Fetal Dystocia and Fetal Malformations in Buffaloes

Dystocia is a term used to describe a difficult birth [1,2]. The incidence of difficult births in buffaloes appears to be low. For 677 calvings in Murrah buffaloes at an organized farm, only 1.62% of calvings required assistance and 0.44% were difficult births [3]. Similar data analysis of 529 calvings in Surti buffaloes at a farm revealed the incidence of abnormal births to be only 4.53% [4] of which only 0.82% were difficult births. Khan et al., [5] analyzed many reports and depicted the incidence of abnormal calvings in buffaloes to vary from 4.6% to 12.6%, however, the incidence of dystocia was not mentioned by these authors. Other studies recorded the incidence of dystocia in buffaloes to range from 2.12% to 4.81% [6-8]. The difficulty in birth may be posed by problems either from the maternal or from fetal side [7,9-14] or both [3,5,8,15,16]. Fetal dystocia poses difficulties in normal delivery of the fetus through the vagina [17-22]. Fetal causes of dystocia are usually evident at the time of parturition [3,19]. Fetal problems culminating in dystocia include fetal oversize (1.60%) [20-23], fetal abnormalities such as malformations (1.78-12.76%) [24,25], fetal dropsical diseases such as ascites, anasarca and hydrocephalus [26-32], fetal emphysema (1.64-12.06%) [33], and fetal maldispositions (9.04-56.7%) [34-36]. The relative frequencies of these fetal problems vary widely among different reports. Most of these problems increase the overall fetal diameter or alter the fetal shape thus occupying more/inordinate space in the birth canal preventing the easy passage of the calf. Besides these fetal problems, human factors such as untimely manipulation during parturition have been mentioned as one cause of fetal dystocia [21]. In buffaloes, difficult births are rarely caused by fetal problems [17,18,22,37]. In a recent analysis, 3.33%-40.17% of dystocias in buffaloes were of fetal origin (depending upon parity) [22].

The relative oversize of the fetus has been suggested as one of the cause in several cases of dystocia of buffaloes in India [3,5,8,16,19]. The incidence of dystocia due to the relative oversize of the fetus has been seen more often in first parity buffaloes [9,13,22]. Overall, when the type of dystocia in buffaloes is compared to cows, similarities and dissimilarities can be seen for example in both cattle and buffalo fetal malpresentation was the commonest fetal cause of dystocia [37,38] whereas, uterine torsion was the most common maternal cause of dystocia in buffalo but not cattle [12,38]. Fetal dystocia can be resolved by manipulation, fetotomy or cesarean section depending upon the type of dystocia and the condition of the dam at presentation. In this chapter the authors mention the various fetal causes of dystocia and their management in buffaloes.

1. Fetal Maldispositions

Similar to cows, the normal parturient disposition of the bubaline fetus is cranial (anterior) presentation, dorsosacral position both limbs extended and head resting on the extended knees [40,41]. Defects of presentation, position and posture constituted 56.7% of the total causes of dystocia in buffaloes in one study [39] whereas in other studies in buffaloes, fetal maldisposition accounted for 18.03% to 35.71% of dystocia [22,38]. This is probably due to the reduced viability of the offspring. Failure of the fetus to adjust from the intrauterine position to the normal parturient position may result in dystocia. Fetal maldispositions can occur in the cranial (anterior) and caudal (posterior) presentation. Transverse presentations are extremely rare in the buffalo [22].

1.1 Defects in Cranial (Anterior) Presentation

Similar to cows, dystocias due to defects in anterior fetal presentation are very common in buffaloes [13] constituting about 80 to 85% of total malpresentations [42]. One study reported that defects in anterior presentations comprised 88.88 % of dystocias due to fetal maldispositions in buffaloes [43]. A few reports [22,37,38] found less dystocias of fetal origin than of maternal origin in buffaloes, while others [16,20] reported more fetal dystocias including malpresentations. The abnormal position in cranial presentation that results in dystocia include dorso-pubic and dorso-ilial whereas abnormal postures include limb flexion and head deviation [22]. Cases of unilateral knee flexion, unilateral shoulder flexion, and shoulder lock condition have been reported in buffaloes [20,42,44-46].

1.1.1. Dorso-pubic or Dorso-ilial Positions

Dorso-pubic or dorso-ilial positions of the fetus during delivery lead to dystocia in buffaloes [13]. Dorsosacral position is the normal parturient position, however, when combined with lateral deviation of the head and neck it may result in dystocia [36,47]. Fetal death in such cases may require cesarean section for fetal delivery [47]. Similarly, Kumar et al., [48] delivered a foul smelling fetus with emphysema in anterior longitudinal presentation, dorsosacral position with left lateral deviation of the head and neck. The authors have also corrected and delivered several buffalo calves that presented in dystocia. These positions are commonly seen in buffaloes, but are less frequently reported [45,46]. This kind of fetal malposition can be corrected by retropulsion and mechanical rotation in fresh cases. A few reports observed bubaline fetuses in dorso-pubic [49] or dorso-ilial position [50-52] and all except one [50] were fetal malformations (monstrosities). Singla and Sharma [16] recorded 10 and 6 cases of dorso-pubic and dorso-ilial positions respectively out of 188 cases of dystocia in buffaloes over 5 years.

Abnormal Postures

1.1.2. Deviation of Head

This is a more serious type of dystocia as it leads to death of the fetus. The head can be deviated to the left or to the right (Fig. 1). Left lateral deviation is more commonly reported [34-36,44,50,53-56] than right deviation in buffaloes. Downwards or upwards head deviations have not commonly been reported in buffaloes although in one report, the fetal head was lodged downwards in the pelvic brim along with bilateral knee flexion was recorded [49], and in another report, downward deviation (nape posture) was recorded in a Jaffarabadi buffalo [57] and in a mixed-breed buffalo [58]. Such deviations become severe due to faulty manipulations of the limbs without proper position correction of the head through cervix [21]. Upward deviation of head is rare and usually not possible [22]. Downward head deviations were recorded in 6.90% of pluriparous and 3.45% of primiparous buffaloes [20]. Lateral head deviations were more prevalent in pluriparous compared to primiparous buffaloes [20]. Purohit and Mehta [37] recorded 7.5% cases of lateral head deviation in buffaloes with dystocia. If the cervix is not fully relaxed during calving, then there is a greater chance for deviation of the head to occur, because of the deflection of the nose, during delivery. If a fresh case is presented to the veterinarian, it can be corrected by snare or rope and manipulation with both hands [13,47,48]. However, application of traction, without correction of the position of the head might lead to compaction of the head and death of the fetus. Traction on limbs without first correcting the deviation of the head is not advisable. Buffaloes in poor condition should be restrained in lateral recumbency in such a way that the deviated head remains on the upper side. This will help in getting some more space to correct the problem; however, attempts to correct the deviated head in a standing position are more beneficial. If manual correction is not possible, then the use of a snare around the muzzle can be helpful. The application of an eyehook has been advocated by some practitioners [19], but only if the fetus is dead. In extreme cases with a dead fetus, where the head is stuck and the muzzle and the eye are beyond reach, then partial fetotomy is suggested to create space [19]. Right lateral deviation of the head in buffaloes has been reported less often. Its occurrence is possibly prevented by the presence of the mother’s rumen on the right side of the calf during delivery. However, in one study, right lateral head deviations were common in both primiparous and pluriparous buffaloes [20].

Figure 1. Line diagram of a buffalo with the fetus with lateral head deviation.

1.1.3. Flexion of the Forelimbs

Flexion of the forelimbs during delivery of buffalo calves is one of the most common causes of dystocia in cattle and buffaloes [22]. The flexion can be at the shoulder, carpal or fetlock region. A minor deviation at the fetlock can lead to carpal flexion, particularly when the forelimb is caught at the pelvic inlet. It has been suggested that this entrapment can lead to backward turning of the forelimb towards the body due to contractions during the second stage of delivery [13]. Limb flexion was recorded in 16.9% of cases of dystocia in buffaloes in one study [37].

1.1.4. Shoulder Flexion

Similar to cows, unilateral shoulder flexion is observed in buffaloes [1,2]. During calving, if one limb and the head are seen in the passage, vaginal examination can be helpful in determining, whether there is a carpal or shoulder flexion [15]. In carpal flexion, the carpal joint is engaged in the passage, while in shoulder flexion, the shoulder is palpable [44]. For correction of unilateral shoulder flexion, one should assess the space available. In the experience of the authors, traction on one limb and head can be helpful in delivering the calf without correction of the flexed shoulder. If the case is bilateral, then to deliver the calf with flexed shoulders, traction can be applied on the head and neck after proper lubrication. If it is felt that there is movement of the body and the calf is alive, then delivery should be carefully planned. In such cases, the rope should be applied on head in such a manner that it does not strangulate the fetus. Bilateral shoulder flexion in primiparous buffaloes is time consuming and difficult to correct. Caesarean section can be an option. If the fetus is found dead, then fetotomy can be a better alternative [13]. The conversion of shoulder flexion into carpus flexion is a useful approach for fetal delivery [1].

1.1.5. Carpal Flexion

Carpal flexion has been reported to be a common cause of dystocia in bovine [13,15]. It is generally unilateral (Fig. 2), but might be bilateral [1,2]. The incidence of bilateral carpal flexion is lower in buffaloes [22]. Unilateral and bilateral carpal flexion accounted for 17.24% and 10.35% of dystocia in pluriparous and 3.45% and 3.45% of primiparous buffaloes respectively [20]. Correction of carpal flexion can be done either by hand alone or by using a rope. The rope should be tied over the limb and slide down just above fetlock. The fetlock can be flexed and the digits should be taken into a cup-shaped hand for proper straightening of the limb. This will avoid injury to the vaginal passage.

Figure 2. Line diagram of a buffalo with the fetus showing unilateral carpal flexion.

1.1.6. Hind Limb Flexion in Cranial Presentation

Retention of hind limbs and their flexion can result in hip lock and dog sitting posture [22]. Neither one of these postures has been reported in buffaloes [18,22]. The approach to correct these postures is the same as described for cattle [1]. In a hip-lock, undue pressure in pulling a fetus without disengaging the pelvis first is futile and not suggested [1].

1.1.7. Ventrovertical Position (Dog Sitting Posture)

In this posture, the head, neck, forelimbs and hind limbs can be palpated in the birth canal [1,2]. This position can present due to wrong pulling of legs during handling of dystocia [21] or it can also be seen after detorsion in some cases of uterine torsion [13]. In these cases, even after correction of the torsion, the fetus remains in ventrovertical position. It is not easy to correct such postural defects, particularly in long standing cases of dystocia, however, attempts should be made to correct by rotating the fetus with the help of ropes on limbs and applying force on the neck of the fetus. If the fetus is seen in mild dorsoventral position then it can be handled by keeping the dam on the ground and lifting its limbs up. Placing ropes on the fetal limbs and maneuvering to rotate the fetus to a lateral position will help in delivering the fetus [1,13]. If delivery is not possible and the fetus is dead, then fetotomy or bisection of the fetus is one of the alternatives for delivery. In a study on buffalo dystocia, evaluating 156 cases over a period of 15 years, no such dystocia was observed in buffaloes presented to the referral center [37]. Transverse ventral position was recorded in 1 buffalo out of 188 buffaloes with dystocia [16].

1.2. Defects in Caudal (Posterior) Presentation

This kind of defect is not uncommon in buffaloes. Under field conditions, in spite of seeing a good number of buffaloes with posterior presentation [8], the cases are not reported for publications. Dystocia due to posterior presentation has been seen in buffaloes with both normal male and female calves and fetuses with abnormalities [51,59-63]. It has been observed in twin [64] and deliveries of malformed fetus [65,66]. The incidence of posterior presentation in buffaloes ranged between 5.7 to 13.3% [37]. Posterior presentations accounted for 13.33% of total dystocias in buffaloes in one study [20]. Delivery has been possible in posterior presentations with manipulative traction forces on fetal limbs, with proper lubrication and careful handling. During delivery in a posterior presentation; hip-lock is a problem, which can be corrected by manual sideways maneuver. Fetuses with fetal abnormalities may be presented caudally [67-69]. Flexion of hind limbs can occur at hock (hock-flexion) and hips (hip-flexion) [70], however, there is little information available. In buffaloes, incomplete extension of the hind limbs, hock flexion and breech presentation has been recorded [20,60,71].

1.2.1. Unilateral and Bilateral Hip Flexion (Breech Presentation)

Unilateral hip flexion has been seen in buffaloes by the authors and in other reports [60,61], although incidence is not that high. Bilateral hip flexion in posterior presentation has been reported in buffaloes [71,72]. Breech presentation can be diagnosed through the presence of the tail, anus and buttocks of the calf in the pelvis [73]. If the calf is alive, its delivery is possible through vaginal manipulations. It has been suggested that vaginal delivery of a breech presentation in buffalo is possible with careful mutations [20]. It has been advised to push the fetus forward in the birth canal towards the head of the dam, and the limbs should be grasped for extension. Hip flexion should be converted into hock flexion and finally the hoof should be grasped and extended for delivery. Delivery of a dead calf is more difficult than delivery of a live calf.

1.2.2. Hock Flexion

Dystocia due to hock flexion is also referred to as extension and retention of hind limbs at the stifle in cows [37] and has not been frequently reported in buffaloes [6]. It is difficult to say whether the incidence in buffaloes is lower or if it has been less reported.

2. Fetal Oversize

It is commonly accepted that calves born from in vitro produced embryos are larger [74,75]. However, the commercial application of in vitro produced buffalo embryos is not wide spread. Fetopelvic disproportion due to breeding of beef and dairy heifers at younger age (>2 years) is a frequent cause of dystocia [76,77], however, similar problems appears to be non-existent in buffaloes due to a higher age at first calving and a broader pelvis [22]. Some dairy (Holstein) [78] and beef cattle sires [79] have contributed to an increased incidence of dystocia due to the heavy birth weight of their calves; however, similar situations appear to be non-existent in buffaloes. Data regarding cross breeding of heavier buffalo breeds like Murrah or Nili Ravi with the smaller breeds like Surti and the resultant incidence of dystocia is unavailable. Inordinate excessive feeding of energy rich diets during the last 2 months of gestation are popular among many buffalo breeders and this could result in heavy birth weights of buffalo calves and probably dystocia. The incidence of dystocia is known to be higher in male births [22]. It has been mentioned that the calf birth weight was higher for male buffalo calves compared to female buffalo calves [80,81], however, this did not essentially increase the incidence of dystocia. Prolonged gestation has been reported to be a cause of dystocia in buffaloes [82]. Primiparous Murrah buffaloes had a significantly longer gestation period (312.57 days) compared to pluriparous (309.60 days) Murrah buffaloes [83], and similarly gestation length was affected by the season. Buffaloes calving in summer and autumn had significantly shorter gestation lengths compared to those calving in winter and spring [83,84], however, the incidence of difficult births was not increased with the calving season. Case reports on fetal oversize in buffalo are scarce [23] and it appears that fetal oversize in a normal fetus is a less frequent cause of dystocia in buffaloes. However, a large number of case reports on buffaloes, blame large fetal size as a cause of dystocia, on account of fetal abnormalities including malformations that are discussed later in this chapter.

2.1. Dystocia Due to Normal Twins or Triplets

This type of dystocia is not very uncommon in buffaloes. Analysis of a large number of reports on calving in buffaloes revealed that the overall incidence of twins in buffaloes varies from 0.057% to 0.66% [85] with most twins being born normally. Twins result in dystocia when the twins are presented simultaneously in the birth canal during delivery [22,64] or when one or both of the fetuses has a fetal abnormality such as anasarca [86] or ascites (Fig. 3). Delivery of twins through manipulation is possible [64,87] yet some cases may require cesarean section or fetotomy.

Figure 3. Twin female buffalo fetuses delivered per vagina. One of the fetuses had fetal ascites. The legs of one fetus were amputated and fluid was drained out to allow its delivery.

Two reports on triplet births in buffaloes [88,89] and one on quadruplet births [90] described normal deliveries whereas one report on triplet births in buffalo described an assisted birth [91]. Twins do not result in a difficult birth, probably due to their lower birth weight [87]. However, incompletely duplicated and conjoined twins invariably result in dystocia as they inevitably occupy more space in the birth canal. Conjoined twins are described in a later section as they are considered malformations.

2.2. Dystocia Due to Fetal Death and Emphysema

It is difficult to show univocally whether intrauterine fetal death leads to dystocia or dystocia increases the chance of stillbirths. It is thought that the death of a calf before the start of expulsion significantly increases the risk of malpresentation. Fetal death may result in an increase in fetal size due to putrefaction of the fetus and accumulation of gases in the subcutaneous tissue (Fig. 4) in the following 24-72 h [32]. This is known as fetal emphysema [34,48,54]. Fetal death/emphysema accounted for 1.46% to 5.7% of dystocia in buffaloes [22,37,39].

Figure 4. Emphysematous fetuses delivered from buffalo. The fetus on the left panel also had excessive fat in the abdomen.

Emphysema is the sequel of all conditions resulting in fetal death or uterine inertia. It has also been observed in prolonged cases of uterine torsion and septic metritis [34]. In the opinion of the authors, during handling of prolonged cases of dystocia, fetal emphysema should always be suspected, i.e. cases exceeding over 24 h. Periodic ultrasonographic assessment of calf could be useful in assessing growth of calf and dystocia can be avoided by preterm-delivery. It can also be emphasized that by knowing the size of the calf, a delivery through caesarean section can be planned to save the calf, and perhaps the cow. Pulling an emphysematous calf for hours will probably lead to its death and increases the risk of the cow dying because of physical damage, stress and shock. Delivery of an emphysematous fetus, provided it is dead, can be attempted by fetotomy which is less invasive for the cow [33,92] compared to a cesarean section [33].

2.3. Delivery of Oversized Calf

For delivery of an oversized live calf, an assessment of available space for delivery should be made. If the veterinarian decides that it is not possible to deliver per vagina, then an immediate decision must be made for a cesarean section in order to avoid excessive pulling of the calf [93,94]. If the calf is already dead, then fetotomy can be attempted [1,22]. Traction on limbs should be applied only if the head is straight and is within reach. One should make it a point to deliver the head first, followed by the limbs. Cotton ropes or obstetrical chains can be helpful for traction. Ropes/obstetrical chains must be appropriately placed on the fetal limbs and gentle traction must be applied after sufficient lubrication of the birth canal. Undue force might result in tearing of the birth canal or prolapse of vagina/cervix.

3. Fetal Abnormalities

Two fetal abnormalities/malformations are distinct in buffaloes: Fetal dropsical conditions and fetal malformations [22,95]; each one is described separately.

3.1. Fetal Dropsical Conditions

Fetal dropsical conditions or edematous conditions that result in dystocia have been described [22] and include hydrocephalus, ascites, anasarca and hydrothorax. The relative increase in the size of the fetus is the cause of dystocia with such fetuses. These conditions have been considered as malformations [95], however, their inclusion as fetal diseases is also a valid approach [22].

3.1.1. Hydrocephalus

The excessive accumulation of fluid in the ventricles of the brain or dura matter of the fetus (Fig. 5) is known as hydrocephalus [22]. The fetus usually dies before delivery or soon after birth due to pressure on the vital centers of the brain [22] although a live fetal delivery has been rarely recorded [96]. The frontal, parietal and temporal bones become deformed, separated and thin [22]. Many case reports of hydrocephalus in buffaloes have appeared in the literature linked to dystocia. The amount of fluid can vary from 500 mL to 8L [63,97,101]. An enlarged fetal head is easily palpable in the birth canal when the fetus is in cranial presentation [22] and a stab incision on the cranium is sufficient to reduce the size of the fetal head for vaginal delivery. Some reports note a delivery by cesarean section [97,24,30]. There appears to be no breed or age predisposition for the occurrence of hydrocephalia in buffaloes.

Figure 5. Hydrocephalic buffalo fetus.

3.1.2. Fetal Ascites

Fetal ascites signifies accumulation of excessive fluid in the fetal abdomen largely increasing its diameter [22]. A large number of reports have described dystocia in buffaloes due to fetal ascites (Table 1). The condition can be present alone, or in combination with other defects. The amount of fluid may vary from 2 L to 80 L (Table 1). The increased fetal abdominal diameter poses difficulty in the normal delivery of the fetus. It is suggested to make an abdominal incision in the fetus using a fetotomy knife to drain the extra fluid thus reducing the fetal diameter and allowing for vaginal delivery. A cesarean section is not commonly done unless other abnormalities such as wryneck (Fig. 6) or bent spinal cord are present.

Figure 6. Ascites in buffalo fetuses. The fetus on the left panel also has a wry neck.

3.1.3. Fetal Anasarca and Hydrothorax

Anasarca refers to generalized edema of the tissues under the skin whereas hydrothorax is the accumulation of fluid in the thoracic cavity [22]. Both anasarca [24,28,113-115] and hydrothorax [116] have been reported as a fetal cause of dystocia in buffaloes. Anasarcous fetuses were delivered by lubrication of the birth canal and manual traction [28,113-115]; however, one case required a cesarean section [24].

3.2. Malformed Fetuses

Teratology is the study of abnormalities that occur during fetal development. A fetus with pronounced developmental anomalies as to be grotesque is usually nonviable. Fetal malformations involving only a part of the body or an organ are called anomalies, whereas a fetus with extensive malformations is termed a monster [73,95,118]. Most of the time, malformations are teratological in nature [1,13]. In the developing fetus, these malformations can involve a single or multiple organs. Abnormal fetuses are described depending on the malformed structures involved [1,22,73,95]. Dystocia due to malformed fetuses was observed in 12.76% of buffaloes presented with dystocia [16]. Extensive malformations leading to increase in fetal size and diameter might require a cesarean section [22,119]; other malformed fetuses may have to be delivered through manipulations [22]. Fetotomy has been advocated in several reports to resolve a dystocia due to a malformed fetus [120,121]. As such malformed fetuses do not produce any typical signs in the dam [122]. Mostly, these are diagnosed only at the time of delivery. A recent report [123] described the identification of equine fetal developmental abnormalities such as microphthalmus, hydrocephalus and renal abnormalities during late gestation (Day 100-Day 250) by ultrasonographic scanning using a wide range of probes (Both transrectal and transcutaneous with 2-10 MHz frequencies). Similarly Curran [124] mentioned that ultrasonography can identify fetal malformations in cattle such as schistosomus reflexus, fetal hydrops and umbilical dilations during routine pregnancy examination of the older fetus. However, prenatal examination of the older fetus is not common in cattle and buffalo and the most appropriate time for detection of fetal malformations, the appropriate sonographic scanning techniques and decisions on termination of pregnancies are yet to be standardized.

3.2.1. Etiology

The etiology of certain malformations is not known. However, several possible factors have been reported as related causes of malformations. One of the best known causes is a polluted environment that contains teratogens [1] and the ingestion of certain plants [125]. Deficiencies in the diet, particularly vitamins (Folic acid, vitamin A, vitamin E, riboflavin, niacin and pantothenic acid), minerals (iodine, zinc, manganese and selenium,) proteins and essential amino acids such as tryptophan have also been implicated as possible etiologies [1]. The incidence of large calf syndrome has increased since the introduction of reproductive biotechniques [74], possibly because of the exposure of sperms, oocytes and embryos to various chemicals and artificial media [75]. It is also surprising that the incidence of malformations is much lower in organized animal farms and most of the reported cases in veterinary clinics are from the rural villages, where either individual animals or small animal herds are maintained. This suggests a probable role of management factors in the abnormal development of fetuses. Wiliams, [118] reported ovum diseases that lead to deviation from normal development during early life. This has been attributed to aberrations in or absence of organs, with abnormal variations in volume, form or texture, which may ultimately lead to dystocia.

Organogenesis in farm animals occurs before Day 45 [4]. During this period, the fetus is highly susceptible to teratogens. Since the fetus survives on amniotic fluid, any change affecting the amniotic fluid might result in malformations. It is not very clear whether the zygote is resistant to teratogens or not. Excessive exogenous doses of glucocorticoids, ACTH, insulin, androgens, progestagens, estrogens, thyroxin, thiouracil, etc. can also affect the function of various body organs of the early developing fetus. Improper diet and feed supplementation may affect hormonal levels in the pregnant dam, ultimately affecting the development of the early fetus [1].

It has been mentioned that the environmental factors such as reduced atmospheric pressure, hypothermia, hyperthermia, anoxia, radioactive substance and X-rays act as teratogens [1]. The authors also mention various chemical substances such as - thalidomide, quinine, tetrachloride, 6-mercapto-purine, azo-dyes, etc. as responsible for some of the teratogenic activity. Although there are no specific studies in buffaloes related to the causes of malformations, it is presumed that what affects other species may also affect buffaloes. It has been suggested that if a pregnant dam is exposed to infectious agents during fetal organogenesis, then abnormalities may result [22]. It has also been suggested that the ageing of the ovum and delayed ovulation increase chromosomal mutations and perhaps may cause fetal abnormalities [1].

Skeletal defects such as schistosomus reflexus, campylorrhacis scoliosa, and perosomus elumbis, or conjoined twins or fetuses with pseudo-ankylosis of limbs or neck; achrondoplastic fetuses with short and broad bodies are all known to result in dystocia due to their relative large size. Reports on different abnormalities in buffaloes have generally appeared as case reports and their incidence in buffalo herds is not described, nor has their hereditary or other origin been traced. Only the most commonly reported abnormalities are mentioned in this chapter.

3.2.2. Delivery of Malformed Fetuses

Dystocia due to fetal malformations have been reported in buffaloes since several decades [126,127]. In the absence of proper diagnosis, mutations to correct fetal positions usually fail to deliver the fetus. Under such circumstances, a cesarean [119,120] or a fetotomy [123,128,129] are required for delivery. Many buffaloes presented to referral centers are found in the second stage of parturition, and are brought in because of failure to deliver the fetus per vagina in spite of preliminary examination and obstetrical manipulations. The approach to opt either for cesarean section or fetotomy depends on the time since the onset of parturition, general condition of the animal, level of relaxation of the birth canal and assistance available [22]. Some workers mention that fetotomy is not a good choice in the presence of malformed fetuses [130,131]. However, with careful handling and early presentation of buffaloes, many of the malformed fetuses can be delivered with manipulation and fetotomy [22]. Approaches for fetotomy in buffaloes are similar to those in cattle and the instrumentation used is essentially the same [92]. In buffaloes, a cesarean section can be performed in right ventral recumbency, with incision at the site that is lateral but parallel to the milk vein [94]. The surgical site is shaved and infused with lignocaine hydrochloride. The site is scrubbed four times with betadine scrub lotion. The incision is made with a scalpel cutting skin and all the muscle layers to enter the abdominal cavity. The omentum can be reflected anteriorly and a stab incision is made over the uterus with a scalpel avoiding cotyledons; the size of the incision is enlarged by using scissors. The malformed fetus should be retrieved, although sometimes a fetotomy may be necessary. The different approaches for cesarean section including the type of anesthesia, postoperative complications and the future fertility of buffaloes, have been recently reviewed [132]. The choice of the surgical site depends upon the condition of the fetus and the dam. At one referral center, dam survival was between 37.5 and 100% (n= 65) [132].

3.3. Typical Malformations in Buffaloes

Honparkhe [95] classified fetal malformations into i) malformations characterized by deformities or absence of fetal parts ii) malformations characterized by multiplication/duplication of fetal parts and iii) malformations characterized by fetal dropsy. Malformations characterized by deformities or absence of fetal parts included schistosoma reflexus, perosomus elumbis, perosomus horridus, achondroplasia, acardiac fetus, cyclopia, fetus with contorted joints such as arthrogryposis. Some of the reported malformations in buffaloes are mentioned below.

3.3.1. Schistosomus reflexus

Schistosomus reflexus (Fig. 7) is characterized by marked ventral curvature of the spine so that occipital bone of the fetus lies near its sacrum. The body and the chest walls are bent laterally and thoracic and abdominal viscera are exposed [17,119]. The pelvis is also deformed. The condition is considered to be hereditary [133].

Figure 7. Buffalo fetus with schistosomus reflexus.

Schistosomus reflexus can be diagnosed by rectal palpation confirming the presence of fetal viscera, all four legs, the head and tail in the vaginal passage. There are several malformations linked to schistosomus reflexus such as scoliosis, cleft sternum, exposure of thoracic viscera, abnormalities of the digestive and urogenital systems, absence of a limb, and concomitant diplopagus (conjoined twins) malformation [134,137-141]. To deliver such fetuses, adequate lubrication of the birth canal is essential. Partial fetotomy is suggested if the spinal curvature is acute, preventing passage of the fetus through the birth canal. Cesarean section to deliver such malformed fetuses has also been used [138,139].

3.3.2. Achondroplasia

This condition has been also referred to as "Bulldog" calf in the literature. As shown in Fig. 8, the delivered malformed fetus is brachycephalic, with a short broad head, bulging fore-head, jaw malocclusion, prognathism of the mandible and pot-belly. Similar features have been described in several reports in buffaloes [46,60,142,143]. The viability of such a calf is low. Rao and Janakirammaya, [142] reported on a calf with a large head with a compressed face giving it a typical bull dog appearance. Eyes were rudimentary without eyeballs. Nose and nostrils were absent. Several authors [16,46,121] have reported similar findings. The malformed buffalo fetuses causing dystocia can be delivered per vagina with manual correction and traction on the fetus in a well lubricated birth canal [46,60,121,142,144-146].

Figure 8. Bulldog buffalo calf.

3.3.3. Perosomus elumbis (Ankylosed Calf)

This malformation is characterized by a small flattened deformed pelvis with strongly ankylosed flexed limb (Fig. 9) and atrophy of muscles [147]. There are several reports of perosomus elumbis in buffaloes [51,72,147]. Pandey et al., [51] reported dystocia due to perosomus elumbis with schistosomus reflexus in a buffalo. The hind and fore limbs are generally rigid in a fetus with perosomus elumbis. The rigidity of limbs and spinal cord leads to problems at delivery time requiring forced extraction or cesarean sections [51,72,147-151]. Perosomus horridus is characterized by general ankylosis and muscle contracture with "S" shaped multiple bending of spine from occiput to sacrum [95].

Figure 9. Perosomus elumbis malformation in a buffalo fetus.

3.3.4. Cyclopia

Cyclopia has been reported in several species including buffalo [24,52,152,153]. Morphological examination in such cases reveals a single orbit with fused eye balls and two separate corneas (Fig. 10). In some cases, the upper jaw may be absent and the lower jaw is rudimentary, teeth might be exposed [152]. The typical nose might also be absent. Sutaria et al., [52] reported a cyclopic and arrhinia malformed fetus in a Mehsana buffalo. The description varies in different reports, however, generally speaking, the eye is central in the forehead region and there is soft tissue in the lower jaw [153]. Since the body parts of the fetus are small, it can be delivered with a slight manipulation [22].

Figure 10. A cyclops buffalo calf with centrally located eyeballs.

3.3.5. Amorphus globosus Malformation

This kind of malformation has been reported in buffaloes [13]. As shown in Fig. 11, the fetus has no identifiable parts. All parts remain within the body cover. The delivery of this malformed fetus per vagina is difficult since there are no parts to hang on to, and obstetrical instruments cannot be placed easily. In such a case, a cesarean section is an option [154].

Figure 11. Amorphus globosus severely malformed fetus delivered from a Murrah buffalo.

3.3.6. Monsters with Contorted Joints/Muscles

Arthrogryposis, torticollis, kyphosis, scoliosis and lordosis are the common fetal malformations characterized by contortion and rigidity of joints and/or spinal column with moderate to severe atrophy of muscles [95]. Arthrogryposis appears to be the most commonly reported malformation (Fig. 12) resulting in dystocia in buffaloes [155-157]. Such condition occurs alone or together with other malformations such as bimelia [158], kyphoscoliosis [159], brachygnathism [160], torticollis [156] and scoliosis [122]. Such malformed fetuses can be successfully delivered per vagina by manipulation [155], fetotomy [70,122] or cesarean section [156,161]. Fetal muscular hypertrophy has been reported as a cause of dystocia in buffaloes [162-165]. Such fetuses can be delivered by traction following partial fetotomy [160,162].

Figure 12. Ankylosed forelimbs in a buffalo fetus delivered following a dystocia.

3.3.7. Campylorachis contorta Malformation

The malformed fetus in Fig. 13 had ankylosed limbs and a short lower jaw (brachygnathism) as described recently by Kumar et al., [167]. Campylorrachis scoliosa malformation presenting a laterally bent vertebral column and ankylosed limbs were recorded in a primiparous buffalo and retrieved by cesarean section [168].

Figure 13. Campylorachis contorta malformation with brachygnathism in a buffalo fetus.

3.3.8. Other Fetal Malformations

Several other kinds of malformations have been reported in literature. A calf with scistocormus fissispinalis was delivered by cesarean section [140,169,170]. Very recently two special kinds of malformations were present in fetuses delivered by the authors in which skin was partially missing on the head, giving the appearance of a star (Catlin mark) over the head region (Fig. 14), while the other malformed fetus had a very long face and jaw bones (Fig. 15).

Figure 14. A buffalo fetus in which the skin was partially missing on top of the head.

Figure 15. A buffalo fetus with a long face and jaw bones and a short neck.

Ganie et al., [171] and Majaheri et al., [172] delivered a fetus with cleft palate (Fig. 16) from a buffalo through partial fetotomy. There was accumulation of fluid in the body of the fetus, the head of the fetus was found to be deviated laterally during trans-vaginal examination.

Figure 16. Fetus with cleft palate delivered by partial fetotomy from a non-descript buffalo.

Other cases of fetal abnormalities such as craniochiasis with meningoencephalocele [173,174], spina bifida occulata [175], epitheliogenesis imperfecta [176,177], cebocephalus [178], monosomian and isosomian malformation [179,180], holocardius amorphous[181], acephalus acardiacus [182], and micropthalmia [183] have also been reported in buffaloes.

3.3.9. Perocephalus-aotus-anomatus

As shown in Fig. 17, this kind of malformation includes face abnormalities; this malformed fetus was delivered by the authors. There were no ears and at the time of delivery, the fetus was emphysematous. The fetus was delivered per vagina using snares.

Figure 17. Perocephalus-aotus-anomatus buffalo fetus.

3.5. Conjoined Twins

Conjoined twins result from the incomplete division of a fertilized ovum [1,13]. These twins may show partial separation to complete duplication of two individuals (Fig. 18). These cases are suspected when an apparently normal birth cannot be delivered as anticipated. A large number of conjoined twins with associated dystocia have been reported in buffaloes [184-191]. Different names are given to such conjoined twin based on the place where they are joined together [22] such as joined at or near the thorax (thoracopagus) [192-194] or at the sternum (sternopagus) [195-198], twins connected at the neck and thorax [199], twins connected at the sacrum (pygopagus), twins with joined heads (craniopagus) and twins joined at the pelvic region with heads in opposite directions (ischiopagus) [200]. Diplopagus malformation denotes conjoined twin with fairly separate bodies although one or more internal organs might be in common. Moreover, conjoined twin with duplication of specific parts are assigned different names such as dicephalus (two head and necks), diprosopus (two faces), two pairs of extra forelimbs (dibrachius) and tri or tetra brachius when there are 3 or 4 pairs of forelimbs. Similarly, when there are 2, 3 or 4 pairs of hind limbs the terms dipus, tripus and tetrapus are used to describe the fetal parts. The term dipygus denotes a malformed fetus with double pelvis. Dicephalic fetuses have been reported in buffaloes with dystocia [201-224]. A large number of dicephalic fetuses also had extra parts such as tetrapus and tetrabrachius [218], dibrachius [223] or dipygus [222]. A large number of reports on conjoined twins in buffaloes and the associated dystocia have appeared recently [225-231] and many of the previous reports have been reviewed previously [22].

Figure 18. Diplopagus conjoined buffalo twins with ill-developed lumbar and sacral regions along with several ankylosed fore limbs. The conjoined twins were delivered following a dystocia.

A shown in Fig. 19, an abnormal fetus with ill-developed lumbar and sacral regions along with several ankylosed limbs can be seen. Ankylosis of all four limbs has also been referred as campylorachis contorta [167]. In one case, in addition to the malformations mentioned above, there was bending of the vertebral column on itself. These conjoined twins were successfully delivered per vagina by mutation and traction [206]. Conjoined twins in buffaloes have been delivered by mutation, fetotomy and cesarean section [19,22,123,129,131,187,205,224].

Figure 19. Conjoined buffalo twins joined at thorax with two forelimbs and four hind limbs delivered from a buffalo with dystocia.

In Fig. 19, the conjoined twins have two forelimbs, four hind limbs and two tails; the body was joined at the thorax. Fig. 20 and Fig. 21, show dicephalus twins and dipygus conjoined twins with duplications in thecaudal region [232].

Figure 20. A dicephalus conjoined buffalo twin. Right panel shows the twins partially cut open.

Figure 21. A conjoined buffalo twin with two heads, two forelimbs and four hind limbs.

3.5.1. Monocephalus

A monocephalus conjoined twin has only one head (Fig. 22) with duplication of other body parts, usually with extra limbs. There is a recent report of a monocephalus by Kumar et al., [236]. Sharma et al., [123] reported on a similar case that was delivered by fetotomy. Kumar et al., [128] also reported on a dystocia due to a monocephalus (one head) tetrabrachius (4 forelimbs) tetrapus (4 hind limbs) fetus in buffalo [128]. Other descriptions reported include monocephalus dipygus [233] and monocephalus (one head) tetrabrachius (4 forelimbs) tetrapus (4 hind limbs) thoracopagus (joined at the sternal region) dicaudatus (2 tails) [128] and there was a similar case that was not joined at the sternal region [235]. Several kinds of monocepahalus conjoined twins have been delivered by the present authors as shown in Fig.22, Fig. 23 and Fig. 24. Besides these, an acephalic monster has also been recorded in buffalo [237].

Figure 22. A monocephalus conjoined buffalo twin. This fetus presented a heterodidymus malformation with two heads, one of which was rudimentary, and four hind limbs.

Figure 23. A buffalo fetus with a single head and six limbs.

Figure 24. A monocephalus buffalo fetus with a single head and 8 limbs.

3.5.2. Diprosopus

There is a report on this double head malformation from 1934 [127]. In this type of malformation, there is partial duplication of the frontal region, nose and mouth [1] (Fig. 25). The head, neck and thorax are joined; there are two ears, four eyes, four forelimbs and four hind limbs. These malformations are classified as diprosopus, distomus, diotus and tetra-ophthalmos. Diprosopus cases in buffaloes have been delivered either manually [238] or through a cesarean section [94].

Figure 25. A conjoined buffalo twin showing diprosopus, a double face with two ears, four eyes, four forelimbs and four hind limbs.