|
Canine Dystocia
|
|
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 © 1997-2009, 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
********************
back to
top
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.
back to top
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.
