**3.2 Treatment of birth complications**

*Animal Reproduction in Veterinary Medicine*

or to sows with prolonged parturition (>300 min) [12]. Obstetric intervention is usually not indicated before 1–15 h has passed since the last piglet was born in sows without risk for dystocia, which are at the beginning of parturition (<300 min since the expulsion of the first piglet) and show no signs of strong abdominal straining or restlessness [11, 12, 57]. Restlessness can occur if stress and pain are present [58]. For instance, increased stress induces higher frequency of postural changes and longer duration of standing position of sows during the expulsion stage of parturition [58]. Whenever the abovementioned criteria are fulfilled, an obstetrical examination needs to be performed. An obstetric examination includes palpation and ultrasonography of the birth canal [12, 59]. Palpation of the birth canal should always occur through the rectum and not through the vagina. Vaginal palpation can lead to an increased risk of subsequent dystocia, stillborn piglets, and PDS [3, 7, 12, 57]. Rectal palpation is necessary to determine the exact cause of dystocia before any intervention is undertaken. When no piglet is felt within the birth canal, then the cause of dystocia is uterine inertia [8, 9, 12]. Other causes are, e.g., obstruction of the birth canal due to ventral deviation of the uterine horns or fetal malposition [8, 9, 12]. After these obstructive causes are ruled out, treatment for uterine inertia can be applied [12]. Ultrasonography can be used to determine whether farrowing is over or if the

*Transabdominal ultrasonographic image of a non-expelled piglet (A; arrows indicate vertical and horizontal dimension) and placentae (B; arrows indicate placentae). Scale bars on right margins in 1 cm steps. Images* 

*Behavioral and physiological indicators of low colostrum intake and neonatal mortality.*

sow has retained piglets [59] or placentae [60] (**Figure 2**).

*taken by Alexander Grahofer (A) and Stefan Björkman (B).*

**96**

**Figure 2.**

**Table 5.**

Oxytocin, an uterotonic agent, is used during farrowing to treat dystocia by provoking uterine contractions [61]. If primary uterine inertia occurs, before administration of any exogenous oxytocin, we recommend trying means of releasing endogenous oxytocin, e.g., manual induction of the Ferguson reflex and massaging the udder of the sow [8]. Furthermore, movement and physical exercise of the sow have positive effects on the farrowing duration, especially if the sow is still at the beginning of the second phase [12]. If that does not help, we recommend waiting for at least 30 min. Often progesterone has not fully declined and oxytocin receptors are not fully expressed [62], which makes oxytocin administration contraindicated. In this case, possible stressors and sources of pain should be investigated, and provision of nest-building material or application of pain medication may be indicated. If the sow is constipated, removing feces from the rectum by hand is beneficial.

Immediate application of exogenous oxytocin is indicated if secondary uterine inertia is diagnosed towards the end of the second phase of parturition [12]. Several studies were conducted to prove the effect of oxytocin on the birth process and piglet survivability and to evaluate the proper dosage of oxytocin in dystotic sows [63–65]. An intramuscular administration of 10 IU of oxytocin did not cause any side effects. However, higher dosages led to an increase in stillborn piglets, changes in the umbilical cord, and higher meconium scoring [63–65]. Furthermore, the improper use of oxytocin can lead to unwanted side effects. These side effects are increased uterine inertia and manual assistance [66, 67] as well as ruptured or damaged umbilical cord [68] and decreased placental blood flow [69]. Hence, we recommend administering oxytocin only restrictively, e.g., 5–10 IU one to two times during parturition [12].
