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IP 11 Theriogenology > 36, 37, 38 - dystocia > Flashcards

36, 37, 38 - dystocia Flashcards

1
Q

what is eutocia?

A

normal birth

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2
Q

what is dystocia?

A

abnormal birth

  • inadequate progress during birth
  • failure to give birth w/o assisstance
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3
Q

what are 3 locations of origin of maternal caused dystocia?

A

uterine
abdominal
pelvic

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4
Q

in the pelvis of the FM, the cause of dystocia may be ____ or _______ in nature

A

bony

soft tissue

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5
Q

what are 4 causes of fetal causes of dystocia?

A
  • disproportionate size
  • mal disposition / mis orientation
  • failure to initiate birth
  • death
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6
Q

t/f

bitches whelp 65 days posts breeding date

A

false

65 days post LH surge, regardless of breeding time

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7
Q

what info must be known about the situation before proceeding with the dystocia?

A 
age
parity
breed
sire
due date
prior exams / interventions
define presenting complaint
relative value of dam vs neonate - which does client want to preserve / which is able to be preserved
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8
Q

components of clinical exam in dystocia case?

A

strength and health of dam
intensity of contraction
is she ambulatory?
metabolic derangements - energy, minerals, hydration

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9
Q

in what species are metabolic derangements particularly important to consider at time of parturition?

A

dairy cattle
dogs
small ruminants

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10
Q

what to assess in birth canal quickly?

A 
patency
trauma
fetal body parts / obstruction
fetal membranes
fetus alive?  viable?
force of abdominal contractions?
Ferguson's reflex?
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11
Q

why is it important to evaluate if the allantocorion has ruptured yet?

A

b/c if not, then she may just be in first stage of parturition

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12
Q

what does viable mean?

A

able to survive / live

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13
Q

t/f

viable is the same things as alive

A

false

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14
Q

what does alive mean?

A

currently living

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15
Q

what is Ferguson’s reflex?

A

stimulation of vagina - stimulates oxy secretion so contraction are stimulated

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16
Q

how can the fetus/es be evaluated?

A

trans rectal plapation
u/s
vaginal exam
x ray

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17
Q

how to establish if fetus is alive if in the cranial presentation?

A
  • interdigital reflex
  • suckling reflex
  • eye reflex (press on eye ball)
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18
Q

which fetal reflex disappears first?

which remains positive in hypoxic calves?

A

interdigital reflex disappears 1st

eye reflex remains

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19
Q

what reflexes to establish fetus is alive in the caudal position?

A

anal reflex
umbilical artery pulse
femoral artery pulse

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20
Q

what is the conclusive diagnostic to determine if fetus is alive?

A

u/s

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21
Q

after the exam, what should you know?

A 
obstructive or non obstructive dystocia
strength of dam
status of birth canal
exact orientation of fetus in birth canal
fetus alive or dead
fetus viable?
relative value of dam and fetus to client
prognosis for survival / future breeding
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22
Q

5 methods a dystocia may be resolved?

A 
vaginal delivery w traction
vaginal delivery after fetal mutation
vaginal delivery with fetotomy
cesarean section
no Tx - sacrifice
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23
Q

what are 3 types of c sections?

A

survival
terminal
hysterotomy OR ovariohysterectomy

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24
Q

how to distinghush an obstructive vs a non obstructive dystocia?

A

obstructive has good contractions and non obstructive has poor contractions

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25
Q

despite good contractions, what are 3 other issues commonly present with obstructive dystocias?

A

usually abnormal orientation
often dead fetus
feto-maternal diss proportion

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26
Q

what is the typical orientation, living status and space status of fetus/es during a non obstructive dystocia?

A

all good

usually normal orientation
often alive fetus
usually enough space

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27
Q

t/f

uterine torsions often resolve on their own so should be monitored but nothing done right away

A

false

always try to correct a uterine toresion

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28
Q

4 methods to resolve an obstructive dystocia?

  • that is NOT a uterine torsion
A

mutation
traction - lubrication
fetotomy

c section

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29
Q

t/f

ecbolics are good therapies to assist with obstructive dystocia?

A

false

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30
Q

what are 2 examples of ecbolic therapy?

A

Ca

oxytocin (oxy)

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31
Q

proper way to apply traction on fetus?

A

roll fetus into dorso ileal position and then apply alternating traction on hind limbs

stagger legs so shoulders are staggered

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32
Q

what is MC used for epidural anesthesia?

drug
amt
dose

A

5-8 mL of 2% lidocaine

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33
Q

what does myometrial relaxation require?

A
  • removal of oxytocin (can occur thru Cd epidural anesthesia)
  • competitive antagonist (B2 agonist)
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34
Q

what is the legal option for a competitive B2 agnoist in the US?

what is a draw back?

A

adrenalin

short acting

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35
Q

what is the best way to mutate a calf to reduce the risk of tearing the already taught uterine wall?

A
  • create space in front of the pelvic inlet to allow for un-flexion of the leg
  • keep the joint to the uterine wall and the foot to the calf
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36
Q

t/f

mandible snares are a good way to provide traction for a calf or foal in dystocia

A

false

mandible is only used to guide the head - NO traction on the fetus head

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37
Q

what must be achieved during mutation of a fetus?

A
  • convert shoulder flexion into carpal flexion

- in Cd presentation: convert hip flexion into hock flexion

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38
Q

what is fetotomy?

A

dis memberment of fetus that is dead w/in the birth canal

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39
Q

what supportive therapy must be provided to dam during fetotomy?

at what point in the procedure?

A

fluids, NSAIDs, sedation, pain control, abx maybe

initiate prior to the fetotomy => b/c uterus full of endotoxins that you will stir up and she will absorb a lot rapidly so will become critically ill

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40
Q

when making selected cuts during a fetotomy, each cut MUST achieve improved chances for delivery.

in what 3 ways might this occur?

A
  • remove flexed body part that cannot be extended
  • dec diameter of fetus [at level of shoulder primarily]
  • create more room to work inside the birth canal [removing head]
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41
Q

t/f

when performing a fetotomy, use short and fast strokes of the wire the maximize effect

A

false

use longest possible strokes and highest possible friction

if using a small area only, the wire will get very hot and will fatigue/weaken

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42
Q

after the fetotomy, what is critical to do?

when doing this, why is sterility not a huge issue?

A

flush the uterus

the uterus is already full of bacT, just clean it out well with a good clean source of water

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43
Q

2 benefits to flushing uterus after fetotomy?

A

flush out bacT

flush out “soup” of materials/fluids that bacT will love to grow in

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44
Q

what is a laparohysterotomy?

A

cesarean section

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45
Q

what is common location on lateral side of cow for c section incision?

ventral incision?

A

fold of skin hanging from the tuber coxae and down over the costal arch

ventral: over milk vein in longitudinal direction

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46
Q

what fetal structure is important to identify first in C section if fetus is in the Cr position?

Cd position?

A

cr position: hind limb

cd position: front limb

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47
Q

when incising the uterus, what structures are important to avoid?

A

placentomes

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48
Q

how far should the incision in the uterus extend from?

A

the length of the lower hind limb -> from fetlock to calcaneous

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49
Q

why must the uterus NOT slip back into the abdomen?

A

risk spilling uterine contents into the abdomen - causing peritonitis - compromise well being of dam

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50
Q

what type of suture material used in uterine wall?

A

dissolvable

often PDS

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51
Q

t/f

when closing the uterus, a suture pattern that penetrates the full thickness of uterine tissue and enters the lumen is necessary for a secure closure.

A

false

if suture penetrates the lumen, it will dissolve to quickly and may lead to suture failure

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52
Q

why should mattress patterns such as cushing be avoided when closing the uterus?

A

b/c they occlude blood supply to wound edges and delay wound healing

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53
Q

what are characteristics of the Utrecht uterine closure pattern?

A

begin distal to dorsal comissure of incision, in healthy tissue, and end ventral to comissure of incision

make bites far to near EVERY TIME

bury knots but NOT in uterine lumen

zig zag fashion at about 45* angle to incision

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54
Q

benefits to Utrecht closure?

A

immediate tight seal - NO leakage thru incision

no suture material on serosal surface so no omental adherance should occur so no adhesions [catch: there actually is suture exposed]

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55
Q

what is not perfect about the Utrecht pattern?

why the modified pattern is preferred by many?

A

suture far to near and the near to far - 4 holes in a row

so near hole pulled to near hole and far hole pulled to far hole

no suture material on serosal surface

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56
Q

why might emphysema occur after c section?

what is done to px this?

A

b/c there is huge void in abdomen where calf used to be, now filled with air

express the air out of the peritoneal cavity before taking the last bite when suturing

57
Q

t/f

cows often experience temporary and reversible nerve damage after c sections

A

true

give her time and good footing to recover at her own pace

58
Q

what is first thing to determine if uterine inertia is suspected?

A

is the dam actually in labor

59
Q

after it is determined that the dam is in labor and uterine inertia is happening, what should we determine next?

A

is the inertia 1* or 2*?

60
Q

what are some causes of uterine intertia?

A

lack of stretching of cervix or anterior vagina

over distended uterus

metabolic disorder

exhaustion or excessive intervention

61
Q

3 MC causes of bovine dystocia

A

feto maternal disproportion
abnormal posture
abnormal presentation

62
Q

t/f

it is appropriate to deliver a dead calf by c section

A

false

do NOT deliver dead calf by c section

most diary cattle - 92% - will not produce milk and will leave the farm as a result if this occurs

if calf alive at time of c section, 87% chance cow will do fine

63
Q

what is schistosomus reflexus?

A

congenital cleft of the trunk; limbs are mal formed and ankylosed
spine lacks some vertebra, and often entire sacrum

64
Q

what is perosomus elumbis?

A

flattened and deformed pelvis, hindlimbs ankylosed

65
Q

what is tibial hemimelia (TH)?

what breed?

A

recessive genetic defect traced to short horn bull in 1970s

calves have many congenital defects: absence of tibia, twisted legs/absent or deformed bones, abdominal hernias, cryptorchid, meningocele

66
Q

what is PHA?

A

pulmonary hypoplasia w anasarca

recessive genetic, cattle

calves have poorly formed lungs and excessive subQ edema

lethal!

67
Q

what is arthrogryposis multiplex?

A

curly calf syndrome

bovine, hereditary - lethal autosomal in angus

muscle hypoplasia, arthrogryposis and kyphoscoliosis

68
Q

what is arthrogryphosis?

A

flexed joint d/t muscle contraction

69
Q

what is kyphoscoliosis?

A

ventral and lateral curve of spine

70
Q

there are 3 genes affected in arthrogryposis multi plex. what is 1 related to?

A

1 gene involved in neuromuscular junction

71
Q

how does arthrogryposis multiplex affect dam / birth process?

A

results in lack of fetal movement in utero

72
Q

the foal has very long fetal extremities. why is this significant?

A

mare has a higher risk of uterine tears occurring during mutation

73
Q

how rapidly can the foal die and how quickly is the mare’s life in danger during dystocia

A

foal: 30-60 mins
mare: 3 hours

74
Q

how much space is needed in front of the pelvis to rotate the limb to fix the flexed carpus?

A

18 inches

must retropulse foal back into the mare before mutating

75
Q

how long do cows have when dealing with a dysticoa typically?

mares?

A

cow: 24 hours
mare: emergency!

76
Q

what are 4 basic and initial measures to take when dealing with mare dystocia?

A

walk her
epidural anesthesia
pass endo tracheal tube
heavy sedation

77
Q

during mare dysticia, what cavity should you always work inside of?

A

allantoic cavity

*outside of the uterine lumen

78
Q

where should the muzzle of the foal be located during normal birth?

A

at the mid level of the cannon bone

79
Q

what is the best position for the mare to be in during fetal mutation?

A

on her back with her legs hoisted high into the air

while she is anesthetized

80
Q

what supportive care should you provide to the mare during dystocia?

A

fluids
NSAIDs
heavy sedation
broad spectrum abx

81
Q

what abx are best used for a mare during dystocia?

A

gentamicin and penicillin

82
Q

after the dystocia, what care does the mare require?

A 
fluids
flush out uterus
5 L mineral oil to Px impactions
prophylactic care for laminitis
continued abx therapy
dry cow mastitis prep to Px vaginal mucosal adhesions
83
Q

what is #1 complication after mare dystocia?

A

infection

84
Q

what occurs during a red bag delivery in a mare?

A

premature placental separation

failure of the cervical star to rupture

85
Q

normally, when should the cervical star rupture?

what causes it to rupture?

A

with inc uterine pressure at the initiation of labor

86
Q

if placental separation has occurred, what else has also occurred?

A

fetal death - b/c fetus loses placental support

87
Q

what is the first thing to do during red bag delivery?

A

cut open the red bag - get the foal out b/c it is dying

88
Q

what are 2 MC causes of red bag in mares?

A

fescue toxicosis

partus induction

89
Q

what tissue layer is the “red bag” ?

A

allanto chorion

90
Q

what structure does not mature properly, whether d/t natural problem or iatrogenic problem, which may result in red bad delivery?

A

cervical star fails to mature properly

91
Q

what is common problem with foals born in a red bag delivery?

A

hypoxia

o2 deprived neonate -> neonatal mal adjustment

also: neonatal septicemia

92
Q

what are common reasons for dystocia in small ruminants?

A

postural abnormallities of twins or triplets
oversized single fetus
“ring womb” = idiopathic failure of cervix to dilate

93
Q

t/f

in sheep and goats, the neonate can be delivered in unilateral shoulder flexion to allow passage of the relatively large head of the fetus

A

true

94
Q

how is a ring womb resolved in small rumintants?

A

c section

95
Q

t/f

it is appropriate to use a head snare to help deliver small ruminant fetuses.

A

true

96
Q

what type of anesthesia is used in small ruminant c section?

A

local infiltration along incision line

mild sedation and hold animal in recumbent position

97
Q

where is the incision for c section made in small ruminants?

A

L or R flank
ventral midline
groin in front of udder - where the skin is bare

98
Q

what are characteristics of alpaca fetuses?

A

very long extremities and necks

bilaterally flexed limbs

99
Q

t/f

hembras do not tolerate c section surgery well

A

false

they tolerate it very well

100
Q

what are MC causes of canine dystocia?

A

uterine inertia [hypocalcemia, stretching]

feto maternal disproportion

single pup syndrome

excessive attention leading to distraction of bitch during birth

101
Q

t/f

traction, mutation and fetotomy are commonly practiced on bitches

A

false

these methods are impractical

102
Q

what is the common Tx for canine dystocia?

A

c section

103
Q

what ecbolics are used in canine dystocia?

A

Ca

oxytocin

104
Q

what is an anasaca puppy?

A

pup born with excessive fluid accumulation of fluid under the head and in the abdomen

105
Q

what is 1* source of circulating Ca levels?

what is another source?

A

GIT

skeleton may be accessed

106
Q

what hormone induces mobilization of Ca from skeleton?

A

PTH - parathyroid hormone

107
Q

Most Ca in circulation is bound to protein or ionized?

therefore, is it readily available or not?

A

bound to protein

bound so NOT readily available

108
Q

what governs the amount of Ca available in ionized form?

A

pH of blood

109
Q

what is the effect of high pH on ionized Ca levels?

A

high pH => Ca goes into bound form => less Ca readily available

110
Q

how does the temperature of a bitch’s whelping environment affect her Ca availability?

A

if kept in a warm area, she will get hot and pant -> inc pH in blood -> more bound Ca -> less ionized Ca

111
Q

t/f

when bitches whelp in a hot environment, their total Ca is lower than bitches given a cooler area to whelp

A

false

ionized Ca is lower => total Ca is the same

112
Q

what, specifically, is hypocalcemia a deficiency of?

A

inadequate circulating free Ca

113
Q

why is Ca from the GIT limited for bitch on the day of labor?

A
  • highest demand for fetal skeletal development on this day
  • initiation of lactation
  • reduced feed intake
114
Q

t/f

prior to parturition the bitch should be kept on a high calcium diet.

why or why not?

A

false

lower calcium diet - or at least NOT given excessive Ca

if Ca levels are high, the PTH will not be active and will take a few days to adjust to her higher demans

if Ca levels are lower, the PTH will already be active and mobilizing Ca for the bitch at the time of parturition

115
Q

when should Ca be supplemented for bitch?

A

after parturition

116
Q

how to Px hypocalcemia in bitch during parturition?

A

feed maintenance levels of Ca during pregnancy

px overheating during whelping

117
Q

how to tell if canine fetus is alive vs viable?

best test to determine this?

A

normal / alive = 200 bpm

u/s exam

118
Q

what is heart rate of compromised canine fetus?

and a critical fetus?

A

150-200 bpm

119
Q

how to assess patency of birth canal in bitch?

A

digital or vaginoscopic exam

120
Q

how to assess the litter size in canine?

A

x rays

121
Q

t/f

obstructive dystocias are best resolved with ecbolic therapy

A

false

NO ecbolic therapy

c section is MC resolution

122
Q

tx of uterine inertia?

A

5% dextrose and hydration
calcium (give to effect)
oxytocin (use small doses frequently)

123
Q

how much oxytocin may be given total to a bitch?

when should it be given?

A

1-5 IU total dose

give oxy AFTER Ca

124
Q

t/f

a common cause of uterine inertia is oxytocin deficiency in bitch

A

false

deficiency of oxytocin is uncommon => MC is a deficiency of Ca

125
Q

one method of administering Ca to a whelping bitch is to measure her ionized Ca levels in her blood, calculate her deficiency and then give her the appropriate amount.

a less precise method but effective and much more practical is what?

A

listen to her heart rate - a hypocalcemic heart rate will have a tremor and a fast, shallow pulse

deliver a bolus of .5 mL of Ca and listen for a slowed heart rate

continue giving her boluses of Ca until her heart rate stabilizes and remains slower

126
Q

at what point should fetal membranes be removed in canine c section?

how should they be removed? why?

A

after last pup is out

remove them slowly to avoid consumption coagulopathy

127
Q

during a c section in a bitch, when should oxy be given?

A

after the fetuses are delivered

128
Q

what induction drug should be used during canine c section?

A

propofol

lidocaine locally

129
Q

why should poly ionic fluids be given to a bitch during a c section?

A

b/c once the pregnant uterus is removed, the abdominal pressure will plummet -> blood may flow into the organs -> leading to a huge drop in blood pressure

130
Q

benefits to a lumbo sacral epidural anesthetic for bitch during c section?

A

pain in bitch is controlled
bitch is not anesthetized

no risk to viability of puppies d/t anesthesia

131
Q

when are elective c sections performed in the bitch?

what MUST BE KNOWN in order to plan for an elective c section?

A

last day or 2 of gestation

MUST KNOW the day of the LH surge

132
Q

if the date of the LH surge is not known, what can be measured and used as indicators of the end of gestation?

A

core temperature falls

p4 levels reach baseline

133
Q

what can be used to accelerate fetal maturation?

A

dexamethasone

134
Q

what dictates the size of the pup?

A

placental support

135
Q

why does a singleton pup fail to initiate labor?

A

its adrenal function does not provide enough of a signal to the bitch to trigger labor

136
Q

if the LH surge date is not known and the bitch is carrying a single pup, how is the date of c section selected?

A

x ray - look for teeth and toe calcification

or intestinal bowl movement if high resolution u/s

137
Q

why aren’t temperature drop or serum p4 used in case of singleton pup to determine stage of gestation?

A

b/c they do not occur -> these signals require a trigger from the fetus, which does not occur

138
Q

why might rubbing a bitch’s belly help her during parturition?

A

deep abdominal massage will stimulate smooth muscle contraction

139
Q

if last pup was born 2 hours ago, what can be done to help the bitch?

A

deep massage to her abdomen
walk her
stimulate vagina digitally
small oxy dose

IP 11 Theriogenology (15 decks)

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