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Canine Dystocia
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Dystocia
Dystocia in the Bitch
Veterinary & Aquatic Services Department, Drs. Foster
& Smith, Inc.
Dystocia means difficult delivery.
It may be due to a number of causes including large fetus size, small pelvic
size in the dam, malposition of the fetus, uterine inertia, or breed. Brachycephalic
breeds such as Bulldogs, Pugs, and Boston Terriers have a higher incidence
of dystocia due to the large head and shoulder size of the puppies. Many breeders
of these breeds have the puppies delivered by a scheduled cesarean section.
Dystocia is diagnosed based on the owner's observations. It is considered
likely in the following scenarios:
30-60 minutes of strong contractions without delivering a puppy
Greater than 4-6 hours between puppies (and more puppies are in the uterus)
Failure to start delivery within 24 hours of the temperature dropping below
99ºF
Crying/licking the vulvar area excessively during whelping
Gestation lasting greater than 70 days from the first breeding or greater
than 60 days from the first day of diestrus
It must be remembered that Stage 1 labor lasts 3-24 hours and strong abdominal
contractions are not seen during this stage.
A physical exam including abdominal palpation and a vaginal exam are necessary.
X-rays are done to determine the number of fetuses, their position, and their
size compared to the bitch's pelvic size. If the puppies appear to be able
to fit through the birth canal and are not malpositioned, she may be given
time to deliver on her own. Oxytocin may be given if indicated. She may also
need fluid therapy with calcium or glucose in it if eclampsia or hypoglycemia
are present. If the puppies are large, or a great number are present, the
decision to perform a c-section may be made. The decision is based on each
individual case.
If a puppy is partly born but hung up in the birth canal, gentle outward
and downward (toward the bitch's hocks) pressure may be applied in time with
her contractions. Be very careful if assisting, as injury to the bitch or
the puppy may occur. Try to pull on the puppy's legs or body to avoid dislocating
the neck, which may occur if the head is pulled. If after gentle pulling the
puppy still cannot be delivered, contact your veterinarian immediately.
A puppy that has had a difficult time being born may be weak or not breathing
when finally delivered. The placenta should be removed from around the puppy,
and the puppy held with its head pointing down to help keep fluid out of the
lungs. The bulb syringe should be used to clear the airways. Some breeders
will 'swing' the puppy downward between their own legs. Be very careful if
you elect to do so. Puppies have been thrown across rooms when the person
loses hold of them. The pressure of the swing helps to clear the airways,
but it will also swing the brain against the skull. When fluid has been removed
from the air passages, the puppy needs to be roughly but carefully rubbed
with a cloth to stimulate the breathing. Try CPR on a nonbreathing puppy for
at least 5 minutes to see if it will breathe. Some puppies, especially if
born by c-section, need 20 minutes of work to survive. Once the puppy starts
giving lusty cries and moving, the immediate danger should be past.
At this point, the puppy can be presented to the mother. Allowing the mother
to lick the puppy will continue to stimulate respirations.
When the puppy has been cleaned by the mother, and is moving well, place
the puppy next to one of the mother's nipples and allow it to start nursing.
If at any time during the delivery things just do not seem to be progressing,
a veterinarian needs to be contacted. Early intervention may save the life
of the bitch and her puppies.
References and Further Reading
Cain, J; Lawler, D. Small Animal Reproduction and Pediatrics. Pro-Visions
Pet Specialty Enterprises. St. Louis, MO; 1991.
Ettinger, SF. Textbook of Veterinary Internal Medicine, 3rd ed. W.B. Saunders
Company. Philadelphia, PA; 1989.
Evans, JM; White, K. Book of the Bitch. Howell Book House. New York, NY;
1997.
Feldman, E; Nelson, R. Canine and Feline Endocrinology and Reproduction.
W.B. Saunders Company. Philadelphia, PA; 1987.
Finder Harris, B. Breeding a Litter: The Complete Book of Prenatal and Postnatal
Care. Howell Book House. New York, NY; 1993.
Holst, P. Canine Reproduction: A Breeder's Guide. Alpine Publications. Loveland,
CO; 1985.
Lee, M. Whelping and Rearing of Puppies. T.F.H. Publications, Inc. Neptune
City, NJ.
Plunkett, SJ. Emergency Procedures for the Small Animal Veterinarian. W.B.
Saunders Company. Philadelphia, PA; 1993.
Copyright © 1997-2007, Foster & Smith, Inc. All
Rights Reserved.
Reprinted as a courtesy and with permission from Josie Pitterle Article Reprint
Coordinator Drs. Foster and Smith
PetEducation.com (
http://www.PetEducation.com)
On-line store at
http://www.DrsFosterSmith.com
Free pet supply catalog: 1-800-323-4208
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Dystocia
in the Bitch (Dystocia means trouble giving birth)
TEXTBOOK OF VETERINARY INTERNAL MEDICINE
Client Information Series; written by Dr Autumn P Davidson
Dystocia can be defined as inability
to expel neonates through the birth canal from the uterus. Dystocia is not
uncommon in the bitch and can have several causes. The diagnosis of dystocia
should be made and treatment insti-tuted in an expedient fashion. An incorrect
diagnosis of dystocia may result in an unnecessary caesarian section, but
failure to recognize or prioritize dystocia usually results in loss of puppies
and perhaps even the dam.
Dystocia can occur as a consequence of problems with the dam's uterus or
birth canal or with the fetus. The diagno-sis of dystocia should be based
on the presence of any of the following criteria:
1. Failure of the dam to initiate labor at term. Bitches can
be considered over term at more than 70 to 72 days from the first breeding,
more than 58 to 60 days of diestrus, or more than 66 days from the luteinizing
hormone (LH) surge or initial rise in progesterone during estrus.
2. Failure of the dam to enter stage] labor beyond 24 to 36
hours after a detectable drop in rectal temperature to less than 99 to 1000F
or to proceed from stage ] to stage 2 labor within 24 hours.
3. Failure of the dam to complete delivery of all fetuses
in a timely fashion. Delivery should occur within 30 minutes to 1 hour of
active labor (visible abdominal efforts) or 4 to 6 hours of intermittent
labor.
4. Fetal distress (unborn puppies with slow heart rates, stillborns).
5. Maternal distress (excessive pain or systemic illness), green
or copious vaginal bleeding.
6. Irreversible history of dystocia (pelvic canal abnormali-ties,
mismatch between fetal and maternal size) or radio-graphic evidence of fetal
malposition.
Your veterinarian's diagnosis of dystocia is based on tak-ing an accurate
history, including reproductive history, ovula-tion timing, and breeding
dates, and performing a careful physical examination including a digital
pelvic examination for the presence of vaginal abnormalities and the presence
of a fetus in the birth canal. A handheld Doppler device, abdominal ultrasonography,
and x-rays can be helpful in assessing fetal viability, litter size, and
fetal position. A blood test to measure calcium and glucose levels may be
helpful in identifying metabolic disorders contributing to dystocia.
Uterine abnormalities contributing to the development of dystocia include
uterine inertia, abnormalities associated with fetal fluids, and herniation
or torsion of a uterine horn. Uterine inertia, failure of the uterine muscle
to contract in an effective manner, can be primary or secondary. Primary
uterine inertia is multifactorial, with genetic, mechanical, hormonal, and
physical components. Bitches exhibiting primary inertia fail to proceed into
an effective labor pattern, and cesarian section is indicated. Bitches exhibiting
second-ary inertia fail to complete expulsion of all fetuses because of exhaustion
of the uterine muscle. Medical management can be attempted, with adequate
fetal monitoring, but cesar-ian section may be necessary. Intravenous glucose
containing solutions and oxytocin ("pit") and calcium injections can be administered
in appropriate doses.
Generally, minute doses of oxytocin are adequate (0.25 to 4.0 units per
dog). Spastic, uncoordinated contractions of the uterus occur if oxytocin
is administered too rapidly or at too high a dose. Uterine contractions interfere
with fetal oxygen supply by compressing placentas. Oxytocin should be administered
only with veterinary guidance. Abnormalities of fetal or placental fluids
include hydrops, an excessive accumulation of allantoic fluid associated with
each fetus, causing the fetal unit to be markedly oversized. Rarely, underproduction
of fetal fluids occurs, resulting in dystocia caused by lack of lubricating
fluids.
Disorders of the birth canal contributing to dystocia include pelvic abnormalities
such as narrowing resulting from a healed fracture or congenital disorders
and vaginovulvar abnormalities such as strictures. Successful natural breedings
can occur despite the presence of septate (vertical) bands in the vaginal
vault. Unfortunately, subsequent vaginal delivery of fetuses is usually
impaired. Strictures should be detected by the veterinarian at the time
of the soundness examination, before breeding. Anular (circular) strictures
are often de-tected at the time of breeding, as they often interfere with
the ability to attain a natural tie. These should be repaired before breeding.
Bitches with unusually small vulvar open-ings may require a partial episiotomy
to deliver puppies vaginally.
Fetal causes of dystocia include fetal oversize; fetal anom-alies; and
abnormal fetal position, presentation, or posture. Fetal oversize can occur
with prolonged gestation in abnor-mally small litters (especially if there
is a single pup) and is the most common fetal cause of dystocia. Fetal anomalies
such as anasarca and hydrocephalus (abnormalities of body fluid distribution)
can cause a mismatch between the size of the birth canal and that of the
fetus. Because both anterior (head-first) and posterior (breech) presentations
are normal in the bitch, only a transverse (sideways) presentation is associated
with dystocia and is rare. Puppies are normally positioned with the fetal
backbone adjacent to the top surface of the uterus. Malpositioning can cause
mild dystocia. Abnormalities of posture, normal being fully extended, are
the second most frequent fetal cause of dystocia. Malpositioning of the head,
forelimbs, or hindlimbs of the canine fetus is not readily corrected with
the use of forceps, traction, or digital manipulation because of the limitations
of the size of the birth canal of the bitch.
Dystocia: "What To Expect
When You Go To The Vet"
Your dog or cat seems to be having
trouble giving birth, or seems to have been in labor for a long time, or
the expected due date has past, or your dog in late pregnancy seems to be
sick: What Do You Do?
Duh...Go to your vet.
What to expect:
If you allow your pet to get pregnant, you need to understand that sometimes
things go wrong. Abortions, miscarriages, birth defects, babies born
dead, and a greatly increased chance of parasitism, medication sensitivity,
disease and death are quite possible.
In an ideal world, the pregnancy is a planned event, the female is young
and healthy, under the care of a veterinarian, well vaccinated, not too
overweight, and not suffering from parasitism. But even then, pregnancy,
especially during birth, is fraught with dangers.
So here’s what to expect when you go to the vet if the delivery event
isn’t going smoothly:
History and Exam: Your vet will be interested in the breeding date
if known as well as recent appetite, energy level, and any symptoms of illness
such as vomiting, diarrhea, lethargy and so forth. The trouble with
taking histories of late stage pregnancies is that it’s often normal to
feel lousy in late pregnancy.
In addition to all the routine things your vet will be evaluating during
the exam, he or she will be paying special attention to:
1. Signs of toxicity which might indicate a dead fetus or
uterine infection.
2. A good pelvic exam for discharges, cervical relaxation,
and of course a possible baby stuck in the canal. Whether or not we
can insert a finger into the vaginal tract to see if the cervix is dilated
or not depends, of course, on the size and temperamentt of the animal.
3. Whether or not milk is present ... not all that critical,
but it’s nice to know and the presence of milk indicates that gestation
is nearing it’s end
4. Body temperature ... it normally drops a couple of degrees
within 24 hours of delivery (I don’t know why) ...another indication that
the body is ready to deliver.
5. Most important of all; General health and vigor.
Is the patient strong enough to go through labor and/or a C-section without
aggressive supportive care.
6. We will want to know whether the health of the mom or the
babies are more important to you... sometimes we need to make a choice.
What’s next?
After the exam and discussion, you and your vet may decide at this time
to either give the situation a little more time, treat whatever other problems
may be apparent, or if needed, do a C section.
Or ... more investigation may be in order. If the vet’s sensitive
antennai are alerted, blood work or radiographs may be in order. And
if you’ve decided a C section is the best course, then blood work to evaluate
glucose levels, clotting, liver, and kidney function may be considered advisable
or routine.
And here’s something you need to understand: C sections are frequently
routine; the patient’s only major problem is getting those babies OUT.
But other times patient’s in late pregnancy are extremely sick, toxic, and
dehydrated. There may be a dead fetus or severe uterine infection,
a bacterial of the blood and/or kidney and both immune and vascular problems.
These patients are often calcium deficient as well. Trust your vet
and understand that some of these cases require fairly aggressive treatment,
are sometimes expensive, and sometimes unsuccessful.
Speaking of expense, this is an aside, but it seems to me that most C sections
seem to be needed in the middle of the night. You might want to consider
getting pet health insurance if you’re planning on breeding.
If we determine that the cervix is dilated enough and the patient is healthy
enough, your vet may give an injection to induce labor. A calcium
injection may also be given to strengthen contractions. If this injection
doesn’t work within about 30 minutes, it may need to be repeated.
If a second injection still doesn’t induce successful labor, well then a
C section will probably be recommended. Just like in human delivery
rooms, decisions on what to do depends on the situation and the situation
can change quickly. In hind sight, we sometimes find we’ve made a
wrong or unnecessary decision, but you simply have to trust your vet’s experience.
Maybe your skillful vet will be able to avoid a C section and be able to
extract a puppy or kitten stuck in the birth canal. (I tell my students
that the 3 most important things in pulling calves, lambs, pups, kittens,
or any other species is “Lubrication, Lubrication, Lubrication!”
Sometimes there’s no viable choice except a C section. If so, one
of the challenges is that the anesthesia will affect the babies too, so we
need to get them out fast, and they may need cpr and cardiac and respiratory
stimulation. They may need supplemental nursing until the mother recovers
from the surgery.
Misc Comments:
Just because a C section is needed for one delivery in a patient doesn’t
mean a future pregnancy will require a C section. Maybe yes, maybe
no.
Your vet
can spay your cat or dog during the C section if you want.
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The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist
you in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.
