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SA Therio > Problem Pregnancy > Flashcards

Problem Pregnancy Flashcards

1
Q

Cabergoline

A
  • Dopamine agonist and anti-prolactin

- Used with dinoprost for medical termination of pregnancy

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2
Q

Prostaglandin F2 alpha

A
  • For medical termination of pregnancy
  • Can cause asthma and allergies in people
  • May cause DUMBLSED signs so treat with anti-parasympathomimetics
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3
Q

What diagnostic test can you not miss for vaginal discharge during pregnancy?

A
  • Brucellosis test
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4
Q

Hypoluteoidism definition

A
  • Low progesterone level
  • > 2-5 ng/mL required for maintenance of pregnancy
  • Luteal insufficiency may be either primary problems or secondary other diseases
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5
Q

Progesterone for hypoluteoidism

A
  • 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
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6
Q

Treatment for vaginal discharge

A
  • 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
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7
Q

Ovarian remnant syndrome

A

Estrus behavior in patient with previous OVH/ovariectomy

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8
Q

What to do with ovarian remnant syndrome to confirm that there is an ovarian remnant?

A
  • 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)
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9
Q

Pyometra

A
  • life threatening uterine infection
  • Purulent fluid in uterine lumen
  • Disease of diestrus
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10
Q

When does pyometra occur in the estrous cycle?

A
  • Diestrus
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11
Q

Breeds with increased incidence of pyometra

A
  • Rough collie
  • Rottweiler
  • Cavalier King Charles Spaniel
  • Bernese Mountain Dog
  • Golden Retriever
  • Saint Bernard
  • Chow
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12
Q

When does pyometra occur?

A
  • Range 8 months to 15 years

- Mean age 8-9 years in a bitch

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13
Q

Time following estrus for pyometra in a bitch vs in a queen

A
  • 0-15 weeks in a bitch

- 4 weeks following estrus in queen

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14
Q

Nulliparous vs multiparous risk for pyometra

A
  • Bitches which have had one or more litters have lower incidence than bitches never whelping
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15
Q

Pseudocyesis effect on pyometra?

A
  • False pregnancy does not increase risk of pyometra
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16
Q

Treatment for pyometra

A
  • Ovariohysterectomy

- Medical management in select cases

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17
Q

Estrogen effects

A
  • Proestrus and estrus
  • Endometrial proliferation
  • Increased vascularity
  • Relaxes cervix
  • Sensitizes progesterone receptors
  • Effects support conception and early pregnancy
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18
Q

Progesterone effects

A

Luteal phase of estrous cycle

  • CLosure of cervix
  • Reduce uterine contractility
  • Stimulates endometrial glands
  • Inhibits local immunity
  • Effects support pregnancy and pyometra
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19
Q

Most common bacteria in pyometra

A
  • E. coli
  • Intestinal microflora
  • Often UTI
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20
Q

E. coli virulence factors

A
  • Alpha hemolysin
  • Cytotoxic necrotizing factor
  • Endotoxins
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21
Q

What’s responsible for the clinical signs of pyometra?

A
  • Endotoxins
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22
Q

Cystic endometrial hyperplasia

A
  • Degenerative change of uterus
  • Four type classifications
  • Cobblestome endometrium
  • Cystic structures
  • Increased glandular elements
  • CHronicity leads to fibrosis
  • Correlated but doesn’t cause pyometra
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23
Q

Cystic endometrial hyperplasia - does it lead to pyometra?

A
  • No
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24
Q

Serosanguinous discharge in pyometra likely organism

A
  • E. coli
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25
Q

Mucoid discharge in pyometra likely organism

A

Streptococcus

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26
Q

Clinical signs of Pyometra

A
  • PU/PD
  • Vomiting
  • Diarrhea
  • Dehydration
  • Abdominal distension
  • Fever or hypothermia
  • Sick, depressed intact bitch - think pyometra
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27
Q

Abdominal palpation of pyometra

A
  • Tubular structure of general fluid distension

- Careful with palpation

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28
Q

Laboratory findings of pyometra

A
  • Leukocytosis
  • Left shift and toxic
  • 25% have normal
  • Anemia
  • Vaginal cytology of diestrus often with large numbers of degenerating PMNs and bacteria
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29
Q

Radiography of pyometra

A
  • Fluid filled tubular mass

- Cannot differentiate early pregnancy, hydrometra, mucometra

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30
Q

Ultrasonography of pyometra

A
  • Enlarged uterus with variable fluid filling

- Fluid is echogenic with swirling pattern

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31
Q

Critical care of pyometra

A
  • Stabilize
  • IVF, oxygen, plasma expanders
  • Short acting corticosteroids
  • Antibiotics: broad spectrum (Clavamox)
  • Caution with nephrotoxic antibiotics like aminoglycosides
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32
Q

Surgery for pyometra

A
  • OVH once stabilized
  • Requires adequate equipment
  • Large incision
  • Prepare for possible abdominal contamination
  • Careful closure of vaginal/cervical area
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33
Q

Medical therapy for pyometra case selection

A
  • 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
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34
Q

Treatment of unwanted pregnancy in a female not intended for breeding

A
  • Ovariohysterectomy
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35
Q

Treatment of unwanted pregnancy in a female intended for breeding

A
  • 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
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36
Q

Estrogen for medical termination of pregnancy

A
  • DO NOT USE

- Can cause pyometra and bone marrow dyscrasia

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37
Q

Medications for termination of pregnancy

A
  • Prostaglandin F2 alpha +/- Cabergoline or bromocriptine (dopamine agonists)
  • Induce luteolysis and diminish progesterone levels that way
38
Q

Progesterone receptor antagonists

A
  • Aglepristone or mifepristone not available for veterinary use in the US
39
Q

Which form of prostaglandin F2alpha would you use for problem pregnancy?

A
  • Dinoprost (lutalyse)
  • Caution as there is a narrow therapeutic index
  • Avoid strong prostaglandin synthetics
40
Q

Is any vaginal discharge during pregnancy normal?

A
  • No

- Possible clear mucoid discharge close to onset

41
Q

Causes of vaginal discharge

A
  • Past term with abnormal whelping
  • Transient “problem” pregnancy
  • Miscarriage or abortion
42
Q

Diagnostics for vaginal discharge during pregnancy

A
  • 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
43
Q

Brucellosis incidence in NA

A
  • Low but devastating impact
44
Q

Which species of Brucella causes canine infection primarily?

A
  • B. canis
45
Q

Brucella public health

A
  • zoonotic disease

- Owners must be informed, and clinical staff must be protected

46
Q

How is Brucellosis transmitted?

A
  • Exposure to infectious fluids, aborted tissues, and semen

- Bacteria then move preferentially to reproductive organs

47
Q

When does Brucella cause abortions?

A
  • mid to late term abortion is classic, but there is possibility of early embryonic death and abortion at any stage in gestation
48
Q

Brucella and male reproductive organs

A
  • Can spread hematogenously and infect most organs of the male reproductive tract
  • Also can cause diskospondylitis
  • Teratozoospermia, testicular degeneration
49
Q

Brucellosis diagnosis

A
  • 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
50
Q

Treatment of Brucellosis

A
  • 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
51
Q

Canine herpesvirus 1 seropositivity

A

30% in NA canines vs 80% in European canines

52
Q

Where is the virus secreted with canine herpesvirus?

A
  • Oronasal and genital secretions

- Infection by mucosal route and transplacental

53
Q

Clinical signs associated with canine herpesvirus 1

A
  • Ocular inflammation, tracheobronchitis, vaginitis, posthitis
  • Lymphoid hyperplasia an vesicles on the mucosa of vagina and penis
  • Generally self-limiting
54
Q

When is canine herpesvirus a problem for puppies?

A
  • 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
55
Q

Post-mortem findings in dead puppies infected with canine herpesvirus 1

A
  • Multifocal hemorrhage and necrosis of the kidneys, livers, and lungs
56
Q

Why are puppies protected from herpesvirus if the mom had been infected prior to late gestation?

A
  • Maternal antibodies
57
Q

Treatment for canine herpesvirus

A

No effective treatment or vaccine

58
Q

Pregnancy edema description

A
  • Swelling of distal rear limbs, mammary glands, and perineum
  • Normal serum albumin level
59
Q

Who gets pregnancy edema?

A
  • large dogs with large litters
60
Q

Problems with pregnancy edema

A
  • Can interfere with whelping
61
Q

Treatment of pregnancy edema

A
  • may resolve after C section
  • May require pregnancy termination
  • Rule out other systemic disease like thrombosis
62
Q

Sub-involution of placental sites description

A
  • 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
63
Q

Diagnosis of SIPS

A
  • Ultrasound

- Cytology of discharge

64
Q

Treatment of SIPS

A
  • Spontaneous remission can occur

- NO effective medical treatment so may need OVH if severe

65
Q

Post-partum metritis

A
  • endometrial and myometrial inflammation immediately after whelping
66
Q

What type of discharge can occur with post-partum metritis?

A
  • Dark bloody vaginal discharge, fever, depression, fading puppies
67
Q

Diagnosis of post-partum metritis

A

CBC may be normal to severe immature neutrophilic leukocytosis

  • Cytology of discharge shows neutrophils and bacteria
68
Q

Causes of post-partum metritis

A
  • Difficult delivery
  • Retained placenta
  • Retained fetus
69
Q

Treatment of post-partum metritis

A
  • IVF, antibiotics, possible ovariohysterectomy?

- Prostaglandin F2alpha may help with uterine evacuation if cervix is open and patient is systemically stable

70
Q

Mastitis

A
  • 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
71
Q

Treatment for mastitis

A
  • 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
72
Q

Proven female

A
  • Produced litter within the past two years and has had regular cycles
73
Q

Proven male

A

Sired litter within the last 6 months

74
Q

Split heat

A
  • 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
75
Q

Diagnosis of split heat

A
  • Cytology can’t differentiate

- Can run a serum progesterone 2-3 weeks after, which would be elevated if it were a normal estrus

76
Q

Treatment of split heat

A
  • It’s pretty normal, so no need to treat
77
Q

Short interestrus interval definition

A
  • Interestrus periods less than 4-5 months
78
Q

Why is a short interestrus period a problem?

A
  • No time for quiescence and involution and preparation for next estrus cycle
79
Q

Treatment for short interestrus period

A
  • Testosterone

- Mibolerone (testosterone analog)

80
Q

Side effect of tesosterone or mibolerone

A
  • Idiosyncraitc liver failure
81
Q

What should you consider first if there’s no estrus in the past 12 months?

A
  • Has estrus ever occurred
82
Q

Dfdx for estrus never occurring

A
  • Primary anestrus
  • Inadequate detection/silent heat
  • Disorder of sexual development
  • Stress related (excess training)
83
Q

Dfdx for no estrus in the past 12 months but have had estrus in the past?

A
  • 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
84
Q

Dfdx for an abnormally short interestrus period (<5 months)

A
  • Split heat

- Incomplete uterine involution or shorter interestrus period

85
Q

Dfdx for an animal persistently in estrus

A
  • Neoplasia
  • Follicular cysts
  • vaginal disease perceived as estrus
86
Q

What four things to consider if interestrus period is normal but the bitch is infertile?

A
  • 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)
87
Q

Likelihood of success of estrus induction if no prior estrus

A
  • Unlikely

- May be a chromosomal abnormality

88
Q

What to do before inducing estrus?

A
  • 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
89
Q

How to induce estrus?

A
  • Estrogen therapy won’t do it
  • Variable success with GnRH
  • Dopamine agonist therapy!! (Suppresses prolactin and stimulates FSH and LH)
  • Bromocriptine or cabergoline
90
Q

Cabergoline to induce estru

A
  • Daily oral
  • Estrus expected within 30 days if it works
  • Estrus may not be fertile
91
Q

How do dopamine agonists induce estrus?

A
  • Suppress prolactin and stimulate FSH and LH

SA Therio (10 decks)

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