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VMS4008 > Management of Parturition and peri-parturient disorders > Flashcards

Management of Parturition and peri-parturient disorders Flashcards

1
Q

What is the normal gestation period ?

A

58-72 days after mating (or 63 days +/1 after ovulation)

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2
Q

What is Parturition (eutocia) initiated by?

A

Foetal signs -> stress from less nutritional supply from placenta to foetus stimulates foetal HPA axis and release of cortisol

Maturation of the foetus

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3
Q

Describe what are the normal parturition steps

A
  • 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)
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4
Q

List predictors of Labour

A
  • Drop in progesterone
  • Drop in temperature 1-1.5°C
  • Mammary development & lactation
  • Vulvular enlargement
  • Mucoid vaginal discharge
  • Reduced appetite
  • Nervousness
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5
Q

How do we define Stage 1 labour

A

Beginning is defined at the start of uterine contractions after removal of the progesterone bloclk -> supports the opening of the cervix

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6
Q

What correlates to placental separation and cervical dilation ?

A

Change in ratio of oestrogen to progesterone

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7
Q

How long after progesterone falls does stage 1 start?

A

24-36h later

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8
Q

why do we see a drop in temp ?

A

because progesterone is thermogenic -> drop of 1°C is noted in most bitches 1é-2h before parturition -> returns to normal at time of parturition

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9
Q

Role of Relaxin in Stage 1?

A

Pelvic soft tissues and vagina o relax to facilitate foetal passage

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10
Q

Describe Ferguson’s reflex

A
  • 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)
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11
Q

Are there abd contractions in stage 1?

A

NO

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12
Q

Detail role of prolactin in stage 1?

A

INC in prolactin 12-24 hrs before onset of parturition -> contributes to bhvr changes

Colostrum production 1wk-> 24h before parturition

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13
Q

What bhvr signs may we see in stage 1?

A

Restlessness - pantingn tearing up bedding, digging, shivering, V+

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14
Q

How long does stage 1 last?

A

6-12 hrs but can be up to 36hrs

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15
Q

Detail the main features of stage 2 labor

A
  • Allantchorionic membrane ruptues and clear discharge
  • Visible abdominal straining, strong uterine/ and contractions
  • Rectal temp back to normal
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16
Q

How long does stage 2 labour last?

A

normally -12 hrs, should not continue > 24hs

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17
Q

Timings of delivery?

A
  • First foetus usually delivered within 4 hrs
  • interval between births normally 30-60 mins -> 120 mins
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18
Q

What happens in stage 3 ?

A

Passing of the placenta - with or within 15 mins of each foetus -> retaining it rare in dogs

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19
Q

How long is post partum discharge present for - what is it called & what colour is it?

A

Lochia -> up to 3 weeks - normally green (uteroverdin)

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20
Q

When is uterine involution complete ?

A

12-15 weeks

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21
Q

Gestation period in the queen?

A

63-67 days (63 after mating)

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22
Q

Describe stage 1 parturition in the queen?

A

Up to one week prior to parturition
- Drop in rectal temp less reliable
- Bhvr changes
- Colostrum 1 week to <24 h prior to parturition

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23
Q

Describe Stage 2 & 3 in queen

A
  • Vaginal discharge less common
  • Lochia red reddish/ brown
  • Interrupted labour
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24
Q

When to worry (points 1-4)

A
  1. Failure of the dam to initiate labour at term → need to know ovulation date! Overdue.
  2. Failure to enter stage 1 → temperature drop (<37.5C) or PG drop but no progression
    over 24-36 hours
  3. Failure to enter stage 2 within 36 hours
  4. 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)
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25
Q

When to worry (points 5-9)

A
  1. Constant unrelenting straining
  2. Foetal distress → stillbirths, low HR in utero, meconium but no pups
  3. Maternal distress → depressed, pain, copious vaginal discharge or bleeding, in shock
  4. Irreversible signs/history of dystocia → foetus stuck in birth canal, foetal/maternal
    mismatch, malposition, pelvic canal abnormality etc
  5. Breed of known anatomical issues…
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26
Q

what is dystocia

A

inability to expel a foetus through the birth canal without assistance

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27
Q

List some risk factors to dystocia

A
  • Age
  • Size
  • Breed -> highest in FBD, Boston terrier, pug, chihuahua
    Purebred 3x more likely than crossbreed
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28
Q

Uterine inertia can be: …

A

Primary complete, Primary partial, Secondary

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29
Q

Define Primary Uterine inertia ?

A

Failure to establish a functional, progressive level of myometrial contractility -> failure of expulsion

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30
Q

Define Secondary Uterine inertia

A

Cessation of parturition after it has been initiated -> failure to deliver the remaining fetuses (metabolic, anatomical and genetic causes)

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31
Q

Apart from uterine inertia - what other maternal factors of dystocia are there?

A
  • Small / narrow pelvic diameters
  • Abnormalities of the reproductive tract, masses
  • Uterine torsion, rupture or malposition
  • Compromised general health, hypoG, hypoCa
32
Q

What Foetal Causes of dystocia?

A
  • Mismatch of foetal/ maternal size
  • Oversize foetus, single puppy - anasarca
  • Malpresentation
  • Foetal death
33
Q

What malpresentation can we get?

A
  • Posterior presentation
  • Breech presentation
  • Two foetuses presenting simultaneously
  • Backward flexion of front legs
  • Lateral or downward deviation of the head
  • Transverse/bi-cornual presentation
34
Q

What history specific to repro should we ask?

A
  • Is this her first litter? What breed was the sire?
35
Q

What history to to with dystocia/ parturition?

A
  • 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 ?
36
Q

What important physical exam & diagnostics ?

A

DAM -> mammary glands , abdominal palpation, vaginal discharge ?

Diagnostic imaging?
Bloods/ electrolytes

37
Q

What are KEY POINTS to do with possible dystocia that warrant an emergency apt?

A
  • prolonged 1st stage
  • Unproductive straining
  • Green discharge and no foetus
  • Maternal stress
38
Q

What options from vet pov

A
  • Manual manipulation
  • medical tx
  • Surgical delivery
39
Q

Detail manual intervention for obstructive dystocia

A
  • Difficult in small patients due to size of pelvis
  • In large dogs consider careful retropulsion / realisgnement and traction if obstruction due to foetal malpresentation
40
Q

When should you manipulate foetus position?

A

In between periods fo straining

41
Q

Describe how traction should be used for manual intervention?

A

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

42
Q

When should we consider medical management?

A
  1. there is no obstruction
  2. The dam is physically healthy
  3. there are no signs of foetal distress
43
Q

What can trigger straining but won’t help with primary uterine inertia?

A

‘featherin’ of the dorsal vaginal wall

44
Q

What else can we do conservatively to help non obstructive dystocia?

A

Get owner to take her for a walk / light run
For nervous bitch consider quiet dark room

45
Q

What is the suggested medical protocol.

A
  • 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
46
Q

HOw successful is meical management in the queen?

A

no very <1/3 response

47
Q

When is oxytocin indicated?

A
  • 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
48
Q

When is oxytocin contraindicated?

A

Any form of obstructive dystocia

49
Q

What happens if we give oxytocin too quick??

A

Uncoordinated contractions of uterus -> delay parturition

50
Q

When is C-section indicated?

A
  • Bitch/ queen fails to respond to medical management
  • Foetal distress evident despite inc in uterine contractility
  • Unsuccessful attempt at relieving obstruction
51
Q

Describe the induction of parturition in smallies?

A
  • Not commonly done
  • Drugs not licensed
  • Potentially therapeutic use for maternal morbidity/ risk of dystocia
52
Q

What are some common Peri-parturient diseases?

A
  • Hypocalcaemia
  • Hypo/hyperglycaemia
  • Metritis
  • Haemorrhage
  • Uterine prolapse
  • Mastitis
53
Q

Hypocalcaemia causes what ?

A
  • Eclampsia, puerperal tetant
  • Risk of seiure and death
54
Q

What to check for with hypocalcaemia?

A

Concurrent hypoglycaemia

55
Q

What C/S of hypoCalcaemia

A

Restlessness, panting, stiff gait, hypersalivation, muscle fasciculations, hyperthermia, facial pruritus

56
Q

Diagnosis fo Hypocalcaemia?

A

Total calcium <1.6mmol/l, ionised calcium

57
Q

What Tx for HypoCal ?

A

Calcium gluconate 10% slow IV, cooling if hyperthermia, oxygen -> often dramatic recovery

58
Q

C/S of hypoglycemia?

A

similar to hypocalcaemia

59
Q

Timing of hypoG?

A

during pregnancy or parturition

60
Q

Tx for hypoG?

A

50% dextrose slow IV (diluted in slaine 1:4)

61
Q

Describe hyper glycaemia

A
  • Gestational diabetes
  • C/S -> PUPD, weight loss with polyphagia, lethargy
  • Difficult to manage, may have to consider termination of pregnancy
  • No further breeding
62
Q

Risk factors to Metritis (ascending bact infection)?

A
  • Dystocia
  • Obstetrical manipulation
  • Retinaed foetus/ membranes
  • abortion
63
Q

C/S of metritis?

A

Dehydration, purulent vag discharge, pyrexia, large uterus on plapation

64
Q

Diagnosis of Metritis?

A

U/S, radiograph, vaginal swab for cytology and C/S

65
Q

Tx of metritis ?

A
  1. Stabilise dam -> IVFT, IV broad spec AB
  2. Evacuate uterine contents -> uterine lavage, oxytocin, PGF2a
  3. Consier OVH in severe cases
66
Q

What is a normal PCV in whelping bitch

A

30%

67
Q

Causes of PP Haemorrhage ?

A
  • Tearing
  • Vessel rupture
  • Underlying coagulation defect
68
Q

Tx for haemorrhage?

A

Repair defect, vaginal packing, oxytocin, blood transfusion, ex lap

69
Q

What to check if hemorrhage is problem?

A

Clotting times

70
Q

Uterine prolapse is common in ..?

A

Cats

71
Q

What to do for small prolapse w/minimal uterine damage:

A
  • Clean with saline
  • Lubricate an gently replace under sedation/ GA
  • Hypertonic fluids
  • Oxytocin
72
Q

What to do for severe prolapse/ damage

A
  • Haemorrhage and shock
  • Restore blood volume-> IFVT / blood transfusion
  • Exlap +/_ OVH
73
Q

What common bacteria cause Mastitis?

A

E.Coli, Staph, strep

74
Q

What clinical signs of Mastitis?

A

Hot, painful enlarged and discolored mammary glands

  • Inc viscosity of milk
  • Milk colour changes +/- blood +/_ disC
  • Pyrexia
75
Q

Tx for Mastitis?

A

Systemic AB warm compress/ massage/ stripping and pain medication!

Sx debridement if absessation
Sepsis
Management of neonates

VMS4008 (10 decks)

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