Reproductive Emergencies Flashcards
If you have a patient with abnormal vaginal bleeding and you wish to perform cytology and digital exam, which order should these go in and why?
vaginal cytology 1st, then digital exam to avoid the lubrication from getting into your cytology sample and to avoid contamination.
what 3 reflexes should you look for in neonates?
- suckling
- righting
- rooting
what are the 3 “H’s” also known as the neonatal killers?
- hypothermia
- hypoglycemia
- hypovolemia
If a neonate presents to your clinic and does NOT have hair on the distal portions of the limbs, what can you infer?
this puppy is premature. hair on the extremities is the last thing to develop.
the prognosis is not great because there may be other prematurities such as the lungs causing fish-breathing.
A client presents to your clinic with neonatal puppies that ADR. You examine them and determine that they have decreased activity, are bradycardic, have decreased nursing reflex, and pale MM.
You check their blood glucose and its low. The thermometer wont read, so you believe the issue is likely hypothermia and hypoglycemia. How should you go about treating these puppies?
- warm them slowly (1 degree per hour) using an incubator, warming pad, or heating lamp
- feed WARM milk once their temperature is above 96F (if you feed them while they are too cold, they could bloat, get aspiration pneumonia, and have ileus)
- WARM fluids
- bolus dextrose/glucose IV or IO over 10-15 min.
Neonatal puppies are at risk for hypovolemia because their compensatory mechanisms to circulatory changes and fluid homeostasis are not mature until 8 weeks of age. How should you treat hypovolemic neonates?
- isotonic fluids (IV, IO, or SQ) at shock bolus, then maintenance. be extra careful not to overload them because of the immature compensatory mechanisms.
- feed with orogastric tube or bottle (if nursing reflex present)
- monitor BQ q6-12h
- monitor urine output, color, USG
- monitor MM color
what are 4 viral causes of sick canine neonates or neonatal mortality?
- canine parvovirus
- canine distemper virus
- canine adenovirus
- canine herpesvirus
What is the treatment for agalactia?
metoclopramide
milk will come in after 3-5 doses
A client brings her dog to you who has just had puppies. The client claims that the dog is not good at being a mom and she keep leaving her puppies. What can you do to help this?
- give sepia (7-10 pills/hr)
- intranasal oxytocin
- use adaptil spray/infuser
- make sure whelping box is in quiet area with optimal temp and humidity.
if they do not improve, do not breed her again.
T/F: hypocalcemia does not usually occur prepartum in small animals
true
when is hypocalcemia most common in small animals?
2 weeks postpartum, but can occur anytime within the 1st 4 weeks postpartum
A client brings her dog into your clinic because she recently had puppies and is nnot acting right. She has lost interest in her puppies, has been panting and being restless, has been itching her face a bunch, and experiencing muscle twitching. What diagnostic test do you want to run on her?
blood ionized calcium
A client brings her dog into your clinic because she recently had puppies and is nnot acting right. She has lost interest in her puppies, has been panting and being restless, has been itching her face a bunch, and experiencing muscle twitching. Her blood ionized calcium is 0.6 (LOW), so you diagnose her with hypocalcemia. How do you treat this patient?
- have puppies drink milk replacer for 12-24 hr during initial treatment
- can give IV or SQ 10% Ca-gluconate
- send patient home with calcium carbonate tablets (TUMS)
- recheck
- correct the dams nutrition is this was the problem, make sure owners also are not supplementing any calcium
- reintroduce pups; if signs recur, then wean permanently.
when does mastitis commonly occur in dams?
first 2-3 weeks post-partum (peak lactation)
A client brings her dog to you because she has swollen, edematous, firm, painful mammary glands and she has not eaten in 2 days. She claims that the dams milk is normal so she is not sure what is going on with the dog. On exam, she has a fever. You collect a sample of the milk and its purulent, red-brown, and thick.
What diagnostic test do you want to run?
aseptic collection of milk in red-top tube and send for culture and sensitivity +/- cytology.
maybe do ultrasound to look for any abscesses
A client brings her dog to you because she has swollen, edematous, firm, painful mammary glands and she has not eaten in 2 days. She claims that the dams milk is normal so she is not sure what is going on with the dog. On exam, she has a fever. You collect a sample of the milk and its purulent, red-brown, and thick.
The culture results came back with heavy growth of staph and e. coli, plus some klebsiella.
How are you planning to treat this patient?
Since there is no necrosis, we can just start her on antibiotics according to the c/s.
Give her something for pain and inflammation (carprofen)
The teats will need to be stripped, so you can advise the client that it is ok for the puppies to continue nursing.
Recommend warm compress after nursing or applying cabbage to decrease edema.
T/F: a severe case of mastitis that causes necrosis of the mammary tissue requires surgical removal of the mammary gland
false – you can allow the tissue to declare itself and then apply tie-over bandages with honey. They may heal within 2 weeks.
When does metritis commonly occur?
1-3 weeks post-partum
what are risk factors for metritis?
- retained placenta
- retained fetus
- dystocia and obstetrical manipulation
- prolonged labor
- poor hygiene
- concurrent mastitis
A dog presents to your clinic 1 week postpartum. The owners say she did not have any birthing issues, but lately has been lethargic, not eating, vomiting, and has a bit of vaginal discharge. She also hasnt been wanting her puppies to nurse as often. On exam, she has malodorous, reddish-brown vulvar discharge. What diagnostics would you like to run?
- vaginal cytology
- ultrasound
- CBC
A dog presents to your clinic 1 week postpartum. The owners say she did not have any birthing issues, but lately has been lethargic, not eating, vomiting, and has a bit of vaginal discharge. She also hasnt been wanting her puppies to nurse as often. On exam, she has malodorous, reddish-brown vulvar discharge.
On cytology you see many degenerate PMNs and bacteria. Ultrasound shows intraluminal fluid, uterine wall thickening, and hyperechogenic endometrium. The CBC showed leukocytosis with left shift.
What is most likely the diagnosis?
post partum metritis
how do you treat post partum metritis?
- need to evacuate the infected material from the uterus (use PGF2a – dinoprost or cloprostenol) or OHE.
if she was in the first 24 hr post-partum, you could give oxytocin, but she is not. - antibiotics – based on c/s (obtain via guarded deep cranial vaginal swab), but ensure they are safe for neonates (amoxicillin, ampicillin, cephalosporins, amoxiclav, erythromycin, azithromycin, etc.)
- NSAIDs
- supportive care (fluids, antiemetics, etc.)
when does vaginal hyperplasia/prolapse typically occur in small animals and why?
during peak estrus because estrogen increases edema in the vaginal vault.
what are the 3 types of vaginal hyperplasia/prolapse?
- dorsal only
- dorsal and lateral
- 360 degrees
how should you treat vaginal hyperplasia/prolapse?
- identify the urethral opening and catheterize
- OHE because the problem is the estrogen source (ovaries) and most cases will reoccur post medical treatment if the estrogen source is not removed.
You can do epidural and replacement (hypertonic saline + replacement + purse string) but surgery will be required shortly after.
Note this condition is heritable so these animals should not be bred.
A cat presents to your clinic that is currently in labor. The owner claims there is a big red bunch of tissue coming out the back end and she has not had any more kittens. What is the diagnosis and how do you fix it?
uterine prolapse
spay! manual reduction during the spay surgery, then remove it. It will recur if you do not.
prescribe antibiotics too.
Canine paraphymosis can occur from breeding or in older males with neurologic deficits. What are the treatment recommendations?
- sedate
- reduce edema (hypertonic saline)
- lubricate and replace
- place tie-over with umbilical tape, but ensure he can still urinate through
keep patient in hospital for 24 hours and keep patient quiet/calm. No sexual arousal!
What are the 4 differentials for bleeding from the prepuce?
- trauma
- neoplasia
- UTI
- prostate disease
