3. approach to dystocia Flashcards
how should you approach investigating dystocia
- clinical hx
- general exam
- obstetrical exam
- forming conclusion
what questions should you ask when considering a case of possible dystocia
- is the birth premature or overdue? (developed enough for life?)
- Has the dam given birth before – if so were there complications and what were these?
- What is known about the sire (and his size)?
- What has recently been observed in this dam?
- Has a recent vulval discharge been noticed?
- Have uterine / abdominal contractions (these are different) been noted and if so when?
- Have any fetal membranes / fluid been expulsed?
- Have any fetuses been delivered (in multiparous species)?
what should you consider on general exam of a possible dystocia
- Is she bright or dull?
- What is her body condition?
- Is she able to stand and walk?
- What are her clinical parameters?
- Can any fetal parts been seen at the vulva?
- What are the fetal parts?
- Is there a vulval discharge present and if so what colour is it?
- Is there any degree of abdominal distention?
- Is there evidence of fetal life?
what should be considered on obstetric exam of a possible case of dystocia
- Restraint of the dam
- Vaginal examination
- Wash perinueum and vulva
- Short fingernails
- Clean PPE
- Carefully wash hands and arms
- Rectal sleeves / gloves (consider zoonotic risk)
- Copious obstetrical lubricant
what should be considered upon vaginal exam of a possible case of dystocia
- Is the vestibule dilated?
- Is the caudal vagina dilated?
- Is the cervix open ? (cannot detect in bitch or queen)
- What is the state of lubrication of the tract?
- Are any fetuses present, are they alive, (how can you tell)
- What is the fetal presentation, position and posture?
- Are any fetal membranes present, are they intact, are they detached?
- What is the relative size of the birth canal and the likelihood of fetuses being delivered?
- Are any lacerations present?
in which species is feto-maternal disproportion unlikely and why
horse - size of uterus determines size of fetus
which causes of dystocia are most common across the species
list treatment options for dystocia
- conservative tx
- manipulative tx
- drug therapy (oxytocin, calcium, clenbuterol)
- sx tx (epidural anaesthesia, episiotomy, fetotomy, Caesarean
- euthanasia
what is the term for correcting presentation, position and posture
mutation
comprises repulsion, correction, rotation and version
what should you do after delivery in a case of dystocia
- Always, always, always examine the dam to:
- Ensure that there is no other fetus
- Ensure that there are no lacerations of perforations
- Ensure that there are no obvious other defects such as pelvic fractures, mastitis etc
- Always consider appropriate analgesia, antimicrobial therapy, ecbolic drugs (dependant on species) and plan attention to nursing care
what is the largest diameter of the birth canal
5 past seven or five to five not 12:00
why is it important that the fetus be delivered rapidly once the umbilicus engages the pelvis
squeezes the umbilicus, disrupting blood flow to fetus
