Uterine Torsion

Uterine torsions may occur as early as 7 to 9 months of gestation, but most occur during the last month. Behavioral signs of uterine torsion are often confused with that of gastrointestinal disorders.² Severe abdominal pain, violent rolling, and general restlessness are the typical presenting signs for uterine torsion. Causes of uterine torsion are unknown, but factors such as genetic predisposition, rolling, right side ovulation, increased fetal size, and increased fetal activity have been hypothesized.⁴ Diagnosis of uterine torsion may be made with a thorough history of breeding dates, a complete physical examination, and rectal or vaginal examination. In a recent report,² 95% of torsions in llamas and alpacas were clockwise (or to the right when viewed from the rear). This is consistent with the author’s experience with over 40 cases of uterine torsion.

A complicating issue in alpacas is that rectal examination may not be possible because of their small size. Depending on the location of the torsion, a vaginal examination may lead to the diagnosis. Rectal examination will be necessary to diagnose a torsion cranial to the cervix. When palpating the broad ligament, in a clockwise or torsion to the right, the ligament on the right side will be pulled ventral and medial. The ligament on the left side will be pulled to the right and over the top of the uterus. Palpation of these ligaments will cause pain and noticeable discomfort to the dam. Conversely, a torsion to the left or counterclockwise will result in a reversal of position of the ligaments. Vaginal examination will permit diagnosis of a torsion that is caudal to the cervix; the torsion will cause a twisting of vaginal tissues that is apparent during manual palpation.

Correction of a torsion can be accomplished by rolling the animal, transvaginal manipulation, or laparotomy.² Correction for the majority of uterine torsions can be performed with a rolling technique described for horses, except that a plank is not required. Sedation of the female with xylazine at a dose of 0.1 mg/kg intravenously will result in lateral recumbency in most females. If the torsion is clockwise, or to the right, the animal is placed in right lateral recumbency. If the torsion is counterclockwise, or to the left, the animal is placed in left lateral recumbency. One person is needed to flex the rear legs, another is needed to control the front legs and head, and a third person is needed to stabilize the fetus. The female is rolled while the fetus is held stationary. If the torsion is greater than 180 degrees, a second rolling procedure may be needed. After rolling, a rectal examination is performed to ensure that the torsion has been corrected. If corrected, a vaginal examination is performed to see if cervical dilation has occurred. When the cervix is dilated, delivery of the cria may then be assisted. In the author’s experience, over 50% of cases of uterine torsion occur at full term and delivery is assisted after correction of the torsion. If there is no cervical dilation, the female is allowed to recover and is monitored closely for recurrence.

If the cervix is open at the time of initial examination, grasping the fetus and rotating it into the correct position can be accomplished. Laparotomy is indicated in longstanding torsions or if one suspects that the uterine wall is compromised. Decisions must be made at the time of surgery if a cesarean section or simple correction of the torsion will be done. Gestation length, fetal size, uterine wall integrity, duration of clinical signs, and presence of colostrum are all factors to consider in this decision.

Multiple episodes of uterine torsion can occur in the same pregnancy and some females have a torsion in subsequent pregnancies.² Multiple torsions in a late-term female may necessitate a cesarean section. The prognosis is good for the dam and cria if the torsion and subsequent correction are performed in a timely manner. Future reproductive ability is generally good if the diagnosis and correction are achieved promptly.

Clinical Approach to Dystocia

When dystocia is suspected and intervention is needed, preparation and planning are important. Even though camelids seldom need sedation for examination and manipulations, adequate restraint facilities are required. Animals should be haltered and placed where restraint is adequate. Many animals will lie down when manipulations begin, so be sure that ample space is available to perform the manipulations if this occurs. Many times, securing the animal to the corner of a stall or pen is sufficient. Placing the animal in a narrow restraint chute with immovable sides is not advised for obstetric manipulations as many females will lie down and make further treatment much more difficult. Tail wrapping is recommended; the tail can be held by an assistant or tied forward. Cleanliness of both the dam and the veterinarian is important. The dam should be thoroughly cleansed as well as the hands and arms of the obstetrician. Adequate lubrication should be used when starting the examination. Damage to the cervix is one of the major causes of infertility subsequent to a dystocia in multiparous females.

A thorough examination should reveal the nature of the dystocia and general principles of mutation and traction used in other species will allow for correction and subsequent delivery of the fetus. In rare instances dilation of the vagina may be incomplete, and a few minutes spent with gentle massage to dilate the vagina before attempting delivery is time well spent. Many times repulsing the fetus cranially will allow sufficient space to reposition an abnormal posture. Most common abnormalities encountered are one leg flexed or both legs flexed. The most difficult corrections involve a ventral or lateral deviation of the head and neck. If there is not adequate lubrication, correction can be very difficult. Many of these cases will require the obstetrician to insert both arms to simultaneously repel the cria and manipulate the neck dorsally and the nose ventrally to extend the neck.

If the presentation is breech, it is important to have adequate dilation of the birth canal before delivery is attempted. Owing to the comparative small size of the fetus and ease of repelling the cria cranially, extending the rear legs is usually accomplished with relative ease. Again, adequate lubrication is important. Placing lubrication into the birth canal and around the cria will greatly assist the delivery process.

A prolapsed uterus is relatively uncommon, but there is a higher incidence after dystocia. Owners should be warned to monitor these animals closely for several hours after an assisted delivery. If a prolapse occurs, owners should be advised to keep the animal calm and the uterus as clean as possible until treatment can be instituted. Treatment of a prolapsed uterus will require caudal epidural anesthesia and light sedation. Extending the dam’s rear legs caudally will aid in replacing the uterus. Cleansing the exposed uterus as thoroughly as possible and placing the female on systemic antibiotics after repositioning the uterus will help ensure continued fertility. Administration of oxytocin and systemic antibiotics are indicated. In the author’s experience, owners can easily confuse a retained placenta for a uterine prolapse. It is important to question the owner carefully if either is suspected.