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SA Therio > Whelping and Dystocia > Flashcards

Whelping and Dystocia Flashcards

1
Q

Dystocia

A
  • difficult birth
  • Life threatening for mother and off spring
  • 5% of all pregnancies
  • Much more frequent in brachycephalic breeds
  • Breeding soundness exam should include consultation regarding delivery
  • General health and body condition are important factors
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2
Q

Screening for dystocia over the phone

A
  • Determine reason for concern
  • Obtain history and prior pregnancies
  • Determine if events are normal
  • Best to see patient early if any doubt, especially if concern is voiced by an experienced breeder
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3
Q

Determining delivery date based on breeding date

A

57-72 days

  • 52-74 for feline
  • Not super reliable
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4
Q

How far past LH surge is delivery?

A

65 +/- days

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5
Q

How far past ovulation is delivery?

A

63 +/- days

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6
Q

How far past fertilization is delivery?

A

60 +/- days

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7
Q

If using vaginal cytology, how far past D1 (???) is delivery?

A

57 days

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8
Q

How to determine delivery date in felines

A
  • Induced ovulator so hormonal timing not very useful

- Must rely on clinical signs of labor

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9
Q

Which hormones cause onset of labor?

A
  • Prostaglandin F2 alpha and fetal cortisol
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10
Q

Relative gestation length in small vs big litters?

A
  • Small litters have prolonged gestation and large litters may shorten gestation in dogs
  • Cat gestation length not affected by litter size
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11
Q

What level is progesterone above to maintain pregnancy during late gestation?

A
  • Above 5 ng/mL
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12
Q

How does prostaglandin F2 alpha induce labor?

A
  • Luteolytic so it drops progesterone to less than 2 ng/mL
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13
Q

How soon after progesterone drops to <2 ng/mL do you expect to see signs of labor?

A

8-24 hours

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14
Q

What will happen to a female dog’s temperature as progesterone drops?

A
  • Her temperature will drop, because progesterone is thermogenic
  • Monitor rectal temperature twice a day at least
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15
Q

Radiographic indicators of gestation length

A
  • Skull and spine observed at 45 days
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16
Q

What can you use radiographs at time of labor for?

A
  • Number of fetuses remaining
  • Size of fetuses
  • Shape
  • Position and presentation
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17
Q

Which method is best for assessing fetal stress?

A
  • Ultrasound
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18
Q

What signals fetal stress best on ultrasound?

A
  • Low heart rate
  • <150 is concerning
  • Less than 100 means death is imminent
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19
Q

Normal fetal heart rate

A
  • 2 times that of the dam

- 180-220+ bpm

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20
Q

Home monitoring of fetuses and pregnancy

A
  • Fetal heart rate with Doppler
  • Hard to distinguish fetuses over time
  • Tocodynamometer
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21
Q

Tocodynamometer

A
  • Measures pressures associated with contraction of the uterus
  • Helps identify beginning of labor and progression either normal or abnormal
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22
Q

Stage 1 labor signs

A
  • Panting, nervous, restless, nesting behavior, vomiting
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23
Q

How long does Stage 1 labor last?

A

6-12 hours or longer with a nervous first litter mother

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24
Q

What can cause a long stage 1 labor?

A

Uterine inertia

  • Examine bitch or queen if any doubt
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25
Q

Stage 2 labor signs

A
  • Contraction of uterus with visible abdominal straining
  • Green or clear fetal fluids passed
  • Amniotic sac may be visible
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26
Q

When should first puppy or kitten appear after stage 2 starts?

A

4 hours

27
Q

Once fetus is visible at the caudal pelvic canal, how soon until it should be delivered?

A
  • 20 minutes
28
Q

How long until litter is fully delivered?

A
  • 12 hours

- DO NOT ALLOW LABOR TO CONTINUE BEYOND 24 hours

29
Q

Large amounts of bright red fluid during labor/delivery - normal or not?

A
  • NOT
30
Q

Fetal membranes - when can you see them?

A
  • Only shortly before delivery and after delivery

- Therefore check the yard for a pup if the bitch went outside unsupervised

31
Q

Stage 3 labor

A
  • Passing placenta
  • Shortening of the uterus
  • Rest period 1-2 hours
32
Q

Complete primary inertia

A
  • Normal birth canal

- No fetuses delivered

33
Q

What can cause complete primary inertia?

A
  • Small litter and inadequate stimulation
  • Large litter and over distended uterus
  • Systemic disease
  • Electrolyte imbalance
  • Fatty infiltration of the uterus
  • Uterine age
  • Unknown
34
Q

Partial primary inertia

A
  • Normal birth canal
  • Some fetuses born
  • Uterus becomes fatigued
35
Q

What can cause partial primary inertia?

A
  • Same as in complete inertia
36
Q

Secondary inertia

A
  • uterus exhausted due to obstruction to passage of fetus
37
Q

What can cause obstruction?

A
  • Narrow pelvis
  • Large fetus
  • Abnormal presentation
  • Fetus malformation
  • Vaginal septum or extensive stricture
38
Q

How do you treat complete primary uterine inertia?

A
  • C-section only
39
Q

How do you treat partial primary inertia or secondary inertia?

A
  • Surgery MAY be needed with partial primary inertia and secondary
  • Surgery is definitely needed if >4 fetuses remain
  • Medical management can work ~25% of the time
40
Q

What to do during examination of the mother for dystocia?

A
  • Keep with puppies or kittens
  • Look for signs of active delivery
  • Evaluate general condition
  • Radiographs
  • Blood tests for PCV, TP, Calcium, and glucose
  • Ultrasound of fetuses to check for stress
41
Q

Vaginal examination

A
  • Check for fluids and relaxation of vagina
  • Use copious amounts of sterile lubricant
  • Check for presence of a fetus in or at the pelvic inlet
  • Assist normal delivery by gentle traction on head or pelvis
  • Try to extend legs if possible
42
Q

Normal presentation of fetuses

A
  • Can be anterior or posterior with legs out or legs tucked under
43
Q

Abnormal presentations

A
  • Head folded back or folded under

- going out sideways

44
Q

How to reposition fetus for delivery?

A
  • Place fetus in normal position
  • Rotate along along axis slightly to help pass through pelvic canal
  • Be cautious of instruments and DO NOT USE OBSTETRICAL clamps
  • Lift and rotate the mother to help bring fetus
45
Q

Ferguson reflex

A
  • Stimulate by stretching the vagina
  • Body will start pushing in response
  • This is what you can do if there is a dystocia
46
Q

Where to grab the fetus?

A
  • Behind jaw bones or behind the hocks
47
Q

Steps for dystocia

A
  • Determine if in Stage I labor or in Stage II uterine inertia/dystocia
  • IV fluids to support blood pressure
  • 10% glucose for hypoglycemia
  • 10% calcium gluconate for hypocalcemia (SC is safer for heart)
  • Low dose oxytocin following fluids, glucose, and calcium
48
Q

Dosing of oxytocin

A
  • Initial dose is 0.25 to 0.5 units per bitch or queen
  • Maximum 2 units per bitch
  • Maximum 3 doses
49
Q

C-section essentials

A
  • Anesthesia, rapid sx site preparation, and a team that can work with newborns
  • Precise surgery is important to avoid post-op hemorrhage
  • Oxytocin may be given to assist uterine involution and help control bleeding
50
Q

Will OVH affect milk production or mothering instinct?

A
  • No
51
Q

Drugs for C-section

A
  • Pre-anesthesia oxygenation
  • Glycopyrrolate pre-anesthetic
  • Propofol for induction
  • Isoflurane or sevoflurane
  • Local anesthetic at incision site
  • Epidurals
  • Oxytocin to promote uterine involution
52
Q

Why give glycopyrrolate during C-section?

A
  • Vagal stimulation with uterine manipulation is expected

- Doesn’t cross the pracenta as much as atropine

53
Q

Why give propofol for anesthesia induction?

A
  • Rapid redistribution with minimal effect on the fetus
54
Q

Why no atropine for c-section?

A
  • Relaxes maternal esophageal sphincter and can lead to esophagitis
55
Q

Why no dexmedetomidine or xylazine for c-section?

A
  • Neonatal and maternal cardio-depressant
56
Q

Why no opioids for c-section?

A
  • Neonatal respiratory depression

- MAY be able to give during pre-anesthetic if you reverse with naloxone during neonatal resuscitation

57
Q

Why no phenothiazine tranquilizers, ketamine, barbiturates for c-section?

A
  • Neonatal overall depression
58
Q

Why no nitrous oxide for c-section?

A
  • Rapid transfer across placenta

- neonatal diffusion hypoxia

59
Q

Why no NSAIDs for c-section?

A
  • Impairs neonatal nephron development and hepatic function, although a single dose MIGHT be given post-surgically
60
Q

Mask induction with iso or sevo in c-section

A
  • Works but greater hypoxia (and stress!!!) than with pre-oxygenation and propofol
61
Q

What medications can be given to stop uterine contraction?

A
  • Terbutaline

- Tocolytic

62
Q

Regumate

A
  • Supplemented progesterone if there is low progesterone
63
Q

What to do in case of a dystocia?

A
  • Brucella testing

- Measure serum progesterone

SA Therio (10 decks)

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