Successful caesarean management of pre-cervical uterine torsion in a Murrah Buffalo

Introduction

Uterine torsion is defined as the rotation of the gravid uterus around its longitudinal axis and constitutes a major cause of dystocia, fetal death, and maternal morbidity in large domestic animals (Ali et al., 2016; Pushp et al., 2024) [1,22] . In torsion species-specific variations exist in its clinical presentation and management. In buffaloes, uterine torsion is commonly associated with prolonged tenesmus, anorexia, and reduced fecal output, whereas affected cattle frequently exhibit systemic symptoms including pyrexia, tachycardia, and inappetence (Yadav et al., 2023; Tharwat et al., 2023) [27] . Uterine torsion may impair uteroplacental perfusion and may result in partial or complete occlusion of the birth canal, thereby compromising fetal viability and maternal health (Dioli et al., 2020; Al-Saeed et al., 2024) [8,2] . Prolonged torsion has been associated with fetal death, premature expulsion of the fetus, retention of fetal membranes, uterine rupture, endotoxemia, reduced reproductive performance and maternal mortality (Hussain et al., 2021; Mahmoud et al., 2020) [11,14] . Definitive diagnosis is established through combined per-vaginal and per-rectal examination, enabling identification of spiral vaginal folds, displacement and tension of the broad ligaments and determination of the direction and extent of uterine rotation (Peter et al., 2013; Tharwat et al., 2023) [17] . Hematological alterations in affected buffaloes include normocytic normochromic anemia, evidenced by decreased erythrocyte count, hemoglobin concentration, and packed cell volume, which may result from circulatory disturbances and hemorrhage associated with dystocia (Amer and Hashem, 2008). Leukocytic responses are characterized by neutrophilia, monocytosis, lymphocytopenia, and eosinopenia, reflecting systemic stress and inflammation and may persist during the early postpartum period following surgical correction (Kaur et al., 1993; Phogat et al., 1991) [25,18] . Pharmacological induction of uterine relaxation can be achieved using β₂-adrenergic agonists such as clenbuterol, which exert a tocolytic effect by inhibiting myometrial contractility (Ballarini et al., 1978; Bostedt and Rudloff, 1983) [4, 5] . Therapeutic management includes detorsion by rolling, manual correction, or cesarean section with selection of the procedure based on the degree and duration of torsion, cervical dilatation, fetal viability and maternal condition (Khalphallah et al., 2023; Đuričić et al., 2023) [12,9] . In chronic cases exceeding 72 hours in duration cesarean section is considered the treatment of choice owing to the reduced likelihood of successful detorsion and the increased risk of maternal and fetal complications associated with repeated rolling attempts (Prabhakar et al., 1995) [19] . This case report highlights timely management of the uterine torsion.Prognosis and future fertility of dam depends on severity and duration of uterine torsion and methods of handling.

Case Report

A 4-year old, female Murrah buffalo at approximately 9 months of gestation was presented to the Veterinary Clinical Complex, MR College of Veterinary Science and Research Centre, Jhajjar, Haryana, India with the chief complaint of uterine torsion. The animal had previously been diagnosed with uterine torsion and treated by a field veterinarian using Schaffer's rolling method. Upon presentation, the buffalo was alert, active, and standing normally. General clinical examination revealed normal conjunctival mucous membranes, indicating adequate peripheral perfusion and absence of severe systemic compromise. Pronounced vulvar edema and udder engorgement were observed, suggesting advancement of gestation and impending parturition. A foul-smelling mucopurulent vaginal discharge was evident, indicating possible uterine contamination and inflammatory changes associated with prolonged dystocia. Trans-rectal ultrasonography was performed using a real-time B-mode ultrasound scanner equipped with a linear-array transducer of frequency 7.5-10MHz Easi-Scan® ultrasound scanner (IMV Technologies, Normandy, France)). Placentomes were clearly visualized and measured approximately 60 × 45 mm (Fig. 1A). The allantoic cavity contained predominantly anechoic fluid interspersed with multiple hyperechoic floating debries (Fig. 1B). [21,16] . [7] ; Bold letter describe low values than normal range.

The surgical site was aseptically prepared after shaving the site using a surgical solution 7.5% Povidone-iodine (Betadine® by CONTROL D). Local anaesthesia was achieved by infiltration of 2% Lignocaine (Xylocaine 2% byZydus healthcare) on the incision line. To prevent tenesmus and violent movement, posterior epidural anaesthesia using [20] ml of 2% Lignocaine (Xylocaine 2%, by Zydus healthcare) was also given. A horizontal line (left paramedian) of incision parallel to milk vein about 35 cm long was put to incise the skin. Further, abdominal muscles were incised ligating all bleeding vessels, while peritoneum was incised using scissors. Uterus was sectioned avoiding placentoms on greater curvature and a dead foetus in the anterior presentation was removed. Foetal fluid and membranes were removed out. Uterus was cleaned using Normal saline solution. The uterine incision was sutured by the Cushing method followed by the Lambert method using braded and coated polyglycolic acid (Truglyde® 2, Helthium Medtech limited, Bangalore, Karnataka). Peritoneum and muscle was sutured with absorbable braded and coated polyglycolic acid (Truglyde® 2). Underlying facia and muscle were sutured with absorbed braded and coated polyglycolic acid (Truglyde® 2-0, Helthium Medtech limited, Bangalore, Karnataka) and skin was sutured through nonabsorbable monofilament polyamide black (Trulon® 2, Helthium Medtech limited, Bangalore, Karnataka) and purse sting suture was removed immediately after surgery. Antiseptic dressing was done with povidone-iodine scrub (Sistadine microbicidal solution-10%, Sisla laboratories, Narela Delhi) and triple-antibiotic (neomycin sulphate, polymyxin B sulphate and bacitracin; Aluspray-AWD®, Vetoquinol). Post-operatively, the cattle were given Penicillin-streptomycin combination (Penstrep) was injected intramuscularly once daily at a dose of 10,000 IU penicillin/kg, 6.2 mg of streptomycin/kg and 6.25 mg of dihydrostreptomycin/kg for five successive days. Phenylbutazone (Phenylbutazone 20% injection) was given intravenously at a dose of mg/kg body weight once daily for three successive days as anti-inflammatory drug. The wound was dressed three times a day with Povidone-iodine antiseptic solution for 10 days. Then, the stitches were removed 10 days post-operatively. The case was followed up for 2 months with uneventful recovery.

Discussion

As in our study uterine torsion cause of maternal dystocia aligned with other studies which also found that uterine torsion is the most common maternal cause of dystocia in buffaloes and may account for more than 50% of maternal dystocia cases encountered in referral clinics (Purohit, 2013; Yadav et al., 2023) [20,27] .Prolonged torsion compromises uterine and placental blood circulation, resulting in fetal hypoxia, death, emphysema, uterine edema and incomplete cervical dilatation (Purohit et al., 2011) [21] which is observed in our case as a dead foetus was expelled out after caesarean section. In the present case, failure of correction by Schaffer's method, presence of incomplete cervical dilatation (ICD), foul-smelling discharge and an emphysematous fetus indicated a chronic uterine torsion which was verified by history provided by owner. Similar findings have been reported in buffaloes with longstanding torsion where vaginal delivery becomes unlikely (Srinivas et al., 2007) [24] .Therefore, caesarean section was performed as the treatment of choice because surgical intervention is recommended when detorsion fails, cervical dilatation is inadequate, or the fetus is dead and emphysematous (Purohit, 2013; Aubry et al., 2008) [20,3] . Prompt surgical management and postoperative care contributed to successful recovery of the dam.

Conclusion

Uterine torsion in buffaloes remains a critical obstetrical emergency associated with significant maternal and fetal losses. Prompt diagnosis using clinical examination and ultrasonography, followed by timely therapeutic intervention, is essential for favorable outcomes. The severity of hematobiochemical alterations and fetal viability status may serve as important prognostic indicators in affected cases. Early correction of torsion can improve reproductive prognosis and reduce peri-parturient losses in buffaloes.

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