Pregnant and whelping dog assessment SOP.

Pregnancy ultrasound is practical and universal tool which, can be carried out
in order to confirm pregnancy and assess foetal viability.
WE DO NOT TELL CLIENTS HOW MANY PUPPIES QUEEN IR BITCH HAS! If
discovered more than one, we suggest answer 1+.
Even in the case when all the foetuses counted correctly there is such a thing as
foetal resorption, partial abortions which may lead to discrepancies. If owners
desire to know actual count we can offer an Xray from 60 day of pregnancy only in
calm and cooperative dogs as should be taken conscious with no manual
restraining according to our local RPS rules. We do not offer elective c-sections as
a standard procedure, however exemptions can be made based on clinical history
and condition – for exextensive pelvic or limb trauma etc. In those circumstances
client should be given full information in risks of foetal prematurity, and possible
fatal outcome for them, ASA grade ga risks and surgical complications standardly
based on patients condition.

Defining Dystocia

During triage of a possible dystocia, determining whether fetuses are term is critical
before proceeding with assistance via medical or surgical means. Canine gestation
lasts approximately 62–64 days. Canine eutocia consists of three stages. The first
stage of parturition generally on average lasts for 6–12 hours, but can range widely,
with 36 hours observed in some primiparous bitches

Maternal Causes of Dystocia

Uterine inertia can occur as a primary issue, presenting as a bitch that lacks
progress into stage two labor. This may present in bitches with singleton or two-
fetus pregnancies, or alternatively may present in a bitch that carries past term with
a normal litter size. Secondary inertia can also occur, which occurs as a result of
prolonged uterine contractions during whelping. Breed-related predispositions are
widely associated with brachycephalic-type breeds but can also extend to those
with extremely large or small litters, as well as breeds that have more frequently
been managed with elective C-sections in recent years. Brachycephalic breeds are
11 times more likely to have a C-section as compared to other breeds.

In brachycephalic breeds pay particular attention to MM colour, temperature (prone

to overheat due to hyperventilation) and SPo2, provide oxygen support via mask or
nasal prong if necessary and cool quiet environment.

If a bitch presents in labor, condition of the fetuses for maturity and stress should be
assessed upon arrival. Fetal distress is defined differently amongst varying
practitioners, however, any fetus that has a fetal heart rate of less than 180 should
be observed repeatedly and is cause for concern. If found to be consistent,
considering a C-section should be stressed as best for fetal survival.

Obstructive dystocias should be aggressively moved to surgery if the obstruction is

not easily relieved by manipulation measures. Color of lochia should be used as an
indication for placental separation, and green fetal fluids should be an indicator for
concern if no fetuses have been passed. After fetuses have been delivered, green
vulvar discharge is considered normal, and is no longer a way to evaluate the
health of the fetuses. Normal progression of fetuses should not exceed 2 hours
between deliveries in most healthy bitches.

It is important to remember to assess for the remainder of fetuses. On occasion,

owners may have not witnessed the birth of a puppy, and radiographic count of
fetuses may not have been accurate. In either case, remaining fetal presence is
important to confirm, prior to pursuit of Caesarian section.

Post-delivery Considerations

In many species, dystocia may create an increased risk for post-delivery concerns
such as metritis and future fertility. No thorough studies exist describing outcomes;
however, the cause of dystocia may have a large impact on expected recurrence or
negative impacts. Fetuses delivered under stress may have undergone a period of
hypoxia and require more attention immediately after birth than their littermates.
Stillbirths may be more frequent in situations where prolonged intervals between
puppies are observed.

Eutocia
Gestation length varies slightly based on how you count.
If the date of luteinizing hormone (LH) surge is known, the due date is calculated as
65 plus or minus one day from that date. Similarly, if you know the date of ovulation
using progesterone timing, the due date is 63 plus or minus one day. Both have
very tight windows.
If you have vaginal cytology (day one diestrus), the due date is calculated as 57
plus or minus three days from that date; however, if you have a breeding date, it is
63 plus or minus seven days from the date of first breeding. This presents a two-
week window within a nine-week gestation, which is a huge margin of error! Thus,
we cannot rely on a breeding date alone to tell us when a bitch is overdue.
Premonitory signs of labor may include:
A rectal temperature decrease within 24 hours of whelping, which is greater

than a one-degree drop from baseline or less than 99 degrees. This temperature

drop only lasts about eight hours, so it is possible to miss it.

Extreme nesting behavior. Some dogs will collect their toys and things

throughout gestation, but when the animal is very uncomfortable (e.g. tearing

bedding up), this would likely represent stage one labor.

The presence of uteroverdin (i.e. green/black vulvar discharge). This is

indicative of placental separation and means a puppy should be born within

about 15 minutes.

It is also helpful to understand the three stages of labor:

Stage one begins at the start of uterine contractions (which are not typically

externally visible) and ends with dilation of the cervix (which is not palpable in the

dog). Typically, this stage averages about six to 12 hours, although it can last up

to 24 to 36 hours.

Stage two is delivery of the fetus. Data shows 60 percent of fetuses are

delivered in cranial presentation (“forward”), while 40 percent are delivered in

caudal presentation (“backward”). Both are normal as long as all limbs are

extended. It should only take up to 30 minutes per fetus for delivery.

Stage three is the delivery of the placenta. Stages two and three occur

simultaneously in the bitch (as well as, in cats, the queen). Thus, it is very

common to get two puppies followed by two placentas.

Dystocia
Some maternal predisposing factors for dystocia include:
Physical obstruction of the birth canal (e.g. vaginal mass, vaginal stricture,

vertical vaginal septum, etc.)

Pelvic fractures which have not healed in perfect anatomical alignment—these

can sometimes narrow the vaginal vault

 Breed predilection:

 Brachycephalic breeds have cephalopelvic disproportion, which means

large head and narrow hips

Terriers have a high rate of uterine inertia

Obesity, both because adipocytes (i.e. fat cells) release some inflammatory

cytokines, and because of physical obstruction of the birth canal if there is excess

fat deposition around the vaginal vault

Fetal predisposing factors for dystocia include:

Fetal malposition or malposture (i.e. fetus not in cranial or caudal presentation

with all limbs extended)

Oversized fetuses or one fetus—often, singletons will grow too large to pass on

their own or will not signal to the bitch when it is time to go into labor, resulting in

prolonged gestation (it is estimated approximately 40 percent of dogs will

spontaneously go into labor with one fetus)

Deceased fetuses, as these do not signal when it is time to go into labor and

often do not present themselves properly

Grossly deformed fetuses (i.e. fetal monsters)

Types of dystocia include:

Obstructive dystocia

Primary uterine inertia—there are a lot of documented causes for primary

uterine inertia, but this is where the uterine contractions start, but fail to organize

into any kind of progressive pattern that leads to fetal expulsion (there are a

variety of causes that all lead to the same presentation, and all etiologies are

typically treated the same)

Secondary uterine inertia (i.e. myometrial exhaustion)

Systemic illness or maternal compromise

Fear and/or inexperience

Diagnosis
Prolonged gestation length—if more than 72 days have passed since the first

breeding, a pregnant female is considered overdue (without more information

than the breeding date, it is very difficult to tell if the puppies may be in trouble or

not)

Four hours after the onset of stage two labor with no puppies produced

More than two hours between deliveries of fetuses (note: some references say

four hours)

Strong and frequent stage two labor contractions that fail to produce the puppy

within 30 minutes (or do not show any progress within 15 minutes)

Large amounts of haemorrhagic vulvar discharge at any time—while discharge

is to be expected, frank blood is not normal and can be suspicious for uterine

torsion (i.e. twisting of the uterus)

Presence of uteroverdin (i.e. green or black discharge) prior to delivery of the

first puppy—if uteroverdin is observed and there is not a puppy immediately

forthcoming (essentially within 15 minutes or so), this may be a problem and

must be investigated

If the dam is ill or distressed at any point—while parturition is stressful, she

should not be distressed

Fetal distress noted on ultrasound (i.e. fetal heart rates slower than 180 beats

per minute)

Dystocia treatment
With dystocia, manipulative treatment is fairly limited by small patient size in most
cases. The cervix is not palpable, so it will not be possible to tell if it is open or
closed. Typically, you only need your fingers and lubrication to deliver a stuck
puppy; if an instrument is required, a spay hook is a good choice. Most importantly,
if progress is not made within five to 10 minutes, a C-section is indicated.
Medical management of dystocia is appropriate if:
the dam is in good health;
 the Ferguson reflex is intact;

no fetal maternal mismatch is noted on radiographs;

obstructive dystocia is ruled out;

no fetal stress is noted on ultrasound; and

we have four or fewer fetuses remaining.

More than 80 percent of canine dystocia is treated via C-section, as the factors
listed above are often not all present. Medications utilized include oxytocin (to
increase the frequency of contraction) and calcium gluconate (to increase the force
of contraction). This author’s general rule is up to three injections of each before
proceeding to C-section.
Ultimately, surgical management is the most common treatment of canine dystocia,
and the most common indication is fetal distress. Other indications include maternal
compromise and obstructive dystocia that cannot be fixed rapidly, or any kind of
anatomical abnormalities that will preclude a vaginal delivery.
Clip and dirty prep the abdomen prior to induction of anesthesia. Induce with
alfaxalone or propofol, ideally in the operating room with surgeons scrubbed in and
the table set up. Maintain on gas (isoflurane or sevoflurane) as well. These girls
have an increased risk of aspiration pneumonia because progesterone will
decrease the lower esophageal sphincter tone. If an epidural can be done quickly,
these are great for pain control. A fentanyl CRI or a single dose of an opioid can be
used once all puppies are removed.
Postpartum conditions
After delivery, there are several postpartum conditions that may also occur.
Among these is SIPS, or subinvolution of placental sites. A primary symptom of
SIPS includes bloody vaginal discharge, especially for longer than three weeks
postpartum. Typical treatment consists of supportive care, though a blood
transfusion is sometimes necessary as well. In severe cases, a spay may be
required to stop the bleeding.
Metritis is a uterine infection that typically occurs postpartum. Bacteria can ascend
into the uterus when the cervix is open during whelping, sometimes resulting in
infection. Symptoms include a fetid discharge postpartum and, in some cases,
systemic illness. Lochia is normal postpartum; however, if the discharge begins to
smell, changes color, or becomes more voluminous, metritis should be considered.
Treatment typically consists of supportive care and antibiotics, though, like with
SIPS, a spay may become necessary.
Hypocalcemia (or puerperal tetany) is the loss of calcium through lactation. This
can also occur through fetal mineralization, but this is uncommon. Typically, this
condition occurs about two to four weeks postpartum (when the demands for
calcium for lactation are highest) in young, small breeds with large litters. The
treatment is to give IV calcium to effect, with electrocardiogram (ECG) monitoring
required during administration. Oral calcium supplementation can then be instituted.
Slow intravenous administration of 10% calcium gluconate—0.5–1.5 mL/kg over
10–30 minutes (5–20 mL is a typical dose)—is an effective treatment for eclampsia,
usually resulting in clinical improvement within 15 minutes. ECG always should be
monitored whilst administration.
Finally, agalactia is a postpartum condition referring to a failure of milk production.
This is most commonly due to premature C-section. Typical treatment involves
domperidone or metoclopramide to enhance milk production.