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Dystocia and Reproductive Emergencies in Dogs and Cats | VETgirl Veterinary Continuing Education Podcasts

In this VETgirl online veterinary continuing education podcast, Dr. Garret Pachtinger, DACVECC (VETgirl, COO) discusses common reproductive emergencies.

DYSTOCIA
Dystocia is defined as the inability to expel fetus from the uterus and birth canal at the expected time of parturition. This is an emergency that requires immediate attention to reduce both the risk of morbidity and mortality to the mother and fetus. Common causes for dystocia include a pelvic obstruction, an oversized fetus, fetal malpresentation, or fetal death. If possible, an attempt should be made to manually remove the fetus if protruding from the vaginal vault. This is performed with a water-based sterile lubricant and gentle traction wearing sterile gloves. Instruments that may injure the mother or fetus should be avoided if possible.

For patients with dystocia it is also important to correct any fluid, electrolyte, calcium, and glucose imbalances. Oxytocin is commonly used, but important to understand the risks and why dosing currently is likely far less than what veterinarians used years ago. Excess dosing of oxytocin can lead to tetanic and unproductive uterine contractions, placental separation and fetal hypoxia. It is also important to identify obstructive dystocia, closed cervix, fetal distress, placental separation, uterine disease, an/or uterine rupture prior to administration of oxytocin. If ruled out, oxytocin can be considered at 1–5 IU SC or IM repeating in 20-30 minutes if ineffective. Calcium gluconate 10% as well as dextrose supplementation can also be considered if electrolyte support is a concern.

HYPOCALCEMIA
Commonly referred to as eclampsia, hypocalcemia is a common condition in bitches, notably small breed patients, 2–3 weeks after delivery. It is uncommon in cats, but can occur. Signs of hypocalcemia include tremors, panting, stiffness, pacing, salivation and restlessness. As it progresses the patient may exhibit worsening signs including tetany, hyperthermia, tachycardia, and seizure behavior. The treatment of choice is 10% calcium gluconate; administered slowly with the patient monitored on ECG. The dose range is 0.22-0.44mg/kg administered slowly IV until signs improve. Other signs such as dehydration or hypoglycemia should be treated accordingly. Oral calcium treatment (500 mg TID per 20 lbs) as well as vitamin D (10,000-25,000 IU) should be continued throughout the rest of lactation with the recommendation of removing the puppies from the bitch and supplemented with milk replacer, at minimum for 12-24.

PYOMETRA
Pyometra generally occurs in middle-aged females during the period of diestrus. Typically, pyometra is referred to as either an open pyometra (cervix remains open) or a closed pyometra (cervix remains closed). Clinical signs of illness include vaginal discharge (open pyometra), vomiting, diarrhea, dehydration, lethargy, anorexia, depression, polyuria and polydipsia.
Pyometra commonly develops 4-8 weeks following estrus with the diagnosis made by either abdominal radiographs or ideally ultrasound showing a fluid filled uterus.
The author recommends medical stabilization and surgical therapy, notably emergency ovariohysterectomy. Care should be taken on examination to also not the presence of mammary tumors.

References:
1) Biddle D, Macintire D. Obstetrical emergencies. Clin Tech Small Anim Pract 2000;15(2):88-93
2) Davidson AP. Obstetrical monitoring in dogs. Vet Med 2003;6: 508.
3) Davidson AP. Dystocia management. In: JD Bonagura, ed. Kirk’s Veterinary Therapy XIV. WB Saunders Co, Philadelphia, PA, in press.
Davidson A. Postpartum disorders in the bitch, queen & neonates. Western Veterinary Conference 2008.
4) Feldman EC, Nelson RW. Periparturient diseases. In: Veterinary Reproduction and Endocrinology. Philadelphia, WB Saunders, 1996.
5) Johnston SD, Root Kustritz MV, Olson PNS. The neonate – from birth to weaning. In: Johnston SD, Root Kustritz MV, Olson PNS, eds. Canine and Feline Theriogenology, 1st edition. Philadelphia: WB Saunders; 2001:146–167.
6) Johnston SD, Root Kustritz MV, Olson PN. Canine and Feline Theriogenology. Philadelphia: WB Saunders Co, 2001
7) Macintire DK. Reproductive emergencies, Atlantic Coast Veterinary Conference 2006
8) Smith FO. Postpartum diseases. Vet Clin North Am Small Anim Pract. 1986;16(3):521-524
9) Wallace MS. Management of parturition and problems of the periparturient period of dogs and cats. Sem Vet Med Surg (Small Anim) 1994;9(1).

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