Postpartum diseases Flashcards
Normal temp for the post partum female is:
❖ Slightly elevated temperature up till 39,5°C
Post partum Lochia should be
odorless and ranges from greenish → reddish/dark brown.
❖ Lochia in the queen is less than in the dog and hardly noticeable due to self-grooming.
❖ Discharge persisting over 3 weeks of time becomes hemorrhagic, should be done at 5-6 weeks pp.
Post-partum Hemorrhage
Blood loss should be minimal, although there is a slight increase just after C- section (always be careful when removing the placentae during surgery).
Excessive hemorrhage could indicate vascular rupture in uterus or vagina, or an underlying coagulopathy.
- Do a vaginoscopy to determine where the blood comes from if possible
- Check hematology/hematocrit (lower in pregnant bitches)
- Give oxytocin IM 1-2 IU → promotes uterine involution.
- Supportive care such as volume replacement or blood transfusion.
- If this is not enough to stabilize go for surgery, explorative laparotomy to stop
the bleeding.
Uterine prolapse
Uncommon complication in small animals (more often in the queen).
Occurs in both primiparous and multiparous females.
Occurs usually immediately post partum.
Sometimes only one uterine horn or a complete prolapse.
Needs acute therapy → rapid deterioration of the female otherwise.
Therapy: manual repositioning, surgical repositioning/amputation → usually via
explorative laparotomy with full OHE.
Uterine rupture
Uncommon but more often in the bitch than queen.
Can occur during:
❖ Dystocia
❖ Due to late term injury
❖ Excessive use or oxytocin (large dosages)
Clinically: the female is presented with acute abdominal pain and rapid
deterioration.
Therapy: supportive care, expl.lap., and OVH (ovarian hysterectomy), antibiotics, NSAIDs etc.
Retained fetal membranes
Not uncommon in the bitch, but normally do not cause illness.
If not released at the time of delivery → will degrade over the next hours and the necrotic tissue will pass with the lochia.
In case of truly retained membranes the female will:
❖ Show signs of illness
❖ The vaginal discharge will be thick and smelly
❖ Palpation or U/ S will show an intrauterine mass.
Treatment:
❖ Oxytocin 2-4 times a day to expel the membranes (dogs 1-5 IU, cats 0,5 IU/dose)
❖ Antibiotics if the female is systemically ill, the placental sites are preferred locations
for bacterial proliferation.
Acute metritis
Severe inflammation of the endo- and myometrium which causes systemic illness.
Symptoms:
- normally depressed, anorexic, dehydrated, showing poor mothering, febrile, poor lactation, purulent/foul smelling vaginal discharge
Diagnosis:
- Vaginal sample culture
- Vaginal cytology
- CBC (for signs of inflammation)
- ultrasound
TX of acute metritis. (6)
❖ IV fluids (potential endotoxemia)
❖ NSAIDs (remove puppies from dam)
❖ AB
❖ Drainage of the uterine contents (if risk of rupture)
❖ Oxytocin if the condition occurs during the first 2-3 days postpartum.
❖ After day 2, PGF2-alfa is an effective ecbolic (contraction inducer), dose 10-25µg/kg SC tid (NOT bitches with azotemia because they cause decreased renal blood flow)
Toxic milk syndrome
It´s a poorly understood condition related to SIPS (subinvolution of the placental sites) and metritis, where the dam excretes toxins into her milk.
The exact explanation for the toxins in the milk have not been established.
Symptoms, pups:
❖ Colicky, vocalize, bloat, diarrhea, salivation and reddened anus
❖ Not possible to measure the toxins, but if the neonates are improving after removing
them from the dam → is considered diagnostic.
Treatment:
❖ Remove the neonates
❖ Treat the female for underlying pathologic conditions in the uterus and return the pups after 48 hours.
Agalactiae
Absence of milk production or secretion due to:
❖ Failure of milk letdown
❖ Failure of lactogenesis (anatomic/physiologic abnormalities, extremely rare)
More often the reason for agalactiae is:
❖ Stress (primiparous dams)
❖ Inadequate nutrition
❖ Premature delivery
❖ C-section
❖ Illness
Therapy:
❖ Oxytocin to promote the letdown, 0,5-1IU IM every 2-4 hours
❖ Stimulate prolactin release: metoclopramide 0,25-0,5mg/kg TID or domperidone 2,2mg/kg BID
Describe Mastitis in bitches.
Inflammation of the mammary gland (s)
❖ Nearly always a postpartum condition, but can occur during lactation/ pseudopregnancy too.
❖ May involve one or more glands.
❖ Can be acute and life-threatening in both dogs and cats! Act fast!
Most common bacteria:
❖ E.coli, staphyloccocal spp, streptococcal spp, clostridial spp, pseudomonas spp
❖ Bacteria can be isolated in normal milk but not in large numbers.
Signs of mastitis in bitches. (5)
❖ The milk becomes discolored (red, brown or combination).
❖ The area will become warm, red, swollen and painful.
❖ The bitch is often depressed, febrile, dehydrated, anorectic, poor interest in her
offspring
❖ Part of the gland can become necrotic and a smelly open wound will show up in a couple of days.
❖ The neonates will be crying or could be acutely ill (from toxins in the milk).
Mastitis tx in bitches. (3)
❖ Antibiotics according to the culture (amox-clav ok for neonates)
❖ IV fluids
❖ Pain medication, especially short term NSAIDs (be careful if nursing neonates).
If repeated need for NSAIDs, the neonates are bottle fed.
Neonates are allowed to nurse the mastitic gland → it will help draining the gland unless toxic bacteria (E.Coli or Clostridium) are present.
Often the neonates refuse to nurse → hand stripping and hot packing has to be done
several times a day.
If necrosis of the tissue appears, …?
the neonates are NOT allowed to nurse the glands involved and surgical removal of the gland can be necessary.
Describe Hypocalcemia in bitches. (5)
Acute decrease in serum calcium. Also called eclampsia and periparturient tetani.
❖ It usually appears within the first 2 weeks postpartum.
❖ Can be seen in late gestation or or up till 6 weeks pp.
❖ Very rare in cats
❖ Most common in small dogs, maiden bitches, large litters, obese or very thin dogs.
