Caesarean Section Flashcards
What percentage of dystocia cases can be managed with medical therapy and manipulation?
20 - 40% of cases
Maternal indications for caesarean? (4)
Prolonged gestation (>70 days c.f. normal 63 +/- 2 days)
Primary uterine inertia refractory to medical treatment (>6 hrs)
Secondary uterine inertia (> 2 hrs between puppies)
Maternal pelvic abnormalities
Foetal indications for caesarean? (4)
Foetal oversize
Small litter - often large foetus and primary inertia due to little hormonal initiation from the foetus
Foetal malpresentation
Foetal death - if unresponsive to oxytocin and supportive care
Why is manual reposition hard?
Due to the size of bitch/ queen it is difficult and leads to iatrogenic damage of the foetus (30 mins of active straining)
What is iatrogenic damage?
illness caused by medical examination or treatment
What is uterine inertia?
abnormal relaxation of the uterus during labour causing a lack of obstetric progress
Why is ultrasonography useful during dystocia?
can be useful in assessment of foetal viability.
Emergency pre-op C-section considerations
Is the patient compromised?
Circulatory status +/- sepsis
What can be used for crystalloid replacement?
balanced electrolyte solution +/- glucose or dextrose
Considerations for +/- desexing during c-section
May prolong anaesthesia/ surgery
May save a subsequent procedure
Be mindful of loss of circulating volume
How to minimise risk of aspiration pneumonia?
Food is rarely withheld
Use prokinetic metoclopramide to increase lower sphincter tone
Also careful ET tube cuff inflation and removal
C-section timing
Time from anesthetic induction to delivery of pups should be as short as possible
Prepare as much as possible before induction (clipping, skin prep, equipment setup, staff ready for puppy care)
C-section anaesthetic goals
Maximise dam safety
Minimise foetal depression
C-section incision
Ventral midline approach
2-3cm cranial, 5-6cm caudal to the umbilicus
Needs to be a large enough approach to allow the uterus to be exteriorised quickly
Why do you need to be careful of when making the c-section incision?
Take care not to damage the abdominal contents particularly the gravid uterus
Once exteriorised, what do you need to do to the uterus?
Pack off the uterus from the abdominal cavity with laparotomy sponges
- be careful not to tear the uterine vessels or uterus
Where do you incise the uterus ?
In an avascular area within the body that will allow removal of foetuses from both horns
Sometimes multiple incisions are required
How to get the puppies out (4 steps)
- Milk each foetus individually down the horn to the uterine incision (avoid swinging in arc as has been implicated as a cause of brain damage)
- Break through the foetal membrane
- Clamp the umbilicus 2-3cm from its base
- Rub the foetuses vigorously to stimulate breathing
What drug can be used to stimulate breathing in puppies?
Sublingual dopram
0.2-1mg (1 drop)
What do you need to check before closure?
If all foetuses are removed
Include check of uterine body and vagina
C-section closure
Single or double uterine closure
- simple continuous inner - submucosa not into lumen
- continuous inverting outer
3/0 - 4/0 monofilament, absorbable
Taper point needle
What do you need to do in between closing the uterus and the abdomen ?
Change gloves and instruments
What do you do to the uterus before returning it to the abdomen ?
Thoroughly lavage it
3 complications of c-section
Haemorrhage - intrauterine or peritoneal (ligature failure)
Infection - long procedure or gross contamination
Foetal or maternal death
