Physical exam vaginal exam abdominal rads fetal ultrasound blood work PCV/TS NOVA (e-lytes, BUN, creat, i-Ca, glucose)

only attempt if not obstructed, alive happy fetuses, no fetal oversize, failure to progress, contractions present Calcium inc strength of contraction give 10-15 min before oxytocin 1 ml/5.5 kg of 10% calcium gluconate Oxytocin inc frequency of contraction 0.25 U SC or IM max dose 2-4 units per bitch +/- glucose and IV fluids

That is ok but probs time to respond don't let it get down to 150/160

CV support with IV balanced e-lyte fluids during induction, anesthesia, recovery Correct metabolic derangement pre-op hypoglycemia hypovolemia clip fur before anesthesia prepare neonatal resuscitation area perioperative antibiotics stop post-op

Ventral midline incision tent linea prior to incision exteriorize uterus (gently) Options C-section C-section then OHE En bloc two layer closure aposition of cut edges inverting pattern to seal (cushings)

Near term and life threatening Gravid uterus rotates about its long axis Signs abdominal pain tenesmus serosanguinous vaginal d/c

Near term and life threatening Cause uterine trauma obstructive dystocia OT, pyometra CS abdominal pain (severe) fluid wave signs of shock febrile

Analgesia opioids IV fluids Abx if abdominal contamination with fetal fluids uterine rupture uterine torsion

Reproductive emergencies (Allen) Flashcards by Jessica Fuller

Fetal causes of dystocia

oversized fetus
- persian
- himalayan
- bulldog
singleton
hydrocephalus
anasarca
fetal monster
fetal presentation
fetal death

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Maternal causes of dystocia

Uterine inertia
- primary
- secondary
abdominal
- age
- hernia
- diaphragmatic hernia
Pelvis
- immaturity
- fracture
- neoplasia
- breed
- developmental
Uterus
- trauma
- rupture
- torsion
- developmental
Vagina
- tumor
- stricture
- septum
Hydrops (golden retriever) => lots of fluid in amniotic sac

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Causes uterine inertia

hormonal
- abnormalities of estrogen, progesterone, relaxin, prolactin, PGs
metabolic
- hypocalcemia, hypoglycemia
myometrial
- single pup, age, toxic degeneration, overstretching
Cervix, vagina, vulva
- immaturity, insufficient dilation, softening, fibrosis, disease, neoplasia, developmental abnormality
Physchologic

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High risk for dystocia

Brachycephalic breeds
toy breeds
bitches with single fetus
primiparous bitches > 6y
hx abortion/dystocia
large litters

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Dystocia diagnostics

Physical exam
vaginal exam
abdominal rads
fetal ultrasound
blood work
- PCV/TS
- NOVA (e-lytes, BUN, creat, i-Ca, glucose)

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assisted vaginal delivery

sterile gloves
sterile lube
grab puppy’s body with fingers/gauze
gentle traction
Sometimes put it back in and wait a minute

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Dystocia med tx

only attempt if
- not obstructed, alive happy fetuses, no fetal oversize, failure to progress, contractions present
Calcium
- inc strength of contraction
- give 10-15 min before oxytocin
- 1 ml/5.5 kg of 10% calcium gluconate
Oxytocin
- inc frequency of contraction
- 0.25 U SC or IM
- max dose 2-4 units per bitch
+/- glucose and IV fluids

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fetal heart rate 180

That is ok but probs time to respond
- don’t let it get down to 150/160

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cystocia pre-op

CV support with IV balanced e-lyte fluids during induction, anesthesia, recovery
Correct metabolic derangement pre-op
- hypoglycemia
- hypovolemia
clip fur before anesthesia
prepare neonatal resuscitation area
perioperative antibiotics
- stop post-op

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Neonatal resuscitation station

Trained staff
Sterile drapes
Bulb or tube suction
Small face masks
Small ET tubes
Reversal agents
Hemostats
Suture and dilute betadine
Warm area for recovery

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Anesthesia for C-section

Pre-oxygenate, induce in OR
Propofol induction
- 4-6 mg/kg or TIVA
Iso maintenance
Analgesia
- Opioids
- Lidocaine/bupivicaine block
ECG, SPO₂, BP, EtCO₂

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Surgical procedure

Ventral midline incision
tent linea prior to incision
exteriorize uterus (gently)
Options
- C-section
- C-section then OHE
- En bloc
two layer closure
- aposition of cut edges
- inverting pattern to seal (cushings)

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Uterine torsion

Near term and life threatening
Gravid uterus rotates about its long axis
Signs
- abdominal pain
- tenesmus
- serosanguinous vaginal d/c

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Uterine rupture

Near term and life threatening
Cause
- uterine trauma
- obstructive dystocia
- OT, pyometra
CS
- abdominal pain (severe)
- fluid wave
- signs of shock
- febrile

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Neonate resuscitation

Remove fetal membranes
Clear nose/mouth
- bulb syringe
Clamp umbilical cord
- 1/4 inch from body
- suture, betadine
dry neonate with towel
if no breath after 30/45s
- GV26
hot dog for warmth

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Post-operative care

Analgesia
- opioids
IV fluids
Abx if
- abdominal contamination with fetal fluids
- uterine rupture
- uterine torsion

Pregnancy toxemia

Negative energy balance
- late pregnancy
- lac of carbs => ketosis
CS
- hypoxemia
- anorexia
- weakness
- lethargy
- seizures
DX
- ketosis w/o glucosuria
TX
- nutrition
- C-section

Eclampsia

Severe hypocalcemia
- usually 1-4 weeks after birth
Predisposing factors
- improper nutrition
- oversupplementation during pregnancy
- heavy lactation
- large litter
- breed: chihuahua with large litter

Eclampsia

Clinical signs

lethargy
hyporexia
muscle fasciculations
tremors
facial rubbing
ataxia
hyperthermia
seizures

Eclampsia

DX
- i-Ca < 1.4 mmol/L
- tCa , 6.5 (dog)
- tCa, < 6.0 cat
Treatment
- ECG, 1 ml/kg calcium gluconate IV over 10-15 minutes
- improve nutrition (puppy food)
- supplement Ca

Pyometra

Middle age/older animals
often preceded by cystic endometrial hyperplasia
occurs during distrus
- high progesterone
open vs closed
causes
- e. coli
- strep, staph, enterobacter, proteus, klebsiella, pseudomonas

Pyometra

Polydipsia
Polyuria
Fever
vaginal discharge
vomiting
dehydration
anorexia
lethargy
hyperemia
septic shock

Pyo

Diagnostics

CBC/Chem/UA FREE CATCH
abdominal rads
AFAST
culture and susceptibility once removed

Pyo DDX

Pregnancy
CEH
mucometra
hydrometra
cancer

Expected labwork with pyo

* neutrophilia/neutrophilia with left shift * mild, non-regenerative anemia * azoteia * isosthenuria * hyperglycemia/hypoglycemia * mildly increased liver enzymes

Pyo tx

* stabilize * IV antibiotics * surgery OHE * aglepristone in Europe

Vaginal hyperplasia

* occurs under influence of estrogen * Diagnostic: visual * TX * if urination possible and no necrosis * keep clean * lubricate * e-collar * will repair self ince follicular phase of estrus passes * If very large may need ressection * SX OHE is definitive

Mastitis

* inflammation of mammary glands, bacterial infection * Dogs \> cats * postpartum/lactating pseudopregnant bitches * Risks * sanitation * trauma by offspring * systemic infection

Mastitis Causes CS DX TX

* Causes * e. coli * staph * CS * asymptomatic to septic shock * swollen mammae, fever * DX * milk cytology, culture * TX * cidal abx * warm packing if abscessed * lance * drain * pack * remove

Penile trauma

* hematuria end of urination * examine under sedation * small nonabsorably suture

Os Penis fracture

* No treatment if non-obstructive * Penile amputation * Bone plating or wiring * Urethrostomy

Scrotal Hematoma

* R/O coagulopathy * Mild * ice, compress, rest * more severe * scrotal ablation \*hemophiliacs

Testicular abscess

* Cause * trauma * brucellosis * DX * culture, sensitivity * TX * antibiotics * neuter * scrotal ablation

Paraphimosis

Protursino of **nonerect** penis w/o ability to retract

Priapism

persistent erection w/o sexual stimulation

Paraphimosis and priapism TX

* Sedation/anesthesia * avoid peripheral vasodilators * lubrication * hypertonic soak * sugar * saline * if necrosis * penile amputation and urethrostomy

Phimosis

* inability to extrude penis from prepuce * can cause * UO * abscess * severe urine scalt * congenital or acquired * trauma * neoplasia * genital sucking * stenosis of preputial orifice * TX * sx, explore

Pyometra occurs in

diestrus