE. Thirteen affected foals born from mares hospitalized for peripartum monitoring (group NE) and twenty affected foals hospitalized after birth (group exNE) were included in the study. Dosage of NGF and VEGF levels was performed using commercial ELISA kits, whereas NGF, VEGF, and BDNF placental gene expression was performed using a semi-quantitative real-time PCR. In group NE, NGF levels decreased significantly from T0 to T24 (p = 0.0447) and VEGF levels decreased significantly from T0 to T72 (p = 0.0234), whereas in group exNE, only NGF levels decreased significantly from T0 to T24 (p = 0.0304). Compared to healthy foals, a significant reduction of TT3 levels was observed in both NE (T24, p = 0.0066; T72 p = 0.0003) and exNE (T0, p = 0.0082; T24, p < 0.0001; T72, p < 0.0001) groups, whereas a significant reduction of TT4 levels was observed only in exNE group (T0, p = 0.0003; T24, p = 0.0010; T72, p = 0.0110). In group NE, NGF levels were positively correlated with both TT3 (p = 0.0475; r = 0.3424) and TT4 levels (p = 0.0063; r = 0.4589). In the placenta, a reduced expression of NGF in the allantois (p = 0.0033) and a reduced expression of BDNF in the amnion (p = 0.0498) were observed. The less pronounced decrease of the two trophic factors compared to healthy foals, their relationship with thyroid hormones over time, and the reduced expression of NGF and BDNF in placental tissues of mares that delivered affected foals, could be key regulators in the mechanisms of equine NE.

Association of Herd Size with Stillbirth and Dystocia Rates in Japanese Black Cattle

The objective of this study was to investigate the effect of herd size on stillbirth and dystocia rates; the relationships between herd size, calving season, parity, and gestation length in Japanese Black cattle were also explored. Data were collected for 41,184 calvings from 15,512 animals on 905 farms between 2006 and 2010. In this study, herds were classified into three groups based on size: small (1−10 cows), medium (11−50 cows), and large (≥51 cows). Herd size had an effect on the dystocia rate (p < 0.05) but not the stillbirth rate. Additionally, interactions between herd size and gestation length were associated with the dystocia rate (p < 0.05), and the dystocia rate was the highest in small herds, followed by medium and large herds for cows with a gestation length of 281−300 days, which is considered a pregnancy of normal duration. In summary, in Japanese Black cattle, there were different effects of herd size on the stillbirth rate and dystocia rates, as herd size was associated with the dystocia rate but not with the stillbirth rate.

Out of step societal and Darwinian adaptation during evolution is the cause of multiple women's health issues

During human evolution, major changes in our societal conditions and environment took place without sufficient time for concomitant genetic alterations, leading to out of step adaptation and diseases in women. We first discuss recent societal adaptation mismatch (menstrual bleeding; increases in cancers of reproductive organs, endometriosis; mother's nursing; polycystic ovarian syndrome; transgenerational epigenetic modifications), followed by Darwinian out of step adaptation (labor difficulties; sex chromosomes, human diseases and sex disparity in genomic DNA). We discuss the evolutionary basis of menstrual bleeding, followed by recent increases in cancers of reproductive organs and endometriosis. The importance of breastfeeding by mothers is also emphasized. Earlier onset of menarche, decreased rates of childbirths and breastfeeding resulted in increased number of menstrual cycles in a lifetime, coupled with excess estrogen exposure and incessant ovulation, conditions that increased the susceptibility to mammary and uterine cancers as well as ovarian epithelial cancer and endometriosis. Shorter lactation duration in mothers also contributed to more menstrual cycles. We further discuss the evolutionary basis of the prevalent polycystic ovary syndrome. During the long-term Darwinian evolution, difficulties in childbirth evolved due to a narrowed pelvis, our upright walking and enlarged fetal brain sizes. Because there are 1.5% genomic DNA differences between woman and man, it is of significance to investigate sex-specific human physiology and diseases. In conclusion, understanding out of step adaptation during evolution could allow the prevention and better management of female reproductive dysfunction and diseases.

Dystocia in the Standardbred Mare: A Retrospective Study from 2004 to 2020

Dystocia as a prolonged stage II parturition (>30 min) was associated with a higher risk of complications. The hypothesis of the study was that any type of dystocia could affect the foal’s health, even when the stage II was <30 min. Clinical reports on 222 Standardbred mares and their foals hospitalized at the Veterinary Teaching Hospital of the University of Bologna from 2004 to 2020 were reviewed. Mares were divided into the Eutocia Group (165, eutocic delivery) and the Dystocia Group (57, dystocic delivery). The incidence of dystocia was 4.9%. Stage II was longer in the Dystocia Group (median 20 min) than in the Eutocia Group (median 12 min). All occurrences of dystocia were retrospectively classified into three categories of severity: mild, moderate and severe dystocia. The occurrence of postpartum complications in mares and neonatal diseases and failure of passive transfer of immunity in foals was higher in the Dystocia Group. Foal venous lactatemia and serum creatine kinase were significantly higher in the Dystocia Group (median 3.9 mmol/L; 262 UI/L respectively) than in the Eutocia Group (median 3.1 mmol/L; 187 UI/L respectively). The APGAR score was lower in the Dystocia Group (median 8) than in the Eutocia Group (median 10) and significantly lower in severe dystocia (median 3). The duration of stage II should not be considered the only parameter of dystocia in mares: even a rapid resolution of dystocia could pose health risks to the foal and the mare.

Establishment of a method to predict dystocia due to physical imbalance between foetus and maternal pelvis in Japanese Black cattle

This study aimed to clarify the relationship between the maternal pelvis and calf size in normal and dystocia groups (Experiment 1) and to establish a method to predict dystocia due to physical imbalance between foetus and maternal pelvis before calving based on the parameters found in Experiment 1 (Experiment 2). In Experiment 1, 26 pairs of dams and their offspring were tested immediately after calving, and various parameters of offspring size and maternal pelvis were measured in normal and dystocia cases. The longitudinal diameter of the maternal pelvis was smaller (P < 0.01), and ratios of the offspring's birth weight and the width of the hoof crown (hoof width; measured using callipers) to the longitudinal diameter of the maternal pelvis were larger (P < 0.01) in the dystocia group than those in the normal group. In Experiment 2, 37 cows were tested, and in addition to the measurement items of Experiment 1, the inner pelvic diameter and the foetal hoof width were measured via ultrasonography at 285 days of gestation. The ratio of the internal diameter of the maternal pelvis (longitudinal diameter, transverse diameter, and area) to the foetal hoof width was compared and was greater (P < 0.01) in the dystocia group than in the normal group. In conclusion, the risk of dystocia can be estimated by the ratio of the foetal hoof width to the longitudinal diameter of the maternal pelvis before calving.

Physiological plateaus during normal labor and birth: A scoping review of contemporary concepts and definitions

BACKGROUND

Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth.

METHODS

We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review.

RESULTS

Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, "rest and be thankful" stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth.

CONCLUSIONS

Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth.

Review on a cesarean section in the cow: Its incision approaches, relative advantage, and disadvantages

Dystocia is an abnormal and difficult birth in which the first or the second stage of labour is markedly prolonged and subsequently found impossible for the dam to deliver without artificial aid. In cattle, it can be relieved by different obstetric methods, including the cesarean operation and fetotomy. Caesarean section is the extraction of the fetus or foeti from the dam, through a surgical opening in the abdominal wall and the uterus. This surgical method can be performed by about eight alternative surgical approaches in bovines with its advantages and disadvantages. However, the selection is dependent on many factors like the type of dystocia, the cows and environmental conditions, the availability of assistants, and the surgeon's preference. For cows, most surgeons use a standing left paralumbar celiotomy. However, the left oblique approach is also preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Besides, alternative approaches are also available that will further limit the potential for contamination but many junior surgeons perform the left paralumbar celiotomy using the same approach each time due to their comfort with one specific approach or lack of familiarity with other available options. Therefore, the objective of this review is to provide basic insights and highlight the cesarean section incision approaches with their relative advantages and disadvantages in cows.

Retrospective analysis of 302 ovine dystocia cases presented to a veterinary hospital with particular attention to uterine torsion

Background

Dystocia is common in sheep, and foetal causes are predominant. Among maternal causes, insufficient cervical dilatation is the most frequent problem. Uterine torsion has been considered rare by many authors.

Objectives

This study was conducted to investigate causes of dystocia in sheep presented for veterinary attention, and particular focus was set on the description of uterine torsion and analysis of potentially predisposing factors for this condition.

Methods

Clinical records of 302 sheep treated for dystocia were evaluated retrospectively. Known and proposed risk factors for uterine torsion in cattle were analysed regarding their potential importance in sheep. These included lamb birth weights, ewe age, parity, season, nutrition, breed type, litter size and husbandry.

Results

Maternal causes of dystocia accounted for 67.2% (203/302) of the presented cases. Of these, insufficient cervical dilatation (121/203, 59.6%) was the most frequent diagnosis. Another substantial proportion of maternal causes (60/203, 29.6%) was identified as uterine torsion. Husbandry, breed type and litter size showed significance in univariate analyses, with lower odds for meat breeds (OR 0.22; p < 0.001), twin‐ (OR 0.49; p = 0.020) or multiple‐bearing ewes (OR 0.19; p = 0.013) and higher odds for fully housed animals (OR 17.87; p < 0.001). Year‐round housing was identified as the most influential factor in a subsequent multivariate analysis.

Conclusions

Uterine torsion was identified as a relevant cause of dystocia in our case load. The condition is likely to be underdiagnosed in sheep, and increased farmer and veterinary awareness is necessary to ensure adequate treatment of affected animals and to prevent unnecessary suffering.

Conditional knockout of leptin receptor in the female reproductive tract reduces fertility due to parturition defects in mice

Leptin is required for fertility, including initiation of estrous cycles. It is therefore challenging to assess the role of leptin signaling during pregnancy. While neuron-specific transgene approaches suggest that leptin signaling in the central nervous system is most important, experiments with pharmacologic inhibition of leptin in the uterus or global replacement of leptin during pregnancy suggest leptin signaling in the reproductive tract may be required. Here, conditional leptin receptor knockout (Lepr cKO) with a progesterone receptor-driven Cre recombinase was used to examine the importance of leptin signaling in pregnancy. Lepr cKO mice have almost no leptin receptor in uterus or cervix, and slightly reduced leptin receptor levels in corpus luteum. Estrous cycles and progesterone concentrations were not affected by Lepr cKO. Numbers of viable embryos did not differ between primiparous control and Lepr cKO dams on days 6.5 and 17.5 of pregnancy, despite a slight reduction in the ratio of embryos to corpora lutea, showing that uterine leptin receptor signaling is not required for embryo implantation. Placentas of Lepr cKO dams had normal weight and structure. However, over four parities, Lepr cKO mice produced 22% fewer live pups than controls, and took more time from pairing to delivery by their fourth parity. Abnormal birth outcomes of either dystocia or dead pups occurred in 33% of Lepr cKO deliveries but zero control deliveries, and the average time to deliver each pup after crouching was significantly increased. Thus, leptin receptor signaling in the reproductive tract is required for normal labor and delivery. Summary sentence. Mice lacking leptin receptor in the reproductive tract produce fewer live pups and have more adverse labor outcomes than controls, but normal numbers of embryos near term, showing that leptin receptor signaling is required for normal parturition.

Can the Dynamic External Pelvimetry Test in Late Pregnancy Reveal Obstructed and Prolonged Labor? Results From a Pilot Study

Background The size and mobility of the maternal pelvic space are fundamental factors in successful childbirth and can allow operators to screen for dystocia. This pilot study including a group of 70 pregnant women aimed to test whether the external dynamic pelvimetry test can be used to predict the likelihood of obstructed labor. Methodology The study cohort consisted of 70 pregnant women in their third trimester. The cohort was divided retrospectively into an obstructed labor group and a control group. Obstructed labor was defined using the following obstetric outcomes: augmentation with oxytocin from the first phase of the dilating period, Kristeller's maneuvers, vacuum extractor (kiwi), forceps, and the cesarean section following the onset of labor. Results The measurements obtained for the longitudinal hemi-diameter of Michaelis, the inter-tuberous diameter, and the base of the Trillat's triangle were statistically significant in every position. The difference in the measurements of the transverse diameter of Michaelis between standing and hands-and-knees position and the difference in the sizes of the bi-cristal diameter between hands-and-knees and squatting position were statistically significant. Conclusions Dimension and biomechanical properties of the pelvic tissue and spaces influence the evolutionary childbirth process. After clinical confirmation on a large population, hypomobility of specified external pelvic diameters measured in shifting positions can become a screening tool to detect the contracted pelvis and prevent damage caused by dystocia and prolonged labor in women and newborns.

Prediction of vaginal birth after cesarean for labor dystocia by sonographic estimated fetal weight

OBJECTIVE

To estimate the association of the weight difference between the index trial of labor after cesarean (TOLAC) sonographic estimated fetal weight (sEFW) and prior delivery birth weight with TOLAC success rate among women with previous labor dystocia and no prior vaginal delivery.

METHODS

A retrospective cohort study including all women with prior cesarean for labor dystocia and no prior vaginal delivery undergoing TOLAC during between March 2011 and June 2020 with a sEFW within 1 week from delivery.

RESULTS

Overall, 168 women were included, of those 107 (63.7%) successfully delivered vaginally. The mean sEFW and mean birth weight were lower in the TOLAC success group (P = 0.010 and P = 0.013, respectively). The rate of higher sEFW in the current delivery compared with the previous delivery did not differ between study groups. The rate of higher TOLAC birth weight was lower in the TOLAC success group (odds ratio 0.30; 95% confidence interval 0.15-0.58). In multivariable regression analysis, maternal age older than 30 years, induction of labor, and higher birth weight were independently negatively associated with TOLAC success (adjusted odds ratio [95% confidence interval]: 0.27 [0.10-0.70], 0.27 [0.08-0.90], and 0.43 [0.19-0.94]; P = 0.008, P = 0.034, and P = 0.035, respectively).

CONCLUSIONS

sEFW characteristics did not predict the success or failure of TOLAC among women with prior labor dystocia and no previous vaginal delivery.

Risk factors associated with dystocia in swine

Background and Aim:

Dystocia in swine can increase the stillbirth rate; however, its importance in pig-breeding systems has been underestimated. Until now, few studies have investigated dystocia and associated risk factors. Therefore, in this study, we aimed to evaluate the effects of various risk factors on dystocia in swine.

Materials and Methods:

Out of 5,557 piglets, we included 4,997 piglets in risk analysis study. The dependent variable was dystocia, which was recorded when a birth interval exceeded 45 min or when obstetric assistance was applied. The independent variables were parity, gestation length, litter size, birth order, gender, presence of a dead piglet, birthweight, crown rump length, body mass index, ponderal index, and oxytocin use. We used generalized linear mixed models to examine the associations between potential risk factors and dystocia at the piglet level.

Results:

A total of 6% of the piglets were born with a dystocia event, and 47.2% of the farrowing experienced at least one event. Dead piglets and piglets with a crown rump length of >31 cm were associated with an increased dystocia rate. This rate decreased from birth order 2 to 7, stabilized to 11, and then increased till the end of the fetal expulsion process.

Conclusion:

Dystocia is common in swine. Therefore, this condition should be carefully addressed by veterinarians and farrowing house personnel so that its adverse effect on welfare and productivity of sows and survivability of piglets can be reduced. Further studies investigating dystocia status and risk factors in different swine farrowing systems should be undertaken to provide more knowledge about this neglected condition.

Correlation of foetal body weight by coronet width measurement using ultrasonography in prepartum cows: a pilot study

This study aimed to clarify the effectiveness of foetal body weight estimation by measuring foetal coronet width using transrectal ultrasonography in beef cows during near-term pregnancy. A characteristic 'gull wing' pattern was obtained from the foetal coronet cross-section from the dewclaw side using ultrasonography. This pattern was matched to the bone surface of the distal part of the middle phalanx. Then, the relationship between coronet width and body weight at birth of 22 Japanese Brown calves was analysed and a high correlation coefficient of 0.8965 (P < 0.001) was obtained. In conclusion, the coronet width of the fetus is depicted as a 'gull wing' hyperechoic structure and can be measured by ultrasonography per rectum during near-term pregnancy. This technique may be a useful tool to identify high-risk cows with dystocia before calving. High foetal coronet values may predispose cattle to dystocia.

Mortality of Dairy Sheep during the Peri-Parturient Period: Results of a Field Investigation in Greece

Simple Summary

The paper presents a field investigation into the death of ewes around the peri-parturient (lambing) period. The problem is financially important because, in such cases, the capital (i.e., the ewes) is lost along with the increased expenses incurred by farmers during gestation. The problem was found to occur sporadically. Most cases of death occurred before lambing. Pregnancy toxaemia, an important metabolic disease, was the clinical problem most often associated with peri-parturient death. Factors found to be significantly associated with occurrence of the problem included the average lambing rate, the season of the year during which the lambing period took place, and the number of animals in the flock.

Abstract

Objectives of the study were (a) to investigate the incidence risk of peri-parturient mortality in dairy flocks in Greece, (b) to study when such mortality occurs in relation to lambing, (c) to identify clinical problems associated with the deaths, and (d) to evaluate potentially associated factors. The deaths of ewes during the peri-parturient period (10 days before to 7 days after lambing) were monitored in 60 flocks over two years. In the ewes that died, detailed post-mortems were performed. The incidence risk of peri-parturient deaths was 0.7%. The daily incidence rate of deaths before, at, and after lambing was 0.05, 0.04, and 0.03%, respectively. Clinical problems most frequently associated with peri-parturient deaths were pregnancy toxaemia, ruminal acidosis and post-partum genital problems. For the occurrence of peri-parturient deaths in flocks, the average lambing rate in the flocks was the only significant factor. Regarding deaths before or after lambing, the season during which lambing took place and the number of animals in the flock, respectively, were found to be significant. Most ewes (54.5%) that died at lambing (dystocia) were primigravidae.