Reproductive Emergencies In Females Part 2

Question 1

Uterine prolapse - when does it usually occur?

Answer 1

• Extremely rare
• usually occurs during or within 48 hours of parturition when the cervix is open
• more common in cats
• both horns of the uterus can prolapse
• if foetuses remain in the uterus, surgery will be needed

Question 2

Mastitis

Answer 2

• range from galactostasis to septic shock
• neonates should be allowed to nurse for as long as female will tolerate
• most common bacteria: E.coli, Staph aureus and B-haemolytic Strep
• nipples should be cultured and hot pack, antibiotics and pain medications
• severe cases: nipples may need to be lanced, drained, flushed and derided females with very high fever beef IV and nutritional support until the fever has subsided and patient eating again

Question 3

Pyometra

Answer 3

• generally occurs in middle-aged females during dies true
• usually during dies true, cervix begins to close and the inner lining begins to return to normal
• cystic endometrial hyperplasia (CEH) may occur during this time fur to inappropriate response to progesterone
• usually e.coli migrates from vagina into the uterus and find the CEH favourable for growth
• progesterone also causes mucus secretion, aids in closing the cervix and decreases uterine contractility which makes the environment even more favourable for bacterial growth

Question 4

Open pyometra

Answer 4

When cervix remains open, the infected material can leave the body making it far easier and safer to treat

Question 5

Closed pyometra

Answer 5

When the cervix becomes fully closed, the uterus may rupture causing a septic abdomen

Question 6

Pyometra signs

Answer 6

Vaginal discharge, vomiting, diarrhoea, dehrdration, lethargy, anorexia, depression, polyuria and polydipsia

Question 7

How is a pyometra diagnosed?

Answer 7

Radiographs or ultrasound

Bloodwork: elevated ALT, hyperproteinemia and hyperglobulinemia caused by dehydration

Urinalysis: proteinuria, pyuria, and/or hematuria

May also have pre-renal azotemia because E.coli interferes with Na and Cl absorption in the loop of henle and also blocks the action of ADH on the collecting ducts resulting in polyuria and subsequent polydipsia

Question 8

Why should you not perform a Cystocentesis if you suspect a pyometra?

Answer 8

As this can rupture the uterus. E.coli can produce an endotoxin upon bacterial death which can result in endotoxemia. This can cause severe shock reaction and death.

Question 9

Aglepristone

Answer 9

Works by blocking progesterone receptors and this impedes the adhesion of bacteria on the surface of the endometrium. It also allows for the opening of the cervix which then allows for emptying of the uterine contents.

Question 10

Tx of open pyometra

Answer 10

Low dose oxytocin to help empty the discharge from the open pyometra.

But if the cervix is only partially dilated or the uterus is fully dilated with purulent material, then this could cause a rupture.

If large amount of material = use prostaglandins (dinoprost, cloprostenol, alphaprostol) 2-3X a day for 2-3weeks
-side effects: anxiety, vomiting, diarrhoea, tachypnea, and tachycardia

Antibiotics: 2-4 weeks for either an open or closed pyometra

Question 11

Uterine torsions

Answer 11

• rare
• can be due to jumping or running late in pregnancy
• partial abortions or abnormalities of the uterus
• life threatening
• can cause severe hemorrhage if uterine artery becomes damaged

Signs

• severe pain
• collapse
• abdominal distention

Diagnosis

• Radiograph: large fluid or air filled tubular structure in abdomen
• Ultrasound: better diagnostic picture

Tx:
*Ovariohysterectomy recommended

Question 12

Eclampsia

Answer 12

*As a result of Hypocalcemia in pregnant or postpartum animals
*Affects mostly small breed dogs and usually occurs 2-3 weeks after delivery
*Uncommon in cats
Cause:
*low calcium intake / absorption or excessive calcium loss through lactation
*high level of calcium supplementation - disrupts body regulation of calcium blood levels
*alkalosis secondary to hyperventilation from dystocia can increase the protein-bound fraction of calcium - thereby decreasing the ionized fraction of ca available leading to hypocalcemia

Signs:

• tremors, panting, stiffness, pacing, whining, salivation, and restlessness
• Muscle spasms, fever, tachycardia, seizures, miosis and death

Diagnosis:

• Hypocalcemia
• total calcium levels of <7mg/dL
• or ionized calcium levels <0.6mmol/L

Tx:

• 10% calcium gluconate slow IV with ECG monitoring for development of bradycardia and/or shortening of QT interval
• fever: IVF
• second dose of calcium gluconate mixed with saline (50:50) can be given SQ
• calcium chloride must be given IV if chosen to prevent tissue necrosis and skin sloughing
• sent home with PO calcium gluconate and continued through lactation
• wean puppies at 3-4weeks old and started on a balanced growth diet
• bottle feeding if problem reoccurs