Dystocia due to parapagus dicephalus dibrachius dipus dicaudatus double foetal monster in a crossbred Jersey cow: A case report

Introduction

Foetal anomalies and monstrosities are the common causes of dystocia in bovines [4] . A monster refers to a fetus with multiple abnormalities affecting several organs and body systems and these deformities are frequently associated with dystocia. Many of these are double monsters, with doubling of parts or nearly the entire fetus. These double monsters apparently arise from incomplete development or separation of monozygotic twins in the early embryonic period [1] . Different types of conjoined twin foetal monsters arise based on the site of fusion and incomplete separation. Twinning in uniparous animal is a common cause of dystocia. Cesarean section is typically performed for the obstetrical management of conjoined twins [6] . In this case report, a successful delivery of parapagus dicephalus dipus dicaudatus double foetal monster by performing caesarean section was reported.

Case History and Clinical findings

A five-year old pluriparous crossbred Jersey cow having difficulty in parturition was presented to the large animal unit of Gynaecology and Obstetrics Unit, Veterinary Clinical Complex, RIVER, Puducherry. The owner reported that the amniotic sac has ruptured previous night and despite the animal straining, all attempts at delivery of the fetus were unsuccessful. Clinical examination revealed elevated respiration and pulse rates with normal rectal temperature. Epidural anesthesia was administered using Lignocaine hydrochloride 2% and per vaginal examination of the cow revealed, fetus in anterior longitudinal presentation, dorso-sacral position with both the forelimbs extending towards the birth canal. A detailed exploration revealed that the fetus was a conjoined twin monster. Hence, the case was tentatively diagnosed to be dystocia due to dicephalic dibrachius conjoined twin monster. To save the dam's life and relieve the fetus, obstetrical intervention and forced extraction were attempted, however the per-vaginal delivery was unsuccessful. Hence, it was decided to perform caesarean section to relieve the foetal monster.

Treatment

After properly restraining the animal in right lateral recumbency, the left lower flank site was aseptically prepared for the surgical procedure. Using 2% Lignocaine hydrochloride injection, local infiltration, an inverted 'L' block, and a line block were performed. Laparohysterotomy was performed as per the standard surgical procedures to locate the foetal limbs. By applying mild traction on the hind limbs, a dead male fetus was relieved. The uterus was closed using a catgut size-1 by Lembert's inversion suture pattern, followed by the closure of the muscle using a catgut size-2 suture by Ford interlocking pattern. As per the standard procedure, skin and subcutaneous tissue were sutured. Post-operative treatment included Dextrose normal saline 2 L, IV, Inj. Oxytetracycline @ 10 mg/kg b.wt. IV, Inj. Meloxicam @ 0.3 mg/kg b.wt. IM, Inj. Chlorpheniramine maleate @ 0.5 mg/kg b.wt. IM and Inj. Tribivet 10 ml IM for 5 days. Antiseptic dressing of the surgical wound was performed every other day and skin sutures were removed on the day 14 post-caesarean section. The cow recovered without any complications. Gross examination of the foetal monster revealed that the conjoined twins were lying side-by-side with ventrolateral fusion, resulting in two heads, two forelimbs, two hind limbs and two tails. Based on the findings, it was named as parapagus dicephalus dibrachius dipus dicaudatus [3] (Fig. 1). Radiographic examination revealed two vertebral columns (one for each dead calf) lying side-by-side but fused at the sacrum (Fig. 2). Dissection of the fetus revealed that there were two hearts fused together, with one fully developed and the other partially developed (Fig. 3), two tracheae (one for each dead fetus) (Fig. 4), two spleens, single thoracic cavity (rib cage) and hepatomegaly. (Fig. 5).

Discussion and Conclusion

Double or conjoined monsters usually arise from a single ovum and are monozygotic [2] . Several genetic and environmental factors are believed to play an important role in the inability of twins to separate after fertilization resulting in the formation of a conjoined twin. These anomalies are believed to occur during the primitive streak development stage of the monster due to incomplete division of a single embryo into two parts. Vaginal delivery of conjoined twins is typically challenging due to their bigger size and fetotomy requires extensive manipulations, hence caesarean section is often a better option to preserve the life of the animal [5] . In the present case, a parapagus dicephalus dibrachius dipus dicaudatus double foetal monster in a cow was successfully relieved through caesarean section.

Conflict of Interest

Authors have no conflict of interest in this study.

Acknowledgement

AcknowledgementThe authors are thankful to the Dean, Rajiv Gandhi Institute of Veterinary Education and Research, Puducherry for the facilities provided to conduct the present study.

References

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