Reproductive Emergencies In Females

Question 1

What is considered late for a bitch or a queen?

Answer 1

After 70-72 days of pregnancy

Question 2

Dystocia

Answer 2

Defined as abnormal labour or birth which could mean anything that is not considered normal

Question 3

Consequence of dystocia

Answer 3

Increased stillbirth rate, mortality of foetuses, neonatal morbidity, increased mortality of foetuses, reduced fertility and increase sterility in the female

Question 4

What are the key indicators that a female is experiencing dystocia?

Answer 4

1) No signs of labor are present within 24 hours of a decrease in rectal temperature or a decrease in progesterone levels
2) If no fetus is produced after 30-60mins of hard labour
3) Crying, biting or injuring the vulva area
4) Abnormal vaginal discharge (haemorrhage, odorous, mucopurulent
5) Resting for more than 4 hours between foetuses without contractions
6) Presence of a Fetus or fetal membranes in the vulva for greater than 15 mins
7) Weak or absent contractions for more than 2 hours
8) Signs of illness on the female (Major exhaustion, fever, tremors, multiple vomiting)

Question 5

What are the maternal causes of dystocia?

Answer 5

Uterine inertia (hereditary, systemic illness, hormones, senility, intrinsic weakness)

Or

Anatomical abnormality

Question 6

Fetal causes of dystocia

Answer 6

Giant foetuses, death, malpostioning

Question 7

What dog breeds commonly experience dystocia?

Answer 7

Brachycephalic (large heads and wide shoulders such as bulldogs, pugs, Boston terriers) and achondroplastic breeds (dwarfism) as it causes reduction in dimension from the sacrum to the pubic bone and thus reduces the pelvic canal (basset hounds, dachshunds)

Question 8

What cat breeds commonly experience dystocia?

Answer 8

Devon Rex (18.2%)

Question 9

When should a C-section be performed?

Answer 9

If it has been 24 hours after the rectal temperature drop, the radiograph reveals fetal oversize or inadequate pelvic diameter, more than 2 doses of oxytocin have been given with no contractions or if the female appears in inappropriate distress

Question 10

Propofol used during a C-section

Answer 10

• Initially rapidly absorbed by the female and therefore the foetuses initially experience a very high concentration.
• Eventually the drug crosses back from the foetuses to the bitch/queen *Optimal time to remove the puppies/kittens would be about 15-20 mins after the induction
• Propofol-isoflurane combination has been shown to have minimal effects on neonatal survival

Question 11

Ketamine and diazepam (or midazolam) in C-section

Answer 11

• Helps increase blood pressure, cardiac output and uterine blood flow in the female
• Ketamine can cause a major depressant effect causing the neonate to need intensive resuscitation

Question 12

What class of drugs are DEFINITELY not recommended for C-section?

Answer 12

Alpha-2 agonists (Xylazine, romifidine and medetomidine)

• higher mortality rate after C-section
• Bradycardia, hypertension and hypodermia
• even low doses (1ug/kg) medetomidine has been shown to decrease cardiac output 60-70% and cause a 20% increase in systemic vascular resistance

Question 13

What drug would you use in severely ill females?

Answer 13

Etomidate as it is fast acting with a short duration of action and still provides good cardiovascular support.

• not a lot of research on this drug
• if female has any pre-existing cardiac dysfunction, this drug will be the drug of choice
• in humans, this drug is a Class C drug = have shown an adverse effect on the Fetus
• causes embroycidal in rats and maternal toxicity in rabbits and rats

Question 14

What systemic problem is caused by placing pregnant females in a dorsal recumbency during surgery?

Answer 14

Hypotension and hypoxia.

Blood flow to the Fetus is not autoregulated

• Uterine perfusion depends on the blood pressure of the rest of the body
• To help with pressure, the patient may need to be slightly tilted towards the surgeon
• aggressive cardiovascular support is needed
• MAP should ideally be >80mmHg

Question 15

What pain medication can be used post-operatively?

Answer 15

*All opioids (fentanyl, morphine, oxymorhphone, butorphanol etc.)

• oxymorphone -shown to be more of a depressant than the other opioids to human neonates
• Fentanyl- no change in human Apgar scores, blood gases, or uterine blood flow
• Both oxymorphone and hydromorphone can be used for pain and both allow for minimal transmission into the milk
• NSAIDS
• can be used
• do not appear to cross into the milk in high quantities

Question 16

Neonates resuscitation

Answer 16

• Should begin immediately
• clear fetal membranes from face and nasal passages by using gentle suction
• administer oxygen and warmth
• Doxapram under the tongue can be used to help stimulate breathing
• Tie umbilical cords off
• Keep them very warm (85-90F for the first 5-8 days of age) as their shivering reflex and vasoconstrictive mechanisms are not mature so as to regulate their body temperature
• Examine for congenital defects and their ability and desire to nurse
• Heart rate should be 180-220bpm
• keep female away from newborns until fully recovered from GA due to potential trauma

Question 17

What should be avoided in neonatal resucitation?

Answer 17

Flinging the neonate in a downward motion should be avoided as this has been shown to cause head trauma or accidental injury by dropping

Question 18

What should clients be aware of for the dam’s increased nutritional requirements?

Answer 18

The dam now needs an increase in energy, fat, carbohydrates, protein, calcium, phosphorus and trace minerals during lactation. These requirements are greater than in any other life stage

• growth formula free-choice will be sufficient
• doctor may prescribe calcium supplementation postpartum