Multiple cesarean section in Jenny

Jenny dystocia occurs very rarely and is associated mainly with postural defects due to long fetal extremities. However, the management of dystocia in equines is relatively difficult compared with that in other large animals. Owing to the absence of well-described published papers on cesarean section in donkeys, this condition remain life-threatening after unsuccessful surgical intervention.

A 4-year-old Jenny with a difficult birth due to a previous car accident presented for 3 consecutive years at different stages of labor onset. Upon early presentation, there was straining and frequent aggressive rolling. Further examination also revealed a fully dilated cervix and narrow pelvic cavity due to the downward bending of the iliac wing. Surgical sites (lower flank, ventral midline, and paramedian) were used for each cesarean section. General anesthesia was used in all three procedures. Additionally, local infiltration of 2% lidocaine along with light general anesthesia was used when the patient presented with a live fetus. In all approaches, surgical sites were prepared for cesarean section, and dead fetuses were removed at the first and third parity due to delayed presentation. However, in the second parity, a live female foal was delivered. In all the approaches, the first layer of uterine closure was made by using a simple continuous suture pattern (biting all the layers of the uterine wall). The sutures were then oversewed with a Cushing suture pattern using # 0 polyglycolic acid. The skin was closed in different suture patterns during each technique using nonabsorbable suture material # 1 silk. Postoperative subcutaneous swelling was observed and regressed gradually in all surgical approaches. The duration of skin suture removal was determined based on the extent of wound healing and the site of the incision.

This is the first ever report describing 3 consecutive cesarean sections in the same donkey with pelvic deformity. Thus, this study was able to indicate different approaches for cesarean section in equines. Moreover, owing to the bleeding nature of the equine uterus, simple continuous suturing was the pattern of choice for 1st layer uterine closure. It was also concluded that subcutaneous edema is unavoidable in donkeys.