Cesarean section Flashcards
Describe Cesarean Section. (4)
– Surgical delivery of the neonates by hysterotomy.
– Relatively common procedure
– 60-80% of dystocia requires surgery
– Presentation can be as an emergency or under routine, planned conditions.
Elective Cesarean Section may be used in the following cases: (9)
– Brachycephalic breed
– Previous uterine inertia or C section
– Diabetes mellitus
– Oversize of fetus
– Litter sizes of two or less
– Position of the litter
– Litter sizes of eight or more
– Dams 6 years of age or older
– Gestation longer than 70 days
7 indications for emergency c-section
– Primary uterine inertia
– Fetal malposition
– Two fetuses in pelvic canal in one time
– Strong straining for 30 min without producing any puppies
– Vaginal discharges
– Sick dam
– Fetal HR of less than 150 bpm
Physical examination in c-section cases. (5)
You may find:
– Dehydration
– Physiologic fatigue (check GLU) and shock
– Lochia and other discharges
Don’t forget to perform:
– Vaginal palpation
– Rectal evaluation
Diagnostics before c-section.
Abdominal radiographs
Abdominal ultrasound to check fetal heart beats (need to be minimum 150- 300 bpm)
(+ bloods e.g. GLU, ionized Ca2+ etc.)
fetal heart rate of < 150 bpm is an indication for c-section
C-section procedure, beginning. (5)
Decide whether also OVH.
Care is taken not to traumatize the nipples while clipping surgical area.
Ventral midline incision made from 1-2 cm cranial to umbilicus to 1 cm cranial to the pubis.
The incision through the subcutaneous tissue is performed with care to prevent incising the mammary glands.
The incision through the muscles should avoid damaging the uterus lying directly beneath.
Surgical procedure steps for c-section once inside the abdomen. (7)
– Exteriorize the uterine horns.
– Opening of the uterus inside of the abdominal cavity is acceptable in some cases of very large litter but high risk of contamination from spillage!
– Make an incision in the BODY of the uterus if a fetus is lodged in the vagina, or do your incision in one or both HORNS depending on the location and number of fetuses.
– ‘Milk’ the fetuses from the uterus (squeeze them toward your incision).
– When visible in the hysterotomy, the fetus is grasped, and gentle but steady traction is
applied until the placenta releases from its attachment zone.
– The amniotic sac is removed from the fetuses head.
– Clamp the umbilical cord and pass fetus to the assistant.
Imagine erroneously includes scissors but don’t do that.
If there are multiple fetuses in each horn…
first all fetuses are removed from one horn, then – from the other. Close the incision in the first horn before removing puppies from the next horn.
You should be able to reach all puppies in each horn even from a uterine body incision. You can even inside-out the uterus a bit to reach a far puppy.
After the puppies have all been removed… (6)
inspect the uterus. There will be oozing from the endometrium, that’s normal. Count your swabs! Don’t leave anything behind by accident.
– Any lochia is cleaned or lavaged from the uterus.
– Take care to minimize the contamination of the abdominal cavity.
– Close the uterine incision using a single or double layered closure through all layers (appositional suture patterns are suitable but you can use Cushing if you want).
– Lavage the abdomen when uterus is closed.
– The surgeon’s gloves and instruments are changed to close the abdomen.
Uterine closure that Nick recommends.
e.g. 2-layer closure, first with simple continuous one-way and then return the other way doing Cushing for the 2nd layer.
Analgesia for c-section. (6)
– Local infiltration of anesthetics at the surgical incision in the dam IS indicated (lidocaine 2% 2 mg/kg or bupivacaine 2 mg/kg).
Systemic analgesia for dam:
– Opioids given orally, transdermally, or via injection.
– The opioid can be combined with NSAID to reduce the dose of opioids.
– NB Some amounts of NSAID can be transferred to the neonate in the milk.
– NSAIDs can theoretically damage neonate renal development.
– Single dose of meloxicam following CS has been advocated.
Complications after c-section. (5)
– Hemorrhagia
– Peritonitis
– Endometritis
– Wound infection
– Agalactia
Neonatal care after c-section. (5)
– The neonates are often depressed due to hypoxia and anesthetics that were administered to the dam. Reversal agents can be given under the tongue (1-2 drops).
– The neonate must be actively warmed (incubator 30’C) and the membranes and mucus cleared from the oropharynx and nasal passages with a bulb syringe.
– Rubbing the neonate with a warm towel for 30s over the right and left lateral thorax will warm it as well as stimulate respiration. Once the neonate has begun vocalizing and moving spontaneously, it can be
placed in an incubator.
Once dam is awake and alert, puppies can be returned to her.
– For first 3 days of life, neonates have a tactical respiratory reflex when the umbilical and genital areas are stimulated.
All neonates should receive a complete physical examination and be inspected for congenital defects including atresia ani, cleft palate and umbilical hernia.
Neonates can even be intubated.
Can dams produce milk if OVH during c-section?
Yes, milk should be present even before c-section. If its not, then there’s already a problem. Dams should be able to nurse normally.
Prolactin comes from the pituitary in response to appropriate stimuli (suckling).
What can you administer in addition to fluids - before c-secton. (3)
GLU, Ca2+, oxytocin
Oxytocin can only be given if
the cervix is open.
