Uterine torsion: correction

• Uterine torsion is a relatively common obstetrical emergency.
• Manual correction of uterine torsion is necessary before vaginal delivery of a calf can be attempted.
• Torsion can vary in severity from mild <90° degree torsion to full >360° torsion.
• Most cases can be corrected manually per vaginum.

Uses

• To correct uterine torsion either during mid-gestation or, more commonly, immediately prior to calving.

Advantages

• Non-invasive.
• Quick.
• Relatively simple.

Disadvantages

• Patient may require cesarean Cesarean section to deliver calf even after torsion is corrected due to inflammation and tissue friability.
• Can be physically demanding.

Technical problems

• When the torsion is >270° it can be very difficult to correct a torsion without casting and rolling the cow.

Alternative techniques

• Alternative to manual correction:
• Surgical correction (cesarean section).
• Casting and rolling
• Detorsion rod (ie Gynstick).

Time required

Preparation

• Less than 10 minutes.

Procedure

• 5-45 minutes.

Decision taking

• A decision must be made whether the cow is in active first stage labor by assessing the stage of pregnancy, pelvic ligament laxity and the cervix.
• The direction and approximate degree or torsion should be determined.
  • This is done by running the palm of your hand along the roof of the vagina towards to cervix, and detecting which way your fingers are being guided by feeling the ‘corkscrew’ effect of the twisted vaginal lumen.
• If unsure, rectal palpation can be useful by palpating the broad ligaments. The broad ligament will feel like a tight band running across ventrally from right to left for anticlockwise torsion, or vice versa for clockwise torsion.
• A <90 torsion at calving can feel like an inadequately opened cervix, similar to ‘ring womb’ in sheep. However by running the fingers cranially along the roof of the vagina it should be noticeable that they are being drawn to the left or right, and not running smoothly in a straight line.
• 180 torsion at calving feels like a soft closed cervix, but on further palpation it is usually possible to insert a few fingers or a hand through the cervix and feel a ‘flattened’ effect.
• >270 torsion will feel like a tightly closed cervix, and barely a fingertip will be able to be inserted. In this case it is almost impossible to rotate the uterus per vaginum, and the decision should be made to cast and roll the cow to begin correction.

Risk assessment

• If casting and rolling the cow, assessment of the environment should be made as there is a requirement for plenty of space and soft surface ie straw bedded pen/pasture.
• Cows that are being rolled are very likely to kick with all four legs, care must be taken to safely position yourself, and your assistants. 
  • Animals should not be rolled with an arm in the vagina or grasping the calf where at all possible as this is very dangerous.