4. Periparturient Conditions Flashcards
normal mothering behaviour for the bitch
-attentiveness
-helping pups nurse
-stimulating urination and defacation
-grooming
-protecting and retrieving pups
Causes of abnormal mothering include:
- Stress
- Pain
- Excessive human interference
first steps when new mother bitch not interacting properly with pups
-history
-physical exam
Normally, a bitch should have mammary glands that are:
- Non painful
- Symmetrical
- Either firm or softer
- Should be warm; NOT hot or cold
when does mastitis commonly occur? when is it less likely to occur?
Commonly occurs post-partum
Less likely to occur in pseudopregnancy or prior to whelping
what is the possible distribution of mastitis? how serious is it?
Can affect 1 or more glands or 1 or more sections of a mammary gland
Can be life threatening and bitch can be systemically ill
when relative to whelping does mastitis usually occur?
6-10 days post-whelping or at early weaning
what does the early disease process or a mild case of mastitis look like?
- Mammary may just feel firm, bitch may be uncomfortable, but without fever
clinical signs of mastitis in more moderate or severe cases:
- Bitch is febrile
- Can see hot, painful, hard, discolored mammary gland (red, bruised, black)
- Milk can look normal, purulent, brown/red to green in color
- Bitch can appear quite sick > lethargic, not eating, not being a good mom, anxious, painful
- Can be septic if abscessed or gangrenous
what diagnostics should we run if we suspect mastitis?
Bloodwork
o CBC > leukocytosis with left shift
o Can be septic with gangrenous
Cytology of milk sample
o Degenerative neutrophils, bacteria engulfed by neutrophils, macrophages
Culture and sensitivity of aseptically attained milk sample
+/- Ultrasound of the mammary gland
how do we treat mastitis? what do we need to consider?
Need to consider if pups will still be nursing from mom > some drugs are passed through the milk & are toxic to neonates
* Should not nurse if gangrenous/abscessed
* Need to consider pup age if removal of pups from mom is necessary
Antibiotics based on culture and sensitivity
Fluid therapy if required
Manual milking
Analgesia
* Tramadol
* Opioids
* Anti-inflammatory (NSAIDs)
> Typically not recommended (pups)
Hot packing/cold packing
Cabbage leaf bandages
Surgical debridement of necrotic tissue & honey bandages
* Abscessed
* Gangrenous
what is agalactia? when should we suspect this? More common in what kind of bitches?
Absence of milk in a female that should be lactating
Suspected if pups are not gaining weight
More common in primiparous bitches
causes of agalactia
-Asynchrony between delivery and milk production (eg. elective c-section)
-Inadequate nutrition
-Stress
-Premature whelping
-Mastitis
-Metritis
-Endotoxemia/systemic illness
treatment for agalactia
◦ Need to supplement pups
◦ Try to treat cause eg. stress
◦ Dopamine receptor antagonists
◦ Dopamine inhibits prolactin > if we block dopamine prolactin increases
Reminder: Prolactin is required for lactation!
what is galactostasis?
◦ Excessive accumulation of milk but with lack of milk let down
what is metritis? how does it arise? when does it generally arise?
Infection of the uterus (endometrium + myometrium)
◦ Normal flora of the reproductive tract invades the uterus
> Cervix is open
◦ Most commonly occurs following a dystocia, retained fetal membranes or fetus, prolonged delivery, contaminated obstetrical manipulations
◦ Usually occurs during 1st week post-partum
character of normal post-partum discharges
- No odor
- Reddish brown to green color
- Present for up to to 3 weeks post partum
- Should decrease gradually with time
- Can have slightly elevated temperature for several days post partum but should not exceed 39oC
clinical signs of metritis
-Poor mothering
-Lethargy
-Inappetance
-Fever
-Decreased milk production > decreased weight gain in puppies
-Vulvar discharge: thick, creamy to reddish brown & malodorous, sometimes copious
-Can present in shock
how can we diagnose metritis?
-CBC > leukocytosis with left shift
-Ultrasound > uterine dilation; potentially presence of retained fetal membranes or fetal structures?
-Radiographs > distended soft tissue structure in caudal abdomen; presence of retained fetus?
-Cytology of fluid > degenerative neutrophils, engulfed bacteria by neutrophils, RBCs
-Culture & sensitivity of fluid
most commonly cultured bacteria from metritis
E. coli
how do we treat metritis?
May need to remove pups from mom if bitch is too sick
Fluid therapy
Antibiotics
* Still need to consider if pups nursing
Prostaglandins
* Contraindicated if at risk of uterine rupture
* Side effects > monitor in clinic
* Monitor response to PGF𝛼 > ultrasound examinations
Oxytocin likely won’t work
May need to spay in severe cases
* If fetus/fetal parts present, need to be surgically removed
is retained fetal membranes usually a problem in bitches
not usually
how should we deal with retained fetal membranes in bitches? when is it a problem? when is it more common, and how can we prevent it?
-Should encourage breeders to keep tract of passed placentas
-If discharge is black/green for longer than 12 hours –> problem = possible metritis
-more common in toy breeds
-prevention: oxytocin during first 24 hours post partum
why does hypocalcemia arise?
calcium is being used rapidly for milk production +/- whelping
when is hypocalcemia more common
-Young bitches (1st litter)
-Large litter
-Small or medium breed
-Bitch fed inappropriate diet during gestation; supplemented with Ca2+
-At 2-4 weeks post-partum > maximum milk production
But, can occur in any age, any breed, any parity and at any time during lactation; even prior to whelping (rare)
clinical signs of hypocalcemia
Restlessness, anxious behavior (pacing, whining)
Weakness
Being a bad mom – not tending to her pups
Tremors
Panting
Staggering
Facial pruritus
Dilated pupils
Change in behavior
Tachycardia
Hyperthermia - fever
Muscle twitching
Hypersalivation
Collapse > convulsions
how do we diagnose hypocalcemia?
◦ History, clinical signs, physical exam
◦ Low ionized calcium
◦ Total calcium can also be low
◦ Check other abnormalities (hypoglycemia, hypomagnesemia, hypophosphatemia)
◦ Check acid-base status, protein levels
how can we treat hypocalcemia
◦ Slow IV administration of calcium > improvement is often rapid
◦ Oral calcium
◦ +/- remove pups to allow mom to recover & slowly re-introduce if too young to wean
◦ +/- cool down bitch if very hyperthermic
◦ +/- diazepam if convulsions
how can we prevent hypocalcemia?
Feed well-balanced diet; especially with appropriate calcium/phosphate ratio
* Avoid diets high in legumes
DO NOT SUPPLEMENT WITH CALCIUM DURING PREGNANCY
Could reoccur with subsequent litters > plan
to supplement feeding if necessary
Start supplementing calcium of next litters during the whelp
what is Subinvolution of placental sites (SIPS)? when does it occur? when should we consider it?
◦ Occurs when involution is delayed
◦ Should be considered anytime there’s serosanguineous vaginal discharge > 4 weeks post partum
when does normal uterine involution occur post partum?
Normal uterine involution is complete by 12 weeks postpartum
what are the clinical signs of subinvolution of placental sites?
Bitches are normal post-partum with exception of passing a hemorrhagic vaginal discharge for several weeks post partum
>Can range from a couple drops of blood to life-threatening hemorrhage
how do we diagnose SIPS
- Vaginal cytology:
> Trophoblast cells (polynucleated and heavily vacuolated) - CBC if bleeding heavily
> Anemia - Ultrasound/radiographs
how do we treat subinvolution of placental sites?
- Usually supportive and resolves on its own
- If severe > spay
how do we treat subinvolution of placental sites?
- Usually supportive and resolves on its own
- If severe > spay
True or false: the bitch is much like the mare: as soon as a placenta is suspected to be retained, treatment should be initiated immediately as it can quickly become a life-threatening condition
FALSE
True or flase: owners should supplement their bitches’ diets with calcium during pregnancy. This will prevent hypocalcemia from occurring at whelping.
False
when should agalactia be most suspected?
a) When the puppies are not gaining weight
b) when milk cannot be expressed when you try
c) When the bitch won’t let the puppies
nurse without your assistance
a) when puppies are not gaining weight
Select the MOST correct statement regarding hypocalcemia in bitches:
a) It can present as poor mothering, hypothermia and muscle tremors.
b) It is most likely to occur in large breed bitches during their 2nd or 3rd litter, especially if
they only have 2-3 puppies.
c) It can present as anxious behavior & facial pruritis. Small breed, primiparous bitches
with large litters are predisposed
c) It can present as anxious behavior & facial pruritis. Small breed, primiparous bitches
with large litters are predisposed
What are the 3 main differentials for a bitch not doing well post-partum?
- Metritis
- Mastitis
- Hypocalcemia
You are explaining to a client what to look for in regards to vaginal discharge post-partum in a bitch. Can you list 3 abnormalities in the nature of the discharge that would warrant a call to your clinic?
- If the vaginal discharge has an odor
- If the vaginal discharge is black-green for >12 hours
- If the discharge is not gradually diminishing in
volume over time - If the discharge is still present >4 weeks post-partum
