Dystocia In Canine And Feline Flashcards
1
Q
Normal parturition
A
- E2 and prostaglandin rises, myometrium becomes more active = contractions
- cervix softens and begins to dilate
- placental attachments are disrupted
2
Q
Stage 1 parturition in canines
A
- synchronous uterine contractions leading to complete cervical dilation
- anorexia, restlessness, panting, shivering, “nesting”
- averages 6-12 hours
- nervous, primiparous bitches can experience up to 36 hours of stage 1
3
Q
Stage 1 of parturition in feline
A
- synchronous uterine contractions leading to complete cervical dilation
- restless, nesting, panting, vocalizing
- can last 1 hours to 24 hours
4
Q
How long does stage 1 parturition last in dogs and cats?
A
Dogs: 6-12 hours
Cats: 1-24 hours
5
Q
What is tocodynamometry?
A
Monitoring uterine contractions
6
Q
A
7
Q
Stage 2 parturition canine
A
- puppies moving thru brith canal
- usually delivered every 30-60 minutes
- up to 2-3 hours between can be normal
- stage 2 usually complete in 6 hours, can extend up to 24 hours
8
Q
Stage 2 parturition feline
A
- kittens moving thru birth canal
- 1st kitten typically delivered within 60 minutes of onset of stage 2
- usually delivered every 30-60 minutes
- extended delivery more common in queens than bitches!! Can interrupt labor if disturbed, several hours between delivery can be normal
9
Q
What is the difference between stage 2 feline and canine parturition?
A
Feline delivery has extended delivery
10
Q
Stage 3 parturition canine and feline
A
- expulsion of fetal membranes
- often occurs during stage 2
- pass with puppies or within 15 minutes
- retained fetal membranes are rare in canine
11
Q
T/F: retained fetal membranes are rare in the canine
A
True
12
Q
In what time period do the fetal membranes get expulsed normally?
A
Pass with puppies or within 15 minutes
13
Q
Dystocia
A
Defined as “abnormal parturition”
- common in the canine, overall incidence not super high, but as much as 100% in some breed
- factors leading to dystopia: fetal, maternal
14
Q
What factors (broad) lead to dystocia?
A
- fetal
- maternal
15
Q
What breeds have 100% dystocia? Ie cannot pass puppies naturally
A
English bulldogs, close second is French bulldogs
Bostons and pugs can potentially deliver naturally
16
Q
Primary uterine inertia
A
- failure of uterus to begin labor at full term
- most common non-obstructive cause of dystocia in the bitch!!
- uterus fails to respond to fetal signals and insufficient stimulation exists to initiate labor
- small litters
- large litters (overstretched myometrium)
- inherited predisposition
17
Q
What are other factors that affect primary uterine inertia?
A
- incompletely dilated cervix
- genetic
- nutritional
- hormonal: obesity, malnutrition
- parity
- age
18
Q
Secondary uterine inertia
A
- continued uterine contractions fail to expel fetuses
- musculature contracting so much it eventually fails
- caused by obstruction of the birth canal
19
Q
What causes secondary uterine inertia?
A
Obstruction of the birth canal
20
Q
Maternal factors affecting secondary uterine inertia
A
- breed
- conformation
- uterus: torsion, rupture, adhesion
- pain
- fear
21
Q
How can you often tell difference between primary and secondary uterine inertia?
A
History!! She kept pushing and pushing vs we never saw her push
22
Q
What fetal factors affect dystocia?
A
- presentation
- position
- posture
- abnormal fetal development
- 40% are born caudal longitudinal in dogs! Not abnormal
23
Q
What is the most common non-obstructive cause of dystocia in the bitch?
A
Primary uterine inertia
24
Q
T/F: primary uterine inertia is not typically diagnosed
A
True
25
Is primary uterine inertia more common in small or large litters?
Small litters. Very predisposed. Think that signals for parturition from 1 or 2 offspring are not strong enough; something has gone wrong in the system when they only have 1 or 2 offspring
26
You see a French bulldog that only had 2 puppies and had labor difficulty. What do you suspect happened?
Primary uterine inertia
27
T/F: primary uterine inertia is heritable
True!! Will have dystocia over and over again
28
Your client comes with a healthy, 4 year golden for breeding that had had dystocia with her last litter. What is your recommendation?
Do not breed this dog!! Primary uterine inertia is heritable! If they had dystocia once they will have it again
29
What is presentation?
- relationship of the spinal column of the fetus to that of the bitch and to the portion of the fetus presented to the birth canal
- normal is cranial longitudinal presentation
30
What % of dogs are born caudal longitudinal?
40%. Not uncommon, happens in almost half of dogs. Coming rear limbs first not uncommon
31
What is normal fetal presentation?
Cranial longitudinal presentation
32
What is position?
- relationship between the dorsum of the fetus and the quadrants of the maternal pelvis
- normal is dorsosacral
33
What is normal position in dogs?
Dorsosacral
34
What is posture?
- relationship of fetal extremities to the fetal body
- normal is forelimbs extended
35
What is normal posture?
Forelimbs extended
36
What are the criteria for dystocia diagnosis?
- stage 2 abdominal contractions with no delivery in 30 minutes
- > 2 hours between delivery of fetuses = weak stage 2 contractions
- presence of uteroverdin (green) without the delivery of a subsequent pup
- >4 hr after onset of weak contractions and no pups
- prolonged gestation
- fetal distress
- partial birth
- systemic illness/collapse
37
Your client calls with a dog giving birth. He is very concerned, saying that it has been 30 minutes since the last puppy was delivered. What do you diagnose this as?
Dystocia: dog has had stage 2 abdominal contractions with no delivery in 30 minutes
38
Your client calls saying that their dog has green discharge coming out of them. What do you tell them?
This is a problem: the placenta is separating and what they are seeing: uteroverdin. This means that there is likely dystocia occurring
39
What does abundant serous fluid indicate when a pup is giving birth?
Allan topic fluid = water breaking! If this occurs without delivery of pup within 1 hours, likely have dystocia going on
40
What is the allantochorion pouch?
- fetal membranes
- if visible without delivery of pup within 1 hour, likely is dystocia
41
T/F: it can be tricky to tell when a dog is having contractions
False. They are dramatic, and you can tell when they are occurring
42
T/F: you should call the vet if your dog has been pushing for more than an hour.
False: they CANNOT PUSH FOR MORE THAN 30 MIN S
43
Prolonged gestation
- it is impossible to determine an accurate due date based on breeding dates
- normal gestation can be 57-72 days post a single breeding date
- therefore all are prolonged if >72 days post breeding
True breeding days are 63 days from ovulation
44
T/F: breeding dates are not helpful
True. Normal gestation can be 57-72 dates post a single breeding date. If you don’t know the true due date and you intervene with dystocia management, can have 100% fetal management
45
How long will sperm be viable in the female reproduction tract?
7-10 days
46
How can you determine prolonged gestation?
- >66 days post LH peak
- > 64 days post ovulation (ovulation typically consistent with 4.0-5.0ng/mL progesterone)
- >60 days after onset of cytologic diestrus
- >12-24 hours post drop in progesterone to <2ng/mL
47
At what date after LH peak do you expect a dog to give birth?
65 days post LH peak. If >66 days, they are overdue
48
>_____ days post ovulation is a prolonged gestation
>64 days
49
Ovulation is typically consistent with with _____ level of progesterone
4.0-5.0ng/mL
50
What is the normal fetal heart rate?
180-220 bpm
51
Fetal distress heart rates (progressing to bad)
- 150-180bpm = fetal distress
- <150 is considered emergency
- <100 very poor/grave prognosis
52
T/F: fetal distress is a sign of dystocia
True
53
You are detecting HR on a fetus in utero and see a heart rates of 145. What do you do?
This is considered an emergency, need to to assess what patient’s status is and if C section is a possibility. If the heart rate drops below 100, this is a very poor/grave prognosis
54
Initial dystocia treatment
- assess general health and present condition: provide supplementary/supportive care if necessary
- reproductive tract assessement
- vaginal discharge: amount, duration, character
- vaginal palpating: fetus? Obstruction? Ferguson reflex present? Prior delivery of 1 or more pups?
55
If there is no Ferguson reflex, what do you do in a dystocia case?
Medical management less successful: lowered chances of medicines/drugs helping
56
abdominal radiographs with dystocia
- fetal #, size, position
- evidence of fetal death
- pelvimetry is poorly correlated with dystocia prediction in the bitch
57
ultrasound with dystocia
fetal viability and fetal distress
58
how do you classify a dystocia patient?
mild dystocia or severe dystocia
59
mild dystocia
- healthy bitch with normal conformation
- pups normal size and appropriate position
- no evidence of obstruction
- no evidence of fetal distress or compromise
- 4 or less pups remaining
- weak or infrequent contractions
have to be all these criteria to be classified as mild
60
severe dystocia
- obvious oversided fetuses
- evidence of fetal compromise
- green/black discharge with no pup born in 20-30 mins
- progesterone level <2ng/mL for 24 hours
- obstructive dystocia (any cause)
- dystocia for any reason with 4 or more pups remaining
61
what are the treatment options for a mild dystocia? (3)
1. manipulative intervention
2. medical therapy
3. c section
62
manipulative intervention
- mild cases
- grasp fetus and provide gentle traction to remove it from the canal, preferably during a contraction
- use LOTS of lube
- don't pull limb or tail!!!
- pull during contraction if possible
- changing positions of the bitch might help
63
when should you use medical intervention with a mild dystocia?
if the bitch has 4 or less pups remaining and if the birth canal is unobstructed
- only 28% chance of success
64
what are the ideal drugs of choice for medical management of dystocia?
calcium and oxytocin
65
oxytocin
uterine contraction action
milk ejection action
direct action on the rate of calcium influx into the myometrial cells
if they are already pushing, start with calcium
66
calcium
affects strength of uterine contractions
monitor heart rate and rhythm using ECG
if they are already pushing, start with this because this will help with strength of contractions
67
you need to administer a drug to a dog who has been pushing but has slowed down the rate of pups coming out. what drug do you choose?
calcium- because pt is already pushing. calcium helps strengthen the contractions of the uterus
68
medical intervention protocol of mild dystocia
- 1st oxytocin 0.5-4 IU IM (use lower than this)
- if no pup in 30 minutes, give 10% calcium gluconate iv slowly, do not exceed 5 mL
- if no pup in 20 mins, give another dose of oxytocin like above
- if delivery begins but slowly, you can repeat oxytocin every 30 mins with a max of 3 doses
- if no pups with above, need C section
69
what is the max amount of oxytocin you can give for medical intervention with a mild dystocia?
repeat oxytocin every 30 mins with max of 3 doses if delivery has begun
70
surgical intervention
severe dystocia
advise C section if the bitch is suffering from severe dystocia
71
dystocia in a feline
- "abnormal parturition"
- prevalence not super high
- purebred cats have higher incidence
- factors leading to dystocia: fetal and maternal
72
maternal factors leading to feline dystocia
- primary uterine inertia
- secondary uterine inertia
- stress/fear
- breed, advanced age, obesity
- conformation (narrow pelvic canal)
- uterus: TORSION, RUPTURE AND ADHESION
73
how can a feline uterus affect dystocia?
TORSION RUPTURE AND ADHESION
74
what is the most common cause of dystocia in the feline?***
PRIMARY UTERINE INERTIA
75
PRIMARY UTERINE INERTIA is what in the feline
most common cause of dystocia in the feline
etiology is same as canine
76
secondary uterine inertia in cat
- same as canine
- common with all causes of obstructive dystocia
- uterine fatigue with large litters
77
what are the big maternal factors affecting dystocia in cats
- stress/fear
- uterine torsion, rupture and adhesion!!
78
criteria for dystocia diagnosis with cats
- active labor (stage 2) for >2 hrs with no kitten
- 69-70 days from breeding = prolonged gestation
- failure of labor to begin within 24 hrs with rectal temp drop >1 degree F
- partial birth: parts visible for more than 15 mins w no progress
- more than 3 hours between birth of normal kittens
- failure to delivery all kittens within 24 hours
- signs of systemic illness
- abnormal vulvar dc: hemorrhage, green/black
- fetal distress: HR similar to puppies
79
what is prolonged gestation in a cat?
69-70 days from breeding
80
your client calls you because she has a cat that has been in labor for 3 hours. what do you tell her?
the cat is experiencing dystocia as it has been over 2 hours and they need to come to the clinic immediately
81
what is the time frame when you can diagnose dystocia in cats (what time between kittens)
more than 3 hours between birth of normal kittens
82
patient evaluation and PE for a cat with dystocia
- general health and present condition: supportive care if necessary
- CONDITION LIKE UTERINE TORSION, RUPTURE ARE MORE COMMON!
- repro tract assessment: discharge, palpation, prior delivery #?
83
why is temp drop less useful in cats?
it is related to the progesterone drop, and progesterone drop is not a pre-requisite for induction of labor in cats
84
T/F: baseline progesterone is not a pre-requisite of onset of labor in cats
true. it is less useful in cats
85
diagnostics of dystocia for cats
radiographs: fetal #, size, position, evidence of fetal death
ultrasound: viability and distress
86
dystocia manipulative intervention with cats
DO IF KITTEN IS PALPABLE
- grasp fetus and provide gentle traction to remove it from the canal, preferably during a contraction
- use LOTS of lube
- don't pull limb or tail
- pull during contraction if possible
- changing positions of the queen might help
87
what are the risks with medical intervention of dystocia in cats?***
FAILURE IS MORE OFTEN THAN IN DOGS!!!
do NOT attempt medical therapy unless you are prepared for surgical intervention
make sure to discuss risks and poor success rate of medical management
88
what is the first recommendation of a cat with dystocia?
C SECTION. medical therapy is much more likely to fail!!
89
why do you want to be very cautious with using calcium in cats for dystocia treatment?
it increases strength of contractions, and can cause very strong contractions in cats and can affect the uterus
