approach to dystocia

Question 1

how should you approach investigating dystocia

Answer 1

• clinical hx
• general exam
• obstetrical exam
• forming conclusion

Question 2

what questions should you ask when considering a case of possible dystocia

Answer 2

• 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)?

Question 3

what should you consider on general exam of a possible dystocia

Answer 3

• 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?

Question 4

what should be considered on obstetric exam of a possible case of dystocia

Answer 4

• 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

Question 5

what should be considered upon vaginal exam of a possible case of dystocia

Answer 5

• 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?

Question 6

in which species is feto-maternal disproportion unlikely and why

Answer 6

horse - size of uterus determines size of fetus

Question 7

which causes of dystocia are most common across the species

Answer 7

Question 8

list treatment options for dystocia

Answer 8

• conservative tx
• manipulative tx
• drug therapy (oxytocin, calcium, clenbuterol)
• sx tx (epidural anaesthesia, episiotomy, fetotomy, Caesarean
• euthanasia

Question 9

what is the term for correcting presentation, position and posture

Answer 9

mutation
comprises repulsion, correction, rotation and version

Question 10

what should you do after delivery in a case of dystocia

Answer 10

• 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

Question 11

what is the largest diameter of the birth canal

Answer 11

5 past seven or five to five not 12:00

Question 12

why is it important that the fetus be delivered rapidly once the umbilicus engages the pelvis

Answer 12

squeezes the umbilicus, disrupting blood flow to fetus