DISEASE SUMMARY PAGE

Dystocia in Elephants

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Summary Information
Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease summary
Alternative Names Difficult birth in elephants.
Disease Agents
  • It is essential to determine the cause of the difficult parturition: myometrial defects, hypocalcaemia, uterine torsion or rupture, uterine inertia, an inadequate pelvic canal, insufficient dilatation of the cervix, vagina or vulva, fetal hormone deficiency, fetal oversize, fetal death or abnormal fetal presentation. (B101)

In Elephants:

  • Dystocia in elephants may result from: (B23.75.w6)
    • Physiologic uterine inertia, caused by exhaustion of the uterine muscles during labour or a preexisting condition affecting the uterus. Environment factors can lead to a psychological uterine inertia. (B16.18.w18, B23.75.w6)
    •  Fetal malposition: this is not particularly common in elephants but is difficult to treat when it occurs.
      • Anterior delivery presentation: head-back malposition. (B23.75.w6)
      • Posterior delivery presentation: buttock or breech malposition. (B23.75.w6, P5.39.w5)
      • A dead calf may be more likely to be malpositioned. (D304)
    • Fetal death: this may be the cause or result of the dystocia. It is difficult to determine, even using ultrasonography and electrocardiography, when exactly the fetus died. However, it appears that the fetal death commonly occurs first; subsequently the fetal fluids are reabsorbed and the uterus contracts on the fetus forming a structure named the "Bandl's rings". This contraction can be very severe and lead to ischemia or necrosis of the uterine wall. (B23.75.w6)
    • Fetal malformation (D304). Arthrogryposis of all four limbs, particularly the hind limbs, leading to dystocia was reported in a Loxodonta africana - African Elephant. (P503.1.w2)
    • Fetal oversize. (D 304)
    • Twin calves may also cause dystocia. (D 304)
  • Note: severe dystocia is common in older females (over 15 years of age) undergoing their first parturition. It is associated with large calf size due to good nutrition, poor positioning of the fetus and loss of flexibility in the pelvic region of the cow. (J23.40.w1)

Further information on Disease Agents has only been incorporated for agents recorded in species for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Only those agents with further information available are linked below:

Infectious Agent(s) --
Non-infectious Agent(s) --
Physical Agent(s)
General Description
  • Dystocia may be obstructive or non-obstructive. (B101)
  • Medical management is indicated in stable animals with clinical history of secondary inertia, chemical deficiency or easily correction of the fetal presentation. (B101)
  • Surgery is indicated for obstructive dystocia or if medical management has failed. (B101)

In Elephants:

Elephas maximus - Asian Elephant

  • A case of breech delivery presentation was described in a wild elephant cow that died while giving birth to a calf. (J178.37.w1)
  • A 19-year-old primiparous Elephas maximus - Asian Elephants was euthanised 11 days after the removal of a dead fetus through a cesarean section, due to severe peritonitis as a result of the deterioration of the uterine wall. (P1.1990.w3)
  • A case of posterior delivery presentation in a 29-year-old primiparous Elephas maximus - Asian Elephants was managed by the successful performance of a vaginal vestibulotomy to assist the delivery of a stillborn calf. (P1.1996.w1)
  • A case of delayed parturition due to uterine inertia was described in an approximately 17-year old Elephas maximus - Asian Elephant. The case was successfully treated medically. (J356.123.w1)
  • A case of posterior delivery presentation in a 30-year-old non-primiparous Elephas maximus - Asian Elephants was treated medically with oxytocin to assist the successful natural birth after 22 hours. (P5.39.w5)
  • More recently, several cases of dystocia in Elephas maximus - Asian Elephants, aged from 6 to 32 years old, have been reported. (B23.75.w6) These included:
    • Six-year-old with a female calf of 120 kg in normal posterior presentation. Episiotomy and manual traction led to successful delivery of a dead calf. 
    • Nineteen-year-old with a male 159 kg calf, dead/decomposing, in posterior breech (buttock) presentation. Episiotomy and reduction were unsuccessful and the cow died 10 days after caesarean section.
    • Thirty-two-year-old with a dead male 120 kg calf in anterior head-back presentation. Episiotomy and reduction were unsuccessful and the cow died 19 days after caesarean section.
    • Twenty-eight-year-old with a 95 kg male dead calf in normal posterior presentation. Episiotomy and reduction were unsuccessful and the cow was euthanased during caesarean section.
    • Twenty-five-year-old with a 110 kg live male calf in normal anterior presentation. Psychological inertia was treated with 20 IU oxytocin resulting in the delivery of a live calf about four days after the onset of labour. 
    • Thirty-year-old with a male calf in anterior normal presentation. Episiotomy failed to extract the dead calf due to placental strangulation and the dam was euthanised.
    • Twenty-nine-year-old with twins of about 20 kg and undetermined sex. Multiple doses of oxytocin were given without result. Macerated twin fetuses were delivered about four months later.

    (B23.75.w6)

Loxodonta africana - African Elephant

  • A 11-year-old Loxodonta africana - African Elephant presenting uterine inertia was treated successfully with acupuncture [calf born dead]. (B23.75.w6)
  • A case of dystocia in a 24-year-old Loxodonta africana - African Elephant failed to respond to medical treatment, resulting in severe peritonitis in the cow and subsequent euthanasia. The calf was found to be abnormal, with arthrogryposis affecting all four limbs, particularly the hind limbs; this abnormality was thought to have caused the dystocia. (P503.1.w2)

Clinical signs:

  • Reproductive system signs:
    • Signs of abdominal pain. (J178.37.w1)
    • Discomfort. (P503.1.w2)
    • Failure of labour to progress to delivery:
      • Contractions only moderate and ceasing after three hours. (P503.1.w2)
      • Continuous and non productive labour. (B23.75.w6)
      • No successful delivery 14 hours after the release of the cervical plug and beginning of labour. (P5.39.w5)
      • No successful delivery 24 hours after the release of the fetal fluids (rupture of the allantoic sac). (B23.75.w6, D304)
      • No successful delivery several days after the release of the cervical plug and fetal membranes. (B23.75.w6)
      • Labour becoming weaker until signs vanish. (P5.39.w5)
    • Absence of labour signs 30 days after the known due date for delivery and/or a two to four weeks delay after a decrease in serum progesterone levels. (B23.75.w6)
    • Hard labour. (B23.75.w6)
    • Absence of fetal fluids. (B23.75.w6)
    • Fetid vaginal discharge. (B23.75.w6)
  • General signs:
    • Decreased appetite and water intake. (P503.1.w2)
    • Loss of condition. (B23.75.w6)
    • Depression. (P503.1.w2)
  • For further information on the signs of dystocia in elephants see: D 304 - Veterinary guidelines for parturition management in captive elephants - FULL TEXT PROVIDED
Further Information
  • Predisposing factors for dystocia in captive elephants include insufficient exercise and excessive weight gain during gestation, and old age in nulliparous cows. (P5.41.w4)
  • Severe dystocia is common in older females (over 15 years of age) undergoing their first parturition. It is associated with large calf size due to good nutrition, poor positioning of the fetus and loss of flexibility in the pelvic region of the cow. (J23.40.w1)
  • Dystocias have also been reported in free-ranging elephants, but are unlikely to have any impact on wild populations. (P5.39.w1)
Gross pathology:
  • Rupture of the uterus. (P503.1.w2)
  • Peritonitis. (P503.1.w1, P503.1.w3, P5.41.w4)
  • Abnormal fetus with arthrogryposis of the four limbs. (P503.1.w2)

Investigation/ Diagnosis:

Detailed information on monitoring normal parturition and dystocia is provided in: D 304 - Veterinary guidelines for parturition management in captive elephants - FULL TEXT PROVIDED

  • Clinical signs. (B23.75.w6)
  • Physical examination which may include rectal palpation or vaginal examination. (B23.75.w6, P503.1.w2)
  • Haematology may revealed an increased white blood cell count in severe cases of dystocia. (B23.75.w6)
  • Blood progesterone levels. 
    • Blood progesterone levels fall at the end of pregnancy. If serial blood samples are taken during pregnancy then the fall in level can be used to confirm that parturition should be occurring. (D304)
    • Note: It is necessary to know the serum progesterone concentration during pregnancy for the individual elephant, measured on a given machine in order to accurately detect the fall in progesterone associated with imminent parturition. A single value taken at the time of suspected dystocia is not sufficient. Arrangements should be made in advance with a facility (human hospital) with the required equipment for measuring blood progesterone concentrations. (D304)
  • Rectal examination and ultrasonography
    • If the cow does not produce her calf within 24 hours of the blood progesterone concentration falling to baseline, then rectal palpation and ultrasonographic examination should be carried out to determine the state of cervical relaxation and whether the allantoic sac or fetal parts are present in the cervix or vagina. (D304)
    • Note: experience is required in order to distinguish the state of the cervix on ultrasonographic examination. A veterinarian should gain experience in carrying out elephant transrectal ultrasonography and interpreting the ultrasonographic images well before the expected parturition. (D304)
    • Repeated rectal examination and ultrasound may be required to monitor responses to treatment. (D304)
    • A 3-m human colonoscope has been used for the examination of the reproductive canal to visualise the cervix dilatation, fetal membranes and fetal limbs. (B23.75.w6)
    • Colour doppler ultrasound has been used to assess fetal viability. (P503.1.w2)
  • Blood calcium concentration A blood calcium level below 2.5 Mmol/L should be treated by giving calcium intravenously or orally. (D304)
  • Episiotomy, under local anaesthesia for direct visualisation of the cervix through a tubular vaginal speculum, has proven to be one of the most valuable diagnostic procedures. This procedure may also facilitate direct palpation of the cervix. After the procedure the episiotomy can be closed or left open, allowing granulation. (B23.75.w6)
  • Post mortem findings. (P503.1.w2)
  • Take and store blood for herpes virus diagnosis (take blood into both EDTA and heparin; store cells and plasma, separated and frozen). (D304) (see: Herpesvirus Infection in Elephants)

Treatment:

Detailed information on monitoring normal and abnormal parturition, and on interventions for dystocia, is provided in: D304 - Veterinary guidelines for parturition management in captive elephants - FULL TEXT PROVIDED

  • Keep the cow with her group for as much of the time as possible, separating her only when specific interventions are required for monitoring and treatment. (D304)
Calcium, intravenously or orally. (D304)
  • Twelve grams of calcium borogluconate were administered in an intravenous infusion in an elephant cow with a plasma calcium level of 9.76 mg/dL (normal range 10-11 mg/dL). (P1.1996.w1)
  • Calcium can be given as an intravenous infusion, with care taken to ensure it is given fully intravenously (see: Intravenous Injection of Elephants). (D304)
  • Calcium syrup can be given orally, within an edible container (e.g. the soft card core from a role of toilet paper), covered with fresh tamarind paste. (D304) (see: Oral Medication of Elephants)
  • Once calcium has been given, its effect should be confirmed by rectal palpation for increased uterine contractibility, and the blood calcium level should be confirmed. (D304)

Oestrogens, applied rectally and to the perineum. (D304)

  • Apply 700 - 800 mg 17-β-estradiol (Oestrogel™ pump pack, Hoescht Marion Roussel, Hoescht). Monitor the effect on cervical dilatation using ultrasound, and after one hour use rectal massage to test and stimulate uterine contraction. (D304)
    • Details of rectal massage for uterine stimulation are provided on page 10 of: D304 - Veterinary guidelines for parturition management in captive elephants - FULL TEXT PROVIDED as follows: "remove feces from rectum, flush out the rectum, use abundant lubrication, keep both gloved hands (NB: the rectal mucosa is vulnerable due to estrogens) with the fists joined in a firm grip and press with the wrists or the dorsal sides of the hands against the pelvic ring to stimulate the pelvic receptors until strong labor waves appear or at least 10 minutes. When labor waves occur, continue this massage for 3 hours (if needed change operator). Check regularly by means of ultrasound the condition of the cervix. If there is still no cervix relaxation, continue monitoring the viability of the calf."
  • An additional dose of 400 - 500 mg 17- β-estradiol can be given if cervical dilatation is still incomplete three to four hours after the first dose was given. (D304)

Oxytocin: (B16.18.w18, B23.75.w6, D304, J356.123.w1, P5.39.w5, P503.1.w2)

  • Oxytocin and rectal massage are the main treatments once the cervix has relaxed. (D304)
  • Oxytocin should not be given until the cervix is sufficiently relaxed. Oxytocin given before this time may lead to uterine rupture. (D304)
  • Oxytocin should not be given if rectal massage does not stimulate uterine contraction. (D304)
    • If rectal massage does not stimulate uterine contraction, administration of calcium is recommended, even if blood calcium concentration is within the normal range. (D304)
    • "Oxytocin should be used with care, as it may dramatically exhaust the contractibility of the uterus muscles as well as the general condition of the female. There might also be the risk of reduced blood circulation in the umbilical chord, due to the spasms in the myometrium." (D304)
  • Initially use 25 - 50 IU oxytocin subcutaneously or intramuscularly, by blow dart if necessary (see: Subcutaneous Injection in Elephants, Intramuscular Injection of Elephants) (D304)
    • Once parts of the calf have entered the pelvic area, are visible as a bulge under the mother's tail, and progress is occurring, the oxytocin dose can be increased to 100 IU. If parturition does not occur at this stage, vaginal vestibulotomy (episiotomy) will be needed (see below) to give better access to the calf. (D304)
  • Stimulation of uterine contractions has been achieved using 200-400 IU oxytocin per animal. (P5.39.w5)
    • Four dosages of 200 IU of oxytocin intravenously for the first 3 doses and intramuscularly for the last dose was used successfully. (P5.39.w5)
    • Four dosages of 30 IU of oxytocin was used to finish successfully a parturition which had stopped advancing, in an elephant cow that weighted 3600 Kg and delivered a 125 Kg calf. (P5.39.w5)
  • A dose of 0.013 IU/kg of oxytocin was first administered subcutaneously, followed by an intravenous injection of the same dose. Both injections induced strong uterine contractions but were not sufficient for the natural delivery of the calf. (P1.1996.w1)
  • Twenty ml of oxytocin 0.5% vol/wt intravenously with 500ml of dextrose 5%. (J356.123.w1)
  • A 3000 Kg elephant cow delivered a 160 kg dead calf, after five doses of 150-235 IU oxytocin intramuscularly had been given over a period of 22 hours. (P5.39.w5)
  • Five to 20 mg of oxytocin intravenously can lead to active labour. (B23.75.w6)
    • Note: Elephants are very sensitive to oxytocin. (B23.75.w6)
    • Repeated doses of oxytocin after the initial dose have commonly been found unproductive. (B23.75.w6, P503.1.w2)
Acupuncture:
  • Successful acupuncture treatment to stimulate the uterine musculature has been documented in one case of uterine inertia in a Loxodonta africana - African Elephant, although the calf was born dead. (B23.75.w6)
Episiotomy (vaginal vestibulotomy) and manipulation: (B23.75.w6, D304, P1.1996.w1, P503.1.w3)
  • Episiotomy is required for assessment of the calf's position. (B23.75.w6)
  • A large incision is required if the calf is to be delivered by this route. (B23.75.w6)
  • Fetal repositioning is extremely difficult due to the size of the elephant cow and calf; it may be easier if the calf is live (which is rare in such cases), since the calf's movements may assist. (B23.75.w6)
  • Repulsion may be attempted using a crutch instrument, but is difficult due to the force of uterine contraction. (B23.75.w6)
  • If the calf's position is normal, delivery may be assisted using traction; heavy chains or straps can be placed around the extremities or trunk and used with mechanically assisted traction. This has been used successfully. (B23.75.w6)
  • The following description of vaginal vestibulotomy and manual delivery is based primarily on the procedure as described in D304 - Veterinary guidelines for parturition management in captive elephants - FULL TEXT PROVIDED
    • Sedate the cow only if necessary; avoid sedation if possible, since sedation will prevent assistance of the cow straining to deliver the calf. (D304)
    • Inject local anaesthesia (Lidocaine (Lignocaine)) intracutaneously and subcutaneously to anaesthetise the incision site (20 cm long, under the tail). (D304)
    • Surgically prepared the skin over the intended incision site using with povidone iodine soap. (P1.1996.w1)
    • Cut through the skin in the midline, starting 5 cm below the anus and extending for 20-25 cm. (D304, P1.1996.w1)
    • Place a flexible plastic or rubber tube, 5-10 cm diameter (e.g. a rumen tube) up through the urogenital canal. Preferably, have a 10 cm long, 2 cm wide "window" cut into the tube. Locate this and incise the vaginal vestibular wall over this. (D304)
    • Increase the length of the incision through the vaginal vestibulum to 20-25 cm long (note: further increase in incision length e.g. to 37 cm, may be required). (P1.1996.w1)
    • Lubricate the genital tract with copious (at least 5 litres) of "artificial embryonic fluid" (lukewarm water); an aquarium-type pump may be used to deliver this into the genital tract. (D304)
    • Pushing the calf back towards the uterus (ensuring that the tail and legs are well-connected to the chains) may assist in the position of presentation. (D304)
    • Normal calving chains and a maximum force provided by three people per leg should be used for traction. (D304)
    • Pulling on one leg at a time, at an angle (with the chains crossed), is more likely to be successful in allowing the legs to pass along the pelvic canal than pulling on both chains in one direction at the same time. (D304)
    • Note: 90 degree rotation of the calf may be normal and required during delivery; this rotation may need to be carried out during traction-assisted delivery. (D304)
    • Once the calf has been delivered, the uterus should be flushed with cold water, preferably until the placenta has been delivered. 50 IU oxytocin should be given intravenously. (D304)
    • A balloon catheter should be placed into the urinary bladder and glued or stitched into place, with the end of the catheter cut off so it is just lower than the end of the wound. (D304)
    • The vaginal vestibular wall should be closed in two layers using PDS or Vicryl, but the skin should not be sutured. Leaving the skin unsutured may give less tension on the wound, giving a greater chance of successful closure. (D304)
      • All skin suture patterns used to date have failed. (D304)
      • All cases to date have resulted in the development of a fistula. (D304)
    • Antibiotics should be given for at least seven days. (D304)
  • Episiotomy has been performed to remove a dead fetus, in some cases unsuccessfully. (B23.75.w6, P1.1996.w1, P503.1.w3)
Caesarean section: this is a mechanically difficult and generally unrewarding procedure (B23.75.w6, D304, P1.1990.w3, P503.1.w3, P505.11.w1) 
  • Seven attempted caesareans resulted in euthanasia or death, due to post-surgical complications. (P503.1.w3)
  • A caesarian was performed on a 19-year-old Elephas maximus - Asian Elephant. Fetotomy was performed on the dead fetus to facilitate the removal. The elephant cow survived the surgery but deteriorated after surgery and was euthanised on humane grounds. (P1.1990.w3)
  • Two caesarian sections were described in Elephas maximus - Asian Elephants to remove dead fetuses. In both cases, the elephant cows survived the surgery but one died 19 days after surgery due to peritonitis and the other was euthanised ten days after surgery. (P505.11.w1)
  • One Elephas maximus - Asian Elephant was euthanised 11 days after surgery due to severe peritonitis as a result of the deterioration of the uterine wall. (P1.1990.w3)
  • One Elephas maximus - Asian Elephant was euthanised after surgery because the uterus could not be fully accessed for safe closure. (B23.75.w6)
  • Three Elephas maximus - Asian Elephants died post-operatively due to uterine complications, such as necrosis and ischemia. (B23.75.w6)
Fetotomy:
  • This has been described as a procedure aiming to save the elephant cow's life for cases of severe dystocia. (P503.1.w3, P5.41.w4)
  • In one case the fetus was removed in six pieces using a long and durable carthorse embryotome (Thygessen's type) to section the fetus. (P503.1.w3, P5.41.w4)
    • The elephant cow died three days after the procedure due to pre-surgical resistant peritonitis. (P503.1.w3, P5.41.w4)
  • An early fetotomy is suggested to maximise the chance of saving the cow (i.e. to act before infection such as peritonitis has occurred). (P5.41.w4)
Euthanasia:

This may be required if all other treatments fail. (B23.75.w6,  P1.1990.w3, P503.1.w2, P505.11.w1) 

Note: Supportive treatment and provision of antibiotics is essential to prevent septicaemia. (B23.75.w6,  P1.1990.w3, P503.1.w2, P505.11.w1) 

Associated Techniques
Host taxa groups /species Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken).

(List does not contain all other species groups affected by this disease)

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