Reproductive emergencies (Allen)

Question 1

Fetal causes of dystocia

Answer 1

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

Question 2

Maternal causes of dystocia

Answer 2

• 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

Question 3

Causes uterine inertia

Answer 3

• 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

Question 4

High risk for dystocia

Answer 4

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

Question 5

Dystocia diagnostics

Answer 5

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

Question 6

assisted vaginal delivery

Answer 6

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

Question 7

Dystocia med tx

Answer 7

• 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

Question 8

fetal heart rate 180

Answer 8

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

Question 9

cystocia pre-op

Answer 9

• 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

Question 10

Neonatal resuscitation station

Answer 10

1. Trained staff
2. Sterile drapes
3. Bulb or tube suction
4. Small face masks
5. Small ET tubes
6. Reversal agents
7. Hemostats
8. Suture and dilute betadine
9. Warm area for recovery

Question 11

Anesthesia for C-section

Answer 11

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

Question 12

Surgical procedure

Answer 12

• 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)

Question 13

Uterine torsion

Answer 13

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

Question 14

Uterine rupture

Answer 14

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

Question 15

Neonate resuscitation

Answer 15

• 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

Question 16

Post-operative care

Answer 16

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

Question 17

Pregnancy toxemia

Answer 17

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

Question 18

Eclampsia

Answer 18

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

Question 19

Eclampsia

Clinical signs

Answer 19

• lethargy
• hyporexia
• muscle fasciculations
• tremors
• facial rubbing
• ataxia
• hyperthermia
• seizures

Question 20

Eclampsia

DX

TX

Answer 20

• 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

Question 21

Pyometra

Answer 21

• 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

Question 22

Pyometra

CS

Answer 22

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

Question 23

Pyo

Diagnostics

Answer 23

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

Question 24

Pyo DDX

Answer 24

• Pregnancy
• CEH
• mucometra
• hydrometra
• cancer

Question 25

Expected labwork with pyo

Answer 25

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

Question 26

Pyo tx

Answer 26

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

Question 27

Vaginal hyperplasia

Answer 27

• 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

Question 28

Mastitis

Answer 28

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

Question 29

Mastitis

Causes

CS

DX

TX

Answer 29

• 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

Question 30

Penile trauma

Answer 30

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

Question 31

Os Penis fracture

Answer 31

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

Question 32

Scrotal Hematoma

Answer 32

• R/O coagulopathy
• Mild
  
  • ice, compress, rest
• more severe
  
  • scrotal ablation

*hemophiliacs

Question 33

Testicular abscess

Answer 33

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

Question 34

Paraphimosis

Answer 34

Protursino of nonerect penis w/o ability to retract

Question 35

Priapism

Answer 35

persistent erection w/o sexual stimulation

Question 36

Paraphimosis and priapism

TX

Answer 36

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

Question 37

Phimosis

Answer 37

• 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

Question 38

Pyometra occurs in

Answer 38

diestrus