Uterine Torsion

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. This article will
focus on uterine torsions.

A uterine torsion is a condition where the pregnant uterine horns rotate
from their normal position. The rotation can be described as either
clockwise or counter-clockwise. This refers to the direction of rotation of
the uterine horns about each other similar to the hands of a clock. If you
are looking at the rear of the llama, visualize a clock face. The uterine
horns are normally at 3 O'clock (right horn) and 9 O'clock (left horn). If
the left horn flips over top of the right horn, then the horn has moves
clockwise similar to the hands of the clock. To state this another way
remember that Camelids have bi-cornate (two horned) uteruses. If you think
about your arms as the two horns and place them in front of you in the shape
of a "Y" you would be a normal uterus. In a clockwise uterine torsion your
left arm would go over top of your right. In a counter-clockwise torsion
your right arm would go over top of your left. The torsion can be anywhere
from 90 degrees to 360 degrees and beyond. The place where it twists is
normally near the cervix. This prevents the cervix from dilating and will
prevent birth if it is not corrected. Uterine torsions are generally
painful and can cause colic-like signs (increased heart rate and respiratory
rate, anorexia, rolling, thrashing and straining). It is still unknown why
uterine torsions occur. It is known that there are some conditions which
make a torsion more likely to occur. For instance, large fetal size (as the
fetus gets close to term), certain dam behaviors (such as rolling
excessively as when placed in new areas), right horn pregnancies (these
represent fewer than 15% of total pregnancies in llamas and alpacas), and
prolonged gestation tend to create uterine torsions. Uterine torsion should
be suspected when a dam is close to parturition (within 3 months) and shows
signs of colic or distress. It can be diagnosed by your regular
veterinarian by rectal palpation, vaginal exam/palpation and/or ultrasound.


Uterine torsions can be corrected with medical or surgical intervention.
Medical intervention generally entails rolling the female while stabilizing
the uterus to "untwist" the trosion. Sedation may be needed to roll the
dam. The dam is placed on her side and rolled over her back to her other
side. The dam in placed on the side "with" the torsion or toward the twist:
e.g. on the right side for a clockwise twist; on the left side for a
counter-clockwise twist. A plank or manual pressure on the outside of the
abdomen helps keep the uterus in place while the dam is "rolled off of her
uterus". This procedure may need to be repeated multiple times. Our rule
of thumb is "three times and your out" meaning that if we can not correct
the twist in three attempts, we perform surgical correction. A vaginal exam
should be performed after each attempt. If rolling is successful the dam
should be kept as quiet as possible to make sure she doesn't twist again.
If it is not successful, your veterinarian should make a decision about when
(or if, depending on the severity of the torsion and health of the fetus) to
go to surgery. Surgical correction of uterine torsion uses the same
approach as a c-section. The surgeon then corrects the torsion. If the
fetus is near term or determined to be dead, a c-section can be performed at
the same time. In some cases the uterus cannot be untwisted without removal
of the fetus. This is a judgment call that the surgeon makes during
surgery. 

The possible complications of uterine torsion are fetal death or compromise,
death of the dam, uterine compromise (twisting can cut off the blood supply
to the uterus and fetus), uterine rupture and subsequent peritonitis, and,
if surgical correction is necessary, all of the complications associated
with c-section. 

At OSU-VTH we have seen many camelid patients that required treatment for
uterine torsions. We reviewed thirteen camelids presented for uterine
torsion; 10 were alpacas and 3 were llamas. Five (38%) of the torsions were
clockwise and 8 (62%) were counter-clockwise. Eight (62%) were corrected
with medical management (rolling), while 5 required surgical treatment. Of
the 13 cases, 9 (70%) were alive and survived to go home and 4 (30%) died.
In one case, the dam died 14 days post-operatively due to peritonitis. In
all of the cases where time of gestation was known, uterine torsions
happened in the last 2 months of gestation. 

We can recommend, based on these findings, that dams should not be stressed
in the last several months of gestation. This would include moving them to
a birthing pasture at least 30 to 60 days before birthing to minimize the
risk of excessive rolling (e.g. dusting behavior) by the dam which can
increase the risk for torsion. 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 labor (for instance,
a foot is out and nothing else for 20 to 30 min) 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.

In conclusion, 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 


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