Problem Pregnancy Flashcards
Termination of Pregnancy
Why?
Problems during pregnancy or unwanted litter (ovariohysterectomy)
What must you do prior to terminating pregnancy
Make sure she is actually pregnant which requires you to wait 30 days to confirm with ultrasound
Recommended to be done prior to 45 days or will be delivering puppies and can become a mess/dangerous
Medical termination of pregnancy
Do NOT use…
Estrogen within 5 days of conception!
Does prevent embryo implantation but can cause pyometra and bone marrow dyscrasia
Medical termination of pregnancy
Luteolysis
Diminish progesterone -> luteolysis
Prostaglandin F2 alpha
Carbergoline or bromocriptine
Combination of PgF2alpha and cabergoline or bromocriptine (how you also treat pyometra!)
Prostaglandin F2alpha
Product
Natural dinoprost tromethamine (Lutalyse):
Micrograms
Narrow therapeutic index
50 mcg/kg to 250 mcg/kg (start with low end) 1-2x/day
Avoid strong prostaglandin synthetics (cloprostenol, Estrumate)
Prostaglandin F2alpha
Human
Absorbed through skin
Asthma and abortion may result
CANNOT be sent home
May want to hospitalize patient
Prostaglandin F2alpha
Adverse effects
Hypersalivation
Vomiting
Diarrhea
Mitigate by taking female on a short walk after administration
Start with low dose; patient will become acclimated so may have to increase dose
Prostaglandin F2alpha
Rx to Diminish effects
Atropine
Pirifinium bromide
Metazopine
Prostaglandin F2alpha
Monitoring
Monitor for adverse effects
Termination confirmed by measuring progesterone levels (< 1ng/mL)
If administered too early in pregnancy will require more drug due to low receptors
Vaginal Discharge During Pregnancy
3 things to pay attention to
Color (red, black, brown, green, yellow)
Quantity
Odor: mucus, purulent, hemorrhagic
Vaginal Discharge During Pregnancy
Possible Causes
Past term with abnormal whelping
Miscarriage/abortion: Primary uterine disease Infection Other systemic disease Trauma Toxin Coagulopathy (rodenticide)
Transient “problem pregnancy”
Diagnostics for vaginal discharge during pregnancy:
What is the MOST important one?
Brucella test!
Must be placed in isolation
Zoonotic
Diagnostics for vaginal discharge during pregnancy
Brucella test CBC and Serum Chem Urinalysis Ultrasound Radiograph Cytology of discharge and vaginal cytology Bacterial Culture and Sensitivity Serum progesterone test
Hypoluteoidism
What is it? Characteristics
Luteal insufficiency may be either primary problem or secondary to other disease
Might be in older females
Low progesterone level
Hypoluteoidism
Treatment
If no systemic problem is identified then treatment with progesterone to maintain pregnancy (first measure progesterone)
Can also do nothing and monitor
Kinds
Altrenogest, allytrenbolone (Regumate) - can be given at home with gloves
Oil by injection (longer duration)
Hypoluteoidism
Treatment Precautions
Progesterone:
Could result in pyometra if infection is present
Will diminish uterine muscular contraction and maintains cervical closure
Can masculinize the fetus (during beginning)
Treatment of Vaginal Discharge
Caesarean section if overdue
Ovariohysterectomy if serious disease
Antibiotics (usually based on culture and sensitivity, empirical while you wait)
Rest and monitor
Brucellosis
Background
Low incidence
Must screen for B. canis in breeding animals
Cats appear resistant to Brucella
Zoonotic disease! Must notify and warn owners
Brucellosis
Positive test
Must cull kennel because cannot guarantee eradication
Brucellosis
Infection
High bacterial load found in: vaginal discharge, semen, aborted tissues
Mid-late term abortions = most common; early embryonic death and abortion at any stage
Brucellosis
Location
Bacteria migrate to reproductive tissues; epididymitis, orchitis, prostatitis, discospondylitis, scrotal dermatitis, testicular degeneration
Brucellosis
Screening Test
Serology (antibodies):
Takes time to develop antibodies
Can go into quiescence
Brucellosis
Confirmation test
Agar gel immunodiffusion
Do NOT do a culture; dangerous to lab
PCR is a sensitive test
Brucellosis: Persistent infection
Antimicrobials; tetracyclines, aminoglycosides, fluoroquinolones
Depopulation of kennel; can resolve clinical signs but Brucellosis most likely still present
Isolate and test new animals
Canine Herpesvirus 1
Background
Only dogs are susceptible
Virus located in oronasal and genital secretions
Infection by mucosal route and transplacental
Canine Herpesvirus 1
Clinical Signs
Variable and self-limiting Occular inflammation (can be serious) Trachea-bronchitis Vaginitis Posthitis
Lymphoid hyperplasia and vesicles on mucosa of vagina or penis
Canine Herpesvirus 1
Diagnosis
PCR
Paired serum samples
Canine Herpesvirus 1
Treatment
No effective treatment or vaccine
Canine Herpesvirus 1
Most important fact to know (mom and puppies)
Infection of a naive female in late gestation or naive puppies after whelping results in abortion or death of the entire litter before two weeks of age
After initial infection the female provides maternal immunity for puppies and neonatal loss does not occur
Infectious diseases reported as causing infertility or abortion in cats (5 main)
Feline leukemia virus Feline immunodeficiency virus Feline herpesvirus Feline panleukopenia Toxoplasma gondii
Pregnancy Edema
Rare
Swelling of distal rear limbs, mammary glands and perineum; could interfere with whelping
Generally large breed dogs with large litter
See normal albumin level
Pregnancy Edema
Treatment
Caesarean section
Termination of pregnancy
Rule out systemic disease
Normal post-partum discharge time
4 to 8 weeks
Sub-involution of placental sites
Bleeding and discharge lasting more than 8 weeks and can be profuse
Trophoblastic cells persist after whelping in endometrium and myometrium => uterus cannot involute
Sub-involution of placental sites
Diagnostics
Ultrasound
Cytology of discharge
Sub-involution of placental sites
Treatment
Spontaneous remission can occur
No effective medical treatment -> requires ovariohysterectomy if severe
Post-partum metritis
What is it
Endometrial and myometrial inflammation (severe) immediately after whelping
Post-partum metritis
Causes
Difficult delivery
Retained placenta
Retained fetus
Contamination during delivery
Post-partum metritis
Clinical Signs
Dark blood vaginal discharge
Fever
Depression
Fading puppies
Can go into shock and possibly die
Post-partum metritis
Diagnostics
CBC: normal to severe immature neutrophilic leukocytosis
Cytology of discharge: neutrophilia and bacteria
Post-partum metritis
Treatment
IV fluid therapy
Antibiotics
Possible ovariohysterectomy
Prostaglandin F2alpha may help with uterine evacuation if cervix is open and patient is systemically stable
Oxytocin is too short acting and is already being produced by mom
No flushing uterus like they do in large animal
Mastitis
What is it?
Focal or diffuse mammary gland swelling
Mastitis
Clinical Signs
Can occur secondary to metritis
Reddened abnormally firm glandular tissue
May progress to dark discolored and then open draining abscess (needs to drain but may not be enough to help)
Can become systemically ill
Mastitis
Treatment
Antibiotic treatment early:
Cephalosporin, clavulanate/amoxicillin
Could do bacterial culture
Okay if puppy drinks from infected gland, try and strip gland; will be hard to keep puppies away
Warm compress
May have to perform mastectomy with severe necrosis
Short Interestrus Interval
How long?
What is it?
Interestrus period is less than 4-5 months
May not be long enough of a quiescence for uterine repair (involution, preparation for next estrus) –> could cause infertility
What is split heat?
Comes into proestrus but never into estrus; skips estrus and enters diestrus
Low progesterone after first estrogen bump when progesterone should raise
Split Heat
Vaginal cytology
Looks like diestrus
Short Interestrus Interval
Treatment
Suppress onset of estrus to prolong anestrus
Milbolerone (testosterone analog)
Testosterone
Contraceptives
Caution: may develop idiosyncratic liver failure
No Estrus in Past 12 Months
One question to ask:
Has estrus ever occurred?
No Estrus in Past 12 Months:
Never had an estrus…(4)
Primary anestrus
Inadequate detection/silent heat
Disorder of sexual development
Stress related (working dogs; usually have to stop competing for about 1 year, also take off any performance enhancing drugs)
No Estrus in Past 12 Months:
Has had a estrus before…(5)
Metabolic disorder (thyroid, Addisons)
Inadequate detection/silent heat
Luteal cysts
Past medications for estrus suppression prolonged effect
Stress related (working dogs; usually have to stop competing for about 1 year, also take off any performance enhancing drugs)
Causes for a female to be persistently in estrus:
Neoplasia (granulosa cell or adrenal tumor)
Follicular cysts
Vaginal disease
Normal interestrus and has not come into estrus
4 Causes
Breeding management (ovulation timing, semen quality, AI)
Prolonged effect of medication to control cycles
Infection (Brucellosis)
Abnormal tubular tract (vagina, cervix, uterus, oviducts)
Estrus Induction
What should you do prior?
If she has never had an estrus cycle than this will not work
Complete evaluation for other systemic diseases (hypothyroidism, hypoadrenocorticism, luteal cysts)
Must be in proper body condition
See if she is in silent heat by placing her with proven male
Estrus Induction
Estrogen use
Estrogen does NOT lead to normal estrus
Estrus Induction
GnRH
Variable success and not available in US
Estrus Induction
Dopamine agonist
Suppresses prolactin and stimulates FSH and LH production
Cabergoline; daily oral med, estrus expected within 30 days, may not be fertile
Ovarian Remnant Syndrome
Clinical Signs
Estrus behavior in patient with previous ovariohysterectomy/ovariectomy
Ovarian Remnant Syndrome
Diagnosis
Performing abdominal explore
Vaginal cytology may show estrogen effect
Serum progesterone 2-4 weeks after display of estrus behavior
Constant increase in LH = ovaries gone
Pyometra; disease of which part of cycle?
Diestrus
Due to progesterone: decrease in uterine contractility and secretions, closes cervix
Pyometra
Breeds
Rough Collie Rottweiler Cavalier King Charles Spaniel Bernese Mountain Dog Golden Retriever Saint Bernard Chow
Pyometra - Dog
Age
Onset
8-9 years
0-15 weeks following estrus
True or False: Pseudocyesis increases chance of pyometra
False!
True or False: Females which have had one or more litters have lower incidence than females who have never whelped
True
Pyometra - Cat
Age
5 years
Pyometra
Treatment
Ovariohysterectomy Medical management (rare)
True or False: Once a female has had a pyometra and she cleared it she is not likely to have another
False
Also, owner MUST get her pregnant next cycle and recommended to spay after this litter is delivered
Bacteria most commonly isolated from pyometra
E. Coli
Estrogen Function
Proestrus and estrus Endometrial proliferation Increase vascularity Relaxes cervix Sensitizes progesterone receptors Effects support conception and early pregnancy
Progesterone Function
Luteal phase of estrous cycle (diestrus) Closure of cervix Reduce uterine contractility Stimulates endometrial glands Inhibits local immunity Support pregnancy and pyometra
Cystic Endometrial Hyperplasia
What is it?
Degenerative changes to the uterus; a old uterus
Cystic structures
Increased glandular elements
Chronicity -> fibrosis
Pyometra
Laboratory Findings
Leukocytosis (30,000+)
Left shift and toxic neutrophils
Anemia
25% = normal
Pyometra
Vaginal cytology
Diestrus with large number of degenerating PMNs and bacteria
Pyometra
Diagnosis Imaging modalities
Radiography
Ultrasound
Pyometra
Stabilization
Usually in septic shock:
IV fluids, oxygen, plasma expanders
Short acting corticosteroids
Antibiotics: Broad spectrum (ampicillin, amoxicillin, clavulanate)
Must stabilize before surgery
