SA - Canine Cesarean Section

Question 1

What are the indications for an emergency C-section?

Answer 1

Dystocia - Fetal maternal mismatch, primary uterine inertia, secondary uterine inertia, uterine torsion or rupture, obstruction of birth canal, fetal death
Failure of medical therapy

Question 2

What are the indications for an elective C-section?

Answer 2

Planned - high risk breeds, prolonged gestation, convenience, maternal illness, and small litter or singleton

Question 3

What miniature breeds are at risk for a C-section?

Answer 3

Chihuahua, Pomeranian, Dachshund, Poodle, and Yorkie

Question 4

What mid-sized breeds are at risk for a C-section?

Answer 4

Scottish terrier

Question 5

What giant breeds are at risk for a C-section?

Answer 5

Irish Wolfhound, Great Dane and Bermese Mountain Dog

Question 6

What Brachycephalic breeds are at risk for a C-section?

Answer 6

Bulldogs, Boston Bull Terriers, Pugs, and Frenchie

Question 7

What cats are at risk for a C-section?

Answer 7

Ragdoll and Abyssinian

Question 8

What are some predictors of the whelping date?

Answer 8

Previous ovulation timing, decline in serum progesterone, and temperature drop

Question 9

How fast is the normal fetal heart rate?

Answer 9

2-3x the dams (220-240)

Question 10

When does the fetal heart rate begin to slow?

Answer 10

4-5 days prior to whelping

Question 11

What fetal heart rate indicates mild distress?

Answer 11

<180

Question 12

What fetal heart rate indicates severe distress?

Answer 12

<170

Question 13

What fetal heart rate indicates that death is imminent?

Answer 13

<150

Question 14

What do normal amnionic and allantoic fluids look like on ultrasound?

Answer 14

They are anechoic with minimal flocculant material

Question 15

What may cause the fetal fluids to be hyperechoic?

Answer 15

meconium and hemorrhage

Question 16

As a fetus is more mature, what changes occur to the kidneys?

Answer 16

The renal cortex is differentiated from the medulla
The pelvices are less dilated
The medulla and renal pelvis become increasingly prominent until term

Question 17

What does the intestinal mucosa look like on ultrasound at 58-60 days? Does this indicate functional maturation?

Answer 17

It is evident as a hypoechoic lumen with a hyperechoic muscular layer
It does not indicate functional maturation

Question 18

What becomes evident in the intestinal mucosa between 62-64 days on ultrasound? Does this indicate functional maturation?

Answer 18

Peristalsis

it does indicate functional maturation

Question 19

How do you determine timing for elective C-sections?

Answer 19

Clinical signs, daily P4 testing, and daily ultrasound evaluation

Question 20

When do you want to begin P4 testing to determine when to do elective C-sections?

Answer 20

3-5 days before the expected whelping date

Question 21

At what level of P4 is it okay to ‘cut’?

Answer 21

If it is <2 ng/mL

Question 22

What do you want to assess on ultrasound when you are determining when to do an elective C-section?

Answer 22

Progression of GI contrast and peristalsis
Progression of corticomedullary distinction
Assessment of fetal heart rates

Question 23

What is the diagnostic approach to elective and emergency C-sections?

Answer 23

Get a thorough history
Pre-anesthetic examination - BW
Obstetrical examination
Imaging - Rads and Ultrasound

Question 24

Can you palpate the cervix in the dog?

Answer 24

NO!

Question 25

What risks are associated with C-sections (i.e. what should you know before you cut)?

Answer 25

Pregnancy anemia, tachypnea may contribute to respiratory alkalosis, there is an increased risk of regurgitation, and rapid decompression of the abdomen needs to be monitored

Question 26

What is pregnancy anemia a consequence of?

Answer 26

expanded volume

Question 27

When does pregnancy anemia start?

Answer 27

around day 25-30 until parturition

Question 28

In cases of pregnancy anemia, what does a normal PCV at the time of surgery indicate?

Answer 28

dehydration - rehydrate if possible but avoid hypoproteinemia

Question 29

If unsure of expected whelping date/not sure about fetal maturity, what drug is recommended to give pre-op for a C-section?

Answer 29

SoluDelta Cortef 2-4 hours pre-op

Question 30

How do you prepare a dam for a C-section?

Answer 30

Pre-hydrate, pre-clip, pre-med, epidural

Question 31

What reversible pre-meds can be used for C-sections?

Answer 31

Alpha 2s, benzodiazepines, and narcotics

Question 32

What non-reversible premed can be used for C-sections?

Answer 32

Acepromazine

Question 33

What pre-med anesthetics can be given to a dam for a C-section?

Answer 33

Maropitant, Mu-agonist opioid, and a sedative if the dam is stressed

Question 34

What can be used for induction of a dam for C-section?

Answer 34

Alfaxalone, Isoflurane, or Sevoflurane

Question 35

What do you use for a line block in a dam that is going to get a C-section?

Answer 35

Bupivacaine (Nocita)

Question 36

True or False: When doing a C-section, you can take your time.

Answer 36

False

Question 37

What are the surgical options for a C-section?

Answer 37

Hysterotomy, hysterotomy and an (Ovario-)hysterectomy, or En Bloc (Ovario-)hysterectomy

Question 38

What is a hysterotomy?

Answer 38

Incision on the dorsal surface of the uterine body or greater curvature of the uterine horns and the base of one or separate horns. The uterus and ovaries remain

Question 39

What is an En Bloc (Ovario-) Hysterectomy?

Answer 39

Removal of the entire uterus quickly and then incise the uterus and deliver puppies

Question 40

Why is a hysterectomy or ovariohysterectomy not recommended at the time of a C-section?

Answer 40

The Dam shares blood volume with the puppies/uterus and if you remove the reproductive tract she will loose a lot of blood volume and may suddenly die within 24 hours

Question 41

When may a hysterectomy or ovariohysterectomy be necessary during a C-section?

Answer 41

If there is damage to the uterus, the uterine contents are putrefied and the health of the female is at risk, or at the owners request

Question 42

Does a hysterectomy or ovariohysterectomy have an impact in milk production?

Answer 42

No, there is no impact in milk production

Question 43

What type of incision is used to begin a c-section?

Answer 43

ventral midline incision

Question 44

What type of pattern is used for the uterine closure post C-section? Suture type?

Answer 44

Utrecht (inverting) with PDS or Monocryl

Question 45

What analgesia is given to a post-up C-section patient?

Answer 45

Rimadyl

Question 46

What should you remind clients about vaginal discharge in their C-section patients?

Answer 46

It is normal for 1-2 weeks following surgery They should monitor for a change in color or develop an odor There should be no discharge fi an OHE was performed

Question 47

If there are external stiches, when should the be removed after a C-section?

Answer 47

in 10-14 days

Question 48

What should clients look out for in regards to the mammary glands after a C-section?

Answer 48

Evidence of mastitis and if there is enough milk for the puppies (check by weighing the puppies)