Exam 3 - Postpartum Disease Flashcards
what are some increased risks associated with causing maternal hypocalcemia?
increased risk with large litters & if calcium is supplemented during pregnancy
T/F: maternal hypocalcemia is rare in cats
true
what are the causes of maternal hypocalcemia?
increased calcium demands from fetal skeleton mineralization & milk production postpartum
what are the clinical signs of eclampsia?
stiff gait, tremors, anxiety, panting, fever
when does eclampsia usually occur?
usually 3 weeks postpartum but can occur in late gestation
T/F: fever/agitation day 1 after parturition is more often hypocalcemia than metritis
true
what is the treatment for eclampsia?
1-20 ml of calcium gluconate IV to effect over 30 minutes SLOWLY (0.5-1.5 ml/kg)
monitor EKG for bradycardiac or PVC - d/c calcium if noted
oral calcium 25-50 mg/day - continue until puppies are weaned
when should puppies be weaned?
after 3 weeks of age
what drug can be used to stop lactation?
cabergoline - anti-prolactinic
how is eclampsia diagnosed?
serum chemistry - low serum calcium
EKG - tachycardia & prolonged q-t interval
what is metritis?
acute, serious postpartum infection of the uterus
what are some causes of metritis?
bacterial invasion of the uterus via open cervix
retained fetuses or abortion
prolonged delivery or dystocia
what are the clinical signs associated with metritis?
foul smelling vulvar discharge generally 1 week postpartum
fever
+/- anorexia
how is metritis diagnosed?
vaginal cytology - neutrophils & bacterial
vaginal culture
what is the treatment for metritis?
antibiotics - penicillins, cephalosporins, fluoroquinolones if puppies are < 4 weeks old (pick based on culture)
nursing pups stimulate oxytocin which will help in uterine clearance
acupuncture to stimulate uterine clearance - CV1, SP6, BL67
what is subinvolution of placental sites?
delayed uterine involution post-whelping where fetal trophoblastic cells persist that is non-infectious & usually resolves on its own
what are the clinical signs of subinvolution of placental sites?
sanguineous/serosanguinous vulvar discharge for > 6-12 weeks - monitor for anemia/hypoproteinemia in severe cases
why not use ergonovine in a bitch with subinvolution of placental sites?
stimulates uterine contraction but puts mom at risk for uterine rupture
why does progesterone carry risk for a bitch with subinvolution of placental sites?
it sloughs the trophoblastic cells but puts mom at risk for pyometra
what therapy can be done if subinvolution of placental sites persists or is severe?
OHE
what is mastitis?
inflammation of glands with or without bacterial infection that ranges from mild/sub-clinical to life-threatening gangrenous
what are some causes of mastitis?
environmental - unsanitary, trauma from untrimmed puppy nails, & rubbing whelping box as they enter/exit
galactostasis
hematogenous spread from neonatal death
if you see gas near the mammary glands on rads for a mastitis patient, what do you suspect?
gangrenous mastitis - worry about septic shock
what are the subclinical signs of mastitis?
neonatal failure because mom won’t let puppies nurse
what are the clinical signs associated with mastitis?
one or more glands affected
heat, redness, abnormal milk color/texture, can see bruising/ulceration
gas = gangrenous
can progress to septic shock
how is mastitis diagnosed?
cbc- neutrophilia & thrombocytopenia if severe
milk cytology - neutrophils & bacteria
milk culture
xray - check for gas!!!
ultrasound - check for pockets on fluid
T/F: gangrenous mastitis has a grave prognosis
true
why does gangrenous mastitis have a grave prognosis?
quick progression of mastitis over hours - need ICU care for sepsis
may have better prognosis with quick surgical intervention
what is the treatment used for mastitis?
broad spectrum antibiotics - based on culture, penicillins, cephalosporins, fluoroquinolones if < 4 week old puppies
warm compress & gentle drainage - don’t drain/milk if pseudocyesis because it encourages more milk production
cabbage - decrease swelling
neonates can continue to nurse
surgical drainage of abscesses may be necessary but ulcerations can heal with wound care
what is uterine torsion?
rare - rotation of one or both horns that can occur anytime but most commonly postpartum
what are the clinical signs of uterine torsion?
vaginal discharge, abdominal pain, lethargy, anorexia, vomiting
what is seen on xray & ultrasound that supports a diagnosis of uterine torsion?
rads - caudal abdominal soft tissue mass
ultrasound - fluid filled segment of uterus
what is the prognosis of uterine torsion?
good prognosis with OHE
what is uterine prolapse?
prolapse of the uterus through the cervix & into the vagina
what causes uterine prolapse?
etiology unknown but excessive straining or forced fetal extraction can play a role
how is uterine prolapse diagnosed?
physical/digital exam
exposed uterus can be necrotic
what do you need to differentiate uterine prolapse from?
vaginal hyperplasia
how is uterine prolapse treated?
manual replacement if tissue isn’t necrotic
OHE if tissue is necrotic
T/F: mortality of puppies/kittens is the highest during the first week of life
true
what is fading puppy/kitten syndrome?
disease or death of neonates from parturition to weaning
what are some risks for neonates regarding fading puppy/kitten syndrome?
higher risk for neonates:
- born late in delivery or dystocia due to hypoxemia/trauma
- low birth weight, >25% below average for puppies & < 75g for kittens, they are more prone to dehydration, hypothermia, hypoglycemia, & sepsis
before all else, how should you treat fading puppy/kitten syndrome?
treat hypoglycemia & hypothermia
what are some maternal causes of fading puppy/kitten syndrome?
dystocia, neglect, malnutrition of dam, agalactia, trauma, cannibalism, & systemic disease
what are some examples of systemic disease in the bitch that can cause fading puppy/kitten syndrome?
mastitis, parasitism, & maternal diabetes mellitus causing puppies to have low BG
what are some congenital anomalies that attribute to mortality in fading puppy/kitten syndrome?
atresi ani, cleft palate, hydrocephalus, heart defects, & hernias
fading puppy/kitten syndrome is responsible for up to ____% of neonatal deaths in puppies & ____% in neonatal kittens?
40% - puppies
20% - kittens
what is the anomaly shown in this puppy?
cleft palate
what are some treatment options for fading puppy/kitten syndrome?
warmth, fluids, correct hypoglycemia, nutritional support, O2 support, antimicrobials (amoxi clav, cephalosporins - reduce dose by 30-50% in neonates) & blood transfusions
how does malnutrition play a role in fading puppy/kitten syndrome?
overeating causing discomfort
inadequate milk production of mom or inadequate nursing
how do you improve malnutrition in fading puppy/kitten syndrome?
allow smaller pups to nurse first
encourage suckle with warm, clean pinky finger
dextrose on nipple to stimulate suckling
when are puppies able to shiver?
7-9 days old
what is a big common cause of fading puppy/kitten syndrome?
environmental causes - too cold & malnutrition
how do environmental causes play a role in fading puppy/kitten syndrome?
whelping box is too hot or too cold & puppies can’t shiver until they are 7-9 days old
what causes neonatal isoerythrolysis in kittens?
queen & kittens don’t share the same blood type - kitten RBC undergo immune-mediated destruction by maternal antibodies in colostrum
if you know the queen’s blood type doesn’t match her kittens, what do you do?
must separate kittens & queen for a period after birth
what blood type cats are often affected by neonatal isoerythrolysis?
type a or type ab kittens born to a type b queen
type b cats have high levels of antibodies against type a cats
type a cats have low levels of antibodies against type b cats
when can parasites be considered as a cause of fading puppy/kitten syndrome?
after 2 weeks of age
what viral causes attribute in causing fading kitten syndrome?
calicivirus, herpesvirus, panleukopenia, felv, & coronavirus
what viral causes attribute in causing fading puppy syndrome?
herpesvirus - high mortality in first 3 weeks of life
parvo, coronavirus, distemper
how does bacteria cause fading puppy/kitten syndrome?
acquired from birth canal, placenta, or uterus - common cause of disease in the first week
what puts puppies/kittens at risk for developing a bacterial cause of fading puppy/kitten syndrome?
lack of colostrum!!! symptoms progress quickly over hours & die within a day
TREAT QUICKLY
what are some general categories of infectious causes of fading puppy/kitten syndrome?
bacterial
viral
protozoal
parasitic
what virus is responsible for high mortality in puppies in the first 3 weeks of age?
herpesvirus
what is this?
uterine prolapse
what is this?
uterine torsion
what is this?
subinvolution of placental sites
what is this?
metritis
what is this?
mastitis
