Dystocia

Question 1

What causes the rectal temperature to drop at the end of parturition?

Answer 1

progesterone levels decreasing

Question 2

Which of the following is FALSE about stage 1 of labor?
A. visible uterine contractions
B. cervix open
C. nesting, restless, anorexia, panting, secclusion behaviors occur
D. begins 24 hrs after the temperature drops
E. lasts for 6-12 hrs or longer is primiparous

Answer 2

A. visible uterine contractions

all of the rest of the statements are true, but uterine contractions are invisible at this time

Question 3

which of the following statements is FALSE about stage 2 of labor?
A. cervix is completely dilated
B. visible abdominal contractions occur
C. lasts 12-24 hours
D. puppies born every 30 min-1 hr
E. chorioallantois membrane breaks and expels transparent yellow fluid through the vulva

Answer 3

C. lasts 12-24 hours

this stage lasts 2-12 hrs.

Question 4

why does a dam have frequent, active pushing when the puppy enters the birth canal?

Answer 4

fergusons reflex is elicited

Question 5

What is characterized by normal stage 3 of labor?

Answer 5

placenta expulsion between each puppy, so technically stage 2 and 3 cycle between one another.

Question 6

What defines an ‘overdue’ pregnany?

Answer 6

> 65 days post ovulation

Question 7

With regard to the dam’s temperature, what could indicate dystocia?

Answer 7

if the temp drops and stage 1 labor signs do not follow within 24 hrs.

if the temp returns to normal after it dropped and then there are no signs of welping.

Question 8

T/F: if stage 1 of labor is > 12-18 hrs, this can be considered normal

Answer 8

false – this would be considered dystocia

Question 9

Which of the following statements is NOT indicative of dystocia?
A. fetuses stuck in birth canal
B. passage of fetal fluids and no other labor signs or labor progression
C. green vulvar discharge after the puppies have been delivered
D. intermittent, weak contractions for 2-4 hrs and no pup born
E. active, frequent pushing >1 hr or >30 min without producing puppy
F. >2-3 hr between puppies born

Answer 9

C. green vulvar discharge after the puppies have been delivered

green discharge is only indicative of dystocia when it occurs before any puppies are born.

Question 10

T/F: a dam is experiencing dystocia if she has any bloody, purulent, malodorous, or black vulvar discharge.

Answer 10

true

Question 11

what are the 2 most common types of dystocia in the bitch?

Answer 11

1. obstructive – either abnormal fetal presentation/position/size OR maternal abnormal birth canal
2. uterine inertia – insufficient/absent uterine contractions (primary or secondary)

Question 12

What are the treatment options for obstructive dystocias?

Answer 12

1. manual correction and vaginal delivery
2. c-section (if manual correction impossible)

Question 13

What are the treatment options for maternal-caused dystocias?

Answer 13

c-section

Question 14

If you are presented with a dam that has primary uterine inertia, what are the guidelines to follow prior to performing c-section?

Answer 14

1. no puppies born yet
2. no obstructions
3. normal birth canal

Question 15

If a dam presents to your clinic for secondary uterine inertia (with obstruction), what are your treatment options?

Answer 15

in these cases, the dam may have had prolonged contractions due to the obstruction and it may cause uterine fatigue and cessation of contractions.

You can attempt manual correction and vaginal delivery, but you may need to perform c-section if she is too fatigued.

Question 16

A bitch presents to your clinic with secondary uterine inertia (with no obstruction). She has already delivered 4 puppies but the ultrasound weeks ago showed she had at least 9. What is your treatment plan?

Answer 16

Her contractions may have stopped due to uterine fatigue. You can attempt medical management or perform a c-section.

Question 17

What is a typical anesthetic protocol for a c-section?

Answer 17

pre-med - fentanyl

induction - propofol

epidural – lidocaine 2%

line block? - bupivacaine

as soon as puppies removed – buprenorphine and oxytocin

gas - sevo

fluids - LRS 10 ml/kg/hr

Question 18

Describe the steps of a c-section.

Answer 18

1. make large incision
2. place laparotomy sponges at the incision site
3. exteriorize the uterus
4. perform hysterotomy
5. remove fetuses and placentas
6. inspect the uterus, cervix, and vagina
7. give oxytocin
8. close the uterus using utretcht suture pattern
9. inspect badomen for hemorrhage and then lavage
10. close abdominal wall

Question 19

what are a few post- c-section directions you need to send home with your client for the DAMs CARE?

Answer 19

1. feed dam as much as she wants during lactation
2. check mammary glands daily for mastitis
3. monitor vulvar discharge. she will have some normal discharge that will change from bloody to mucoid, brownish over the following days. It should NEVER be foul-smelling, increase in amount, or be large amounts of blood.
4. monitor the incision daily
5. bring her back if she becomes lethargic, depressed, anorexic, or has fever
6. monitor for signs of hypocalcemia – facial rubbing, muscle tremors, ataxia, panting, restlessness
7. restrict exercise for 2 weeks

send them home with carprofen

Question 20

what recommendations should you make for a client whose dog just had puppies?

Answer 20

1. keep whelping box clean
2. weigh puppies daily
3. keep puppies warm and protected from drafts
4. weaning takes place after 3 weeks of age. you can start offering gruel. if they eat well on their own, they can be removed from the whelping box.

Question 21

When is medical management of dystocia appropriate?

Answer 21

1. no obstruction, fully dilated cervix
2. good condition of dam
3. < 2-4 fetuses remaining in utero
4. fetal heart rate >190-200 (no fetal distress)

Question 22

A bitch presents to your clinic for dystocia. She is in good condition and has had 2 puppies already. You perform xray and she only have 1 fetus remaining. Her cervix is fully dilated, so you want to move forward with medical dystocia management.
What is your plan?

Answer 22

1. place IV cathether and start fluids, do some bloodwork to see if she is hypocalcemic or hypoglycemic
2. lubricate birth canal
3. place the puppies on the dam to nurse to stimulate oxytocin
4. give calcium gluconate SQ and wait 15 min
5. give her oxytocin IM/SQ, wait 20-30 min for response, if not response give another dose.
6. give glucose is hypoglycemic

Question 23

what does green vulvar discharge indicate?

Answer 23

placental separation

this is normal unless the dam is not giving birth to a puppy.

Question 24

what are 2 ways to do gestational aging via ultrasound?

Answer 24

1. biparietal diameter (BPD) – in late gestation
2. inner chorionic cavity diameter (ICCD) – early gestation

you can also look at gastrointestinal peristalsis and the corticomedullary distinction of the kidneys to determine fetal maturity.