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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