Whelping and Dystocia

Question 1

What is Dystocia?

Answer 1

Difficult birth

Life threatening for mother and offspring

5% of all pregnancy

Question 2

Dystocia

Prevention

Answer 2

Breeding soundness examination

Good BCS

Question 3

Dystocia

What breed is it more frequent in?

Answer 3

Brachycephalic - just do a C-section

Question 4

Dystocia

What is important to determine? How?

Answer 4

Delivery date!

How:
LH surge: 65 +/- 2 days
Ovulation: 63 +/- 2 days
Fertilization: 60 +/- 2 days

Question 5

What induces labor?

Answer 5

Increasing prostaglandin F2alpha and fetal cortisol

Question 6

Small vs. large litters

Answer 6

Small: will have prolonged gestation, causing them to grow beyond normal size

Large: may shorten gestation (more cortisol produced b/c more fetuses)

Note cat gestation not effected by this

Question 7

Progesterone and Labor

Answer 7

Late gestation: pregnancy maintained by progesterone level above 5 ng/mL

Is thermogenic; luteolysis lowers body temp to less than 99 => good way to know if she will be giving birth soon (within 24 hours) is if you take temps regularly

Question 8

PGF2alpha and Labor

Answer 8

PGFalpha = luteolytic

Luteolysis will cause progesterone to drop to less than 2 ng/mL

Question 9

What do radiographs at time of labor tell you?

Answer 9

Number of fetuses
Size of fetuses
Position

Question 10

What is the most reliable method for assessing fetal stress?

Answer 10

Ultrasound

Fetal stress:
Low HR (less than 150)

Question 11

Fetus Heart Rate

Answer 11

180 to 220 bpm

Question 12

Fetus Heart Rate in Which Death is Imminent

Answer 12

100 bpm

Question 13

Stage 1 Labor

Signs

Answer 13

Panting
Nervous
Restless
Nesting
Vomiting

Question 14

Stage 1 Labor

Length

Answer 14

6 to 12 hours

Nervous first mothers usually have longer labor

Question 15

Stage 1 Labor

If too long?

Answer 15

Potentially uterine inertia (not contracting)

Question 16

Stage 2 Labor

What occurs?

Answer 16

Contraction of uterus

Visible abdominal straining

Green or clear fetal fluid (bright or dark red is abnormal)

Amniotic sac may be visible

Question 17

Stage 2 Labor

When should first puppy/kitten be delivered?

Answer 17

Within 4 hours

Once fetus is visible it should be delivered within 20 minutes

Question 18

Stage 2 Labor

When should entire litter be delivered?

Answer 18

Within 12 hours

Question 19

Stage 3 Labor
What occurs?
How long?

Answer 19

Passing of placenta
Shortening of uterus

Rest period of 1 to 2 hours

Question 20

Delivery; how long should you wait between puppies

Answer 20

Max 2 hours

If getting close to 2 hours need to intervene

Question 21

Uterine inertia:

Complete primary inertia (what is it)

Answer 21

Normal birth canal
No fetuses delivered
Uterine dysfunction

Question 22

What can cause uterine dysfunction?

Answer 22

Small litter and inadequate stimulation
Large litter and over distended uterus 
Systemic disease
Electrolyte imbalance
Fatty infiltration of uterus
Uterine age
Unknown

Question 23

Partial primary inertia

Answer 23

Normal birth canal
Some fetuses born
Uterus becomes fatigued

Question 24

Secondary inertia

Answer 24

Uterus exhausted due to obstruction to passage of fetus

Obstruction: 
Narrow pelvic canal
Large fetus
Abnormal presentation
Fetus malformation 
Vaginal septum or stricture

Question 25

Uterine inersia | Treatment

Answer 25

Caesarean section surgery required with complete primary inertia (sometimes with primary partial and secondary as well) Surgery a must with more than 4 fetuses Medical management: Successful for about 27% of patients (IV fluids, dextrose, oxytocin) -> if 1-3 puppies remain

Question 26

Dystocia and Examining Mother

Answer 26

Ultrasound is best; check for fetal stress Blood tests for PCV, TP, calcium, glucose

Question 27

Dystocia | Vaginal Examination

Answer 27

Sterile gloves and lubricant! ``` Check for: Relaxation Contraction Presence of fetus at pelvic inlet Try and extend neonate feet forward ```

Question 28

Repositioning Fetus

Answer 28

Rotate along long axis slightly to help pass through pelvic canal Cautious using instruments to not hurt neonates or uterus Can lift and rotate mother to help bring fetus into pelvic canal Stimulate Ferguson Reflex

Question 29

What is the Ferguson Reflex?

Answer 29

Putting fingers into the pelvic canal stimulating contraction (body thinks its a puppy coming out) while simultaneously causing abdominal contraction

Question 30

Medications for Dystocia | First steps

Answer 30

Determine if in Stage 1 or Stage 2 uterine inertia/dystocia

Question 31

Medications for Dystocia

Answer 31

IV fluids to support BP 10% glucose for hypoglycemia 10% Calcium Gluconate for hypocalcemia (1 mL/4.5 kg body weight every 4-6 hours) -- monitor HR Low dose oxytocin following fluids, glucose, and calcium

Question 32

Medications for Dystocia | Precautions with Oxytocin

Answer 32

Initial dose 0.2 to 0.5 units per mother (canine or feline) Maximum: 2 units or 3 doses Wait 20 minutes between administration Too much will get uterine contraction as a unit opposed to "waves"

Question 33

Caesarean Section Surgery Dystocia Cautions

Answer 33

Required when medical management is not feasible Post-hemorrhage is concern Oxytocin may be given to assist uterine involution

Question 34

Drugs for Caesarean Surgery

Answer 34

Pre-anesthetic oxygen Glycopyrolate pre-anesthetic (low passing into placenta) Propofol for induction (minimal effect on fetus) Isoflurane Oxytocin to promote uterine involution Tramadol for pain control

Question 35

Drugs not to be given: | Preanesthetic (why)

Answer 35

Atropine Relaxes maternal lower esophageal sphincter; causes regurgitation

Question 36

Drugs not to be given: | Sedatives (why)

Answer 36

``` Dexmedetomidine Xylazine Phenothiazine Ketamine Barbiturates ``` Neonatal and maternal cardio-depressant and overall depressant

Question 37

Drugs not to be given: | Opioids (why)

Answer 37

Neonatal respiration If given must be able to be reversed!

Question 38

Drugs not to be given: | Anti-inflammatory

Answer 38

NSAIDs Impairs neonatal nephron development and hepatic function