CESAREAN SECTION IN LABRADOR BITCH - REVIVAL OF NINE LIVE PUPS : A MEMORABLE CASE

In this post, I am sharing some blessed moments of my career  as a vet surgeon. 

Last week a case of 4 yr old biparous Labrador retriever in 64^th day of gestation was presented in total refractory state of complete uterine inertia with history of straining from past 24 hours . The owner brought this dog in a very late stage and the animal had severe dehydration, cachexia and stage of unconsciousness. After initial stabilization with fluid therapy , an emergency cesarean was performed which  saved the  animal and nine live pups were successfully revived

Even though this operation was done with out assessing the foetal position and number  by an ultrasonic scan due to the late night presentation of the case , the animal responded very well and the anesthetic ombination of propofol @ 6 mg/kg  and diazepam @ 0.5 mg/kg gave excellent results.

PLEASE WATCH THE VIDEO BELOW 

Dystocia can occur as a consequence of problems with the dam’s uterus or birth canal, or with the fetus.  An abnormally long time between deliveries of puppies,  prolonged period of labor with no puppies being born, delivery of stillborn puppies (born dead),presence of a puppy in the birth canal without obvious abdominal contractions or movement of the puppy, agitation in the dam, persistent nesting behavior (digging, circling),fatigue, exhaustion, Straining as if to defecate , suggests an obstruction in the birth canal or uterine inertia which demands a Cesarean section to save the mother as well as the pups.

The diagnosis of dystocia should be based on the presence of any of the following criteria:

Failure of the dam to initiate labor at term.  Bitches can be considered over term at >70-72 days from the first breeding, >58-60 days of diestrus, or > 66 days from the LH surge or initial rise in progesterone during estrus (All ovulation timing methods performed during the previous cycle).

Failure of the dam to enter Stage 1 labor, beyond 24-36 hours after a detectable drop in rectal temperature <99-100 degrees F or decline in progesterone level below 2 ng/ml, or failure to proceed from Stage 1 to Stage 2 labor within 24 hours.

Failure of the dam to complete delivery of all of the fetuses in a timely fashion.  Delivery of the first fetus should occur within 1 hour of active labor (with visible abdominal efforts) or 4-6 hours of intermittent labor.

Fetal distress (unborn puppies with slow heart rates, stillbirths).

Maternal distress (excessive pain or depression), green or copious vaginal bleeding.

Irreversible history of dystocia (pelvic canal abnormalities, mismatch fetal/maternal size, malposition)

In the present case the mother was totally non responsive and cachectic with

Severe straining. The owner did gross neglect to the mother leading to the presentation of case in advance stage.

Oxytocin injection can be given if the mother is in a position to initiate a contraction. In this case emergency fluid therapy stabilized the animal.

My previous post on  C-Section in a PUG can also be refereed in this context.

http://drssnairvet.blogspot.in/2014/12/clinical-veterinary-surgery-video.html

C- SECTION IN PUG

IMPORTANCE OF FLUID THERAPY

Patients who present for dystocia often will be dehydrated, so it is appropriate to fluid-resuscitate them before surgery. Electrolyte abnormalities should be corrected pre-operatively. Every animal must be evaluated for evidence of hypovolemic shock, and treated appropriately if necessary. The vast majority of animals, however, will require only one-third to one-quarter of their shock dose of isotonic crystalloid fluid (15-20 ml/kg), followed by a surgical rate of fluid administration (10 ml/kg/hr crystalloid unless complicating factors are present, such as heart disease or hypoproteinemia).

Nearly all analgesic and anesthetic drugs will cross the placenta and enter the fetal circulation. As such, it is important to minimize fetal exposure to cardiovascular depressant drugs by minimizing time from induction to delivery.

PROPOFOL -DIAZEPAM COMBINATIONS FOR ANESTHETIC MANAGEMENT IN C- SECTION.

Propofol is an anesthetic injection for use in dogs for induction and maintenance of general anesthesia for up to 20 minutes and for induction where maintenance is provided by inhalant anesthetics.
When using propofol, patients should be continuously monitored, and facilities for the maintenance of a patent airway, artificial ventilation and oxygen supplementation must be immediately available. Propofol contains no antimicrobial preservatives. Strict aseptic techniques must always be maintained during handling since the vehicle is capable of supporting the rapid growth of microorganisms.

Propofol works by binding to the GABA receptor (the primary inhibitory neurotransmitter binding site) CNS Effects Propofol produces CNS depression and unconsciousness. Propofol is considered “cerebral-friendly” because it decreases cerebral oxygen consumption, decreases cerebral blood flow (CBF), lowers intra-cranial pressure .Administration of other GABA agonists (e.g. benzodiazepines (diazepam/ midazolam)) immediately before propofol can decrease the amount of propofol needed by almost 50%. This is cost saving, and also decreases the cardiovascular and respiratory depression seen with bigger doses of propofol.

I thank my colleague Dr Nagaraj, the internees in Veterinary Surgery and the final B.V.Sc. students who helped me in this procedure.Hope this case has inspired the budding vets .

I am sure my  team will remember this case through out  the career  for the timely decision to cut open and the joy of taking live pups one by one and counting the heartbeats  reviving nine pups sequentially was beyond the words to express.  

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CASTRATION AND ITS EFFECT ON CANINE SERTOLI CELL TUMOR

In this segment I would like to share some experience with Canine testicular tumors-  sertoli cel tumor and seminoma  which is a testosterone dependent tumor seen in un-castrated old male dogs. Testosterone is the male hormone that is universal in all male species. When it comes to dogs, the hormone has multiple role in their behavior and also in their social order and structure.  As dogs grow, crosses his adolescence of 18 months, steep hike in the testosterone trigger secondary sex-related characteristics like  mounting, lifting of leg and higher levels of aggression.The causes for canine aggression are of great concern for many dog owners.

A male dog when presented with signs of feminisation like well developed teats, gyaenecomastia , bilateral alopecia and enlarged testicle, it is a sure case to be suspected for sertoli cell tumor.

Testicular tumors are common in dogs and account for 90% of all cancers arising from the canine male genitalia . Sertoli cell tumor is a testicular tumor arising from the Sertoli cells located within the seminiferous tubules. Several factors are believed to influence the development of testicular tumors, including cryptorchidism, age, breed and exposure to environmental carcinogens . German shepherd dogs, Afghan hounds, Weimaraners and Shetland sheepdogs appear to have an increased risk of developing primary testicular tumors. Both Sertoli cell tumors and seminomas are associated with intra-abdominal or inguinal cryptorchidism and these tumors develop the male feminizing syndrome, from the production of estrogen and estrogen-type hormones .

This six year old intact male GSD , had bilateral symmetric alopecia and hyperpigmentation with gradual weight loss three months prior to presentation of the case. On palpation and detailed examination , large pedunculated mass was found at the site of left testicle and the right testicle was absent on the scrotal sac. The animal had characteristic signs of feminisation with well-developed teats and subcutaneous cystic swelling seen close to the teats at the inguinal region

Signs of feminization , contralateral testicular atrophy, squamous metaplasia within the prostate gland, symmetrical alopecia, and bone marrow atrophy are common symptoms noticed in sertoli cell tumor. In the present case the animal had signs of feminisation as evidenced by  Gynecomastia and presence of cystic swelling near the inguinal teat which may be attributed to the excess estrogen . Cryptorchidism has been associated with testicular tumors in animals and human . Tubular arrangement of the neoplastic Sertoli cells with cord-like and diffuse pattern is regarded as a common histo-pathological findings in Sertoli cell tumors.  In the present case, the animal successfully recovered after the operation. The third month post-operative evaluation showed complete reversion of the feminisation and till date no re-occurrence of tumor was noticed.

 

YOU CAN WATCH A PRESENTATION ON SERTOLI CELL TUMOR IN THE GSD DOG BELOW

EFFECT OF CASTRATION

From the animal behavior point of view, there are two kinds of aggression seen in dogs , fear aggression and dominance aggression. Fear aggression results from previous experience of being attacked, or because they feel they are unable to escape a particular situation. As a Vet, I had encountered this response in some patients in the second visits.  

Many owners complain that the dog mounts on every one . Mounting behavior against humans is a land mark of  puberty. This is normal but demands castration if the dog shows the symptom even in adult stage.

Castration may be recommended where aggression between dogs is orientated towards other males and where fear aggression has been ruled out. Castration may reduce the desire to dominate and reduce overall aggression thresholds.

The advantages of castration can be enlisted in two headings

Behavioral advantage which includes

decreased roaming,

decreased aggression,

increased concentration

Well focused traits of army dogs may be attributed to the early castration

Medical advantages of castration  includes prevention of

Testicular tumors- seminoma and sertoli cell tumor

Perianal hernia

Perianal tumor

All male species suffer from begnign prostatic hyperplasia .An intact male dog shows the sign of difficulty in defecation and urination and the main cause will be that of an enlarged prostate.

Testosterone dependent prostatic enlargement needs castration and this for this reason Castration is recommended for all male dogs.