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REPRO, DERM, CCU > Periparturient Disorders and C-Section > Flashcards

Periparturient Disorders and C-Section Flashcards

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1
Q

inflammation of mammary gland caused by infectious agent (bacteria)

less common than in cats

A

Mastitis

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2
Q

What is the typical signalment of mastitis

A

Nursing bitch (rarely pseudocyesis)
-Small litters
-Large litters

Firm, reddened, painful mammary gland
-One or multiple glands
-Abnormal milk

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3
Q

a common condition where unspayed female dogs exhibit signs of pregnancy, such as mammary gland enlargement and milk production, even though they are not pregnant

A

pseudocyesis

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4
Q

What might happen if you spay a dog in late diestrus

A

Pseudocyesis
-milk and mammary gland development

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5
Q

What atre the clinical signs of mastitis

A

1) Hot, painful glands
2) Fever, lethargy, anorexia
3) Neglecting neonates
4) Pups not gaining weight

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6
Q

What is the cause of mastitis

A

1) Ascending infection (although hematogenous spread possible)

2) Milk congestion (galactostasis)
-Infrequent milk expression leads to gland congestion
-Ascending bacterial infection (Ecoli, Strep, Staph)

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7
Q

What can happen if puppies do not nurse frequently

A

Mastitis from

Milk congestion (galactostasis)
-Infrequent milk expression leads to gland congestion
-Ascending bacterial infection (Ecoli, Strep, Staph)

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8
Q

What are the risk factors for mastitis development

A

1) Infrequent nursing - galactostasis

2) Poor sanitary conditions

3) Trauma

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9
Q

How do you typically diagnose mastitis

A

-Usually history and PE
-CBC: leukocytosis in severe cases
-Chem: usually in normal limits
-Cytology: milk discharge often reveals inflammatory cells
-Culture: always culture milk/discharge (even if it appears normal)
-FNA v Expression

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10
Q

What should you always do for mastitis cases

A

always culture milk discharge (even if it appears normal)

culture contents from FNA or expression

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11
Q

How do you treat mastitis cases *

A

1) Supportive: can present severely ill (dehydration, shock)- IV fluid therapy, IV antibiotics

2) Pain/Inflammation
-Patients are significantly painful
-Base therapy knowing all meds will be passed to nursing offspring
-Hot packing- encourage drainage
-Cabbage leaves: alternating warm/cool. Glucosinolates reduce inflammation

3) Antimicrobial therapy: all will be passed in milk
start with broad spectrum and base final decision on culture
-Probiotics for dam and offspring

4) Keep glands expressed
-Hand stripping
-Keep pups nursing (controversial)

5) Surgery
-Abscess drainage might be necessary in severe cases
-Mastectomy

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12
Q

What should you not give for mastitis because it will be passed to the puppies

A

beware of NSAIDs bad for developing kidneys)

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13
Q

What antimicrobial therapy should you use for mastitis

A

Start with broad spectrum and base final decision on culture

-Typically start with beta-lactams

avoid fluroquinolones, tetracyclines, aminoglycosides

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14
Q

no milk production

somewhat uncommon in canine and feline

A

Agalactia

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15
Q

What is the typical signalment for agalactia in dogs

A

1) Nursing bitch
2) Poorly developed mammary glands late gestation/early parturition (true agalactia)

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16
Q

What are the typical clinical signs of agalactia

A

-No milk obviously present in the glands
-Pups not gaining weight, not nursing for long
-Sometimes post C-section (prematurity)
-Nervous bitch?
-Progesterone supplementation during pregnancy

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17
Q

What is the cause of agalactia in dogs

A

-Genetic
-Stress (epinephrine inhibiting oxytocin- milk letdown)
-Systemic illness (dehydration)

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18
Q

What are risk factors for agalactia

A

-Premature
-Progesterone during gestation

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19
Q

How do you diagnose agalactia

A

1) History: no milk during hand stripping, are neonates gaining and content?
2) Evaluate for systemic illness: body condition, pain, hydration, vulvar discharge, CBC, Chem, U/S of uterus

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20
Q

How do you treat agalactia

A

Recognize and treat quickly are possible
1) Correct dehydration
2) Reduce stress if present
3) Get pups suckling ASAP
4) Oxytocin- helps milk letdown 0.5-2U SC
5) Metoclopramide- might help prolactin release
0.1-0.2 mg/kg SC q8-12h
6) Domperidone -increases prolactin (dopamine receptor antagonists)
7) Acupuncture

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21
Q

What drugs might you use to treat agalactia

A

1) Oxytocin

2) Metoclopramide

3) Domperidone

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22
Q

What is the mechanism of Domperidone

A

Dopamine receptor antagonists - results in increase in increase in prolactin
*off label

2.2mg/kg poBID

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23
Q

postpartum uterine infection where inflammation occurs at all layers of uterus
-endometrium
-myometrium
-perimetrium

A

Postpartum metritis

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24
Q

When do dogs with postpartum metritis typically present

A

within a week of parturition

have vulvar discharge - purulent in nature

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25
What is your top differential for a dog with fever 2-3 days after parturition
Postpartum metritis
26
What are the clinical signs of postpartum metritis
-Purulent vulvar discharge (sometimes green/black colored) -Poor mothering behavior -Lethargy, anorexia, fever (often significant), dehydration, reduced milk production
27
What are the two causes of postpartum fever
1) Mastitis 2) Postpartum metritis 3) Eclampsia
28
What is the etiology of postpartum metritis
ascending infection leads to significant inflammation of the endometrium (and deeper)
29
What are risk factors for postpartum metritis
abortion fetal infection dystocia retained fetal membranes ***
30
How do you diagnose postpartum metritis
-History/PE: large, flaccid uterus palpable -Vulvar discharge: purulent vulvar discharge -CBC: leukocytosis with left shift -Chemistry: prerenal azotemia with severe illness -Ultrasound/Rads: aid in diagnosis of fluid, fetal membranes or retained feti in uterus -OVE/OVH (if stable)
31
How do you treat postpartum metritis
1) Supportive: IV fluids and broad spectrum antibiotics 2) Antibiotics ultimately based on culture 3) Evacuate uterus: -Oxytocin (0.5-1 U IM) -PGF2alpha (10-20 ug/kg SC)
32
What can you do for evacuating the uterus in cases of postpartum metritis
-Oxytocin (0.5-1 U IM) -PGF2alpha (10-20 ug/kg SC)
33
acute, life-threatening hypocalcemia following parturition
eclampsia
34
What kinds of dogs is eclampsia common in
1) Small breeds during peak lactation (2-3 weeks postpartum) 2) Large litters -very high lactation demands
35
T/F: eclampsia can occur in any breed/size dog at anytime of lactation
True, but typically see it during 1) Small breeds during peak lactation (2-3 weeks postpartum) 2) Large litters -very high lactation demands
36
What are the clinical signs of eclampsia
somewhat acute onset of signs in previously normal nursing bitch -panting, restlessness, disorientation, vocalization -fever -muscle spasms -tachycardia -Seizures
37
What is the cause of eclampsia *
1) Inappropriate mobilization of calcium stores to serum pool during lactational demands leads to systemic hypocalcemia 2) Low serum Ca leads to lower threshold potential of Na channels resulting in highly excitable nerve and mm fibers excitatory effect and possible tetany (unlike cows)
38
Unlike cows, how does eclampsia in dogs present
Excitatory effect and possible tetany (unlike cows)
39
What are the risk factors of eclampsia *****
1) Calcium supplementation during pregnancy- down regulates normal calcium regulation? 2) Large litters 3) Small breeds with large lactation demand
40
How do you diagnose eclampsia
-History/PE -Response to therapy (sometimes instituted as part of diagnosis) -Serum Ca <7.0 mg/dL is consistent with hypocalcemia -Chemistry: hypoglycemia and electrolyte abnormalities
41
How do you treat eclampsia
1) Remove pups for 12-24h 2) Supportive: IV fluid for electrolyte abnormaltiies, correct hypoglycemia 3) 10% calcium gluconate given slowly IV over 20-30 min 4) Continue oral supplementation as necessary
42
When treating eclampsia with IV 10% calcium gluconate, what do you need to do
Give slowly IV over 20-30 minutes monitor HR and ECG for bradycardia/arrhythmias- discontinue immediately if necessary
43
What is a major sign of Sub-Involuted Placental Sites (SIPS)
Prolonged serosanguinous postpartum vulvar discharge more than 3 weeks
44
What is the typical signalment/ presentation of Sub-Involuted Placental Sites (SIPS)
-Postpartum bitch more than 3 weeks -Usually, young bitches -Persistent serosanguinous vulvar discharge
45
Sub-Involuted Placental Sites (SIPS) causes persistent serosanguinous vulvar discharge that last
longer than 3 weeks in otherwise normal postpartum bitch
46
What is the pathogenesis of Sub-Involuted Placental Sites (SIPS)
Focal areas of endometrial inflammation (eosinophilic) possibly caused by trophoblastic cell migration into the endometrium persistent bleeding caused by lack of appropriate thrombosis and uterine involution
47
What are the risk factors of Sub-Involuted Placental Sites (SIPS)
very large litters - overstretched myometrium dystocia
48
How do you diagnose Sub-Involuted Placental Sites (SIPS)
*Must rule out other potential causes - metritis, vaginitis, clotting disorders, etc CBC- typically normal but can become anemic with chronicity Chemistry, UA all normal Ultrasound shows normal postpartum uteris
49
How do you treat Sub-Involuted Placental Sites (SIPS)
Supportive: Transfusion if significant anemia Yunnan Baiyo OHE if necessary
50
What must you rule out if you see Sub-Involuted Placental Sites (SIPS) **
other causes - metritis, vaginitis, clotting disorders, etc
51
Do dogs with Sub-Involuted Placental Sites (SIPS) have a fever?
No
52
Cesarena section is performed for what
dystocia management or on an elective basis (previous dystocia or anatomic abnormality like septa, persistent hymen, stricture)
53
What is critical when performing Cesarean section to reduce complications to dam and pups
Timing Five days early often results in 100% neonate mortality Early results in difficulty removing placenta from uterus - excessive hemorrhage
54
What should you be prepared for when doing a Cesarean section
Neonate resuscitation area- clean, organized and well staffed (1 resuscitator/pup is ideal) Anesthesia, surgical assistants need to be ready
55
What should you do if a bitch is suffering from severe dystocia
Advise Cesarean section
56
What constitutes mild dystocia
1) healthy bitch with normal conformation 2) Pups normal size and appropriate postion 3) No evidence of obstruction OR fetal distress/compromise 4) 4 or less pups remaining 5) Weak or infrequent contractions
57
What constitutes severe dystocia
1) Obvious oversized fetuses(es) 2) Evidence of fetal compromise 3) Green/black disicharge with no pup born in 20-30 min 4) Progesterone level <2ng/ml for 24 hours 5) Obstructive dystocia (any cause) 6) Dystocia for any reason with 5 or more pups remaining
58
What progesterone levels would constitute a severe dystocia
Progesterone level <2ng/ml for 24 hours
59
How many pups constitute severe dystocia
5 or more = severe 4 or less = mild
60
How do you prepare a patient for Cesarean section
Decision to incision shave ventrum prior to induction for proper positioning Preoxygenate and hydrate perform local block prior to incision Incision between umbilicus and pelvis Uterus is exteriorized carefully
61
What incision should you make for Cesarean section
Ventral midline incision - umbilicus to cranial aspect of the pelvis do not reach udner uterus in area of the broad ligament (vasculature)
62
What are the pros of doing an incision of body of uterus for Cesarean section
Pros: one incision Cons: -likely more bleeding -access to all fetuses can be difficult, more time consuming -weaker scar formation (risk for future dystocia or rupture) -Risk of intercornual septum damage, bleeding
63
What are the pros and cons of doing uterine horn incision for Cesarean section
Pros: -Less bleeding if incision is in relatively avascular area -Better healing (doesnt involve large muscles) -Quicker access to pups, less moving -Better assessment of placental sites -easier, complete removal of placenta Cons: -Multiple incisions if pups in both horns = more suture and anesthesia time
64
How should you make your incision into the uterus
Avascular area of greater curvature of uterine horn -Puncture uterus (carefully) -Extend incision (blunt scissors) large enough to remove pups
65
How should you deliver pups when doing Cesarean section
Grasp carefully Try not to rupture all membranes and try to deliver placenta with pup -Only remove the placental between the fetal portion (trophoblasts) and maternal portion (endometrium) -If endometrium is removed with pup, significant hemorrhage can develop -Placenta will easily detach in well timed c-section -carefully hand pup/placenta to puppy reviver in sterile towel
66
If what part of the placenta is removed during C-section, what can cause severe hemorrhage
The endometrium instead remove only the placenta between the fetal portion (trophoblasts) and maternal portion (endometrium)
67
How should you finish Cesarean section
-Inspect placental sites for excessive hemorrhage -Administer oxytocin if necessary -If single layer closure is desired - do inverting Cushing or Lembert pattern (do not penetrate lumen) -If double layer is desired- add additional inverting patter n -Monofilament, absorbable suture 3-0 or 4-0 -Flush abdomen as needed with warm saline -Routine abdominal closure- intradermal skin closure is most desirable
68
How should you close a Cesarean section
Single layer closure- inverting Cushing or Lembert pattern (do not penetrate lumen) if double layer - additional inverting pattern Monofilament, absorbable suture 3-0 or 4-0 intradermal for skin
69
Which hormone is primarily responsible for the physical changes observed during estrus in the bitch?
Estrogen
70
Which hormone peaks and "signals" the ovarian follicle to ovulate (rupture) in the bitch?
LH
71
Which hormone provides negative feedback to the pituitary to inhibit secretion of FSH?
Inhibin
72
Which hormone is primarily responsible for luteolysis in the bitch?
PGF2a
73
The bitch has ______ stages of the estrous cycle.
4
74
The queen has _______ stages of the estrous cycle.
5
75
Which of the following best describes the estrous cycle of the queen?
Polyestrous, seasonal, polytocous, induced ovulators,
76
Which of the following best describes the estrous cycle of the bitch.
Monoestrous, non-seasonal, polytocous, spontaneous ovulators
77
On average, how long is the fertility period in the bitch?
72-96h
78
On average, how many hours after the LH peak does ovulation occur in the bitch?
48
79
What are the primary luteotropic hormones in the Queen?
Relaxin, Prolactin
80
What are the primary luteotropic hormones in the bitch?
LH, Prolactin
81
What is the average length of estrus in the bitch?
9 days
82
On average, how long is proestrus in the queen?
1-2 days
83
Once ovulation occurs in the queen, about how long are the ovum viable before they begin to degenerate?
24 hours
84
If mating does not occur in the queen during estrus, what stage of the estrous cycle does she next experience?
Postestrus
85
What is the average duration of pseudopregnancy in the queen?
40-50 days
86
What is the average length of postestrus stage in the queen?
7 days
87
What is the average length of estrus in the bitch?
9 days
88
T/F: The queen will enter anestrus during long days (more light).
False
89
T/F: The dominant hormone during diestrus in both the queen and the bitch is progesterone.
true
90
T/F: Onset of puberty is determined strictly by age and is not affected by season or body condition in the queen.
false
91
T/F: There is no known maternal recognition of pregnancy in the bitch.
True

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