C-Sections: The Good, The Bad, The Puppies!

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So many questions enter my head when I’m told by a concerned receptionist that a whelping bitch is on the way to the practice. Is this bitch owned by an experienced breeder or a complete novice? Is this a brachycephalic breed, notorious for having problems or a young fit and healthy cross breed? What stage of labour is this bitch in and how long has it been going on for? These questions are just the tip of the iceberg when it comes to the information required for vets to make the correct decisions for both bitch and puppies. The good news is that last week’s webinar led by Aylin Atilla, Assistant Professor at the University of Calgary, helped shine a light on how to logically approach answering some core questions and how to process this information so the most appropriate decision can be made based on a solid knowledge base.

Understanding the normal from the abnormal is a key starting point in deciding whether veterinary assistance is indeed necessary. Aylin describes the three stages of labour, stage one where the bitch is preparing for birth which usually lasts for 12-24 hours, stage two where the bitch gives active foetal birth and is usually complete by six hours and stage three where placentas are expelled. Stage one usually only culminates in behavioural changes with bitches becoming restless and panting more. In stage two however, bitches will usually be passing active foetal fluids such as lochia (dark green discharge), have active abdominal contractions and a rectal temperature which has returned to normal having dropped to <37.2⁰C, 12-24 hours prior to the onset of whelping. Understanding and being able to differentiate between these normal stages of labour can be really useful in determining whether veterinary intervention is necessary. For example, if no foetus is produced after four hours of the onset of stage two labour veterinary assistance should be sought. Other indicators include:

  • No sign of labour 24-36hrs after the dam’s drop in rectal temperature (the rectal temperature needs to be taken at least three times a day to monitor the trend)
  • No puppy is expelled within one-two hours of producing lochia
  • If the interval between producing pups is longer than two-three hours
  • If there are strong contractions lasting longer than 30 minutes without expelling a puppy
  • No signs of labour if the date is 72 days or more post breeding
  • Any abnormal vaginal discharge
  • The presence of foetal membranes in the vulva for longer than 15 minutes
  • Failure to deliver all foetuses within 18-24 hours
  • The bitch is crying and biting at her vulva

Once veterinary intervention has been sought the question usually top of most vets’ list is whether this whelping bitch requires a caesarean or whether medical management and perhaps the use of manual assistance is enough to do the job? Given that 56-64% of all cases of dystocia eventually lead to surgical intervention, this would indeed seem a very appropriate question to ask. The key to answering this question is to determine whether there is foetal distress by measuring their heart rates using ultrasound. Anything below 150 beats per minute would indicate foetal distress and the necessity for surgical intervention. Aylin also advised monitoring heart beats over at least a 30–60 second period as their heart beats can appear normal until a uterine contraction takes place which can cause the rate to drop below the desired level. Foetuses with heart rates between 150-170 beats per minute (bpm) should be monitored closely and hearts rates of 180 bpm and greater should be considered normal. Medical therapy should only be considered if the dam is in good health, the cervix is dilated, there is normal foetal size and position (determined by radiography) and there are normal foetal heart rates. Aylin recommends initially performing a basic blood screen checking for the presence of hypocalcaemia and/or hypoglycaemia and if indicated supplementing with 10% calcium gluconate and/or 50% dextrose as necessary. Oxytocin can also be used but Aylin reminded us that oxytocin can drive calcium into cells and for this reason she recommends firstly giving one dose of oxytocin, waiting for 30-40 minutes, and if it has no effect then administering calcium gluconate. If this has no effect after another interval of 30-40 minutes a second and final dose of oxytocin can be administered.

Surgical intervention is warranted if there are signs of foetal distress, obstruction or if the dam is systemically unwell. Aylin discussed in detail the process of preparing and performing a C-section and advised the key to a successful surgery is to limit the time from induction to delivery of the pups and this is essentially achieved by good team work. Analgesia was also discussed including the use of local anaesthesia by performing line blocks and epidurals. Aylin also advised making sure naloxone is available to reverse any negative effects of opiates in puppies if used pre-operatively in the bitch. It was also advised to only administer a one-off dose of NSAIDs as COX-2 is important in neonatal renal development. Aylin advised she usually uses opiates such as tramadol or codeine alongside local anaesthesia for post-operative analgesia but usually doses them directly after the puppies have had a feed so they are less exposed to their effects.

I’m sure there aren’t many of us whose heart rate doesn’t increase just slightly at the thought of attending to a whelping bitch. There are so many possible scenarios and potential pitfalls, it can all be somewhat daunting. I’m glad to say this webinar has allowed me to see ‘the wood from the trees’ by acting as a reminder of those all-important basics and offering some simple guidelines which if adhered to should consistently point us down the right path for both mum and pups.  Of course, we shouldn’t forget about our feline friends which despite being significantly less prone to dystocia, also got discussed as part of this essential ‘must see’ webinar.

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