ALINA MCCLAIN, VETERINARY STUDENT

Reproductive problems in camelids are a source of great stress for both the
animal and the owner. We hope to help decrease some anxiety associated with
reproductive problems by increasing knowledge and awareness of some common
peri-parturient (near the time of birthing) problems. Hopefully, increased
awareness will lead to earlier and more successful intervention when
problems exist. This article will focus on Caesarian section.

Caesarian Section
A Caesarian section (commonly referred to as a "c-section") is a surgical
procedure for removing a fetus from the uterus. This surgery entails making
an incision in the body wall, commonly centred in the left flank, and then
opening the uterus to extract the fetus. Under some circumstances this is
the only way to remove a fetus; however, it is obviously not natural and
therefore less than ideal. Whenever possible, we would prefer natural birth
to take place.

Common reasons to perform a c-section include: malpositioning of the fetus,
inadequate dilation of the cervix, a narrowed birth canal (due to tumours,
abscesses, or a narrowing of the bony pelvis), inability to manually extract
a fetus through manipulation, and uterine torsion. The proper position for
natural birthing is anterior (the front of the fetus first), dorsosacral
(the back bone of the fetus is toward the back bone of the dam), and limbs
and head in extension (meaning both forelimbs are fully extended in front of
the fetus' nose, and the head is lying on top of the forelimbs). This
positioning normally happens during the last 2 weeks of gestation by
coordinated contractions of the uterus and movements of the fetus. If the
dam or fetus are stressed malpositioning can occur. There are many
different ways for the fetus to be malpositioned. Some can be easily
corrected by manual manipulation through the vagina, while others are
impossible to correct manually. Inadequate dilation of the cervix can also
occur in many ways. If the fetus is not positioned properly, it may not
stimulate the reflex required for cervical dilation. Likewise, if the
uterus is twisted (as in a uterine torsion) adequate dilation may not occur
because of mechanical restriction.

Possible complications with c-section include: incisional infection,
intra-abdominal adhesions, incisional dehiscence (opening up of the
incision), evisceration, and rarely death. The most common of these are
infection and adhesions. Incisional infections can happen due to many
causes, but can often be controlled in most cases with medical management
(antibiotics, warm water lavage or hot-packing). Adhesions are scar tissue
formation in the abdomen that can stick abdominal organs together. If the
uterus is touching another structure in the abdomen, the scar tissue can
cause the two structures to become stuck together. This can cause future
reproductive problems or gastro-intestinal problems. We try to minimise the
occurrence of adhesions by using a variety of medical treatments including
anti-inflammatory drugs, antibiotics, and anti-adhesive agents. Incisional
dehiscence may be more common in camelids than it is in other large animal
species (e.g. cattle, sheep, goats) due to their thin body walls. Often a
belly wrap is placed post-operatively to help support the weight of the
gastro-intestinal tract. We also recommend limiting exercise by confining
the animal to a stall or small pen until the skin sutures are removed.

In conclusion, although a c-section is a common surgery, it should never be
used unless it is necessary for the health of the dam or fetus. By taking
some routine precautions we can limit the post-operative complications
encountered.

Clinical research at Ohio State University

At OSU-VTH we have seen many camelid patients that required c-section or
treatment for uterine torsions. Of the 20 camelids that required a
c-section in the past 5 years, 17 (85%) were done through flank incisions
and 3 (15%) were done through midline incisions. Fourteen (70%) were done
under sedation only while the remaining 30% were done under general
anesthesia. It is preferable to do a flank incision under sedation because
this reduces the number of possible complications the patient has to endure.
Twelve of the 20 fetuses (60%) were extracted alive during the c-section and
survived to go home. Nine (45%) were either dead when they were removed
from the dam or died shortly afterward. Out of the 20 camelids only one dam
died. Most of the complications were mild and included vaginal tearing,
uterine tears that were repaired at surgery, incisional infection, retention
of fetal membranes, and in one case, peritonitis.

We recommend that dams should not be stressed in the last month of
gestation. Close observation of late-term dams can also help to catch
dystocias before harm occurs to the fetus or dam. Any dam that shows signs
of colic or a prolongation of stage 2 labour (for instance, a foot is out and
nothing else for 20 to 30 minutes) should be evaluated by a veterinarian as
soon as possible. Early detection of problems can help increase the number
of healthy fetuses born to healthy dams.

When your animal has a reproductive problem, the most important questions an
owner or barn manager should ask themselves are: "Is this a departure from
normal?", "Can I manage this problem myself?", and "How long do I wait
before I ask for help, or call my vet?" By staying educated in the normal
processes of camelids, you can usually answer the first question. Your
experience and expertise should allow you to make a decision on the second
question. And finally, the sooner the better is almost always the answer to
the third question. We would much rather see your camelid too soon than too
late.



REFERENCES:
The Reproductive Process in South American Camelids, Bravo, P. Walter
Theriogenology in Camelidae, Tibary, Anouassi A.
Current Therapy in Large Animal Theriogenology, Youngquist, Robert S., DVM
Medicine and Surgery in South American Camelids: Llama, Alpaca, Vicuna and
Guanaco, Fowler, Murray E.

David E Anderson, DVM, MS, DACVS
Head and Associate Professor of Farm Animal Surgery
Director, International Camelid Initiative
Ohio State University
College of Veterinary Medicine
601 Vernon L Tharp Street
Columbus, Ohio 43210
Phone 614-292-6661
Fax: 614-292-3530
E-mail: Anderson.670@osu.edu