Risk Of Dystocia Research Articles

A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes. Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e., an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [5.3 mmol per liter]) were randomly assigned to usual prenatal care (control group) or dietary intervention, self-monitoring of blood glucose, and insulin therapy, if necessary (treatment group). The primary outcome was a composite of stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, hypoglycemia, hyperinsulinemia, and birth trauma. A total of 958 women were randomly assigned to a study group--485 to the treatment group and 473 to the control group. We observed no significant difference between groups in the frequency of the composite outcome (32.4% and 37.0% in the treatment and control groups, respectively; P=0.14). There were no perinatal deaths. However, there were significant reductions with treatment as compared with usual care in several prespecified secondary outcomes, including mean birth weight (3302 vs. 3408 g), neonatal fat mass (427 vs. 464 g), the frequency of large-for-gestational-age infants (7.1% vs. 14.5%), birth weight greater than 4000 g (5.9% vs. 14.3%), shoulder dystocia (1.5% vs. 4.0%), and cesarean delivery (26.9% vs. 33.8%). Treatment of gestational diabetes mellitus, as compared with usual care, was also associated with reduced rates of preeclampsia and gestational hypertension (combined rates for the two conditions, 8.6% vs. 13.6%; P=0.01). Although treatment of mild gestational diabetes mellitus did not significantly reduce the frequency of a composite outcome that included stillbirth or perinatal death and several neonatal complications, it did reduce the risks of fetal overgrowth, shoulder dystocia, cesarean delivery, and hypertensive disorders. (ClinicalTrials.gov number, NCT00069576.)

Dystocia in 3-year-old beef heifers; Relationship to maternal nutrient intake during early- and mid-gestation, pelvic area and hormonal indicators of placental function

The influence of nutrition during the first and second trimesters of gestation on the occurrence of dystocia was investigated in 3-year-old composite-breed beef heifers. Heifers were allocated according to stratification by weight and genotype to either a high (H/− = 76 MJ metabolisable energy (ME) and 1.4 kg crude protein (CP)), or low (L/− = 62 MJ ME and 0.4 kg CP daily) nutritional treatment on the day of artificial insemination (day 0) to the same Senepol bull. Half of each nutritional group changed to an opposite nutritional group on day 93 of gestation (−/H = 82 MJ ME and 1.4 kg CP; −/L = 63 MJ ME and 0.4 kg CP daily), resulting in four treatment groups: HH ( n = 16); HL ( n = 19); LH ( n = 17); LL ( n = 19). From 180 days until calving all heifers were fed the same diets. Pelvic area measures were taken at heifer selection (−72 days) and at 117 days. Maternal circulating concentrations of estrone sulphate (ES), bovine placental lactogen (bPL), bovine pregnancy associated glycoprotein and progesterone were monitored throughout gestation. Heifers were observed continuously over the calving period and delivery type classified as being either eutocic or dystocic. The occurrence of dystocia was 14.1%. Increased calf birth weight increased the odds of occurrence of dystocia (odds ratio (OR) = 1.40; 95% confidence interval (95% CI) 1.12–1.76; P < 0.01). High diets in the second trimester were associated with heavier calves at birth ( P = 0.01). The mean pelvic area of eutocic heifers on −72 d, tended to be greater compared to that of dystocic heifers ( P = 0.08) such that a 1-cm 2 difference in pelvic area tended to decrease the risk of dystocia (OR = 0.97; 95% CI 0.93–1.01; P = 0.09). Longer gestation length was associated with an increased risk of dystocia ( P = 0.03). ES ( P = 0.04) and bPL ( P = 0.09) at calving were positively associated with the risk of dystocia. In conclusion, the current study demonstrates (a) that pelvic area measurement at selection in 3-year-old Bos indicus × Bos taurus heifers may be useful for identifying heifers at an increased risk of dystocia and (b) increased ES and bPL concentrations at calving are associated with increased risk of dystocia. Pelvic area measurements obtained prior to conception remain valid in their assessment of the relationship between pelvic area and likelihood of dystocia occurring in the event of changing maternal nutrient intake during gestation. This is an important finding given maternal diets high in protein and energy during the second trimester of gestation increased calf birth weight and calf birth weight was associated with an increase in the occurrence of dystocia in heifers calving as 3-year olds.

Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort

To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress. Prospective cohort study. Danish National Birth Cohort. A total of 25 297 healthy nulliparous women in spontaneous labour with a single fetus in cephalic presentation at term following an uncomplicated pregnancy. Data were collected during 1997-2003 from computer-assisted telephone interviews twice in pregnancy linked with national health registers. Risk for emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth. Fear of childbirth in early (16 weeks, 6 +/- 29 days) and late (31 weeks, 4 +/- 21 days) pregnancy was associated with emergency caesarean section: OR, 1.23 (1.05-1.47) and 1.32 (1.13-1.55), respectively. When fear of childbirth was expressed at both interviews, the OR was 1.43 (1.13-1.80). Women who feared childbirth had an increased risk for dystocia or protracted labour (OR, 1.33; 1.15-1.54), but not for fetal distress (OR, 0.94; 0.72-1.23). Fear of childbirth during pregnancy was associated with dystocia and emergency caesarean section but not with fetal distress.

Body Condition Change Ante‐ and Postpartum, Health and Reproductive Performance in German Holstein Cows

The effects of body condition score (BCS) change and status ante- and postpartum (pp) on health and reproductive performance in 234 German Holstein cows from eight dairy farms were evaluated. BCS was determined from 6 weeks antepartum until 20 weeks pp in 2-week intervals. Three and 5 weeks pp progesterone concentrations in blood serum were determined to detect the presence of luteal tissue as an indicator of cyclicity. The incidence of various diseases, percent cycling cows, reproductive measures and culling rate were assessed. Data were subjected to logistic regression to account for possible herd and lactation number effects. Cows with a low BCS status (<3.0) at calving and during early lactation (4-10 weeks pp) were at a higher risk of suffering from lameness (OR 2.9-9.4), not being cycling at 3 and/or 5 weeks pp (OR 2.24-3.99) and being culled (OR 2.56-2.79) than cows in better body condition (> or =3.0) In addition, cows with a low BCS status at parturition were at a higher risk of developing endometritis (OR 2.95) and becoming pregnant later than 105 days pp (OR 5.92) than cows with a BCS > or = 3.0. At 10 weeks pp, the risk of dystocia (OR 4.10) or retained placenta (OR 2.78) at the preceding calving and not being pregnant at 200 days pp (OR 2.42) was higher in cows with a BCS < 3.0 than with a BCS > or = 3.0. Cows with no BCS loss antepartum were more likely to have an interval from calving to first artificial insemination of <80 days and <105 days open, to be cycling at 3 and 5 weeks pp and to be pregnant at 200 days pp than cows with a BCS loss of >0.25 (OR 2.44-6.67). Furthermore, cows with no BCS loss from calving to 4 weeks pp had a lower risk of suffering from displaced abomasum than cows with a slight or a severe BCS loss (OR 0.09-0.07 respectively). In conclusion, our results suggest that body condition loss during the antepartal period affected BCS status at parturition and to a certain extent during lactation which was linked to a higher incidence of reproductive disorders and lameness, a higher culling rate and lower reproductive performance.

A Meta-Analysis of the Impact of Monensin in Lactating Dairy Cattle. Part 3. Health and Reproduction

A meta-analysis of the impact of monensin on health and reproductive outcomes in dairy cattle was conducted. A total of 16 papers were identified with sufficient data and quality to evaluate health and reproductive outcomes for monensin. The available trials provided approximately 9,500 cows with sufficient data for analysis. This provided good statistical power to examine the effects of monensin on health and reproduction. Over all the trials analyzed, monensin decreased the risk of ketosis [relative risk (RR)=0.75], displaced abomasums (RR=0.75), and mastitis (RR=0.91). No significant effects of monensin were found for milk fever, lameness, dystocia, retained placenta, or metritis. Monensin had no effect on first-service conception risk (RR=0.97) or days to pregnancy (hazard ratio=0.93). However, the impact of monensin on dystocia, retained placenta, and metritis was heterogeneous for all 3 outcome measures and random effect models were utilized. Causes of the heterogeneity were explored with meta-regression. Days of treatment with monensin before calving increased the risk of dystocia. Delivery method of monensin influenced the incidence of retained placenta and metritis, with risk being lower with controlled release capsule treatment compared with delivery in either topdress or in a total mixed ration. Days of treatment before calving also influenced retained placenta with an increase in risk with more days treated before calving. Improvements in ketosis, displaced abomasums, and mastitis with monensin were achieved. Exposure to prolonged treatment in the dry period with monensin may increase the risk of dystocia and retained placenta.

Risk factors for recurrent shoulder dystocia, Washington state, 1987-2004

The objective of the study was to identify recurrent shoulder dystocia risk factors. This was a population-based case-control study in Washington state (1987-2004). Primary and recurrent shoulder dystocia incidences were calculated. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for subsequent shoulder dystocia risk factors. Primary and recurrent shoulder dystocia annual incidences were 2.3 of 100 and 13.5 of 100. Of 26,208 women with shoulder dystocia deliveries, 8991 had subsequent vaginal births, and of those, 1060 (11.8%) had a recurrent shoulder dystocia. Index pregnancy birthweight was associated with an increased risk of subsequent shoulder dystocia: 3500-3999 g, aOR 1.8 (95% CI 1.5 to 2.3); 4000-4499 g, aOR 3.3 (95% CI 2.6 to 4.1); 4500-4999 g, aOR 3.1 (95% CI 2.3 to 4.3); and 5000 g or greater, aOR 3.8 (95% CI 2.0 to 7.3). Vacuum delivery, aOR 1.4 (95% CI 1.2 to 1.7), and severe shoulder dystocia, aOR 2.1 (95% CI 1.6 to 2.7) in the index delivery, were also significant. Birthweight of 3500 g or greater, vacuum delivery, or severe shoulder dystocia in the index delivery were independent risk factors for shoulder dystocia recurrence.

The effect of epidural analgesia on labor progress and outcome in nulliparous women

Objective. The present study was designed to investigate the influence of epidural analgesia on labor progress and outcome in nulliparous women.Methods. A population-based study comparing women with and without epidural analgesia was conducted. Deliveries occurred during 1988–2006 at the Soroka University Medical Center. A multivariable logistic regression model with backward elimination was constructed to control for confounders.Results. During the study period there were 39 498 deliveries; epidural analgesia was given in 9960 (25.2%) of these. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age, oligohydramnios, premature rupture of membranes, induction of labor, and Jewish (vs. Bedouin) ethnicity. These patients were more likely to deliver by cesarean delivery (CD; OR = 1.4, 95% CI 1.3–1.5; p < 0.001) and vacuum extraction (OR = 1.5, 95% CI 1.4–1.7; p < 0.001). After controlling for possible confounders such as macrosomia, failed induction, hypertensive disorders, gestational diabetes, maternal age, labor dystocia, and ethnicity, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (OR = 0.9, 95% CI 0.8–0.9; p = 0.038). When vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (OR = 1.1, 95% CI 1.01–1.3; p = 0.04).Conclusions. Epidural analgesia in nulliparous parturients increases the risk for labor dystocia and accordingly is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.

Influence of parity on the partographic management of labour in a Nigerian tertiary hospital

To assess whether parity influences progress of labour between primigravidae and multiparae as recorded on the partgraph. Retrospective analysis of partographs of women who were monitored with partograph prior to delivery. Participants were selected using specified exclusion criteria. Out of the 1,319 deliveries in the year 2004, 445 women had partographic monitoring; 368 medical records were retrieved and analysed. There were 136 (37.0%) primigravidae and 232 (63.0%)multiparae. The two groups were similar in booking status and risk level. Primigravidae had lower rates of spontaneous labour onset (78.7%) and thus higher rates of induction labour (21.3%) than multiparae [p< 0.05; OR.51, 95% Cl (0.28 - 0.93). Primigravidae presented at lower cervical dilatations and had more frequent vaginal examination than multiparae. Most multiparae (78.2%) had delivered within 6 hours of admission compare with primigravidae (53.1%); prolonged labour occurred more frequently in primigravidae than multiparae (6.9% vs 1.8%). These differences were statistically significant (p=0.000). Higher rates of inadequate uterine contractions were noted among primigravidae. Primigravidae more frequently crossed the alert and reached the action lines compared with multiparae; higher rates of augmentation of labour and emergency caesarean section were also recorded among primigravidae. The outcomes for mother and infant were similar in the two groups. Primigravidae are at a higher risk of dystocia compared with the multipara. Quality monitoring of the primigravida with the partograph will reduce the morbidity and mortality in both mother and the newborn.

Do increasing c-section rates lower the risks of shoulder dystocia or brachial plexus injury?

Do increasing c-section rates lower the risks of shoulder dystocia or brachial plexus injury?

Incidence and Breed Predilection for Dystocia and Risk Factors for Cesarean Section in a Swedish Population of Insured Dogs

To estimate the incidence and breed predilection for canine dystocia using data from insurance claims. The risk factors for cesarean section (CS) were assessed for bitches with dystocia. Retrospective, longitudinal study. Insurance claims records (1995-2002) from a Swedish animal insurance database (Agria), including approximately 200,000 bitches. The overall incidence rate of dystocia in insured bitches was calculated by dividing the number of reimbursed dystocia claims with the number of dog years at risk. Subsequently, incidence rates were stratified by breed, region, and habitat. The proportion of bitches with a dystocia claim that had CS were calculated, and risk factors for CS were assessed using a logistic regression model. Between 1995 and 2002, 3894 (2%) of 195,931 Swedish bitches included in the study had a reimbursed insurance claim for dystocia. The overall incidence rate of dystocia was 5.7 cases/ 1000 dog years at risk. Some breeds like the Scottish terrier were at increased risk of dystocia. Among bitches with dystocia, 63.8% were treated by CS. Dystocia in the bitch is more common than reported earlier. The risk of developing dystocia varies by breed, and a high percentage (63.8%) of affected bitches undergo CS. Clinical Relevance- Breeders and veterinarians could use this information to better predict which bitches are likely to experience dystocia and/or CS.

SELECTION INDEXES FOR IMPROVING GROWTH RATE IN HOLESTEIN HEIFERS WITH MINIMUM CONCOMITANT INCREASE IN BIRTH WEIGHT

SUMMARY The aim of this paper was to improve pre and post weaning growth rates while keeping birth weight increase at minimum level to alleviate risk of dystocia. A total number of ten selection indexes were derived from data on Holstein heifers raised at an Egyptian State-owned farm, from 1988 through 1994. These data represent records of 552 progeny of 25 sires and 459 dams. The traits considered as sources of information in the indexes were birth weight (BW), weaning weight (WW), yearling weight (YW) and the average daily gains during the periods separating birth (B) from weaning (W), (DGB-W), weaning from yearling (Y), (DGW-Y), and birth from yearling, (DGB-Y). In constructing the indexes the aggregate genotype included DGB-W and DGW-Y. Phenotypic and genetic parameters were estimated from a multitrait animal model where year and season of birth effects were considered as fixed and the additive direct genetic effects as random. Selection index with BW, WW and YW (I1) had comparable accuracy with the index including the two segmented daily gains (I6), but with greater increase in BW, WW and YW. Excluding BW from I1, to form I3, resulted in an increase of 17% in BW, while accuracy and improvements in WW and YW remained the same. Ignoring both BW and WW from I1, to form I5, is expected to reduce the increase in BW by 0.10 kg but with reduction in the increase in WW and YW by 0.50 and 0.10 kg, respectively. Results indicated that in case of populations where a level of increase of less than 0.7 kg in BW would be tolerated in each round of selection, the three indexes including YW, (I1, I3 and I5), are recommended. However, breeders using I5 would benefit from its being a single trait index that can be less expensive and easier to apply. In case of populations that have already reached optimal BW, restricting I1 to form I1(BW), genetic gain in BW is limited to zero, but at the expense of reduction in improvement of 35% in WW and 10.5% in YW as compared with the unrestricted form (I1).

Magnetic Resonance Imaging Pelvimetry and the Prediction of Labor Dystocia

To study whether magnetic resonance imaging (MRI) pelvimetry has the ability to identify those women who require cesarean delivery for labor dystocia. From July 2003 to April 2004, nulliparous women scheduled for a labor induction for prolonged pregnancy (42 weeks) were asked to participate in a pelvimetry study. Those who consented underwent fast-acquisition MRI that included two 90-second acquisitions to evaluate fetal biometry and volumetry and maternal pelvimetry, including novel measurements of pelvic bony and soft tissue volumes as determined by MRI. Information about each patient's pregnancy, labor course, and neonatal outcome was prospectively collected. Pelvimetry results for those women undergoing operative delivery for labor dystocia were compared with those who did not. Single fetal and maternal pelvic measurements, as well as ratios of both, were analyzed. In addition, previously described radiographic pelvimetry techniques and formulas to predict dystocia were used. One hundred one women underwent MRI, and 22 of these underwent cesarean delivery for dystocia. No single fetal measurement was statistically associated with dystocia. Several maternal pelvic measures, fetal-to-maternal ratios, and previously reported pelvimetric techniques were significantly associated with dystocia. The ratio of magnetic resonance (MR) fetal head volume to pelvic soft tissue volume had statistical significance (P = .04). Receiver operator characteristic curves were developed for the different measurements, ratios, and formulas studied to assess whether any of the techniques could accurately predict labor dystocia requiring operative delivery. The area under the curve values ranged from 0.6 to 0.8, with the ratio of MR head volume to pelvic soft tissue being 0.7. These values suggest that MRI can identify those women at greatest risk for dystocia, but it cannot with accuracy predict which ones will require a cesarean. We found significant associations with MRI pelvimetry and labor dystocia, but MRI was not a significant improvement over previously described pelvimetric techniques. II-3.

Genetic Influence on Dystocia

Dystocia, a prolonged and difficult labor, complicates from 3% to 8% of all deliveries worldwide. There is evidence of familial aggregation of the disorder, prompting this population-based retrospective study using registry information on dystocia in sisters and mothers. The goal was to detect any genetic influences on susceptibility to dystocia. The study group included 2,539,534 births taking place in Sweden from 1973 through 1997. Relationships between sibling and mother-daughter pairs were examined, and model fitting served to estimate the relative contributions of genetic and environmental factors to dystocia. The incidence of dystocia, identified in 190,747 births, was 8%. Compared with a monozygotic twin whose cotwin did not have dystocia, 1 whose cotwin did have dystocia exhibited a nearly 4-fold increase in the risk of dystocia. Considering all diagnoses of dystocia, the odds ratio was highest for monozygotic twins at 3.82. For dizygotic twins (biologically full-sisters), half-sisters with the same mother, and mother-daughter pairs, the respective odds ratio values were 1.66, 1.85, and 1.60. Half-sisters sharing the same father had a lower risk of dystocia. Model fitting suggested that genetic effects accounted for 28% of susceptibility to dystocia (95% confidence interval, 21-32%). Nonshared environmental factors accounted for 67% of susceptibility. The same patterns were found for primary and secondary dystocia. When analyzing women with primary dystocia who had cesarean section, the risk of dystocia was significantly elevated only in monozygotic twins and mother-daughter pairs. These findings suggest that detecting genes related to dystocia might clarify the pathophysiological of this disorder, and might make it possible to detect, before parturition, an increased risk of dystocia.

A Newborn Who Has an Abdominal Wall Defect

A newborn female born at 35 weeks gestational age presents with an abdominal wall defect. ### Prenatal History: ### Presentation: Figure 1. Figure 2. The appearance of the abdominal wall was grossly abnormal and …

Population-based trends and correlates of maternal overweight and obesity, Utah 1991-2001

This study aims to identify recent population-based trends in maternal overweight and obesity and adverse outcomes. Statewide retrospective cohort study of birth certificate data for live singleton births to women in Utah between 1991 and 2001. Prepregnancy overweight and obesity increased from 25.1% in 1991 to 35.2% in 2001, a 40.2% increase (prevalence ratio [PR] 1.40 [1.37-1.43]), whereas maternal obesity at delivery rose 36.2% from 28.7% to 39.1% (PR 1.36 [1.33-1.39]). The attributable fraction of cesarean delivery in overweight and obese women was 0.388 (0.369-0.407). Statewide, among all women having a cesarean delivery in 2001, 1 in 7 is attributable to overweight and obesity. This is the first state-wide analysis of maternal obesity trends demonstrating a significant increase in maternal overweight and obesity. Overweight and obese women are at increased risk of cesarean delivery, preeclampsia, eclampsia, dystocia, and macrosomia, risks that increase as the body mass index rises.

Birth Weight as a Predictor of Calving Ease and Perinatal Mortality in Holstein Cattle

The objective of this research was to determine the effect of birth weight on perinatal mortality (PM) (alive or dead at 48h of age) and dystocia (unassisted or assisted). Data were 4528 records of births between 1968 and 1999 from the Iowa State University research dairy farm in Ankeny. The incidence of PM was 7.1%; dystocia was 23.7%. A logistic regression model was used to predict both PM and dystocia. The PM model included effects of year of birth, season (summer or winter), dystocia, parity (first or later), birth weight (kg), ratio of calf's birth weight to dam's weight (%), and gestation length (d). Odds of PM increased by 2.1%/yr. Calves born in the winter have a 36% higher risk of PM than calves born in the summer. Difficult births tend to result in PM 2.7 times more often than unassisted births. First-parity cows have a 2.4 times higher risk of PM than cows in later parities. Probabilities of PM for birth weights of 29, 35, 40, 46, and 52kg were 2.1, 2.5, 3.4, 5.1, and 9.6%, respectively, when other factors were set at their average value. Similarly, ratios of calf to cow weight of 4.5, 5.7, 6.9, 8.1, and 9.3% yield probabilities of PM at 8.2, 4.2, 3.1, 3.5, and 5.7%, respectively. Finally, gestation lengths of 268, 273, 279, 284, and 290 d yield probabilities of PM of 5.5, 3.9, 3.1, 3.1, and 3.6%, respectively. The dystocia model included effects of year of birth, season, sex of calf, PM, parity, birth weight, and pelvic area (externally measured). Odds for dystocia decreased by 4.7%/yr. Calves born in the winter have a 15% higher risk of dystocia than calves born in the summer. Odds of male calves needing assistance were 25% greater than female calves. If a calf died in the first 48h, then it is 2.7 times more likely that the calf needed assistance. First-parity cows have a 4.7 times higher risk of dystocia than cows in later parities. Odds of dystocia increase by 13%/kg increase in birth weight. An 11% decrease in odds for dystocia is associated with a one square decimeter (dm2) increase in pelvic area.

On the relationship between lactational performance and health: is it yield or metabolic imbalance that cause production diseases in dairy cattle? A position paper

The objective of this review was to explore the relationship between lactational performance and health. We focused on lactational incidence rates (LIR) of the production diseases that are of economic importance to the dairy industry. Based on a review of 11 epidemiological and 14 genetic studies we found little evidence that high yielding cows have increased risk of dystocia, retained placenta, metritis and left-displaced abomasum. Results for periparturient paresis were inconsistent. Whilst we found no phenotypical relationship between milk yield and the risk of ketosis and lameness, selection for higher milk yields will probably increase LIR for these diseases. Mastitis was the only disease where there was a clear relationship between milk yield and risk of infection. Continued selection for higher milk yields will worsen this situation. However, our overall conclusion is that reviewing existing literature, even with a structured literature selection, is inadequate to the task of elucidating the relationship between lactational performance and risk of production diseases. There are substantial problems with confounding effects and unaccounted for biological correlations. In the second part of the review we argue towards a common basis for addressing production diseases. We propose abnormal body mobilisation and immune competence as common currencies for metabolic and immune status and argue for the development of indicators of metabolic imbalance and the early development of diseases. Furthermore, we suggest the use of indicators of ‘imbalance’ to guide feeding according to the needs of individual cows with their specific genotype and management history. We believe that this approach has the potential to provide new diagnostic and decision support tools to improve animal health and reproduction, whilst simultaneously maintaining optimal production and efficiency. Further research is needed to identify and validate new indicators and individual feeding strategies.

Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 microg.mL(-1): a study in singleton breech presentation.

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In this trial, we compared bupivacaine 0.125% with a combination of a low concentration of bupivacaine (0.0625%) and sufentanil (0.25 microg.mL(-1)) both administered by continuous infusion. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between group bupivacaine (n = 23) and group bupivacaine-sufentanil (n = 35). A greater number of patients in the bupivacaine 0.125% group required more than two top-ups (32 vs. 8% of patients, P = 0.03) while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a trend toward a decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group (92% vs. 74%, P = 0.09). Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was no significant difference in mode of delivery between the two analgesic regimens.

Risk factors for dystocia in farmed red deer (Cervus elaphus).

To analyse data from a study of deer herd health and productivity to identify potential risk factors for the occurrence of dystocia. A 2-year longitudinal observational study of 14 red deer farms was carried out in New Zealand. About 2700 hinds were monitored each year for individual characteristics including body condition score (BCS), and reproductive performance. Grazing and calving management practices were recorded. During calving, farmers recorded calving difficulties (dystocia) that needed human assistance or caused the death of the hind. Risk factors potentially affecting the occurrence of dystocia were identified and analysed by multivariable statistical techniques. The percentage of hinds with dystocia was 0.52% (95% CI 0.32 to 0.78). Hinds with a post-winter BCS over 3.5 were 2.7 times as likely to experience dystocia as hinds scoring 3.5 or less. Given the same BCS class, bodyweight gain in late pregnancy was associated with an increased risk of dystocia. Grazing steep paddocks in the last trimester of pregnancy decreased the risk of dystocia in hinds with a BCS over 3.5. The risk of dystocia on red deer farms may be reduced if key individual animal, management and environmental factors are optimal.

Risk factors for high herd level calf morbidity risk from birth to weaning in beef herds in the USA

We analyzed data from a national survey of beef cow–calf producers in the USA to quantify the effects of hypothesized risk factors on herd-level calf morbidity risk from birth to weaning. The analysis included 2490 herds from 23 states. Two stepwise logistic regressions were fit to identify factors associated with ≥10% morbidity. The first model included all herds dichotomized into high-morbidity herds with ≥10% morbidity and low-morbidity herds with <10% morbidity. The second model excluded herds with between 5 and 10% morbidity, and compared ≥10% morbidity with ≤5% morbidity. The risk of dystocia was categorized into five levels for analysis; all non-zero categories were associated with increased odds of being a high-morbidity herd compared to herds with no dystocia (OR=2.7–5.5). Having >70% of cows and heifers calves in confinement also increased the odds of being a high-morbidity herd (OR=1.8). The population attributable fractions for dystocia and confined calving for the model including all herds dichotomized at 10% morbidity were 0.41 and 0.11, respectively. The summary population attributable fraction for both factors was 0.46.