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InFocus

Caesarean of pregnant bitches

Some medicinal interventions can aid in cases of difficult parturition, but if no improvement is seen a caesarean will most likely be indicated

The gestation period for dogs is generally 62 to 64 days. There are a few physical changes that an owner might notice if their bitch is pregnant. These include an increased appetite, mammary gland enlargement, enlarged abdomen/weight gain and a change in behaviour/nesting behaviour (Meyers, 2021).

Ultrasonography is widely used in veterinary practice to confirm a pregnancy, as well as monitoring for any foetal abnormalities (England, 1998). Foetuses can generally be seen on ultrasound from 28 days of pregnancy. Abdominal ultrasounds can be carried out while conscious so the procedure will not cause any harm to the bitch or puppies. Although ultrasound confirms a pregnancy, it can be hard to count the exact number of puppies present. To get an exact number of puppies, radiography is more reliable, although puppies cannot be seen on radiographs until much later into the pregnancy (Concannon, 2005). Due to the radiation that is involved with radiography, whether it is necessary should be carefully considered. If owners do not want imaging, veterinary surgeons can manually palpate the abdomen from 21 to 28 days to confirm a pregnancy.

Indications for caesarean

Most caesarean operations are needed due to abnormal parturition. This could be due to dystocia, trauma or infection. Dystocia can be very common in dogs. A factor affecting this can be breed. Some breeds, such as brachycephalic breeds, are more prone to needing a caesarean than others. There is a higher risk of dystocia when different breeds where the bitch is smaller than the stud are mated due to the puppies being too large for the birth canal. Foetal death could be another cause of unsuccessful parturition. Abnormal physiology of the birth canal and illness in the bitch may also lead to a caesarean being necessary (Moore and Simpson, 1999b). If any of these are a concern at the time of parturition, the dam should be monitored closely.

Clinical signs that would indicate a caesarean may be needed include unsuccessful straining and the passing of foetal fluid. If no puppies have been delivered but the bitch has been straining persistently for over 30 minutes, there may be a puppy stuck in the birth canal. If a green vaginal discharge is noticed, this could be the start of placental separation. The bitch should be closely monitored for any of these signs as surgery may be needed to deliver the puppies safely and successfully (Reichler, 2010).

What can be done to prevent surgery?

If dystocia is occurring and uterine inertia is developing, medical management can be attempted. Oxytocin can be given before uterine contractions stop completely. The administration of oxytocin will increase the frequency of uterine contractions. Calcium gluconate can be given when uterine contractions are weak or ineffective, as it will increase their strength. If no improvement is seen after administration of these medications, a caesarean will most likely be indicated (Davidson, 2020).

Anaesthesia considerations

If general anaesthesia is needed to perform a caesarean, medications used should be carefully considered. To reduce the amount of time that the bitch is anaesthetised, the clipping and prepping of the surgical site should be done consciously beforehand. All the equipment needed for surgery, recovery and reviving of puppies should be prepared before the bitch is anaesthetised. These patients often come in as an emergency so it is important to check when they were last fed so the risk of vomiting and regurgitation can be assessed.

Most of the drugs used in anaesthesia cross both the blood–brain barrier and the placenta, meaning that they can affect the neonates. If the bitch allows you to gain intravenous access without a premedication, then not using one should be considered. Induction can be achieved using propofol or alfaxalone with maintenance of anaesthesia controlled by isoflurane or sevoflurane. The physiological changes during pregnancy mean that the minimum alveolar concentration of inhalational agents is reduced and the oxygen consumption is increased. It is important to remember this when monitoring the anaesthetic. The theatre table should be tilted slightly to relieve the pressure of the neonates from the bitch’s chest; this will help to reduce hypoventilation. This pressure may also cause hypotension so intravenous fluid therapy should be considered (Lane and Cooper, 2002). Once the last neonate has been delivered, analgesia should then be administered to the bitch (Heskin, 2018). Drugs and anaesthetic protocols used should be determined by the anaesthetist or veterinary surgeon.

Care of puppies immediately after delivery

Once the puppies have been removed, they will need to be revived. The remaining residues of the foetal membrane should be removed and the airway checked to ensure it is clear from fluid. If necessary, fluid can be removed using suction. Swinging puppies to remove fluid is contraindicated due to the risk of cerebral haemorrhage. A clean and warm towel should be used to rub the puppy to stimulate respiration. The umbilical cord will need to be clamped and ligated. Once the puppies are breathing regularly and efficiently by themselves, they should be placed into a warm incubator while waiting for the bitch to recover from general anaesthesia. Perineal massage can be done to stimulate urination and defecation if required, although this is generally only needed if the puppies are being bottle fed (Reichler, 2010).

Post-operative care

As soon as the bitch has recovered from general anaesthesia, she should be reunited with the puppies. To start with, she should be monitored with the puppies to ensure she does not cause any harm by trying to move around or stand post-anaesthesia. The bitch’s abdomen should be cleaned prior to the puppies being able to suckle. This will remove any chemicals that were used to clean the abdomen prior to surgery (Moore and Simpson, 1999a). Once the puppies are feeding and the dam is comfortable post-surgery, they can all be discharged from the hospital so that they can be settled in at home. It is important to advise the owners to monitor the surgical incision as the puppies may cause damage to the tissue when feeding.

Conclusion

Caesareans in dogs often happen overnight when there are limited staff available at the hospital. If everyone involved stays calm and prepares well, there is a great chance the caesarean will be successful. Veterinary nurses play a vital role in helping owners prepare for the eventuality of caesarean sections by teaching them to recognise signs of what to look out for. Once the puppies have been revived and the bitch has recovered from anaesthesia, they will generally go home quite quickly following surgery. These cases are often very rewarding for all staff members involved.

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