Vol 2 No 1, p 107-108
SURGICAL MANAGEMENT OF A MACERATED BOVINE FETUS
Pramod Kumar, GN Purohit* and JS Mehta
College of Veterinary and Animal Science, RAJUVAS, Bikaner Rajasthan, INDIA
. Department of Veterinary Gynecology and Obstetrics
*gnpobs@gmail.com
Fetal maceration may occur at any stage of
gestation and has been reported to occur in all species
(Purohit, 2012) following fetal death, regression of
corpus luteum and failure of abortion (Arthur et al,
1989). The condition is common in cattle and buffaloes
(Purohit and Gaur, 2011) but may be rarely encountered
in mares (Burns and Card, 2000), small ruminants
(Mehta et al, 2005; Ajitkumar et al, 2007) and
companion animals. In rare instances the disintegrated
fetus parts and bones may be retained in the uterus for
prolonged periods necessitating surgical removal (Drost,
2007) which is reported for the present case.
History and clinical examination
A seven years old full term pregnant cross bred
cow was referred to the Veterinary College Hospital,
Bikaner with the history of reddish brown watery foul
smelling discharge from the vagina, since five days with
no progress in parturition. The animal evidenced severe
tenesmus and was treated with prostaglandin F2 alpha
for inducing parturition by the local veterinarian. The
animal was depressed and evidenced rectal temperature
of 102 0F. Vaginal examination revealed a hard and
partially dilated cervix. Rectal examination revealed a
contracted uterus lying on the pelvic brim, distended
with fluid, a thickened uterine wall and a crepitating
mass of fetus. Transrectal ultrasonography was done and
the bony pieces (hyperechogenic) were observed within
the echogenic pus (Fig 1). Based on clinical examination
the case was diagnosed as fetal maceration.
Treatment
To improve the general condition and to combat
toxemia the animal was administered intravenous fluids
and antibiotics. An attempt was made to evacuate the
uterus by the administration of prostaglandin (Inj-
Repregna Vet Mankind, 2 ml IM) and estradiol (Inj-
Progynon depot German Remedies 2 ml IM). On the
second and third day stilboesterol (Inj- Haristrol 10ml
IM) was administered. There was no change in the
Ruminant Science
1
condition of the birth canal and an effort to deliver the
fetus per vaginum was futile due to improper cervical
dilation. It was, therefore, decided to perform a
laparohysterotomy by left flank site under local
infilteration anaesthesia as described previously (Purohit,
2012). After removal of the fetal bones and decomposed
muscles (Fig 2), the uterus was cleaned with normal
saline and diluted povidone iodine solution. The uterus
was subsequently sutured with cushing’s sutures using
Chromic catgut no. 2 followed by closure of the
abdominal incision as per the standard method.
Post operative care included infusion of fluids,
antihistaminics and parentral antibiotics for 5 days. There
was an uneventful recovery. The skin sutures were
removed after 10 days post operative.
Discussion
Fetal maceration is the disintegration of a fetus
that has died after formation of the fetal bones (after 4
months of pregnancy in cattle) and has failed to abort,
although the cervix is open (Purohit and Gaur, 2011).
Although uncommon, the reason for the non delivery of
a dead fetus could be a partially dilated cervix, or the
abnormal presentation of a fairly dry fetus which causes
it to be retained in the uterus (Drost, 2007). Bacterial
invasion of the fetus leads to fetal emphysema and
maceration (3 to 4 days). There is formation of plenty of
(24-48 h) pus and the bones of the fetus separate out.The
animal discharges plenty of foul smelling, reddish gray
vulvar discharge and strains frequently (Purohit and Gaur,
2011). Fever and anorexia may develop due to infection.
The condition is noticed by the owners when foul
smelling pus is discharged by a pregnant animal. Rarely,
it may be diagnosed during pregnancy examination.
The condition can also be diagnosed by the history,
finding of a piece of bone lodged in the cervix, rectal
palpation (free fetal bones palpable in crepitating pus
and doughy thick uterine wall) radiography (especially
in small animals) and ultrasonography (finding of
June 2013/107
Fig 1. Sonogram of a bovine macerated fetus. The
hyperechogenic bones are visible in echogenic
pus.
hyperechogenic scattered bones in an echogenic or non
echogenic fluid with echogenic floating pus) (Kumar and
Purohit, 2009). Sonographic and palpable findings
during the present case were similar to previously
described findings characteristics to fetal maceration.
The animal should be examined per vaginum
and any pieces of bones lodged in the vagina or cervix
must be removed manually if the cervix is dilated.
Infusion of large quantities of normal saline in the uterus
is useful in removing the pus and bone pieces 24 hrs
later (Drost, 2007). When the cervix is not open
prostaglandins or estrogens can be given to regress the
partially regressed CL and/or increase the uterine
contractions (Purohit and Gaur, 2011). Sufficient
lubrication and gentle removal of the bones is necessary.
In the present case all these approaches were unsuccessful
hence laparohysterotomy had to be performed.
Laparohysterotomy to remove the macerated
fetus is potentially dangerous and must be considered as
a last resort (Sood et al, 2009). The prognosis is always
poor. Rarely long standing cases may develop peritonitis
subsequent to uterine rupture. In multiparous animals
hysterectomy may be suggested. In the present case
however hysterotomy could be successfully performed
without any complication. It was concluded that
macerated fetus can be removed by laparohysterotomy
and with sufficient care the clinical outcome is good.
Ruminant Science
Fig 2. The bones and disintegrated tissues of a macerated
fetus removed from the uterus of a cow by
laparohysterotomy.
References
Ajitkumar G, Kuriakose AM, Ghosh KNA and Sreekumaran
T (2007). Fetal maceration in a goat. Indian Journal
of Animal Reproduction 28:107-108.
Arthur GH, Noakes DE and Pearson H (1989).
Veterinary Reproduction and Obstetrics. 6th
Edn, ELBS Publication, Britain.
Burns TE and Card EE (2000). Fetal maceration and
retention of fetal bones in a mare. Journal of American
Veterinary Medical Association 217:878-880.
Drost M (2007). Complications during gestation in the
cow. Theriogenology 68:487-491.
Kumar V and Purohit GN (2009). Ultrasonographic
diagnosis of the bovine genital tract disorders.
Vet Scan 4: Article 43 (1-11).
Mehta V, Sharma MK and Bhatt L (2005). Macerated
fetus in goat. Indian Journal of Animal
Reproduction 26:75.
Purohit GN and Gaur M (2011). Etiology, antenatal
diagnosis and therapy of fetal complications of
gestation in large and small domestic ruminants.
Theriogenology Insight 1:45-63.
Purohit GN (2012). Domestic Animal Obstetrics. Eds
Purohit GN, Lambert Academic Publishers,
Germany.
Sood P, Vasistha NK and Singh M (2009). Use of a novel
surgical approach to manage macerated fetus in
a crossbred cow. Veterinary Record 165:347-48.
June 2013/108