1. GRAVIDITY
1.1 Hypoluteidism (Hl)
HL is characterized by a red-black/black-red mucous VD varying in quantity, or, by high grade bleeding from the vagina accompanied by coagula which can be as large as a hen's egg, from about the 20th day after mating. Abdominal palpation around the 25th/30th day of pregnancy reveals smaller ampullae of pregnancy which are tenser in tone, and foetal compartments which do not slip through the fingers.
Therapy: If the VD is still bloody after the 8th day following mating, a progesterone substitute should be started SQ in a dosage of 12.5 mg to 50.0 mg. In many cases, two days later a normal metoestrus can be observed. It can then be assumed that HL was not present. The therapy started can therefore be discontinued. The owner should be advised to carry out daily checks for any bloody VD. If the VD is red-brown as before, the treatment must be continued at 2 day intervals. The more frequently progesterone injections have to be administered, the sooner an oral gestagen maintenance dose is necessary (1.25 mg to 5.0 mg/animal/day).
1.2 Abortion
Abortion can be precipitated by trauma, hormonal disturbances or infections (Brucella canis, E. coli, streptococcus, canine herpes virus, salmonellae, mycoplasmas, toxoplasma and others). A green to black-green VD commences between the 40th and 50th day, passage of foetuses enclosed in membranes (pathological changes).
Therapy: Antibiotics and prostaglandin F2α in a dosage of 50 150 µg/kg SQ BID over 5 to 8 days, clinical and ultrasound checks. Ovariohysterectomy and antibiotics.
1.3 Foetal Maceration
The foetuses succumb to an infection, following which they are subject to emphysematous decomposition. The mother displays high grade impairment to general health: loss of appetite, fever, lassitude, reddened/washed out mucosa and dehydration. A foul smelling VD. Discoloured placentas and foetuses can be passed. Abdominal palpation is painful.
Therapy: Ovariohysterectomy. Antibiotics.
1.4 Foetal Mummification
Can be caused by a canine herpes virus infection.
Therapy: Ovariohysterectomy. Attempts to treat with prostaglandin F2α do not guarantee success.
1.5 Haemorrhage Due To Pregnancy
In the last third of pregnancy, haemorrhages of varying degree can occur. The probable cause is placentitis, which leads to detachment of the placenta and haemorrhage.
Therapy: Ovariohysterectomy.
1.6 Pregnancy and Hernia Inguinalis
The gravid uterus is displaced into the processus vaginalis. As the length of the pregnancy increases, the hernia becomes larger.
Therapy: If the puppies are wanted: laparotomy: replacement of the uterus, and repair of the hernia. Discuss genetic implications. If the litter is not wanted: Ovariohysterectomy.
2. PARTURITION (PA)
Before PA there is further oedema of the vulva and perineum. The mucus of pregnancy is clear, interspersed with grey/whitish flakes. The cervix is closed and surrounded by copious amounts of mucus. The opening of the cervix can take up to 24 hours. If PA is progressing normally, uterine activity is clearly recognizable and the foetal membranes are bulging into the birth canal. The mucus which is passed before PA, if labour has not started, must be neither green, red, brown, nor any variation of these colours. The internal body temperature is within the normal and decreased range before PA. Any increase in temperature indicates a pathological process.
2.1 No Dilatation of the Cervix
The bitch presents at the expected date with no uterine activity and a green VD. The vaginal mucosa is pale pink, the cervix is closed, and the cervical mucus is various shades of green.
Therapy: Section.
2.2 Insufficient Dilatation of the Cervix
Bitch presents at the expected date uterine activity and green VD.
Therapy: Section.
2.3 Dystocia
2.3.1 Primary Uterine Inertia
No uterine activity from the onset. There is mucoid amniotic fluid of various degrees of colour, and vaginoscopically the foetal sac is seen to be flaccid.
2.3.2 Secondary Uterine Inertia
After the birth of one or more foetuses, uterine activity ceases. There is mucoid amniotic fluid of various degrees of colour, and vaginoscopically the foetal sac is seen to be flaccid.
2.3.3 Dry Birth Canal
If PA lasts a long time and the amniotic fluid drains away, the birth canal is dry. The puppies cannot be fully born and become stuck in the birth canal.
2.3.4 Narrowed Pelvis
After fracture of the pelvis, callus formation can lead to pelvic narrowing which can impede the passage of the foetuses.
2.3.5 Unicornual Pregnancy
In a unicornual pregnancy the possibility exists that the cervix will not open. A smaller number of foetuses probably results in a deficit of foetal hormone, which is necessary to initiate PA.
2.3.6 Single Foetus
In the case of a single foetus, the rather rare impediment of too large a foetus can occur.
2.3.7 Simultaneous Entry of Two Puppies into the Birth Canal
The simultaneous entry of two puppies into the birth canal hinders or stops the birth process with usually strong uterine action.
2.3.8 Malposition and Malformation of the Foetus
Malposition (headbreast, headflank, transverse lie), malformations hydrocephalus, anasarca, duplicitas) can impede the birth process.
2.3.9 Rupture of the Uterus
Rupture of the uterus is caused by trauma or an overdose of oxytocin, and can be detected on X-ray or ultrasound examination.
2.3.10 Torsion of the Uterus
Either one horn of the uterus is twisted one or more times around the longitudinal axis near the bifurcation of the uterus, and thus displaces the other horn, or there is a torsion between the bifurcation and the tip of the horn. The puppies remaining in utero are dead due to lack of oxygen and shock. The abdomen is more enlarged on one side. An introduction of the vaginal speculum into the body of the uterus is impossible.
2.3.11 Vaginal Cords, Remnants of Mueller's Ducts
Vaginal cords are persistent Müller's ducts, and are mainly found in the caudal area of the vagina. They can appear at parturition as an obstruction.
Therapy: 1 and 2: There are always pauses during parturition. If no puppies have been born within 2 hours, treatment to stimulate the uterus is necessary to avoid too great a number of stillborn puppies. SQ or IM administration of a uterine stimulant in a weight-dependent dosage in the following composition: 0.1-0.5 IU oxytocin and 10-50 mg of the uterine spasmolytic vetrabutine hydrochloride. It can happen that a uterine stimulant is given for each foetus. This is only done when living puppies are being born. A repeat treatment is possible after an interval of 2 hours if there is no rise in internal temperature and the VD is normal. If no puppies are born after the second uterine stimulant, a section must be carried out. If only the last foetus remains, an obstetric forceps can be carefully inserted, protecting the soft birth canal.
3: After applying a lubricant (liquid paraffin) in the birth canal, the puppies are extracted by gently pulling on skin folds over the limbs.
4 to 10: Conservative Caesarean or Porro section.
11: Operative technique: sedation is not normally required. Operative removal can be carried out with the patient in a standing position. Using a vaginal speculum and a long hook, the tissue is brought forward in front of the labia. Anaesthesia of the superficial mucosa is of benefit. The cords are dissected out between two ligatures
3. PUERPERIUM
3.1 Retained Placenta
The larger the litter, the more likely is the placenta to be retained. Retention of the membranes can result in PP atonia of the uterus, placentitis or placental necrosis. The evidence of retained placenta can be obtained both by vaginal examination and by abdominal palpation. Dark black-green, sometimes friable, VD. The vaginal speculum shows dark green, sometimes friable membranes in the cervical canal and in the body and horns of the uterus, and large quantities of dark black-green watery VD. On palpation, characteristic soft, bulbous enlargement is detectable.
Therapy: Timely removal of the retained placenta(s) with a forceps via an inserted vaginal speculum. If all the placentas have been removed, both horns of the uterus are easily recognizable on palpation. 1 to 4 IU oxytocin SQ or IM BID
3.2 Post Partum Uterine Inversion and Prolapse
Prolapse of the uterus can be observed after an easy, rapid birth, or, more rarely, after a long and difficult parturition. It can be complete or incomplete. The incomplete prolapse has a cylindrical appearance, and the complete uterine prolapse looks Y-shaped. If the prolapse exists for a long time, the surface dries out, and necrosis occurs.
Therapy: Conservative treatment: Only indicated in fresh cases. Except in very calm patients, repositioning is carried out under general sedation. The prolapsed uterus is replaced up to the ends of the horns with the tip of a vaginal speculum. This process is controlled by palpating the abdomen.
Surgical method: Laparotomy. The mesovarium is more tense and the ovaries are displaced caudally according to the degree of the prolapse. After bilateral ovariectomy the mesometrium is separated. The prolapsed parts of the uterus can be replaced in the abdominal cavity by gently pulling on the non-prolapsed uterus while simultaneously aiding repositioning with the tip of a vaginal speculum via the vagina. Hysterectomy is carried out using a catgut stump ligature.
3.3 Post Partum Haemorrhage
PP haemorrhage is caused by birth injuries and placental necrosis, or develops from sub-involution of the placental sites. Bleeding can vary in its intensity.
Therapy: Low grade haemorrhage: 1-4 IU oxytocin SQ BID or TIP Moderate haemorrhage: 25-50 mg gestagens High grade haemorrhage: ovariohysterectomy, blood transfusion.
3.4 Delayed Involution of the Uterus
The most commonly occurring pathology of the puerperium is the post partum atony of the uterus. The causes are a long birth, overstretching of the wall of the uterus by a large number of foetuses, increased age, overweight mother, and disease in the mother before or during parturition.
Therapy: 1-4 IU oxytocin SQ, BID or TIP.
3.5 Post Partum Intoxication and Infection
General puerperal intoxication arises from the reabsorption of toxins from the dammed up contents of the uterus. It is usually chronic, manifests itself clinically most commonly around the 3rd PP day, and lasts over several days. The disease is characterized by lassitude, loss of appetite, dehydration, low grade rise in temperature, uneven skin temperature distribution, increased cardiac activity, small frequent pulse, cyanosis of the mucosa and increased injection of the episcleral vessels. The VD is mucous, a grayish red-brown colour, and have an unpleasant sweetish odour. On palpation, a poorly contracted uterus is detected. The progress of general puerperal infection is more stormy. The symptoms are exhaustion, loss of appetite, dehydration, high grade increased body temperature, increased cardiac activity, small frequent pulse, reddened mucosa, increased epigastric tension, vomiting and complete suppression of lactation. The lochia are abundant, as in puerperal intoxication, grayish red-brown, of a mucous consistency and with an unpleasant sweetish smell.
Therapy: Antibiotics, infusions, puppies reared on formula milk.
3.6 Necrosis of Placental Sites
One particular form of puerperal infection is placental necrosis. The causes are uterine infection, dead emphysematous foetuses and placentas which have remained too long in the uterus and which can lead to necrotic changes at the placental sites and rupture into the abdominal cavity. Clinically the symptoms are recognizable as those of a rapid onset septicaemia. The bitch declines very quickly. The low grade to moderate lochia are yellow-brown and friable.
Therapy: Immediate ovariohysterectomy, infusion therapy, abdominal lavage and antibiotics.
3.7 Subinvolution of Placental Sites
Subinvolution of the placental areas is recognizable on colposcopy as a low grade bright red to red-brown VD, and on palpation by the ampullary uterine swellings, from the size of a pigeon's egg to that of a hen's egg, in the area of the placental sites (ultrasound). The patients have low grade anaemic mucosa and very largely unimpaired general health.
Therapy: Ovariohysterectomy