Schistosomus reflexus is a rare, congenital malformation primarily identified as a cause of dystocia in dairy cows6. The malformation is characterized by a group of core anatomic abnormalities (spinal inversion, exposure of abdominal contents, limb ankylosis, and diaphragm hypoplasia) with a range of other concurrent abnormalities. This paper discusses a case of schistosomus reflexus in a Holstein cow with emphasis on considerations for management decisions. Fetal pain, fertility, and surgical risk are examined in choosing fetotomy or cesarean section for management of dystocia and an abnormal fetus.