Sonogram of a bovine macerated fetus. The hyperechogenic bones are visible in echogenic pus. hyperechogenic scattered bones in an echogenic or non echogenic fluid with echogenic floating pus) (Kumar and Purohit, 2009). Sonographic and palpable findings during the present case were similar to previously described findings characteristics to fetal maceration. The animal should be examined per vaginum and any pieces of bones lodged in the vagina or cervix must be removed manually if the cervix is dilated. Infusion of large quantities of normal saline in the uterus is useful in removing the pus and bone pieces 24 hrs later (Drost, 2007). When the cervix is not open prostaglandins or estrogens can be given to regress the partially regressed CL and/or increase the uterine contractions (Purohit and Gaur, 2011). Sufficient lubrication and gentle removal of the bones is necessary. In the present case all these approaches were unsuccessful hence laparohysterotomy had to be performed. Laparohysterotomy to remove the macerated fetus is potentially dangerous and must be considered as a last resort (Sood et al , 2009). The prognosis is always poor. Rarely long standing cases may develop peritonitis subsequent to uterine rupture. In multiparous animals hysterectomy may be suggested. In the present case however hysterotomy could be successfully performed without any complication. It was concluded that macerated fetus can be removed by laparohysterotomy and with sufficient care the clinical outcome is good. 

Context in source publication

Context 1

... maceration may occur at any stage of gestation and has been reported to occur in all species (Purohit, 2012) following fetal death, regression of corpus luteum and failure of abortion (Arthur et al , 1989). The condition is common in cattle and buffaloes (Purohit and Gaur, 2011) but may be rarely encountered in mares (Burns and Card, 2000), small ruminants (Mehta et al , 2005; Ajitkumar et al , 2007) and companion animals. In rare instances the disintegrated fetus parts and bones may be retained in the uterus for prolonged periods necessitating surgical removal (Drost, 2007) which is reported for the present case. A seven years old full term pregnant cross bred cow was referred to the Veterinary College Hospital, Bikaner with the history of reddish brown watery foul smelling discharge from the vagina, since five days with no progress in parturition. The animal evidenced severe tenesmus and was treated with prostaglandin F alpha 2 for inducing parturition by the local veterinarian. The animal was depressed and evidenced rectal temperature of 102 0 F. Vaginal examination revealed a hard and partially dilated cervix. Rectal examination revealed a contracted uterus lying on the pelvic brim, distended with fluid, a thickened uterine wall and a crepitating mass of fetus. Transrectal ultrasonography was done and the bony pieces (hyperechogenic) were observed within the echogenic pus (Fig 1). Based on clinical examination the case was diagnosed as fetal maceration. To improve the general condition and to combat toxemia the animal was administered intravenous fluids and antibiotics. An attempt was made to evacuate the uterus by the administration of prostaglandin (Inj- Repregna Vet Mankind, 2 ml IM) and estradiol (Inj- Progynon depot German Remedies 2 ml IM). On the second and third day stilboesterol (Inj- Haristrol 10ml IM) was administered. There was no change in the condition of the birth canal and an effort to deliver the fetus per vaginum was futile due to improper cervical dilation. It was, therefore, decided to perform a laparohysterotomy by left flank site under local infilteration anaesthesia as described previously (Purohit, 2012). After removal of the fetal bones and decomposed muscles (Fig 2), the uterus was cleaned with normal saline and diluted povidone iodine solution. The uterus was subsequently sutured with cushing’s sutures using Chromic catgut no. 2 followed by closure of the abdominal incision as per the standard method. Post operative care included infusion of fluids, antihistaminics and parentral antibiotics for 5 days. There was an uneventful recovery. The skin sutures were removed after 10 days post operative. Fetal maceration is the disintegration of a fetus that has died after formation of the fetal bones (after 4 months of pregnancy in cattle) and has failed to abort, although the cervix is open (Purohit and Gaur, 2011). Although uncommon, the reason for the non delivery of a dead fetus could be a partially dilated cervix, or the abnormal presentation of a fairly dry fetus which causes it to be retained in the uterus (Drost, 2007). Bacterial invasion of the fetus leads to fetal emphysema and maceration (3 to 4 days). There is formation of plenty of (24-48 h) pus and the bones of the fetus separate out.The animal discharges plenty of foul smelling, reddish gray vulvar discharge and strains frequently (Purohit and Gaur, 2011). Fever and anorexia may develop due to infection. The condition is noticed by the owners when foul smelling pus is discharged by a pregnant animal. Rarely, it may be diagnosed during pregnancy examination. The condition can also be diagnosed by the history, finding of a piece of bone lodged in the cervix, rectal palpation (free fetal bones palpable in crepitating pus and doughy thick uterine wall) radiography (especially in small animals) and ultrasonography (finding ...