Problem Pregnancy Flashcards
Cabergoline
- Dopamine agonist and anti-prolactin
- Used with dinoprost for medical termination of pregnancy
Prostaglandin F2 alpha
- For medical termination of pregnancy
- Can cause asthma and allergies in people
- May cause DUMBLSED signs so treat with anti-parasympathomimetics
What diagnostic test can you not miss for vaginal discharge during pregnancy?
- Brucellosis test
Hypoluteoidism definition
- Low progesterone level
- > 2-5 ng/mL required for maintenance of pregnancy
- Luteal insufficiency may be either primary problems or secondary other diseases
Progesterone for hypoluteoidism
- Use cautiously
- Diminishes uterine muscular contraction and maintains cervical closure
- May cause pyometra if uterine infection is present
- Exogenous progesterone can cause masculinization of fetus particularly during first seven weeks of gestation
- Altrenogest or allytrenbolone is preferred for oral vs progesterone in oil by injection
Treatment for vaginal discharge
- C-section if overdue
- OVH if serious disease or serious infection
- Abx (empirically clavamox or Cephalosporin)
- Antibiotics based on C&S
- Rest
- Monitor uterine contractions
Ovarian remnant syndrome
Estrus behavior in patient with previous OVH/ovariectomy
What to do with ovarian remnant syndrome to confirm that there is an ovarian remnant?
- Vaginal cytology showing estrogen effects
- Increased serum progesterone 2-4 weeks after display of estrus behavior
- Consistently increased LH in absence of functioning ovaries
- Presence of anti-Mullerian hormone (ovarian remnant)
Pyometra
- life threatening uterine infection
- Purulent fluid in uterine lumen
- Disease of diestrus
When does pyometra occur in the estrous cycle?
- Diestrus
Breeds with increased incidence of pyometra
- Rough collie
- Rottweiler
- Cavalier King Charles Spaniel
- Bernese Mountain Dog
- Golden Retriever
- Saint Bernard
- Chow
When does pyometra occur?
- Range 8 months to 15 years
- Mean age 8-9 years in a bitch
Time following estrus for pyometra in a bitch vs in a queen
- 0-15 weeks in a bitch
- 4 weeks following estrus in queen
Nulliparous vs multiparous risk for pyometra
- Bitches which have had one or more litters have lower incidence than bitches never whelping
Pseudocyesis effect on pyometra?
- False pregnancy does not increase risk of pyometra
Treatment for pyometra
- Ovariohysterectomy
- Medical management in select cases
Estrogen effects
- Proestrus and estrus
- Endometrial proliferation
- Increased vascularity
- Relaxes cervix
- Sensitizes progesterone receptors
- Effects support conception and early pregnancy
Progesterone effects
Luteal phase of estrous cycle
- CLosure of cervix
- Reduce uterine contractility
- Stimulates endometrial glands
- Inhibits local immunity
- Effects support pregnancy and pyometra
Most common bacteria in pyometra
- E. coli
- Intestinal microflora
- Often UTI
E. coli virulence factors
- Alpha hemolysin
- Cytotoxic necrotizing factor
- Endotoxins
What’s responsible for the clinical signs of pyometra?
- Endotoxins
Cystic endometrial hyperplasia
- Degenerative change of uterus
- Four type classifications
- Cobblestome endometrium
- Cystic structures
- Increased glandular elements
- CHronicity leads to fibrosis
- Correlated but doesn’t cause pyometra
Cystic endometrial hyperplasia - does it lead to pyometra?
- No
Serosanguinous discharge in pyometra likely organism
- E. coli
Mucoid discharge in pyometra likely organism
Streptococcus
Clinical signs of Pyometra
- PU/PD
- Vomiting
- Diarrhea
- Dehydration
- Abdominal distension
- Fever or hypothermia
- Sick, depressed intact bitch - think pyometra
Abdominal palpation of pyometra
- Tubular structure of general fluid distension
- Careful with palpation
Laboratory findings of pyometra
- Leukocytosis
- Left shift and toxic
- 25% have normal
- Anemia
- Vaginal cytology of diestrus often with large numbers of degenerating PMNs and bacteria
Radiography of pyometra
- Fluid filled tubular mass
- Cannot differentiate early pregnancy, hydrometra, mucometra
Ultrasonography of pyometra
- Enlarged uterus with variable fluid filling
- Fluid is echogenic with swirling pattern
Critical care of pyometra
- Stabilize
- IVF, oxygen, plasma expanders
- Short acting corticosteroids
- Antibiotics: broad spectrum (Clavamox)
- Caution with nephrotoxic antibiotics like aminoglycosides
Surgery for pyometra
- OVH once stabilized
- Requires adequate equipment
- Large incision
- Prepare for possible abdominal contamination
- Careful closure of vaginal/cervical area
Medical therapy for pyometra case selection
- Open cervix
- Otherwise healthy bitch
- No CEH
- Need to preserve genetics
- Luteolysis to decrease progesterone
- Evacuate uterus
- Appropriate antibiotics 4-6 week therapy**
- Long term repeated antibiotic therapy
- OVH after breeding
Treatment of unwanted pregnancy in a female not intended for breeding
- Ovariohysterectomy
Treatment of unwanted pregnancy in a female intended for breeding
- First of all, wait to see if they are pregnant as 40% of mis-matings don’t result in pregnancy
- Wait 30 days to ultrasound
- If pregnant, consider medical termination
Estrogen for medical termination of pregnancy
- DO NOT USE
- Can cause pyometra and bone marrow dyscrasia
Medications for termination of pregnancy
- Prostaglandin F2 alpha +/- Cabergoline or bromocriptine (dopamine agonists)
- Induce luteolysis and diminish progesterone levels that way
Progesterone receptor antagonists
- Aglepristone or mifepristone not available for veterinary use in the US
Which form of prostaglandin F2alpha would you use for problem pregnancy?
- Dinoprost (lutalyse)
- Caution as there is a narrow therapeutic index
- Avoid strong prostaglandin synthetics
Is any vaginal discharge during pregnancy normal?
- No
- Possible clear mucoid discharge close to onset
Causes of vaginal discharge
- Past term with abnormal whelping
- Transient “problem” pregnancy
- Miscarriage or abortion
Diagnostics for vaginal discharge during pregnancy
- Brucella test!! (maintain isolation and biosecurity if suspicion of brucellosis
- CBC and chem screen
- Urinalysis
- Ultrasound and radiography
- Cytology of discharge and vaginal cytology
- Bacterial C&S if indicated
- Serum progesterone
Brucellosis incidence in NA
- Low but devastating impact
Which species of Brucella causes canine infection primarily?
- B. canis
Brucella public health
- zoonotic disease
- Owners must be informed, and clinical staff must be protected
How is Brucellosis transmitted?
- Exposure to infectious fluids, aborted tissues, and semen
- Bacteria then move preferentially to reproductive organs
When does Brucella cause abortions?
- mid to late term abortion is classic, but there is possibility of early embryonic death and abortion at any stage in gestation
Brucella and male reproductive organs
- Can spread hematogenously and infect most organs of the male reproductive tract
- Also can cause diskospondylitis
- Teratozoospermia, testicular degeneration
Brucellosis diagnosis
- Screening test by serology
- Can have a false negative if tested too soon after infection or a long time after infection
- organism is intracellular and infection can return in animals which are stressed
- Cross reactivity may lead to false positive
- AGID is a confirmatory test
- PCR is highly sensitive
- DO NOT DO BACTERIAL CULTURE
Treatment of Brucellosis
- Antimicrobials (fluoroquinolones, aminoglycosides, tetracyclines)
- Depopulation of kennel would be required to eliminate
- All new animals should be isolated and tested before placement with non-infected animals
- Frequent travel and exposure to other animals make prevention problematic and strict biosecurity quite difficult
Canine herpesvirus 1 seropositivity
30% in NA canines vs 80% in European canines
Where is the virus secreted with canine herpesvirus?
- Oronasal and genital secretions
- Infection by mucosal route and transplacental
Clinical signs associated with canine herpesvirus 1
- Ocular inflammation, tracheobronchitis, vaginitis, posthitis
- Lymphoid hyperplasia an vesicles on the mucosa of vagina and penis
- Generally self-limiting
When is canine herpesvirus a problem for puppies?
- Infection of naive bitch in late gestation or naive puppies after whelping results in abortion of death of the entire litter before two weeks of age
Post-mortem findings in dead puppies infected with canine herpesvirus 1
- Multifocal hemorrhage and necrosis of the kidneys, livers, and lungs
Why are puppies protected from herpesvirus if the mom had been infected prior to late gestation?
- Maternal antibodies
Treatment for canine herpesvirus
No effective treatment or vaccine
Pregnancy edema description
- Swelling of distal rear limbs, mammary glands, and perineum
- Normal serum albumin level
Who gets pregnancy edema?
- large dogs with large litters
Problems with pregnancy edema
- Can interfere with whelping
Treatment of pregnancy edema
- may resolve after C section
- May require pregnancy termination
- Rule out other systemic disease like thrombosis
Sub-involution of placental sites description
- Normal mild post-partum discharge can last for 4-8 weeks
- SIPS bleeding and discharge is prolonged and may be profuse
- Trophoblastic cells persist in endometrium and myometrium
Diagnosis of SIPS
- Ultrasound
- Cytology of discharge
Treatment of SIPS
- Spontaneous remission can occur
- NO effective medical treatment so may need OVH if severe
Post-partum metritis
- endometrial and myometrial inflammation immediately after whelping
What type of discharge can occur with post-partum metritis?
- Dark bloody vaginal discharge, fever, depression, fading puppies
Diagnosis of post-partum metritis
CBC may be normal to severe immature neutrophilic leukocytosis
- Cytology of discharge shows neutrophils and bacteria
Causes of post-partum metritis
- Difficult delivery
- Retained placenta
- Retained fetus
Treatment of post-partum metritis
- IVF, antibiotics, possible ovariohysterectomy?
- Prostaglandin F2alpha may help with uterine evacuation if cervix is open and patient is systemically stable
Mastitis
- Focal or diffuse mammary gland swelling
- Reddened abnormally firm glandular tissue that may progress to dark discolored then open draining abscess
- Bitches may become systemically ill
Treatment for mastitis
- Early abx important
- Cephalosporin or clavamox
- Bacterial milk culture with sensitivity may be useful
- Warm compress and gentle stripping of milk is helpful too
- May need mastectomy if severe
Proven female
- Produced litter within the past two years and has had regular cycles
Proven male
Sired litter within the last 6 months
Split heat
- Bitch comes into proestrus but never cycles into a full-blown estrus
- FSH and LSH are stimulating cells around developing follicles at a level that produces an estrogen surge but not producing in a manner that will proceed into proestrus
Diagnosis of split heat
- Cytology can’t differentiate
- Can run a serum progesterone 2-3 weeks after, which would be elevated if it were a normal estrus
Treatment of split heat
- It’s pretty normal, so no need to treat
Short interestrus interval definition
- Interestrus periods less than 4-5 months
Why is a short interestrus period a problem?
- No time for quiescence and involution and preparation for next estrus cycle
Treatment for short interestrus period
- Testosterone
- Mibolerone (testosterone analog)
Side effect of tesosterone or mibolerone
- Idiosyncraitc liver failure
What should you consider first if there’s no estrus in the past 12 months?
- Has estrus ever occurred
Dfdx for estrus never occurring
- Primary anestrus
- Inadequate detection/silent heat
- Disorder of sexual development
- Stress related (excess training)
Dfdx for no estrus in the past 12 months but have had estrus in the past?
- Stress
- Inadequate heat detection
- Silent heat
- Luteal cysts (may or may not be functional)
- Past medications for estrus suppression having a prolonged effect
- Metabolic disorders
Dfdx for an abnormally short interestrus period (<5 months)
- Split heat
- Incomplete uterine involution or shorter interestrus period
Dfdx for an animal persistently in estrus
- Neoplasia
- Follicular cysts
- vaginal disease perceived as estrus
What four things to consider if interestrus period is normal but the bitch is infertile?
- Breeding management (ovulation timing, semen quality, insemination)
- Prolonged effect of medication to control cycles (megestrol, mibolerone, testosterone)
- Infeing estrction (Brucella)
- Abnormal tubular tract (vagina, cervix, uterus, oviducts)
Likelihood of success of estrus induction if no prior estrus
- Unlikely
- May be a chromosomal abnormality
What to do before inducing estrus?
- Complete evaluation of other systemic disease
- Hypothyroid
- Hypoadrenocorticism
- Luteal cysts
- Attend to proper BCS and nutrition
- Stimulate estrus by exposing to other cycling females
- Observe male and female behavior over time to detect silent heat
How to induce estrus?
- Estrogen therapy won’t do it
- Variable success with GnRH
- Dopamine agonist therapy!! (Suppresses prolactin and stimulates FSH and LH)
- Bromocriptine or cabergoline
Cabergoline to induce estru
- Daily oral
- Estrus expected within 30 days if it works
- Estrus may not be fertile
How do dopamine agonists induce estrus?
- Suppress prolactin and stimulate FSH and LH
