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SA Therio > Whelping and Dystocia > Flashcards

Whelping and Dystocia Flashcards

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1
Q

Dystocia

A
  • difficult birth
  • Life threatening for mother and off spring
  • 5% of all pregnancies
  • Much more frequent in brachycephalic breeds
  • Breeding soundness exam should include consultation regarding delivery
  • General health and body condition are important factors
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2
Q

Screening for dystocia over the phone

A
  • Determine reason for concern
  • Obtain history and prior pregnancies
  • Determine if events are normal
  • Best to see patient early if any doubt, especially if concern is voiced by an experienced breeder
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3
Q

Determining delivery date based on breeding date

A

57-72 days

  • 52-74 for feline
  • Not super reliable
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4
Q

How far past LH surge is delivery?

A

65 +/- days

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5
Q

How far past ovulation is delivery?

A

63 +/- days

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6
Q

How far past fertilization is delivery?

A

60 +/- days

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7
Q

If using vaginal cytology, how far past D1 (???) is delivery?

A

57 days

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8
Q

How to determine delivery date in felines

A
  • Induced ovulator so hormonal timing not very useful

- Must rely on clinical signs of labor

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9
Q

Which hormones cause onset of labor?

A
  • Prostaglandin F2 alpha and fetal cortisol
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10
Q

Relative gestation length in small vs big litters?

A
  • Small litters have prolonged gestation and large litters may shorten gestation in dogs
  • Cat gestation length not affected by litter size
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11
Q

What level is progesterone above to maintain pregnancy during late gestation?

A
  • Above 5 ng/mL
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12
Q

How does prostaglandin F2 alpha induce labor?

A
  • Luteolytic so it drops progesterone to less than 2 ng/mL
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13
Q

How soon after progesterone drops to <2 ng/mL do you expect to see signs of labor?

A

8-24 hours

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14
Q

What will happen to a female dog’s temperature as progesterone drops?

A
  • Her temperature will drop, because progesterone is thermogenic
  • Monitor rectal temperature twice a day at least
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15
Q

Radiographic indicators of gestation length

A
  • Skull and spine observed at 45 days
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16
Q

What can you use radiographs at time of labor for?

A
  • Number of fetuses remaining
  • Size of fetuses
  • Shape
  • Position and presentation
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17
Q

Which method is best for assessing fetal stress?

A
  • Ultrasound
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18
Q

What signals fetal stress best on ultrasound?

A
  • Low heart rate
  • <150 is concerning
  • Less than 100 means death is imminent
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19
Q

Normal fetal heart rate

A
  • 2 times that of the dam

- 180-220+ bpm

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20
Q

Home monitoring of fetuses and pregnancy

A
  • Fetal heart rate with Doppler
  • Hard to distinguish fetuses over time
  • Tocodynamometer
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21
Q

Tocodynamometer

A
  • Measures pressures associated with contraction of the uterus
  • Helps identify beginning of labor and progression either normal or abnormal
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22
Q

Stage 1 labor signs

A
  • Panting, nervous, restless, nesting behavior, vomiting
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23
Q

How long does Stage 1 labor last?

A

6-12 hours or longer with a nervous first litter mother

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24
Q

What can cause a long stage 1 labor?

A

Uterine inertia

  • Examine bitch or queen if any doubt
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25
Stage 2 labor signs
- Contraction of uterus with visible abdominal straining - Green or clear fetal fluids passed - Amniotic sac may be visible
26
When should first puppy or kitten appear after stage 2 starts?
4 hours
27
Once fetus is visible at the caudal pelvic canal, how soon until it should be delivered?
- 20 minutes
28
How long until litter is fully delivered?
- 12 hours | - DO NOT ALLOW LABOR TO CONTINUE BEYOND 24 hours
29
Large amounts of bright red fluid during labor/delivery - normal or not?
- NOT
30
Fetal membranes - when can you see them?
- Only shortly before delivery and after delivery | - Therefore check the yard for a pup if the bitch went outside unsupervised
31
Stage 3 labor
- Passing placenta - Shortening of the uterus - Rest period 1-2 hours
32
Complete primary inertia
- Normal birth canal | - No fetuses delivered
33
What can cause complete primary inertia?
- Small litter and inadequate stimulation - Large litter and over distended uterus - Systemic disease - Electrolyte imbalance - Fatty infiltration of the uterus - Uterine age - Unknown
34
Partial primary inertia
- Normal birth canal - Some fetuses born - Uterus becomes fatigued
35
What can cause partial primary inertia?
- Same as in complete inertia
36
Secondary inertia
- uterus exhausted due to obstruction to passage of fetus
37
What can cause obstruction?
- Narrow pelvis - Large fetus - Abnormal presentation - Fetus malformation - Vaginal septum or extensive stricture
38
How do you treat complete primary uterine inertia?
- C-section only
39
How do you treat partial primary inertia or secondary inertia?
- Surgery MAY be needed with partial primary inertia and secondary - Surgery is definitely needed if >4 fetuses remain - Medical management can work ~25% of the time
40
What to do during examination of the mother for dystocia?
- Keep with puppies or kittens - Look for signs of active delivery - Evaluate general condition - Radiographs - Blood tests for PCV, TP, Calcium, and glucose - Ultrasound of fetuses to check for stress
41
Vaginal examination
- Check for fluids and relaxation of vagina - Use copious amounts of sterile lubricant - Check for presence of a fetus in or at the pelvic inlet - Assist normal delivery by gentle traction on head or pelvis - Try to extend legs if possible
42
Normal presentation of fetuses
- Can be anterior or posterior with legs out or legs tucked under
43
Abnormal presentations
- Head folded back or folded under | - going out sideways
44
How to reposition fetus for delivery?
- Place fetus in normal position - Rotate along along axis slightly to help pass through pelvic canal - Be cautious of instruments and DO NOT USE OBSTETRICAL clamps - Lift and rotate the mother to help bring fetus
45
Ferguson reflex
- Stimulate by stretching the vagina - Body will start pushing in response - This is what you can do if there is a dystocia
46
Where to grab the fetus?
- Behind jaw bones or behind the hocks
47
Steps for dystocia
- Determine if in Stage I labor or in Stage II uterine inertia/dystocia - IV fluids to support blood pressure - 10% glucose for hypoglycemia - 10% calcium gluconate for hypocalcemia (SC is safer for heart) - Low dose oxytocin following fluids, glucose, and calcium
48
Dosing of oxytocin
- Initial dose is 0.25 to 0.5 units per bitch or queen - Maximum 2 units per bitch - Maximum 3 doses
49
C-section essentials
- Anesthesia, rapid sx site preparation, and a team that can work with newborns - Precise surgery is important to avoid post-op hemorrhage - Oxytocin may be given to assist uterine involution and help control bleeding
50
Will OVH affect milk production or mothering instinct?
- No
51
Drugs for C-section
- Pre-anesthesia oxygenation - Glycopyrrolate pre-anesthetic - Propofol for induction - Isoflurane or sevoflurane - Local anesthetic at incision site - Epidurals - Oxytocin to promote uterine involution
52
Why give glycopyrrolate during C-section?
- Vagal stimulation with uterine manipulation is expected | - Doesn't cross the pracenta as much as atropine
53
Why give propofol for anesthesia induction?
- Rapid redistribution with minimal effect on the fetus
54
Why no atropine for c-section?
- Relaxes maternal esophageal sphincter and can lead to esophagitis
55
Why no dexmedetomidine or xylazine for c-section?
- Neonatal and maternal cardio-depressant
56
Why no opioids for c-section?
- Neonatal respiratory depression | - MAY be able to give during pre-anesthetic if you reverse with naloxone during neonatal resuscitation
57
Why no phenothiazine tranquilizers, ketamine, barbiturates for c-section?
- Neonatal overall depression
58
Why no nitrous oxide for c-section?
- Rapid transfer across placenta | - neonatal diffusion hypoxia
59
Why no NSAIDs for c-section?
- Impairs neonatal nephron development and hepatic function, although a single dose MIGHT be given post-surgically
60
Mask induction with iso or sevo in c-section
- Works but greater hypoxia (and stress!!!) than with pre-oxygenation and propofol
61
What medications can be given to stop uterine contraction?
- Terbutaline | - Tocolytic
62
Regumate
- Supplemented progesterone if there is low progesterone
63
What to do in case of a dystocia?
- Brucella testing | - Measure serum progesterone

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