Disorders of the Pregnant and Post-Partum Dog

Question 1

are there any external signs of a pregnancy loss prior to 40d gestation?

Answer 1

nah; usually resorb fluids and tissue

Question 2

describe signs of pregnancy loss between 40-65d gestation

Answer 2

1. hemorrhagic vulvar discharge
2. expulsion of fetuses
3. +/- signs of maternal illness

Question 3

what is always important to consider when dealing with an aborting dog?

Answer 3

BIOSECURITY!!!!!

CHV1, brucellosis, lepto

1. wear gloves when handling tissues, dams, pups
2. isolate aborting dam
3. clean and disinfect areas dog contacts
4. change shoes and clothing after handling the dam
5. test other dogs and people once agent ID

Question 4

list infectious causes of pregnancy

Answer 4

1. CHV-1
2. brucella
3. campylobacter
4. salmonella
5. toxo
6. lepto
7. E. coli

anything that causes severe systemic illness

Question 5

describe canine brucellosis

Answer 5

many strains!

-brucella canis, B. abortus (cows in other countries), B. suis (wild boars)

transmission: oral, conjunctiva, venereal, transplacental

secreted in aborted material, vulvar discharge, milk, urine, semen

-can shed high loads for 1-4 weeks post infection, but can shed for years (64 months) after infection

Question 6

describe brucellosis clinical signs

Answer 6

1. can be asymptomatic
2. reproductive:
   -infertility
   -vulvar discharge
   -embryonic death
   -abortion
   -neonatal death
   -testicular atrophy
   -epididymitis
   -scrotal dermatitis
3. non-repro
   -disco
   -anterior uveitis
   -lymphadenitis
   -glomerulonephritis
   -meningoencephalitis

Question 7

describe testing for brucella

Answer 7

1. takes 4-12 weeks for antibodies to be detected in serum
   -acute infections can be hard to detect
2. antibodies remain elevated 3-9 months after abacteremic
3. bacteremia can recur in chronic infections when dog is in heat, pregnant, or aborting (most reliable times to test)
4. brucella card test
   -detects antibodies to cell wall antigens of brucella canis
   -used as screening test (highly sensitive)
   -false positive common (cross reacts with other bacterial antigens)
   -can increase specificity by adding 2-mercaptoethanol (inactivates IgM)
   -if STILL positive, submit for AGID (uses cytoplasmic antigens) +/- confirm with blood culture

Question 8

describe brucella treatment

Answer 8

1. ZOONOTIC and persists in tissues and puppies!!!
2. euthanasia: most common in food animal
3. sterilization: still may shed in urine
4. tetracycline + genatmicin, or enrofloxacin LONG TERM
   -even though control bacteremia, often don’t eliminate bacteria from intracellular location
   -can/will relapse
   -repeat blood culture after 6 months

Question 9

describe brucella prevention and control

Answer 9

1. test new kennel dogs twice, 30d apart
2. only use brucella-negative males
3. screen all dogs every 3-6 months in breeding kennels
4. remove positive animals
   -quarantine and test all dogs monthly, must have THREE consecutive negative tests

Question 10

describe CHV-1: transmission, shedding, and clinical signs

Answer 10

transmission: transplacental, oronasal, venereal

shed in:
-nasal discharge
-vulvar discharge
-aborted tissues

clinical signs:
-macerated or mummified fetuses
-stillbirths
-neonatal death

Question 11

describe CHV-1 in adult dogs

Answer 11

1. mild respiratory, ocular, or genital infections
   -can see self-limiting papulovesicular vaginitis in bitches
2. self-limiting after developing immunity
   -most repro problems if infected for 1st time during pregnancy
   -protective colostral antibodies
3. latency/recrudescence: avoid stress during pregnancy!
4. naive pregnant dogs
   -isolate during last 3 weeks gestation: most susceptible period
   -maintain good biosecurity with pregnant dogs in your clinic!
   -there is a vaccine but not effective and not available here

Question 12

describe CHV-1 in neonates

Answer 12

1. disease/death if infected in utero or <3 weeks of life
2. replication at low temps (<100F, 44-55% humidity)
3. diagnosis:
   -virus isolation (nasal or vaginal swabs) or IHC (aborted tissue)
   -histopathology (necrosis and viral inclusion bodies) in aborted tissues
4. treatment:
   -antibodies in colostrum of immune bitches; can supplement with colostrum or serum from immune
   -infection usually fatal: puppies will cry nonstop, acute hemorrhagic septicemia, thrombocytopenia, interstitial pneumonia, encephalitis, cerebellar and retinal dysplasia segmental renal necrosis
   -antivirals like acyclovir rarely helpful

Question 13

describe uterine torsion

Answer 13

1. rare in the bitch but does occur
   -often see uterine rupture at time of surgery
   -oxytocin CONTRAINDICATED
   -usually when only one horn gravid (singleton)
2. resolution:
   -C section +/- OVH
   -urethral obstruction rare sequela to dystocia or obstruction

Question 14

describe pregnancy toxemia

Answer 14

1. relatively rare in the dog
   -associated with inadequate carbohydrate intake, large litter size, and poor body condition
   -ketonuria in absence of glucosuria
   -can be life threatening to both dam and fetuses
2. treatment:
   -nutritional support as long as possible
   -C section when no longer able to stabilize
   -best to intervene early (when bitch anorectic >24 hr)

Question 15

describe nutrition and monitoring of the post-partum dog

Answer 15

nutrition:
-growth/lactation formula ad libitum
-need 2-3 times normal food intake

monitoring:
-daily rectal temp for 2 weeks
-mammary glands: color, size, secretions
-lochia (vulvar discharge): greenish-black to tan for up to 3 weeks

Question 16

what can cause vulvar discharge >3 weeks post partum?

Answer 16

1. metritis
2. SIPS
3. coagulopathy
4. brucellosis
5. trauma
6. neoplasia

Question 17

describe SIPS

Answer 17

subinvolution of placental sites

1. hemorrhagic vulvar discharge >3 weeks post partum
2. occurs when fetal trophoblastic cells do not degenerate
3. trophoblasts continue to invade endometrium and myometrium, resulting in
   -damage to blood vessels
   -endometrial ulceration
   -uterine perforation (rare)
4. diagnosis:
   -radiographs or ultrasound: uterine swelling
   -vaginal cytology: trophoblast-like cells (multinucleate and vacuolated)
5. treatment:
   -spontaneous resolution
   -transfusions if severe
   -OVH
   -antibiotics if concurrent infection (usually not necessary)

Question 18

describe clinical signs and causes of postpartum metritis

Answer 18

clinical signs:
-malodorous red to brown vulvar discharge
-fever, dehydration, depression, endotoxemia
-can turn into toxic/septic metritis, septicemia, shock

causes:
-retained fetal membranes
-macerated or decomposed pups
-dystocia and uterine compromise

Question 19

describe metritis diagnostics

Answer 19

1. clinical signs
2. clinical pathology
3. vaginal cytology:
   -degenerate or toxic PMNs
   -endometrial cells
   -muscle fibers (of pups)
4. bacterial culture:
   -vaginal or uterine
   -aerobic and anaerobic
5. ultrasound/radiographs!
   -enlarged/fluid filled uterus

Question 20

describe metritis treatment

Answer 20

1. stabilize the dog
   -IV fluids
2. control bacterial growth (systemic broad-spectrum antibiotics)
3. evacuate uterine contents
   -surgical removal of pups, membranes, devitalized tissues
   -careful with ebolics (oxytocin and prostaglandin) because uterus prone to rupture
   -uterine lavage: risk of rupture?

Question 21

describe mastitis

Answer 21

1. usually in first 2 weeks of lactation (rarely with pseudopregnancy; if see with pseudopreg = reason to treat pseudopreg)
2. acute:
   -fever, depression anorexia
   -can be life threatening
   -hot, painful mammary glands
3. chronic:
   -asymptomatic
   -puppy failure to thrive
4. mammary gand secretions
   -macroscopic exam: normal, purulent, or reddish brown
   -cytology!: degenerate neutrophils, bacteria
   -culture: >10^4 bacteria/ml; usually E. coli, staphylococcus, or streptococcus
5. antibiotic selection:
   -based on culture and sensitivity
   -must penetrate milk: blood barrier
   -must be safe for nursing pups
   -NO FLUOROQUINOLONES FOR YOUNG PUPPIES

Question 22

describe puerperal tetany

Answer 22

1. also called eclampsia, post-parturient hypocalcemia
2. common in small breeds in the 1st 4 weeks of lactation
   -common in dogs with small body weight:litter weight ratio (small dog large litter)
3. decreased extracellular ionized calcium
   -increased membrane permeability
   -spontaneous muscle depolarization
4. clinical signs:
   -hyperthermia: temp can be >105 without infection!
   -restlessness
   -poor mothering
   -panting, tremors
   -stiffness
   -seizures, death
5. diagnosis:
   -clinical signs
   -total blood calcium <7mg/100ml; ionized calcium <0.8mmol/L

Question 23

describe treatment of puerperal tetany

Answer 23

1. 10% calcium gluconate SLOWLY IV
   -to effect until signs resolve
   -slowly to avoid cardiac side effects
2. often benefit from 1 dose dextrose too
3. remove pups from nursing for at least 24 hrs
4. supplement oral calcium and vitamin D until weaning
5. large litters: supplement puppies with milk replacer until weaning
6. can occur in subsequent pregnancies so maintain optimal Ca:P ratio of 2:1; maintain diet adequately during gestation!!

-use oral calcium: TUMS tablets postpartum only!!!

Question 24

what are reasons for postpartum panting?

Answer 24

1. temperature: room and in whelping box; ensure there is a cool place for bitch to access
2. anxiety: no other dogs/pets/people intruding!
   -give quiet environment and maybe cover whelping box or dim lights
3. ionized calcium levels +/- tums trial (subclinically hypocalcemic)
4. pain meds if post op
5. sometimes associated with oxytocin release at time of nursing