Periparturient Conditions Flashcards
normal mothering behaviour (5)
-attentiveness
-helping pups nurse
-stimulating urination and defecation
-grooming
-protecting and retrieving pups
three possible causes of abnormal mothering
-stress
-pain
-excessive human interference
what is mastitis
inflammation of mammary glands
normally, a bitch should have mammary glands that are: (4)
- Non painful
- Symmetrical
- Either firm or softer
- Should be warm; NOT hot or cold
when does mastitis commonly occur /when is it less likely to occur
-Commonly occurs post-partum. Usually occurs at 6-10 days post-
whelping or at early weaning
-Less likely to occur in pseudopregnancy or prior to whelping
does mastitis affect every mammary gland
Can affect 1 or more glands or 1 or
more sections of a mammary
gland
is mastitis life threatening
Can be life threatening and bitch
can be systemically ill
clinical signs of mastitis in early disease process/mild cases
- Mammary may just feel firm, bitch
may be uncomfortable, but without
fever
clinical signs of mastitis as condition progresses/moderate-severe cases (5)
- Bitch is febrile
- Can see hot, painful, hard, discolored mammary gland (red, bruised, black)
- Milk can look normal, purulent, brown/red to green in color
- Bitch can appear quite sick → lethargic, not eating, not being a good mom, anxious, painful
- Can be septic if abscessed or gangrenous
4 diagnostics for mastitis
-Bloodwork
o CBC → leukocytosis with left shift
o Can be septic with gangrenous
mastitis
-Cytology of milk sample
o Degenerative neutrophils, bacteria
engulfed by neutrophils,
macrophages
-Culture and sensitivity of
aseptically attained milk sample
+/- Ultrasound of the mammary
gland
treatment for mastitis (8)
-Analgesia (Tramadol, Opioids, Anti-inflammatory (NSAIDs) but Not recommended (pups))
-Hot packing/cold packing
-Cabbage leaf bandages
-Surgical debridement of necrotic tissue & honey bandages (Abscessed, Gangrenous)
-Antibiotics based on culture and sensitivity
-Fluid therapy if required
-Manual milking
-Need to consider if pups will still be nursing from mom → some drugs are passed through the milk & are toxic to neonates
–> Should not nurse if gangrenous /abscessed
–>Need to consider pup age if removal of pups from mom is necessary
what is agalactia and when is it suspected
-Absence of milk in a female that should be lactating
-Suspected if pups are not gaining weight
causes of agalactia (7)
-Asynchrony between delivery and milk production (eg. elective csection)
-Inadequate nutrition
-Stress
-Premature whelping
-Mastitis
-Metritis
-Endotoxemia/systemic illness
treatment of agalactia
-Need to supplement pups
-Try to treat cause eg. stress
-Dopamine receptor antagonists (Dopamine inhibits prolactin → if we block dopamine → prolactin inc. )
what is galactostasis
◦ Excessive accumulation of milk but with lack of milk let down
what is required for lactation
prolactin!
what do you expect to see with normal PP discharge (5)
-No odor
-Reddish brown to green color
-Present for up to to 3 weeks post partum
-Should decrease gradually with time
-Can have slightly elevated temperature for several days post partum but should not exceed 39C
metritis occurs following what
◦ Most commonly occurs following a dystocia, retained fetal membranes or fetus, prolonged delivery, contaminated obstetrical manipulations
when does metritis usually occur
1 week PP
what is metritis
infection of the uterus (endometrium and myometrium)
clinical signs of metritis (7)
-Poor mothering
-Lethargy
-Inappetance
-Fever
-Decreased milk production →decreased weight gain in puppies
-Vulvar discharge: thick, creamy to reddish brown & malodorous, sometimes copious
-Can present in shock
diagnostics for metritis (5)
CBC → leukocytosis with left shift
Ultrasound → uterine dilation; potentially presence of retained fetal membranes or fetal structures?
Radiographs → distended soft tissue
structure in caudal abdomen; presence of retained fetus?
Cytology of fluid → degenerative
neutrophils, engulfed bacteria by
neutrophils, RBCs
Culture & sensitivity of fluid
what is the most common pathogen cultured in metritis cases
E coli
dose of lutalyse
0.01 to 0.05 mg/kg subcutaneously
every 12hrs of lutalyse, as needed =
microdosing
treatment of metritis (6)
-May need to remove pups from mom if bitch is too sick
-Fluid therapy
-Antibiotics (Still need to consider if pups nursing)
-Prostaglandins (Contraindicated if at risk of uterine rupture, Side effects → monitor in clinic. Monitor response to PGF2a → ultrasound examinations)
-Oxytocin likely won’t work
-May need to spay in severe cases (If fetus/fetal parts present, need to be surgically removed)
are RFM usually a concern in bitches
no
preventin of RFM
oxytocin in the first 24hr PP
what breeds are RFM more common in
toy breeds
what does green/black discharge for more than 12 hours possibly indicate
metritis
hypocalcemia is more likely in: (5)
-Young bitches (1st litter)
-Large litter
-Small or medium breed
-Bitch fed inappropriate diet during gestation; supplemented with Ca2+
-At 2-4 weeks post-partum → maximum milk production
clinical signs of hypocalcemia (14)
-Restlessness, anxious behavior (pacing, whining)
-Weakness
-Being a bad mom – not tending to her pups
-Tremors
-Panting
-Staggering
-Facial pruritus
-Dilated pupils
-Change in behavior
-Tachycardia
-Hyperthermia - fever
-Muscle twitching
Hypersalivation
-Collapse → convulsions
diagnosis of hypocalcemia
◦ History, clinical signs, physical exam
◦ Low ionized calcium
◦ Total calcium can also be low
◦ Check other abnormalities (hypoglycemia, hypomagnesemia, hypophosphatemia)
◦ Check acid-base status, protein levels
why is it important to treat hypocalcemia quickly
Can be life-threatening & is a rapidly progressive disease important to treat quickly!!
what form of calcium is being measured in supplements
elemental calcium
treatment of hypocalcemia
Slow IV administration of calcium → improvement is often rapid
~~10% calcium gluconate (0.5-1.5mL/kg) slow IV – monitor for bradycardia/arrhythmias during tx
~~Can follow up with subQ calcium after – diluted 50% saline q6-8hrs until stable
Oral calcium
~~25-50mg/kg/day of elemental calcium – calcium carbonate (eg. Tums; 500mg tums = 200mg of elemental calcium)
+/- remove pups to allow mom to recover & slowly re-introduce if too young to wean
+/- supplement with milk replacer
+/- cool down bitch if very hyperthermic
+/- diazepam if convulsions
prevention of hypocalcemia (4)
-Feed well-balanced diet; especially with appropriate calcium/phosphate ratio (Avoid diets high in legumes)
-DO NOT SUPPLEMENT WITH CALCIUM DURING PREGNANCY
-Could reoccur with subsequent litters → plan to supplement feeding if necessary
-Start supplementing calcium of next litters during the whelp
what is SIPS and when does it occur/should it be considered
SIPS = subinvolution of placental sites
◦ Occurs when involution is delayed
◦ Should be considered anytime there’s serosanguineous vaginal discharge > 6 weeks post
partum
when does normal uterine involution take place by
by 12 weeks PP
diagnosis of SIPS
- Vaginal cytology:
- Trophoblast cells (polynucleated and heavily vacuolated)
- CBC if bleeding heavily
- Anemia
- Ultrasound/radiographs
treatment of SIPS
- Usually supportive and resolves on its own
- If severe → spay
