Successful Per-Vaginal Management of Dystocia Due to Fetal Hydrocephalus in a Holstein Friesian Crossbred Cow: A Case Report

Hydrocephalus is a dropsical condition with the accumulation of fluid as a result of an imbalance between the formation and drainage of cerebrospinal fluid (CSF), either in the ventricular system or subarachnoid space, characterized by marked enlargement of the cranium (Arthur et al., 2001; Noakes et al., 2009). It is common in animals (Jubb et al., 1993), particularly in dairy cows. However, this condition primarily results from abnormal fetal development during pregnancy; environmental, infectious, nutritional, and genetic factors may also contribute to its occurrence (Dar et al., 2012; Megahed, 2017). It is assumed that hydrocephalus might result from disturbance in the normal flow of CSF and its reabsorption (Saini et al., 2019). Hydrocephalus in cattle has been associated with a simple autosomal recessive gene (Roberts, 1986), an autosomal dominant gene exhibiting incomplete penetrance (Leipold et al., 1972), and hypovitaminosis A (Jubb et al., 2012) as well. It results in dystocia, and fetuses are usually delivered either by head excision followed by traction or via a cesarean section (Murali et al., 2020). Calves exhibiting substantial cranial enlargement typically die within 48 hours, while those with milder manifestations may survive (Leech et al., 1978). The present case report describes a successful per-vaginal delivery of a male hydrocephalic calf following fluid drainage from an enlarged head.

A two-and-a-half-years-old Holstein Friesian crossbred dairy cow, weighing 200 kg in its first parity at full term, with the manifestation of straining since the last eleven (11) hours. The water bag ruptured six (6) hours after the onset of straining, whereby a local AI technician attempted to deliver the case but failed. Then, a licensed veterinarian was called upon to treat the case. On clinical examination, the animal showed pale pink mucous membranes, a rectal temperature of 101 oF, and heart rate and respiration rate were within normal ranges. The per-vaginal examination revealed an edematous and congested birth canal with a completely open and relaxed cervix, a large fluid-filled fetal head, anterior longitudinal presentation, and dorsosacral position with carpal flexion. The examination indicated the condition of hydrocephalic fetus characterized by a significant enlargement of the cranial head. Palpation confirmed the absence of reflexes, indicating that the fetus was non-viable. Based on the above clinical findings, the case was confirmed as dystocia due to a hydrocephalus fetus.

At first, epidural anesthesia in the sarco-coccygeal space was performed using 5 ml 2% Lignocaine hydrochloride (G-Lidocaine, Gonoshasthaya, Bangladesh). Following the palpation of the fetal head, a stab in the skin of the cranial cavity was given via a guarded knife to evacuate the fluid from the edematous head (Figure 1A). The volume of the head was reduced in size after fluid evacuation, and with slight manipulation, the forelimbs and head of the fetus were pulled into the birth canal. Then, the forelimbs were tied with rope, and the fetus was tried to deliver, but it was unsuccessful. Then, the obstetrical hook was also applied to the inner canthus of the eye socket (Figure 1B). The forelimbs and obstetrical hook were pulled, and finally, the dead male fetus was successfully delivered with manual traction (Figure 1C, D). As manual traction is less invasive, quicker, economical, and provides fewer complications to the reproductive health of the cow compared to caesarean section (C-section), it was preferred over C-section. The fetal membranes were manually removed. The cow stood up right away after calving. Immediately after calving, Metronidazole (Diro Vet, Acme, Bangladesh) was inserted into the uterus to prevent secondary bacterial infections. The postoperative treatments included Calcium borogluconate together with magnesium, phosphorus, boric acid, and dextrose (A-Cal vet, Acme, Bangladesh) 250 ml i/v once, and Amoxicillin 2 g (Renamox vet, Renata, Bangladesh), Meloxicam 10 ml (Loxikam vet, Opsonin, Bangladesh), Diphenhydramine HCl 10 ml (Phenadryl vet, Acme, Bangladesh) each i/m for 5 days. Then, the cow recovered eventfully after five days. Fetal dropsical conditions that can lead to dystocia include hydrocephalus, ascites, hydrothorax, and anasarca (Purohit et al., 2006, 2012). Among them, congenital hydrocephalus is morphologically characterized by a large fluid-filled sac hanging over the head. In severe cases, hydrocephalus leads to dystocia, which cannot be relieved through mutation or forced traction. Therefore, fetal delivery is typically achieved either by head incision followed by traction (Bhandari et al., 1978) or through caesarean section (Balasubramanian et al., 1997; Bugalia et al., 1990). The excessive enlargement of the cranium may require a fetotomy (Roberts, 1971), but in the present case, there was no excessive enlargement of the cranium except for a large volume of fluid-filled head which might facilitate per-vaginal delivery by forceful manual traction. Similar observations of per-vaginal delivery in dairy cows have been reported by several authors worldwide (Purohit et al., 2006; Noakes et al., 2009; Dar et al., 2012; Wasef and Islam, 2024). Hydrocephalic fetus has consistently posed a significant challenge for field veterinarians. In the present case, instead of other medical interventions, an emergency veterinary surgeon was required to perform a per-vaginal delivery.

The delivery of hydrocephalic fetus can be successfully facilitated through the evacuation of accumulated fluid after puncturing the apical soft region of the cranium, thereby reducing the head size.

The authors are grateful to Upazila Livestock Officer (ULO), Upazila Livestock Office and Veterinary Hospital, Manoharganj, Cumilla, Bangladesh, for his support during the study.

Despite adopting surgical intervention like most reported cases, this case demonstrated an effective, economic, and minimally invasive alternative.

All the authors contributed to the research and manuscript writing.

The authors have declared no conflict of interest.