Female Reproduction Flashcards
What is the blood supply to the vagina?
Internal pudendal —> vaginal artery
What are two congenital abnormalities seen in the female vagina?
Vesitbulovaginal stenosis (vv) -septal/annular/vaginal
Rectovaginal fistula
-connection between rectum and vaginal
What are clinical signs associated with vesitublovaginal stenosis?
Vaginitis
UTI
Painful breeding
Hydrocolpos (fluid accumulation in vaginal wall)
How can you diagnose vestibulovaginal stenosis ?
Digital exam —> all dogs have some degree of narrowing (experiance)
Contrast radiographs —> sterile iodinated contrast media (if ratio between max and min is <0.2 = severe stenosis)
Vaginoscopy —> direct visualization
What is the best diagnostic modality to determine vestibulovaginal stenosis?
Vaginoscopy —> direct visualization
Evaluate entire UG and repro tracts
Can tree stenosis with scope
When is treatment for vestibulovaginal stenosis indicated?
Breeding dogs
Spayed dogs with clinical signs (eg vaginitis, UTI, hydrocolpos)
What are the types of lesions that can be seen with vestibulovaginal stenosis?
Septal stenosis - band of tissue oriented dorsoventrally (double vagina)
Annular stenosis -ring lesions at V-v junction
Hypoplasia - narrowing of vaginal vault (between vv junction and cervix)
What is the treatment for a septal stenosis vv?
Episiotomy —> incision of vulvar orifice to all access to the vestibule and vagina
Mucosal reception at attachments
Suture mucosa
OR
Laser ablation
What are the indications for an episiotomy?
Explore vagina
Excise vaginal masses
Repair lacerations
Modify strictures
How will you perform an episiotomy and control the hemorrhage?
Place animal in perineal position
Place instrument in vulvar tissue
Incise from dorsal commissure to limits of vestibule
Control hemorrhage
-Electrocautery/doyen forceps
Close in 3 layers -> mucosa, muscle, and skin
What is the treatment for vv due to annular stenosis if it is caudal to the pelvis?
Dorsal approach
Vaginal resection and anastomoses
What is the treatment for vv due to annular stenosis if it is intrapelvic?
Transpelvic approach
Vaginectomy
What is the treatment for vv due to vaginal hypoplasia?
Vaginectomy (more diffuse disease) along with OHE
What are the indications for vaginectomy?
More extensive lesions
Intrapelvic annular stenosis
Vaginal hypoplasia
- may also perform ventral abdominal approach and OHE
What is the usual signalment for recessed (hooded) vulva?
Medium to large breed
Overweight
Early OHE (juvenile vulva)
Clinical signs of a hooded vulva?
Skin fold dermatitis
Vaginitis
Recurrent UTI
Incontinence
You have a overweight dog with a mild hooded vulva. How would you treat this animal?
Cleansing and weight loss
You have a patients with a 3/5 BCS and a severe hooded vulva. How would you treat?
Episioplasty - vulvoplasty
What condition occurs during proestrus/estrus due to high estrogen levels?
Vaginal edema/hyperplasia
Signalment for vagnial hyperplasia?
Young
<2yrs
One of first 3 estrus cycles
Presentation of vaginal edema/hyperplasia?
Mucosa protrudes from vulva
Tissue arise from ventral vaginal floor
Treatment for vaginal hyperplasia?
Conservative —> lubricants and Ecollar —> reduce tissue —> resolves with termination of estrus —> OHE to prevent reoccurrence
Surgical (if significant mucosal injury or in breeding animals)
—> mucosal resection through episiotomy
How can you tell vaginal prolapse from vaginal hyperplasia?
Prolapse —> can see entire circumference of vaginal, appears donut shaped
Hyperplasia —> area of mucosa protrudes from vulva arising from ventral vaginal floor
Treatment for vaginal prolapse?
Manual reduction and OHE
What is ovarian remnant syndrome?
Exactly like it sounds… there is a remnant of ovary from a previous OHE..
Caused by
—> poor visualization
—> improper surgical technique
—> dropped ovarian tissue revascularizes
You have recurrence of estrus in a dog after it was just spayed..
dx?
Ovarian remnant syndrome
Clinical signs of ovarian remnant syndrome?
Vulvar enlargement - dog
Attraction to males
Willingness to breed
Treatment for ovarian remnant syndrome?
Surgical removal
- usually at caudal pole of kidney
- surgery usually done during estrus
- avoid ureter
How can you confirm a case of ovarian remnant syndrome?
Vaginal cytology (dog) —> mimics normal heat cycle
Hormone levels
—> estrogen >15pg/ml
—>progesterone >2ng/ml
—> cats required lutinization (HCG) to evaluate progesterone
What are maternal causes of dystocia?
Primary/secondary uterine inertia
Birth canal obstruction
- small pelvic canal
- malunion fracture
What are fetal causes of dystocia?
Malposition
Malformation
Oversized
Fetal etiology can cause secondary uterine inertia
What are clinical signs of primary uterine inertia?
No signs of parturition
Prolonged gestation > 68days
No puppies after 36h after temp <100F
What is the etiology of primary uterine inertia?
Oversized litters —> uterine stretching
Undersized litters —> uterine stimulation
What is primary uterine inertia?
Parturition fails to proceed
Birth canal/fetal size/presentation normal
No neonates born
What is secondary uterine inertia?
Normal delivery of part of the litter
Develops uterine fatigue
What is the etiology of secondary uterine inertia?
Fetal obstruction
Pelvic obstruction
Fetal malposition
Fetal size
What are clinical signs so secondary uterine inertia?
Prolonged interval between neonates (>4hours)
Weak or absent uterine contractions
What are possible PE findings you can have with dystocia?
Lucia (green tinged fluid) without delivery
Obstructed canal on palpation
Abnormal fetal presentation
Lack of uterine contractions in response to Fergusons reflex
What can you see on radiographs that would indicate dystocia?
Fetal malposition
Pelvic obstruction
Retained fetuses
Fetal death -> intravascular gas
T/F: Ultrasound cannot be used to determine number of fetuses but can be used to find fetal distress syndrome
True
—> fetal stress syndrome (low HR) associated with lack of O2 during parturition
T/F: secondary uterine inertial can be treated medically with oxytocin
False
ONLY primary uterine inertia can be treated medically
In a primary uterine inertia case, you treat with oxytocin but have no results, so you try manuals manipulation of fetus and still fail.. what should you do next?
C-section
What are indications for C-section
Secondary uterine inertia
Primary uterine inertia -refractory to treatment
Systemic signs of bitch
Fetal distress diagnosed by US
Planned for high risk patients
What are the steps in a C-section?
Incisions - midway between xyphoid and umbilicus to cranial pubis
Exterisorize uterus
Pack off with laparotomy sponges
Perform hysterotomy
- ventral midline into uterine body
- avoid incision over fetus
- milk fetus into incision
- pull until placenta releases
Clamp umbilical cord 2-6cm from abdominal wall
Close with 3/0 monofilament absorbable
Single or double layer with inverting
Holding layer
What can you do if following C-section, involution has no started or there is excessive hemorrhage??
Administer oxytocin IM
What are the advantages of an En block resection C-section
Treat dystocia
Decreased anesthesia time
OHE
Decreased abdominal contamination
What is the procedure of an en bloc recsection c-section?
Break down broad ligament
Triple clamp pedicle
Transection
Remove puppies <60seconds after claps (no increased fetal mortality)
