578-584

105-145


The III Stages and signs of normal parturition
568

105-110

• Stage I of parturition is the preparatory phase for whelping. It is averages approximately 6-12 hour long but can be as long as 36 hours.
• The bitch is usually restlessness and may show nesting behavior. She is nervous, panting, anorexic, and may tremble or shiver.

• You may see a temperature drop (to 99^o F) about 24 h before stage II in approximately 85% of bitches. This temperature drop is related to prostaglandin release and the abrupt decline in progesterone.
• Can be identified with uterine monitoring.

• Stage II is the active propulsive stage when the bitch pushes the puppies out. It lasts approximately 20 minutes to 1 hour per puppy but, no more than 2 hours should elapse between each puppy born.
• Stage II usually lasts a total of 3-6 hours but, may be as long as 24 hours total.

• The pup engages the cervix and anterior vagina, which initiates the Ferguson reflex (uterine contractions). The presentation of the puppies is 60% anterior in bitch and 60% posterior in queen.
• External signs do not always match uterine contractions when uterine contractions are monitored.

Stage III

• Stage III is the expulsion of the placenta.
• You may see pup-placenta-pup-placenta or pup-pup-placenta-placenta.

• There can be 6 hours between deliveries in the bitch, and the queen can go overnight between deliveries, but use 2 hours to diagnose a dystocia.
• Differentiation between resting in Stage III and completed parturition is difficult. You may need to take radiographs or ultrasound the bitch to be sure. Best to have films taken that last week of pregnancy!

Diagnosis of Dystocia - When should the client be concerned?

• 30 minutes of strong contractions with no pups delivered.
• 2-3 hours of weak and infrequent expulsive efforts failing to produce a pup.
• 4 of more hours between pups.
• Obvious problem (pup hanging out etc.)

• Predisposing factors such as breed, parity, age, size of litter must be considered.
  • Bulldogs
  • Single pup
• Establish the following information:
  •  1) the time of onset of Stage II,
  •  2) the frequency and intensity of expulsive efforts,
  •  3) the time since the last delivered fetus, 
  •  4) any assistance given prior to your entry into the case, 
  •  5) the general health of the bitch.

• Vaginoscopy - Do a digital exam to determine location of puppy. You can try "feathering" (massaging or tickling) the vagina to stimulate the Ferguson reflex.

• You can use the ultrasound to determine fetal viability by looking for heartbeats.
  • It may be hard to accurately count the number of puppies left using ultrasound.

• You can radiograph the abdomen to see how many puppies are left, but it is difficult to assess fetal viability.

• CBC
• Chemistry panel
• These may help determine the health of the dam prior to prolonged manipulation or surgery.
• Progesterone - bitches will whelp with progesterone over 2 ng/ml

• Primary uterine inertia is a delay in starting the second stage of labor after the first stage signs have been established.. This occurs because the uterus is not contracting.
• If there is no response to feathering the vagina, give oxytocin (1-2 IU oxytocin for a total of 4 units over the entire whelping. We used to give more, but these doses cause clonic contractions of the uterus and results in ineffective expulsive efforts.)  You can repeat the oxytocin at 20 to 30 minute intervals for up to three doses, but if there is no response, a cesarean is usually the best course of action.

• Diagnosis of prolonged gestation rests heavily on subjective information from the owner/breeder.
• Prolonged gestation may be considered, but the reference point in counting the gestation duration is critical in determining the whelping date. Is the first day of diestrus known or is gestation being calculated from breeding dates?
• Rule out pseudopregnancy, incorrect breeding date, incorrect calculation of breeding date in determining if gestation is prolonged.
• If ultrasound or radiographs indicate viable fetuses, then waiting may be the best course.

• Secondary uterine inertia is the delay in resuming stage II labor after one or more births (for example more than 4-6 hours since the preceding delivery) It is caused by the uterus being exhausted after prolonged delivery. This prolongation may be from low calcium, low blood glucose, or an old bitch.
• Laboratory work may be helpful in assessing the dam. Take samples for PCV, WBC, TP BUN, , and Glucose. If the bitch is 'sick', take samples for a CBC and a serum chemistry panel.
• Rule out obstruction or completed complete delivery using vaginal examination, radiographs, and/or ultrasound.

• Administer calcium gluconate 10% @ 1 cc/30 lb IV with Glucose 10-50% 1cc/30lb, followed in 5 minutes by 1-2 IU oxytocin for a total of 4 units over the entire whelping. (We used to give more, but these doses cause clonic contractions.) If there is no response in 45 minutes, repeat the calcium gluconate. If there is still no response after another 45 minutes, a cesarean is probably the best treatment. You can probably even skip this and go right to C-section.
• The probability of the bitch requiring surgery in cases of secondary uterine inertia is high.
• Prognosis for the puppies and the bitch depends on the status of the bitch on admission.
• Prolonged dystocia will usually result in exhaustion, toxemia, and death of fetuses in utero.

• Obstructive dystocia is when the bitch is pushing hard but there are no puppies. (not pushing = inertia)
• Guidelines for examination/intervention
• 30 minutes of strong contractions with no pups delivered.
• 2-3 hours of weak and infrequent expulsive efforts failing to produce a pup.
• 4 of more hours between pups.
• Obvious problem (pup hanging out etc.)

• Do not give oxytocin, because if a puppy is lodged in the birth canal, you may cause a uterine rupture.
• Consider assisted delivery by vagina using instruments or digital manipulation when your examination suggests that delivery can be accomplished within 20-30 minutes subsequent to your manipulations, and the subsequent delivery will proceed normally.
• It is essential that you be very clean and use adequate lubrication. A contaminated procedure may result in metritis.
• You may have to perform an episiotomy to open the vulva sufficiently to remove a puppy.
• Cesarean section is always a viable option.
  • Pups born as little as 2 days early (timed C-section) do not have surfactant and probably will not live.

Whelpwise™

• Click to visit their web site
• This may make everything we have said about monitoring dystocia obsolete.
• Karen Coley RN manages a company that provides whelping monitors for dogs.
• Her work (Proceeding SFT 2002) show temperature drop to be inconsistent at predicting whelping. 
• Time from initial contractions to whelping averages 12.1 hours, with very little range.
• The system can also diagnose:
  • Inertia
  • Obstruction
• There seems to be very little correlation between uterine contractions and signs that the bitch is pushing and/or having contractions.

   

contributed by Bruce E Eilts on 25 July 2006

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