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Theriogenology > Problem Pregnancy > Flashcards

Problem Pregnancy Flashcards

1
Q

Termination of Pregnancy

Why?

A

Problems during pregnancy or unwanted litter (ovariohysterectomy)

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2
Q

What must you do prior to terminating pregnancy

A

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

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3
Q

Medical termination of pregnancy

Do NOT use…

A

Estrogen within 5 days of conception!

Does prevent embryo implantation but can cause pyometra and bone marrow dyscrasia

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4
Q

Medical termination of pregnancy

Luteolysis

A

Diminish progesterone -> luteolysis

Prostaglandin F2 alpha
Carbergoline or bromocriptine
Combination of PgF2alpha and cabergoline or bromocriptine (how you also treat pyometra!)

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5
Q

Prostaglandin F2alpha

Product

A

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)

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6
Q

Prostaglandin F2alpha

Human

A

Absorbed through skin

Asthma and abortion may result

CANNOT be sent home
May want to hospitalize patient

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7
Q

Prostaglandin F2alpha

Adverse effects

A

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

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8
Q

Prostaglandin F2alpha

Rx to Diminish effects

A

Atropine
Pirifinium bromide
Metazopine

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9
Q

Prostaglandin F2alpha

Monitoring

A

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

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10
Q

Vaginal Discharge During Pregnancy

3 things to pay attention to

A

Color (red, black, brown, green, yellow)

Quantity

Odor: mucus, purulent, hemorrhagic

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11
Q

Vaginal Discharge During Pregnancy

Possible Causes

A

Past term with abnormal whelping

Miscarriage/abortion:
Primary uterine disease
Infection
Other systemic disease
Trauma
Toxin
Coagulopathy (rodenticide)

Transient “problem pregnancy”

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12
Q

Diagnostics for vaginal discharge during pregnancy:

What is the MOST important one?

A

Brucella test!

Must be placed in isolation
Zoonotic

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13
Q

Diagnostics for vaginal discharge during pregnancy

A 
Brucella test
CBC and Serum Chem
Urinalysis
Ultrasound
Radiograph
Cytology of discharge and vaginal cytology 
Bacterial Culture and Sensitivity 
Serum progesterone test
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14
Q

Hypoluteoidism

What is it? Characteristics

A

Luteal insufficiency may be either primary problem or secondary to other disease

Might be in older females

Low progesterone level

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15
Q

Hypoluteoidism

Treatment

A

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)

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16
Q

Hypoluteoidism

Treatment Precautions

A

Progesterone:
Could result in pyometra if infection is present

Will diminish uterine muscular contraction and maintains cervical closure

Can masculinize the fetus (during beginning)

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17
Q

Treatment of Vaginal Discharge

A

Caesarean section if overdue
Ovariohysterectomy if serious disease
Antibiotics (usually based on culture and sensitivity, empirical while you wait)
Rest and monitor

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18
Q

Brucellosis

Background

A

Low incidence

Must screen for B. canis in breeding animals

Cats appear resistant to Brucella

Zoonotic disease! Must notify and warn owners

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19
Q

Brucellosis

Positive test

A

Must cull kennel because cannot guarantee eradication

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20
Q

Brucellosis

Infection

A

High bacterial load found in: vaginal discharge, semen, aborted tissues

Mid-late term abortions = most common; early embryonic death and abortion at any stage

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21
Q

Brucellosis

Location

A

Bacteria migrate to reproductive tissues; epididymitis, orchitis, prostatitis, discospondylitis, scrotal dermatitis, testicular degeneration

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22
Q

Brucellosis

Screening Test

A

Serology (antibodies):
Takes time to develop antibodies
Can go into quiescence

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23
Q

Brucellosis

Confirmation test

A

Agar gel immunodiffusion

Do NOT do a culture; dangerous to lab

PCR is a sensitive test

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24
Q

Brucellosis: Persistent infection

A

Antimicrobials; tetracyclines, aminoglycosides, fluoroquinolones

Depopulation of kennel; can resolve clinical signs but Brucellosis most likely still present

Isolate and test new animals

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25
Q

Canine Herpesvirus 1

Background

A

Only dogs are susceptible

Virus located in oronasal and genital secretions

Infection by mucosal route and transplacental

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26
Q

Canine Herpesvirus 1

Clinical Signs

A 
Variable and self-limiting
Occular inflammation (can be serious)
Trachea-bronchitis
Vaginitis
Posthitis

Lymphoid hyperplasia and vesicles on mucosa of vagina or penis

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27
Q

Canine Herpesvirus 1

Diagnosis

A

PCR

Paired serum samples

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28
Q

Canine Herpesvirus 1

Treatment

A

No effective treatment or vaccine

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29
Q

Canine Herpesvirus 1

Most important fact to know (mom and puppies)

A

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

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30
Q

Infectious diseases reported as causing infertility or abortion in cats (5 main)

A 
Feline leukemia virus
Feline immunodeficiency virus
Feline herpesvirus
Feline panleukopenia 
Toxoplasma gondii
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31
Q

Pregnancy Edema

A

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

32
Q

Pregnancy Edema

Treatment

A

Caesarean section
Termination of pregnancy
Rule out systemic disease

33
Q

Normal post-partum discharge time

A

4 to 8 weeks

34
Q

Sub-involution of placental sites

A

Bleeding and discharge lasting more than 8 weeks and can be profuse

Trophoblastic cells persist after whelping in endometrium and myometrium => uterus cannot involute

35
Q

Sub-involution of placental sites

Diagnostics

A

Ultrasound

Cytology of discharge

36
Q

Sub-involution of placental sites

Treatment

A

Spontaneous remission can occur

No effective medical treatment -> requires ovariohysterectomy if severe

37
Q

Post-partum metritis

What is it

A

Endometrial and myometrial inflammation (severe) immediately after whelping

38
Q

Post-partum metritis

Causes

A

Difficult delivery
Retained placenta
Retained fetus
Contamination during delivery

39
Q

Post-partum metritis

Clinical Signs

A

Dark blood vaginal discharge
Fever
Depression
Fading puppies

Can go into shock and possibly die

40
Q

Post-partum metritis

Diagnostics

A

CBC: normal to severe immature neutrophilic leukocytosis

Cytology of discharge: neutrophilia and bacteria

41
Q

Post-partum metritis

Treatment

A

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

42
Q

Mastitis

What is it?

A

Focal or diffuse mammary gland swelling

43
Q

Mastitis

Clinical Signs

A

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

44
Q

Mastitis

Treatment

A

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

45
Q

Short Interestrus Interval
How long?
What is it?

A

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

46
Q

What is split heat?

A

Comes into proestrus but never into estrus; skips estrus and enters diestrus

Low progesterone after first estrogen bump when progesterone should raise

47
Q

Split Heat

Vaginal cytology

A

Looks like diestrus

48
Q

Short Interestrus Interval

Treatment

A

Suppress onset of estrus to prolong anestrus

Milbolerone (testosterone analog)
Testosterone
Contraceptives

Caution: may develop idiosyncratic liver failure

49
Q

No Estrus in Past 12 Months

One question to ask:

A

Has estrus ever occurred?

50
Q

No Estrus in Past 12 Months:

Never had an estrus…(4)

A

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)

51
Q

No Estrus in Past 12 Months:

Has had a estrus before…(5)

A

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)

52
Q

Causes for a female to be persistently in estrus:

A

Neoplasia (granulosa cell or adrenal tumor)

Follicular cysts

Vaginal disease

53
Q

Normal interestrus and has not come into estrus

4 Causes

A

Breeding management (ovulation timing, semen quality, AI)

Prolonged effect of medication to control cycles

Infection (Brucellosis)

Abnormal tubular tract (vagina, cervix, uterus, oviducts)

54
Q

Estrus Induction

What should you do prior?

A

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

55
Q

Estrus Induction

Estrogen use

A

Estrogen does NOT lead to normal estrus

56
Q

Estrus Induction

GnRH

A

Variable success and not available in US

57
Q

Estrus Induction

Dopamine agonist

A

Suppresses prolactin and stimulates FSH and LH production

Cabergoline; daily oral med, estrus expected within 30 days, may not be fertile

58
Q

Ovarian Remnant Syndrome

Clinical Signs

A

Estrus behavior in patient with previous ovariohysterectomy/ovariectomy

59
Q

Ovarian Remnant Syndrome

Diagnosis

A

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

60
Q

Pyometra; disease of which part of cycle?

A

Diestrus

Due to progesterone: decrease in uterine contractility and secretions, closes cervix

61
Q

Pyometra

Breeds

A 
Rough Collie
Rottweiler
Cavalier King Charles Spaniel
Bernese Mountain Dog
Golden Retriever
Saint Bernard
Chow
62
Q

Pyometra - Dog
Age
Onset

A

8-9 years

0-15 weeks following estrus

63
Q

True or False: Pseudocyesis increases chance of pyometra

A

False!

64
Q

True or False: Females which have had one or more litters have lower incidence than females who have never whelped

A

True

65
Q

Pyometra - Cat

Age

A

5 years

66
Q

Pyometra

Treatment

A 
Ovariohysterectomy
Medical management (rare)
67
Q

True or False: Once a female has had a pyometra and she cleared it she is not likely to have another

A

False

Also, owner MUST get her pregnant next cycle and recommended to spay after this litter is delivered

68
Q

Bacteria most commonly isolated from pyometra

A

E. Coli

69
Q

Estrogen Function

A 
Proestrus and estrus
Endometrial proliferation
Increase vascularity
Relaxes cervix
Sensitizes progesterone receptors 
Effects support conception and early pregnancy
70
Q

Progesterone Function

A 
Luteal phase of estrous cycle (diestrus) 
Closure of cervix
Reduce uterine contractility 
Stimulates endometrial glands
Inhibits local immunity
Support pregnancy and pyometra
71
Q

Cystic Endometrial Hyperplasia

What is it?

A

Degenerative changes to the uterus; a old uterus

Cystic structures

Increased glandular elements

Chronicity -> fibrosis

72
Q

Pyometra

Laboratory Findings

A

Leukocytosis (30,000+)
Left shift and toxic neutrophils
Anemia

25% = normal

73
Q

Pyometra

Vaginal cytology

A

Diestrus with large number of degenerating PMNs and bacteria

74
Q

Pyometra

Diagnosis Imaging modalities

A

Radiography

Ultrasound

75
Q

Pyometra

Stabilization

A

Usually in septic shock:
IV fluids, oxygen, plasma expanders
Short acting corticosteroids

Antibiotics: 
Broad spectrum (ampicillin, amoxicillin, clavulanate)

Must stabilize before surgery

Theriogenology (7 decks)

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