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 64th 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
Last week a case of 4 yr old biparous Labrador retriever in 64th 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.
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.
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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