Canine Peripartum Care and Diseases
   

129-143

Retained placenta
History

  • Retained placenta is often associated with prolonged whelping or dystocia, and is more often seen in toy breeds.
Clinical signs
  • The persistence of greenish-black discharge for longer than 24-26 hours after parturition.
  • Normally the discharge should be rust colored 48 hours postpartum.
Diagnosis
  • A diagnosis that a placenta is actually retained may be difficult, because great reliance is placed on the owner counting the placentas as they are passed. Since placentas are not necessarily passed with each pup and the bitch commonly eats the placentas, it is easy for the owner to miscount. Palpation is not reliable to diagnose a retained placenta.
  • Ultrasound may be used, but it too is very subjective in determining if a placenta is retained.
  • Exploratory celiotomy may be used to definitively diagnose retained placenta.
Therapy
  • Calcium gluconate (10%) 3-10 ml IV slowly. Followed by oxytocin, 5-25 IU, IM
  • Oxytocin (5-25 IU IM) may be given routinely to all bitches once delivery has been completed. This has been suggested to aid in the expulsion of remaining placentas, and even retained fetuses! This is a higher dose than I would currently suggest.

Postpartum Metritis
  • Postpartum metritis is associated with a variety of organisms and is seen at a higher incidence when contaminated instruments, dirty digital manipulations, and unsanitary environment. It is complicated by tissue traumatized during manipulations and the degree of uterine inertia. The less uterine inertia, the less lochia is expelled and involution is hampered.
History
  • The bitch that had an abortion, retained fetus, retained placenta, dystocia, and manipulations runs a higher risk of developing a postpartum metritis.
  • There may be a lack of interest in the pups by the bitch.
  • The pups may cry and have red, edematous ani.
Clinical signs
  • The bitch may show depression, anorexia, toxemia, and/or tenesmus.

  • The temperature is 103-105o F., but often the bitch's temperature is normally up to 104o F in the first two days postpartum, however in a normal postpartum period the bitch is not sick.
  • The pulse is rapid and frequently weak.
  • The mucous membranes are congested.
  • The vaginal discharge may be thin or thick, fetid, reddish to chocolate brown. Normal lochia should be brown-redish (green shortly after whelping) with no odor.
  • The milk flow may be diminished or absent.
  • You may see puppies dying, because of toxins being absorbed from the uterus.
  • The leukocyte count is usually elevated with a left shift, but may be decreased in extremely ill bitches.
  • If a fetus is retained, it will be evident with radiographs.
Diagnosis
  • Diagnosis is usually based upon the clinical signs seen in a postpartum bitch.
  • Ultrasound and radiology may help in visualizing an enlarged uterus full of fluid.
  • Culture and sensitivity from anterior vagina may aid in choice of antibiotic, but treatment should be started immediately with empiric antibiotics.
Therapy
  • Early recognition and prompt treatment is imperative for successful results.
  • Fluid therapy should be instituted in most bitches, as dehydration is a common occurrence.
  • Antibiotics selection should be based on culture/sensitivity, but administer broad spectrum antibiotics until culture/sensitivity results are obtained.
  • Ampicillin (20 mg/kg QID) trimethoprim or oxacillin are good choices, with oxacillin and ampicillin being safe for nursing pups.
  • Evacuation and involution of uterus can be hastened by use of ergonovine maleate (0.2 mg BID, p.o., for 5 d) (oxytocin can give non-peristaltic contractions)
  • Prostaglandin (0.025-0.10 mg/kg) SID or BID for 3-5 days can also help evacuate the uterus.
  • Puppies should be hand fed, because toxins passed through milk may kill the pups (toxic milk syndrome).
  • Advanced cases are fatal due to toxemia and/or peritonitis from necrosis of the uterine wall.
  • Ovariohysterectomy after stabilization of the bitch is an alternative.
Sub-involution of placental sites (SIPS)
  • Bitches normally discharge lochia for approximately 4-6 weeks postpartum. The uterus returns to normal size by approximately 9 weeks postpartum and uterine involution is histologically complete by 12 weeks postpartum.
  • With SIPS the postpartum hemorrhage continues for 8-16 weeks postpartum. The continued hemorrhage occurs due to a failure of the normal thrombosis and normal occlusion of endometrial blood vessels caused by damage to these vessels by persistence of trophoblast-like cells. The trophoblast cells (also called decidua-like cells) do not degenerate and invade the endometruim and myometrium causing hemorrhage.
Clinical Signs
  • Bitch is bright, alert, and responsive (BAR)
Diagnosis
  • Differential diagnoses include metritis, vaginal inflammation, neoplasia, and even proestrus.
  • Perform a CBC to rule out metritis..
  • With SIPS, the bitch is not sick.
  • Presenced of decidua-like cells in the vaginal smear.
    • Multinucleated, vacuolated.

Single multinucleated vacuolated cell.

Group of cells in swab

Therapy -
  • No good clinical studies to determine the optimal therapy.
  • Ergonovine maleate (0.2 mg BID or TID for 5 d) can be administered.
  • Prostaglandins have been suggested (0.25 mg/kg SC SID 5 days).
  • Ovariohysterectomy is an alternative for the non breeding bitch.
  • See surgery notes for surgical treatment.
Puerperal tetany (eclampsia)
  • Puerperal tetany usually occurs 2-4 weeks postpartum, but may also occur prepartum.
  • It is often seen in small bitches with large litters.
  • It is caused by hypocalcemia, but the underlying causes are poorly defined.
Differential Diagnosis
  • Rule out other causes of tonic and tono/clonic seizures.
Clinical signs
  • Onset characterized by restlessness and panting progressing to muscle stiffness and ending in complete tonic paralysis with legs in hyperextension.
  • Hyperpyrexia (107oF).
Therapy
  • Calcium gluconate (can mix with 10% glucose 1:1), given slowly (1.0-1.5 ml/kg or until vomition or recovery). The hypoglycemia associated with the condition may be helped by adding the glucose to the calcium gluconate. You must monitor the heart and interrupt injection of calcium gluconate if arrhythmia or bradycardia occurs.
  • A respiratory alkalosis may cause lack of response to calcium therapy. Sedation will prevent hyper-ventilation.
  • Glucocorticoids are contraindicated because they decrease intestinal absorption of calcium and enhance renal excretion of calcium.
  • Prevent nursing for 24-48 hours, and then alternate nursing and hand feeding the puppies.
  • Recurrence is common during the same, or subsequent, lactation
  • Send the bitch home on 1-3 g calcium lactate or calcium gluconate and 10,000-25,000 Units oral Vitamin D daily.
Mastitis
  • Etiologic agents - coliforms, staph. strep.
Clinical signs
  • One or more of the mammary glands is enlarged, painful, hot, and red.

  • The bitch is febrile

  • The bitch may neglect the pups.
  • The bitch may be asymptomatic in mild cases, but the pups fail to thrive.
  • Monitoring puppy health by weight
    • Puppies should be weighed at birth.
    • They should gain about 10% of that weight daily. (i.e. if they weigh 300 gms at birth they should gain about 30 grams daily).
    • If they are not gaining that much they should be examined and/or supplemented individually.
Diagnosis
  • Examination of the mammary glands will reveal that they are enlarged, painful, hot, and red. The milk may be off color.
  • There may be a leukocytosis
Therapy
  • Perform a culture/sensitivity of milk.

  • Treat with antibiotics that distribute to the milk. Mastitic milk is usually acidic, and bases distribute better into acidic milk. Ampicillin or oxacillin are good choices until a culture and sensitivity results are back.

    • Acute Mastitis Bitch without nursing pups

      • Aerobic bacteria

        • Gram-negative infection - Broad-spectrum cephalosporin (second- or third-generation), quinolones, chloramphenicol

        • Gram-positive infection - Lactamase-resistant penicillins, amoxicillin—clavulanic acid, first-generation cephalosporin, erythromycin, chloramphenicol

      • Anaerobic bacteria - Penicillin, metronidazole, clindamycin, cefoxitin, chloramphenicol, erythromycin

    • Bitch with nursing pups

      • Aerobic bacteria

        • Gram-negative infection - Cefoxitin, ehloramphanicol

        • Gram-positive infection  - First-generation cephalosporins, erythromycin

      • Anaerobic bacteria - Cefoxitin, erythromyein, chloramphenicol

  • You may want to keep the pups nursing the bitch if possible, because this will keep the glands drained.

  • If there is an open abscess or gangrene, then remove pups and hand feed. Treat the abscessed gland as open wound.

Nonseptic mastitis
  • The mammary glands are engorged and sensitive.
  • There is usually no fever and the bitch is not sick.
  • Encourage nursing by the pups.
Galactostasis/Poor Milk Production
  • With galactostasis you see hard, caked glands because the bitch is not producing milk.
  • Give symptomatic relief by soaking the glands, analgesia for the bitch, and encouragement of nursing by the pups.
  • Metoclopramide (dopamine antagonist....prolactin agonist)
    • 0.1-0.5 mg/kg TID PO, SQ or IM
    • Potential side-effects of behavioural changes.
  • Domperidone at 2.2 mg/kg po bid - said to work faster than metoclopramide and less side effects
Uterine torsion
  • Uterine torsion is not common. Although the bitch may be asymptomatic, they often are in shock.
  • These bitches need surgery to correct the torsion or remove the uterus if it is devitalized.
Uterine prolapse
  • Uterine prolapse has been reported in the bitch
  • Surgery is probably required.
 


contributed by Bruce E Eilts on 27 July 2009


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