CS in Small Animals

• Background Information

• Indications

• Approaches

• Anaesthesia

• C/S Procedure

• Post-operative care and Discussion

Background Information

• Normal Parturition- III stages :• Stage I- the preparatory phase- approximately 6-12

hour long but can be as long as 36 hours.

• Stage II - active propulsive stage. It lasts approximately 20 minutes to 1 hour per puppy but, no more than 2 hours should elapse between each puppy born.

• Stage II usually lasts a total of 3-6 hours but, may be as long as 24 hours total.

• Stage III- the expulsion of the placenta.

• You may see pup-placenta-pup-placenta or pup-pup-placenta-placenta.

DystociaDystocia

• Diagnosis of Dystocia - When should

the client be concerned? • 30 minutes of strong contractions with no pups

delivered. • 2-3 hours of weak and infrequent expulsive

efforts failing to produce a pup. • 4 or more hours between pups.

• Obvious problem (pup hanging out etc.)

Protocol for Handling Dystocia

1. History • Predisposing factors such as breed, parity, age, size of litter must

be considered. • Establish the following information:

– 1) the time of onset of Stage II, – 2) the frequency and intensity of expulsive efforts, – 3) the time since the last delivered fetus, – 4) any assistance given prior to your entry into the case,

– 5) the general health of the bitch.

2. General systemic and genital exam – Vaginoscopy - Do a digital exam to determine location of puppy.

You can try "feathering" (massaging or tickling) the vagina to stimulate the Ferguson reflex.

3. Ultrasonography

• You can use the ultrasound to determine fetal viability by looking for heartbeats. • It may be hard to accurately count the number of puppies left using ultrasound

4. Radiography

• You can radiograph the abdomen to see how many puppies are left, but it is difficult to assess fetal viability.

5. Laboratory tests

• CBC • Chemistry panel • These may help determine the health of the dam prior to prolonged manipulation or

surgery. • Progesterone - bitches will whelp with progesterone over 2 ng/ml

Plan of Action• The plan is determined by the etiology and

presenting complaint.

Primary uterine inertia • Primary uterine inertia is a delay in starting the second

stage of labor after the first stage signs have been established.. This occurs because the uterus is not contracting.

• Prolonged gestation • Diagnosis of prolonged gestation rests heavily on subjective

information from the owner/breeder. • Rule out pseudopregnancy, incorrect breeding date, incorrect

calculation of breeding date in determining if gestation is prolonged. • If ultrasound or radiographs indicate viable fetuses, then waiting may

be the best course.

Indications

• Uterine inertia unresponsive to oxytocin

• Pelvic obstruction

• Fetal oversize

• Vaginal obstruction that can not be manipulated

• In utero fetal death

• Planned surgery

Secondary uterine inertia

• Secondary uterine inertia is the delay in resuming stage II labor after one or more births (for example more than 4-6 hours since the preceding delivery)

• Laboratory work may be helpful in assessing the dam. Take samples for PCV, WBC, TP BUN, , and Glucose. If the bitch is 'sick', take samples for a CBC and a serum chemistry panel.

• Rule out obstruction or completed complete delivery using vaginal examination, radiographs,

and/or ultrasound.

• Obstructive Dystocia

• Obstructive dystocia is when the bitch is pushing hard but there are no puppies. (not pushing = inertia)

• 30 minutes of strong contractions with no pups delivered.

• 2-3 hours of weak and infrequent expulsive efforts failing to produce a pup.

• 4 of more hours between pups. • Obvious problem (pup hanging out etc.)

CS-procedure

• General: Surgical removal of pups from uterus is relatively safe, simple and succesful procedure.

Anaethesia• Induction & Maintainance• Isoflurane alone• Induction protocol:- Xylazine + Thiopentone• ACP+ Thiopentone• Barbiturates*• Halothane*-regulated (0-5)

• the procedure requires significant anesthesia• the pet will not cooperate and lie still for surgery even if all pain is

relieved. Thus general anesthesia is needed to induce pain relief, unconsciousness and relaxation. In the usual case, the pet will receive a pre-anesthetic sedative-analgesic drug to help her relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and subsequently inhalation (gas) anesthesia in oxygen during the actual surgery.

A photo showing the distinct gestational sacs

A photo showing how the gestational sacs become confluent,

and therefore difficult to distinguish

Placenta

Approaches

• Median

• Paramedian

• Flank

How is it done-Midline

• Following anesthesia, the pet is placed on a surgical table, lying on her back.• The hair is clipped over the lower abdomen, the skin is scrubbed with surgical soap to

disinfect the area and a sterile drape is placed over the surgical site.• a midline incision similar to that used to spay a female; however, the incision line will

be relatively longer.• Skin is tensed using thumb forceps• A scalpel is used to incise the skin of the lower abdomen and then open the

abdominal cavity. • The uterus will be exposed, bifucation located and then incision (s) made to remove

the fetus. • Pups are removed by milking them out towards the incision• The pup(s) is (are) handed to an assistant who clears the airway, stimulates

breathing, and gives drugs if necessary.• The uterus may be contracted with a hormonal drug and then the incision is closed

with sutures (stitches) that dissolve over time. • Alternatively, the female may be spayed. • The abdominal incision is then closed with one or two layers of self-dissolving sutures

(stitches). The outer layer of skin is closed with sutures or surgical staples that must be removed in about 10 to 14 days.

C/S Procedure

Post Operative and Peripartum Care

Video

Foster Mother

Discussion

• The overall risk of this surgery is very low. The major risks are those of general anesthesia, bleeding (hemorrhage), infection (peritonitis), post-operative infection and wound breakdown (dehiscence) over the incision. Overall complication rate is low, but serious complications can result in death or the need for additional surgery.