Management of Parturition and peri-parturient disorders Flashcards
What is the normal gestation period ?
58-72 days after mating (or 63 days +/1 after ovulation)
What is Parturition (eutocia) initiated by?
Foetal signs -> stress from less nutritional supply from placenta to foetus stimulates foetal HPA axis and release of cortisol
Maturation of the foetus
Describe what are the normal parturition steps
- Parturition in the bitch typically lasts 4-18 hours.
- Stage 1: preparatory stage (uterus and cervix)
- Stage 2 + 3: expulsive stages
- Stage 2 is active labour
- Stage 3 is passage of foetal membranes (often at same time as stage 2)
List predictors of Labour
- Drop in progesterone
- Drop in temperature 1-1.5°C
- Mammary development & lactation
- Vulvular enlargement
- Mucoid vaginal discharge
- Reduced appetite
- Nervousness
How do we define Stage 1 labour
Beginning is defined at the start of uterine contractions after removal of the progesterone bloclk -> supports the opening of the cervix
What correlates to placental separation and cervical dilation ?
Change in ratio of oestrogen to progesterone
How long after progesterone falls does stage 1 start?
24-36h later
why do we see a drop in temp ?
because progesterone is thermogenic -> drop of 1°C is noted in most bitches 12-24h before parturition -> returns to normal at time of parturition
Role of Relaxin in Stage 1?
Pelvic soft tissues and vagina o relax to facilitate foetal passage
Describe Ferguson’s reflex
- Neuroendocrine Ferguson’s reflex is active → sensory neurons in the cervix and the vagina detect pressure
→ hypothalamus → release of oxytocin → uterine contractions → sensory neurons (+ve feedback loop)
Are there abd contractions in stage 1?
NO
Detail role of prolactin in stage 1?
INC in prolactin 12-24 hrs before onset of parturition -> contributes to bhvr changes
Colostrum production 1wk-> 24h before parturition
What bhvr signs may we see in stage 1?
Restlessness - pantingn tearing up bedding, digging, shivering, V+
How long does stage 1 last?
6-12 hrs but can be up to 36hrs
Detail the main features of stage 2 labor
- Allantchorionic membrane ruptues and clear discharge
- Visible abdominal straining, strong uterine/ and contractions
- Rectal temp back to normal
How long does stage 2 labour last?
normally -12 hrs, should not continue > 24hs
Timings of delivery?
- First foetus usually delivered within 4 hrs
- interval between births normally 30-60 mins -> 120 mins
What happens in stage 3 ?
Passing of the placenta - with or within 15 mins of each foetus -> retaining it rare in dogs
How long is post partum discharge present for - what is it called & what colour is it?
Lochia -> up to 3 weeks - normally green (uteroverdin)
When is uterine involution complete ?
12-15 weeks
Gestation period in the queen?
63-67 days (63 after mating)
Describe stage 1 parturition in the queen?
Up to one week prior to parturition
- Drop in rectal temp less reliable
- Bhvr changes
- Colostrum 1 week to <24 h prior to parturition
Describe Stage 2 & 3 in queen
- Vaginal discharge less common
- Lochia red reddish/ brown
- Interrupted labour
When to worry (points 1-4)
- Failure of the dam to initiate labour at term → need to know ovulation date! Overdue.
- Failure to enter stage 1 → temperature drop (<37.5C) or PG drop but no progression
over 24-36 hours - Failure to enter stage 2 within 36 hours
- Failure to deliver foetus within 1 hour of active labour or 4-6 hours of intermittent labour
* Greater then 2 –4 hours in between foetuses (remember interrupted labour in the cat)
When to worry (points 5-9)
- Constant unrelenting straining
- Foetal distress → stillbirths, low HR in utero, meconium but no pups
- Maternal distress → depressed, pain, copious vaginal discharge or bleeding, in shock
- Irreversible signs/history of dystocia → foetus stuck in birth canal, foetal/maternal
mismatch, malposition, pelvic canal abnormality etc - Breed of known anatomical issues…
what is dystocia
inability to expel a foetus through the birth canal without assistance
List some risk factors to dystocia
- Age
- Size
- Breed -> highest in FBD, Boston terrier, pug, chihuahua
Purebred 3x more likely than crossbreed
Uterine inertia can be: …
Primary complete, Primary partial, Secondary
Define Primary Uterine inertia ?
Failure to establish a functional, progressive level of myometrial contractility -> failure of expulsion
Define Secondary Uterine inertia
Cessation of parturition after it has been initiated -> failure to deliver the remaining fetuses (metabolic, anatomical and genetic causes)
Apart from uterine inertia - what other maternal factors of dystocia are there?
- Small / narrow pelvic diameters
- Abnormalities of the reproductive tract, masses
- Uterine torsion, rupture or malposition
- Compromised general health, hypoG, hypoCa
What Foetal Causes of dystocia?
- Mismatch of foetal/ maternal size
- Oversize foetus, single puppy - anasarca
- Malpresentation
- Foetal death
What malpresentation can we get?
- Posterior presentation
- Breech presentation
- Two foetuses presenting simultaneously
- Backward flexion of front legs
- Lateral or downward deviation of the head
- Transverse/bi-cornual presentation
What history specific to repro should we ask?
- Is this her first litter? What breed was the sire?
What history to to with dystocia/ parturition?
- Has the client been measuring rectal tep
- Has there been vaginal discharge - what colour?
- Has she passed a foetus yet?
- Can the client see a foetus in the vaginal canal ?
What important physical exam & diagnostics ?
DAM -> mammary glands , abdominal palpation, vaginal discharge ?
Diagnostic imaging?
Bloods/ electrolytes
What are KEY POINTS to do with possible dystocia that warrant an emergency apt?
- prolonged 1st stage
- Unproductive straining
- Green discharge and no foetus
- Maternal stress
What options from vet pov
- Manual manipulation
- medical tx
- Surgical delivery
Detail manual intervention for obstructive dystocia
- Difficult in small patients due to size of pelvis
- In large dogs consider careful retropulsion / realisgnement and traction if obstruction due to foetal malpresentation
When should you manipulate foetus position?
In between periods fo straining
Describe how traction should be used for manual intervention?
LUBE
- Do not apply traction to the limbs
- Squeee transabdominally to move F caudal
- Side to side tocking/ wiggling
- Do not use forceps unless deceased
When should we consider medical management?
- there is no obstruction
- The dam is physically healthy
- there are no signs of foetal distress
What can trigger straining but won’t help with primary uterine inertia?
‘featherin’ of the dorsal vaginal wall
What else can we do conservatively to help non obstructive dystocia?
Get owner to take her for a walk / light run
For nervous bitch consider quiet dark room
What is the suggested medical protocol.
- Oxytocin every 20-30 min up to 3 times
- 10% calcium gluconate (with ECg & HR monitoring)
- 2 ml of 50% dextrose by slow IV infusion
HOw successful is meical management in the queen?
no very <1/3 response
When is oxytocin indicated?
- Stimulation fo uterine contraction to facilitate parturition in the presence of fully dilated cervix
- To promote involution of the post-parturient uterus and thus aid the passage of etained placenta
- to aid in control of PP haemorrhage
When is oxytocin contraindicated?
Any form of obstructive dystocia
What happens if we give oxytocin too quick??
Uncoordinated contractions of uterus -> delay parturition
When is C-section indicated?
- Bitch/ queen fails to respond to medical management
- Foetal distress evident despite inc in uterine contractility
- Unsuccessful attempt at relieving obstruction
Describe the induction of parturition in smallies?
- Not commonly done
- Drugs not licensed
- Potentially therapeutic use for maternal morbidity/ risk of dystocia
What are some common Peri-parturient diseases?
- Hypocalcaemia
- Hypo/hyperglycaemia
- Metritis
- Haemorrhage
- Uterine prolapse
- Mastitis
Hypocalcaemia causes what ?
- Eclampsia, puerperal tetant
- Risk of seiure and death
What to check for with hypocalcaemia?
Concurrent hypoglycaemia
What C/S of hypoCalcaemia
Restlessness, panting, stiff gait, hypersalivation, muscle fasciculations, hyperthermia, facial pruritus
Diagnosis fo Hypocalcaemia?
Total calcium <1.6mmol/l, ionised calcium <0.8
What Tx for HypoCal ?
Calcium gluconate 10% slow IV, cooling if hyperthermia, oxygen -> often dramatic recovery
C/S of hypoglycemia?
similar to hypocalcaemia
Timing of hypoG?
during pregnancy or parturition
Tx for hypoG?
50% dextrose slow IV (diluted in slaine 1:4)
Describe hyper glycaemia
- Gestational diabetes
- C/S -> PUPD, weight loss with polyphagia, lethargy
- Difficult to manage, may have to consider termination of pregnancy
- No further breeding
Risk factors to Metritis (ascending bact infection)?
- Dystocia
- Obstetrical manipulation
- Retinaed foetus/ membranes
- abortion
C/S of metritis?
Dehydration, purulent vag discharge, pyrexia, large uterus on plapation
Diagnosis of Metritis?
U/S, radiograph, vaginal swab for cytology and C/S
Tx of metritis ?
- Stabilise dam -> IVFT, IV broad spec AB
- Evacuate uterine contents -> uterine lavage, oxytocin, PGF2a
- Consier OVH in severe cases
What is a normal PCV in whelping bitch
30%
Causes of PP Haemorrhage ?
- Tearing
- Vessel rupture
- Underlying coagulation defect
Tx for haemorrhage?
Repair defect, vaginal packing, oxytocin, blood transfusion, ex lap
What to check if hemorrhage is problem?
Clotting times
Uterine prolapse is common in ..?
Cats
What to do for small prolapse w/minimal uterine damage:
- Clean with saline
- Lubricate an gently replace under sedation/ GA
- Hypertonic fluids
- Oxytocin
What to do for severe prolapse/ damage
- Haemorrhage and shock
- Restore blood volume-> IFVT / blood transfusion
- Exlap +/_ OVH
What common bacteria cause Mastitis?
E.Coli, Staph, strep
What clinical signs of Mastitis?
Hot, painful enlarged and discolored mammary glands
- Inc viscosity of milk
- Milk colour changes +/- blood +/_ disC
- Pyrexia
Tx for Mastitis?
Systemic AB warm compress/ massage/ stripping and pain medication!
Sx debridement if absessation
Sepsis
Management of neonates
