Obstetrics and post-dystocia care of camelid dams (Proceedings)

Fortunately, camelid parturition generally goes off without a hitch, with less than 5% of births being dystocias. Because the time of parturition is stressful for both dam and owner, it is important to know normal progression and be decisive with intervention.

Normal parturition is divided into three stages:

Stage I consists mainly of cervical dilation and fetal repositioning. It can last from 2-6 hours (avg. 2-6 hours) and is terminated by the entrance of fetal parts into the pelvis. The dam may exhibit signs of abdominal pain, restlessness, frequent urination and defecation and vocalization. If pastured, she may try and isolate herself. Rupture of the first water bag (allantois) usually occurs late during this stage as it is forced through the dilated cervix.

Stage II can be defined as the passage of the fetus through the birth canal and this lasts 10-30 min. Entrance of the head and both front feet vagina stimulates abdominal straining or "true labor." This is important to remember in that some malpresentations, particularly backwards fetuses, may not induce true labor and therefore will not show signs of labor. The amniotic sac (second water bag) may appear at the vulva as a translucent sac.

Stage III consists of passage of the fetal membranes within 2-6 hours and uterine involution. Fetal membranes retained in utero for longer than 6 hours should be considered retained.

If Stages I or II do not progress as listed above, the birth is considered a dystocia and intervention should occur. The most common causes of dystocia are uterine torsion, fetal malposition, incomplete cervical dilation. Intervention should occur when: Stage I labor does not progress to Stage II, Stage 2 labor is not completed in 30 minutes, a portion of the fetus is visible with no progress in 15-20 minutes, fetal membranes hang from the vulva with no fetus produced or back feet are exiting the vulva (feet may appear upside down).

To examine the dam, she should be well restrained to protect both she and the examiner. The tail should be wrapped or held/tied to the side and the vulva should be cleaned well with disinfectant and water. It is wise to give the dam a caudal epidural of 2% lidocaine at 1mL/45kg, given at the sacro-coccygeal or an intercoccygeal space. A well-lubricated, sleeved hand should be introduced into the vulva and the fetal viability, size, and position determined relative to the maternal pelvis. Because one never knows at the start of this exam if a uterine tear may occur of if the case may go to surgery, only water-soluble reproductive lubricants should be used (i.e. KY Jelly, not J-lube). J-lube has been well documented to be fatal when leaked into the peritoneal space. The cervix should be examined to confirm full dilation. If the fetus is alive and in normal position, manual extraction may be attempted. If the fetus is in abnormal position, the position must be corrected prior to attempting extrication. If the fetus is backwards, it must be extracted quickly to prevent constriction of the umbilicus over the maternal pelvis. If extraction or re-positioning of the fetus requires more than 30 minutes with minimal or no progress, or there are obvious fetal abnormalities, a cesarean section should be pursued.

When a camelid dam shows signs of colic in late pregnancy or at term, a uterine torsion should be suspected. If a uterine torsion is diagnosed, attempts to roll the dam in the direction of the torsion (almost always clockwise in camelids) may be made while attempting to hold the fetus and uterus stationary by sitting on or pressing on the abdominal wall. If this type of correction is unsuccessful three times, a laparotomy is indicated to correct the torsion. The age of the fetus should be determined at the time of correction of the torsion as many torsions occur a few weeks pre-partum. If the fetus is premature, the uterine torsion should be corrected by rolling or surgery and the dam allowed to carry the fetus to term. Risk factors for uterine torsions include being moved to a new pen in the last 60 days of gestation, a large fetus, right horn pregnancy and being overdue.

The decision to manage dystocias with or without surgery can be made based on criteria determined upon examination. Vaginal extraction can be performed when there is full cervical dilation, adequate pelvic space for examination and cria, the uterus has enough space for manipulation or there is room for a fetotomy. Surgical intervention is required when vaginal palpation is not possible due to dam size, the cervix is inadequately dilated, uterine torsion is not corrected in 3 attempts, or manual manipulation requires more than 30 minutes. It is important to go to c-section as soon as the need is suspected or recognized and not delay the decision. The trick is to be early and be clean with c-sections.

When surgery is indicated, dams who are in shock and hypovolemic should receive IV fluid therapy. We typically prefer to do c-sections in the left paralumbar fossa, with the dam sedated with butorphanol 0.5-0.1 mg/kg IM or SC, casted into sternal or lateral recumbency with lidocaine line block of the flank. Alternatively, a ventral midline approach may be taken, but general anesthesia may be detrimental to the cria. After removal of the fetus, close the uterus with #0 double layer closure and lavage the uterus well. We will then make a mixture of systemic doses of K-penicillin, Na-ampicillin or ceftiofur sodium + 1mg/kg flunixin + 20-40 u/kg heparin in 1L of 0.9% saline to add to the abdomen prior to final closure. Alternatively carboxymethylcellulose 14 mL/kg may be added. If c-sections are done early and with care for asepsis, the prognosis for future fertility is good.

After successful delivery, the dam should be examined for injury to the birth canal. If there was significant vaginal manipulation, fill an OB sleeve with crushed ice and place it into the vagina and uterus to reduce swelling and pain. After difficult dystocias and c-sections, flunixin 1mg/kg q 12h for 48 hours, perhaps continued to 3-5 days, to prevent adhesions may be given and broad-spectrum antibiotics are indicated. Owners should take a rectal temperature on animals with uterine tears or c-section for 5-7 days after delivery to monitor for peritonitis or metritis.

Because camelids are induced ovulators, vaginal stricture after dystocia is an important cause of infertility from anovulation due to lack of stimulation during breeding. To prevent this, a nolvasan or betadine-soaked tampon should be placed in the vagina once the placenta has passed. It should be changed out every 8 hours for a couple of days, then changed daily out to a week If vaginal bleeding is present, epinephrine may be added to the first tampon to provide hemostasis.

If there is profuse vaginal bleeding (this will usually be from the dorsal vaginal artery), the artery should be clamped and ligated. Depending on the difficulty of the delivery, the dam should be given 5mL oxytocin. Additionally, antibiotics and antiinflammatories may be given, if warranted by the individual case. The dam's udder should be examined for production and letdown of milk.

After delivery, the dam and cria should be continually monitored for normal bonding, attitude and appetite. Two major events can occur to the dam after delivery: retention of fetal membranes and prolapse of the uterus. Retention of fetal membranes may occur after a difficult delivery or in animals with uterine inertia. If the placenta is not passed, oxytocin can be administered at low doses (5-10units IM) every 30-60 minutes until cleaning occurs.

Uterine prolapse can occur after fetal delivery as a result of dystocia or exhaustive uterine inertia. This is an emergency situation and should be corrected immediately. In this case, the uterus everts out through the vulva, placing tremendous strain on the middle uterine arteries, exposing the endometrium to the environment and during the cold season, the dam can lose significant amounts of body heat through the uterus. The dam should be handled as carefully as possible and not allowed to travel. It is common for the weight of the uterus to break the uterine arteries, causing the dam to bleed out into her abdomen. It is best to have the dam in the cushed position for replacement. A lidocaine caudal epidural should be given and the uterus washed and disinfected thoroughly. The veterinarian should kneel behind the dam and, starting near the vulva, begin to replace the uterus. It is important to use your hands in "fists" or with your fingers folded, rather than using your extended fingers to push. Prolapsed, post-partum uteruses are very friable and easy to puncture. Once the uterus has been replaced, time should be spent to make sure it is fully extended back to its normal conformation. A pursestring suture should be placed temporarily (3-5 days) in the vulva and I recommend that oxytocin, fluids, calcium and systemic antibiotics be given.

One of the most common situations we are presented with is the "overdue" dam. This is a cause for great concern to owners, who often wish to have parturition induced. In this situation, a complete physical exam, rectal exam and vaginal exam with an epidural should be performed. Rectal exam is best performed by placing 60-100mL of lube into the rectum and then gently entering with a lubed, sleeved hand. If available, transabdominal ultrasound can be used to assess fetal heart rate, with normal being 90-120 bpm (about 1.5-2x the maternal heart rate). When the fetal heart is <60 bpm over serial measurements, intervention should be considered. As a rule, we do not recommend induction of parturition where the life of the cria is to be spared. Induction of parturition in an "overdue" dam, in my experience, almost always results in a premature or dysmature fetus with poor survival rates.

Another common request is to hospitalize expectant dams to monitor for parturition. This change in environment, in our experience with this species, increases the likelihood of uterine torsion, incomplete cervical dilation, and premature placental separation.

References available upon request