Caesarean Section

Question 1

Pre op

Answer 1

The mother is placed on intravenous fluid therapy and prophylactic antibiotics are given. Make sure that you have everything set up in the anaesthetic room and surgery, prior to induction. Ideally the time between onset of anaesthesia and removal of the foeti should be minimal. Prepare the incubator or warm bed for the new born, so that they can be kept warm and dry until the mother is recovered.

Question 2

Patient Prep

Answer 2

The patient is clipped along the ventral midline, extending from the xiphoid to the pubis. The clip should extend laterally 5-10cm either side of the incision. The skin is then prepared aseptically.

Question 3

Patient positioning

Answer 3

The patient is placed in dorsal recumbency, it may be helpful to position the mother slightly tilted to the left from true dorsal recumbency. This avoids the weight of the full uterus compressing the caudal vena cava and reducing the blood volume returning to the heart.

Question 4

Instruments / Materials

Answer 4

A general surgical kit should be selected with some larger haemostats (Rochester Pean or Rochester Carmalt). Extra laparotomy sponges are required to isolate and pack around the uterus and sterile saline is required to flush the abdominal cavity prior to closing.

Question 5

Surgical Procedure

Answer 5

The incision is made through the caudal aspect of the linea alba. Once the uterus is opened, an assistant takes each new-born as the surgeon hands it to them.

Care of the neonate includes:

1. Establish a clear airway by wiping away the mucus from the nose and the mouth
2. Stimulate respiration by vigorous rubbing with a warm towel
3. Use a suction bulb to remove any excess fluid from the nose or the mouth
4. Keep the neonates warm via heatmat and blankets
5. Check umbilicus for any herniation; apply a suture around the umbilicus 3cm from the abdominal wall
6. Check for evidence of cleft palate and normal anatomical features
7. Provide flow by oxygen to the puppies

After the puppies or kittens have been removed, the uterus is closed with synthetic absorbable suture material. The abdominal cavity is flushed with sterile saline and often the veterinary nurse is directed to administer oxytocin to encourage uterine contractions.

Question 6

Post op care

Answer 6

The dam is returned to a warm environment

New-borns should be introduced and encouraged to suckle whilst she is still waking.

The process should be supervised until the mother is sufficiently awake not to damage the new-borns and until the new-borns are suckling successfully.