Dystocia, Cesarean Section, post partum probs (Kelleman)

Question 1

Predicting parturition

Answer 1

• 1-2 weeks before
  
  • small amount clear/tan vulvar d/c (for d/c should see vet)
  • anorexia and panting
  • +/- mammary development
  • ‘nesting’ behavoir
• Body temp drop (from progesterone drop)
• Serum progesterone (drops to below 2 ng/ml 12-48 hrs before)
• Rads => progressive ossification

Question 2

As progesterone falls, prolactin….

Answer 2

• Goes up
  
  • promotes mammary gland development

Question 3

predicting parturition with ultrasound

Answer 3

• organ development
  
  • renal cortex and medulla just like in cats
• GI layering
• GI peristalsis (62-64 days post LH)

Question 4

Three stages parturition

Answer 4

1. preparation
2. fetal expulsion
3. placental passage

Question 5

Assistance

Answer 5

• break sac rub/dry
• tie off/clamp umbilical cord
• aspirate mucus from mouth

Question 6

Passive transfer if not suckling

Answer 6

• can use serum from mom given orally in first 12 hours
• can give serum from mom SQ

Question 7

Rules of Dystocia

Answer 7

1. Prolonged gestation => single pup
2. Stage 1 > 12 hours
3. Stage 2 > 4 hours no pup
4. Stage 2 labor with hard contractions > 30 minutes
5. > 2 hours since pup was born
6. Bitch systemically ill
7. Frank vulvar hemorrage
8. Green d/c before pups
9. Obvious abnormal presentation

Question 8

Uterine inertia

Answer 8

• Primary: dam fails to expel normal pups through vagina
  
  • singleton
  • hypocalcemia
• Secondary: obstructive dystocia

Question 9

Birth canal, uterine problems

Answer 9

• Inadequate size birth canal
  
  • breed with large head, small pelvis
  • vaginal srictures or septae
• Uterine torsion or rupture
  
  • acute abdomen

Question 10

Dystocia - fetal causes

Answer 10

• fetal oversize
  
  • singleton litters
  • hydrocephalus / anasarca
• abnorml presentation/posture
  
  • Transverse
  • Breech
  • Deviation head/neck/limbs

Question 11

Oxytocin

Answer 11

Oxytocin

• don’t give with obstruction
• use lower doses than historically
• re-dose 20-30 minutes until 3 doses

Calcium gluconate (SQ - later lump/abcess or IV - VERY SLOWLY)

• can be given in addition
• helps efficacy of oxytocin

Question 12

Dystocia Hypoglycemia

Answer 12

• Karo syrup PO
• 5-10 % glucose IV in the hospital

Question 13

Assisted vaginal Delivery

Answer 13

• Must be in correct position/bosture
• clean perineum
• lubricant
• Head or pelvis
  
  • not limbs
• Bandage ‘snare’

Question 14

Dystocia - Workup

Answer 14

• Thorough but quick exam and history
• Digital exam of vagina
• bloodwork
• abdominal ultrasound
  
  • harder to see dead babes
• Fetal HR (2-2.5 X dam)
• Rads

Question 15

C-section

Anesthesia

Answer 15

• Don’t use
  
  • ketamine
  • xylazine
  • Ace
• Have everything ready before induction
  
  • preoxy
  • lidocaine (don’t overdose)
• Routine laperotomy
  
  • milk puppies out (more than one incision ok)

Question 16

Yellow puppies

Answer 16

• meconium stained
• stressed in-utero

Question 17

Placentas in c-section

Answer 17

• remove if they come away easily
• ok to leave behind
  
  • may cause metritis
• do not miss a puppy in the vagina tho

Question 18

Post c-section

Answer 18

• specific closure not huge deal
• give oxytocin after closing
• lavage abdomen and uterin incision with warm saline
• routine closure

Question 19

Promoting lactation post c-section

Answer 19

• small dose metoclopramide
• ace

Question 20

Elective cesarean

Answer 20

• Breeds with history of dystocia
• Singleton litters
• Extremely large litters
• Bitches with a history of uterin inertia

Question 21

TIming of elective c-section

Answer 21

• >/= 63 days from LH surge
• No later than 65
• Morning P4 monitoring
• +/- fetal HR monitoring => cut when HR , 180 bpm

Question 22

Corticosteroids

Answer 22

• used around day 40 => abortion
• used later => fetal maturation
  
  • surfactant…blah
• Oral or parenteral dexamethasone
• Prednisolone sodium succinate

Question 23

Neonate Resuscitation elements

Answer 23

• Airway - suction
• Breathing - supplemental oxygen
• Circulation - breathing stops before HR
• Drugs - dextrose, doxapram, epinephrine
• Warm and dry

Question 24

Neonatal Examination

Look for

Answer 24

• cleft palate
• limbs & toes
• Functional anus
• Umbilical hernia
• Gender

Question 25

Normal Uterine Involution

Answer 25

• Complete at 3 months post partum
• Lochia
  
  • vulvar d/c common until 4-6 weeks even 12 in healthy bitch
  • Red brown or green
  • No oder

Question 26

Agalactia

Answer 26

• lack of milk production
• Nutrition: needs 2.5-4 X maintenance
• Nervous: acepromazine
• Oxytocin, domperidone, metoclopramide, acupuncture

Question 27

Post partum bitch issues

Answer 27

• uterus
• mammary glands

Question 28

Metritis

Answer 28

• Can require aggressive care!

Question 29

Hypocalcemia / Puerperal Tetany / ‘eclampsia’

Answer 29

• small breed multiple puppies
• 1-4 weeks postpartum
  
  • CNS, nervous, trembling, weak, pupil dilation, Inc TPR, convulsions, death
• TX
  
  • IV Ca gluconate SLOWLY
  • supplement or remove pups

Question 30

SIPS

Answer 30

• Sub-involutio of placental sites
  
  • left over fetal membranes
• Hemorrhagic vulvar d/c, prolonged
• Benign, don’t worry about goes away by next heat usually

Question 31

Feline Dystocia

Answer 31

• Rare
• Devon rex, short and long headed/nosed breeds

Question 32

Feline post Partum Problems

Answer 32

• Same as bitch
  
  • Metritis
  • Mastitis
  • Pstparturient hypocalcemia
  • Agalactia
  • SIPS

*Post partum uterine prolapse