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Year: 2009

Dystocia: recognition and management


Reichler, I M; Michel, E

Reichler, I M; Michel, E (2009). Dystocia: recognition and management. European Journal of Companion Animal
Practice, 19(2):165-173.
Postprint available at:
http://www.zora.uzh.ch
Posted at the Zurich Open Repository and Archive, University of Zurich.
http://www.zora.uzh.ch
Originally published at:
European Journal of Companion Animal Practice 2009, 19(2):165-173.

Dystocia: recognition and management


Abstract
The morbidity and mortality of bitches and queens and their offspring at parturition is significantly
reduced by optimum veterinary care. Usually, the patient's history already indicates that a parturition
disorder may be present. If during physical examination a dystocia is confirmed, the cause of dystocia,
the general condition of the dam and the fetal number and vitality are the cornerstones of the decision as
to whether medical management or surgical therapy is indicated. As a consequence of scientific progress
in veterinary medicine overall, and especially in veterinary anesthesia, a caesarean section is the
treatment of choice in a wide variety of conditions. Medical management of dystocia is only indicated if
expulsion of all fetuses is possible via the birth canal without delay. If medical therapy fails, surgical
intervention is mandatory. Keywords: abnormal parturition, dog, cat, obstetrics

Dystocia: Recognition and Management

PD Dr. med. vet. Iris Margaret Reichler, Dr. med. vet. Erika Michel, Dipl. ECAR

Small Animal Reproduction, Clinic of Reproductive Medicine, Vetsuisse-Faculty University


Zurich, Winterthurerstr. 260, CH-8057 Zurich

Summary

The morbidity and mortality of bitches and queens and their offspring at parturition is significantly
reduced by optimum veterinary care. Usually, the patient's history already indicates that a
parturition disorder may be present. If during physical examination a dystocia is confirmed, the
cause of dystocia, the general condition of the dam and the fetal number and vitality are the
cornerstones of the decision as to whether medical management or surgical therapy is indicated.
As a consequence of scientific progress in veterinary medicine overall, and especially in
veterinary anesthesia, a caesarean section is the treatment of choice in a wide variety of
conditions. Medical management of dystocia is only indicated if expulsion of all fetuses is
possible via the birth canal without delay. If medical therapy fails, surgical intervention is
mandatory.

Keywords: abnormal parturition, dog, cat, obstetrics

Introduction

Dystocia is defined as the inability to expel the fetus through the birth canal without assistance.
The incidence is around 5 per cent overall, but reaches almost 100 % in some breeds of dogs
and 20 % in some breeds of cats (1-3).

Date of Delivery

A thorough knowledge of physiology and endocrinology of normal parturition as well as an


accurate prediction of the date of delivery is essential for the diagnosis and treatment of dystocia.

In the cat, 94 % to 97 % of all deliveries take place between the 61st and 69th day of gestation,
mean gestation length is 65 days (4, 5). Gestation length, when timed from the first breeding, is
even more variable in the dog and can range from 57 to 71 days. This is because estrous
behaviour of the bitch is not necessarily most obvious at the time of ovulation and because
canine spermatozoa are capable of staying fertile in the female genital tract for a period of up to 7
days. Parturition date can be accurately predicted if the estimated date of ovulation at time of
breeding using serum luteinizing hormone or progesterone concentrations is known: from the
initial rise in preovulatory progesterone concentration, which is concurrent with the ovulatory
surge in LH, gestation length in the bitch is 64-66 days (6, 7). Therefore a planned cesarean
section should be scheduled on day 63. If ovulation timing has not been done, the first day of
cytological diestrus and therefore whelping date can be reliably estimated if daily vaginal
cytologic smears are evaluated (table 1).

If the date of ovulation is unknown, estimation of parturition date using ultrasonography or


radiology is recommended (table 1 and 2). In the second half of pregnancy the ability to
determine the day of parturition within 2 days by measuring the biparietal diameter was 85 % in
bitches (8). Ultrasonography and radiology are also suitable for estimation of date of delivery in
the cat. Radiographic identification of teeth indicates that parturition will take place in the next 6
days (9). Detection of fetal gastric rugal folds is first possible by ultrasound at day 54-57 after
breeding (10). Kittens with a skull diameter of 2.5 cm and a body diameter of 4 cm at the level of
the liver are considered to be mature (11).

The rapid decline in serum progesterone is a reliable predictor of impending parturition (table 1
and 2). If signs of impending parturition are unclear, determining progesterone plasma
concentration using commercial assay kits also used for estimating the time of ovulation is a
suitable method to detect onset of labour (12). The decrease in serum progesterone, which takes
place in the last 24 hours prepartum, causes a transient rectal temperature drop (1 C or more) in
many bitches. This temperature drop can be recognized by monitoring rectal temperature two to
three times daily and is considered a trustworthy indicator of beginning parturition (13). However,

predicting onset of whelping / kittening by measuring rectal temperature in the bitch is not always
(12) and in the cat usually is not possible. Increasing litter sizes are associated with a shorter
gestation period (4, 14). Breed also affects gestation length: Korat cats and German shepherd
dogs have the shortest gestation period compared to other breeds (4, 14).

Stages of Parturition

Parturition can be divided in three stages. The first stage, the dilatation period, lasts about 6 to 12
hours in the bitch (up to 24 hours in primiparous bitches), but usually less than two hours in the
queen. It is characterized by the abrupt decline in progesterone, the concurrent onset of externally not visible - myometrial contractions, and cervical dilatation, which is recognizable by a
smoky mucous vaginal discharge (figure 1). The dam may be restless, seeking attention or
seclusion. Maternal heart rate and respiratory rate increase. The second stage of parturition, the
expulsive period, is characterized by strong myometrial contractions and the onset of abdominal
straining. As the fetus enters the birth canal, the chorioallantoic membrane ruptures and a clear
vaginal discharge is noted. About 60 per cent of all pupppies / kittens are born in anterior, the
remaining 40 per cent in posterior presentation (13). In the bitch, expulsion of the puppy should
be finished after 30 minutes of active straining. In the queen, expulsion of the kitten usually lasts
5 minutes, and may rarely be longer in the first kitten. The third stage of parturition, during which
expulsion of the fetal membranes take place, follows 5 to 15 minutes after the delivery of each
fetus. In polytocous species as the canine and feline, expulsion of one or two fetuses are
followed by the passage of their placentas, as the fetuses are usually expelled alternating from
the two uterine horns. Normally, the dam frees the neonate by licking the fetal membranes away
and severs the umbilical cord. Rarely, and especially in canine brachycephalic breeds, the dam
needs assistance. As eating of the placentas can induce vomiting in the dam, it is prevented by
most breeders. In the bitch, a rest period of 0.5 to 4 hours between the expulsion of two puppies
is not abnormal. In the queen, however, kittens are usually born shortly after each other. Overall,
parturition in the bitch lasts about 12 hours, in the queen 6 hours. Increasing age of the dam
tends to be associated with a longer expulsive period (2, 15). Anecdotally, the delivery of healthy

puppiess or kittens 37 to 48 hours after beginning of parturition has been reported (4). Increasing
delivery time is associated with a lower survival rate of the offspring (16).

Evaluation and Diagnosis of Dystocia

If an owner suspects dystocia, he or she will most often seek telephonic advice first. By taking a
thorough history, the veterinarian is able to decide whether the dam needs clinical examination
and whether indicators of dystocia are present. Questions asked should include the following
ones:
Maternal well-being
Accurate breeding date (first and last breeding date). Bitch: Has optimum breeding date been
determined? Is gestation prolonged?
Age of the dam (risk of uterne inertia and singleton pregnancy increases with increasing age of
the dam)
Breed (brachycephalic breeds have a higher risk of dystocia)
Has pregnancy been confirmed, has the number of the fetuses been determined? (In singleton
and twin pregnancies dystocia is much more common) (2, 17))
Number and course of previous parturitions
o 41 % of all cases of dystocia are encountered in primiparous animals (the birth canal in
primiparous animals is still narrow, so fetuses are often relatively oversized)
o Previous history of dystocia?
Are there any indicators that the dam suffered a pelvic trauma since the last parturition?
Have any diseases, and especially metabolic disorders, been diagnosed during pregnancy?
Are there any signs that parturition has begun?
o Bitch: Drop in rectal temperature
o Vaginal discharge (Green vaginal discharge in the bitch and brown-reddish vaginal
discharge in the queen before delivery of the first puppy / kitten indicate the beginning

of placental separation. Hemorrhagic vaginal discharge is a sign of genital tract injury.


Foul smelling vaginal discharge indicates a neglected birth.)
o Passage of fetal fluids, straining
o Are there any neonates already delivered? When was the last one born?
Were any drugs given to the dam during pregnancy or parturition? (It is very common practice
among breeders to administer oxytocin without searching for veterinary advice (3).)

Indicators of possible dystocia, which make an immediate veterinarian examination compulsory,


are listed in table 3. As veterinary advice given on the telephone often causes forensic conflicts,
one should minutely document the conversation and make sure that preexisting disorders and
treatment measures that have already been instituted are recorded. Critical parameters which
make presentation of the dam mandatory have to be discussed with the owner. Details of the
conversation have to be noted, with time specification, in the case history. If any doubt remains
that the parturition is progressing normally, the dam should be presented to a veterinarian.

Causes of Dystocia

Traditionally, according to its cause, dystocia is considered to be of maternal or fetal origin


(table 4), the former being more common (2, 18-20). Often however, a combination of different
causes is responsible for dystocia, and one can rarely diagnose them by performing only an
obstetric examination. To meet the needs of the clinician, it is more useful to differ between a
dystocia which occurs before the delivery of the first puppy / kitten and one which occurs after
this (table 5).

Primary uterine inertia is defined as failure to induce expulsive contractions despite a completed
period of dilatation and a non obstructed birth canal. In a study of dogs presented with dystocia,
primary uterine inertia was the cause in 22.5% (21). A breed predisposition seems to exist for the
dachshund, some small terrier breeds, the chihuahua, the bulldog and the welsh corgi. In
dolichocephalic cat breeds, primary uterine inertia is the most common cause of dystocia,
accounting for 41 % of all dystocias. As cats of these breeds tend to be nervous, taking the

queen to a quieter environment may help. If no additional causes of dystocia are present, one
can try to treat primary uterine inertia conservatively.

Secondary uterine inertia occurs when after initially normal labor activity the myometrium is
fatigued and contractions stop. Possible causes are large litters, aged dam or obstruction of the
birth canal. If obstruction of the birth canal can be excluded, only one or two fetuses remain to be
delivered and the dam is not exhausted, conservative treatment may be tried.

One possible cause of obstructive dystocia is fetomaternal disproportion. In brachycephalic


breeds as the scottish terrier and the welsh corgi, fetomaternal disproportion is more common.
Depending on the breed, either the fetal head or shoulder may be too large or the maternal pelvis
too narrow (22-24). In singleton or twin pregnancies, the fetus may be absolutely oversized and
therefore cannot be delivered by way of natural maternal passages. If a fetal malformation such
as anasarca, schistosoma reflexum, hydrocephalus or conjoined twins is present, the fetus
usually is too large for the birth canal and has to be delivered surgically. Dead fetuses may
occasionally cause an obstructive dystocia, especially if the first fetus to be delivered is dead or if
massive emphysema formation has already taken place. Further causes of obstructive dystocia
are faulty fetal disposition such as transverse presentation, lateral or ventral deviation of the head
or breech posture (especially if the first pup in a primiparous dam is concerned). If manual
reposition is not possible, caesarean section is indicated. Furthermore, obstructive dystocia may
also be caused by pathological alterations of the soft or bony tissue of the birth canal (pelvic
fractures, tumors, vaginal prolapse, congenital malformations of the uterus, the vagina or the
vestibulum).

Clinical examination

Clinical examination consists of a general examination as well as a vaginal exploration (digitally


performed with sterile gloves and vaginoscopically), which gives information about width and
lubrication of the birth canal, relaxation of the vagina and sometimes about fetal disposition. If
palpation (feathering) of the dorsal vaginal wall triggers an episode of involuntary straining,

uterine inertia can be excluded as cause of dystocia. The fetus can often be made palpable by
the induction of abdominal contractions, and possible malpresentations can be diagnosed. If the
fetus is out of reach, the abdominal wall can be lifted with one hand. If the cause of dystocia
cannot be determined by palpation of the vaginal vault, examination of the birth canal using a
vaginoscope or pediatric proctoscope with a large diameter is performed.

To get additional information, imaging methods can be used. Radiographic images always must
be obtained in two radiographic planes to avoid misinterpretations (figure 2). They give
information about the number of fetuses, the developmental stage, abnormal presentation,
position or posture and fetomaternal proportion. Depending on the breed, there are different
pelvic constrictions which may cause dystocia (24, 25). A rough estimation if delivery by way of
natural maternal passages is possible can be obtained by calculating the ratio of the broadest
transverse diameter of the fetal skull to the horizontal diameter of the maternal pelvis on a
ventrodorsal radiograph. If the ratio is greater than one, the probability of vaginal delivery is
reduced. If the ratio is greater than 1.25, vaginal delivery is highly unlikely (26). Radiographically,
fetal death cannot be diagnosed radiographically sooner than six hours post mortem (1).
Radiographic signs of fetal death include for example presence of gas within the fetuses or
collapse of fetal skull bones. To determine fetal viability, fetal heart rate is evaluated
ultrasonographically. Healthy puppies physiologically have a heart rate above 200 beats per
minute, healty kittens even above 220 beats per minute. Heart rate can decline as a
consequence of fetal distress, for example hypoxia caused by premature placental separation,
but also during straining (1). If the heart rate of a fetus is permanently below 180 beats per
minute, the authors recommend a caesarean section.

Laboratory examinations complete the assessment of maternal health status. Important


parameters are packed cell volume, total protein, urea, glucose and calcium (27).

Management

Obstetric procedures include conservative techniques as delivery by traction and surgical


interventions as episiotomy and caesarean section. If dystocia is diagnosed, surgical intervention
is required in 60 to 80 % of cases (17, 18, 28). The incidence of dystocia is around 5 % (1, 4, 5).
Overall, the probability of delivering all fetuses alive is significantly higher in planned caesarean
sections than in emergency ones (29). The reasons for the worse outcome of emergency
caesarean sections are the facts that patients presented with dystocia often have been in labor
for several hours, that maternal and / or fetal compromise have occurred, and that insufficient
time and staff members are available for optimum management. Therefore, a caesarean section
should be planned whenever preliminary examinations indicate that a normal parturition is not
possible for anatomical reasons, for example fetomaternal disproportion. In singleton
pregnancies, the fetus commonly is absolutely oversized, preventing a delivery by way of natural
maternal passages. If a singleton pregnancy is recognized before the fetus has become too large
and if the ovulation date is known, induction of parturition with aglpristone, with or without
additional oxytocin or prostaglandin, can be considered as an alternative to caesarean section
(30-32). Induction of parturition may also be indicated if gestation is prolonged and delivery by
way of natural maternal passages is possible (33). The induction of a premature delivery can
result in the expulsion of nonviable fetuses, and retention of fetal membranes is common.
Therefore, an accurate prediction of the date of delivery which is difficult in practice - is a
prerequisite for inducing labour.(34). A thorough monitoring of the course of parturition, including
evaluation of fetal heartrates, is strongly recommended, as surgical invervention is sometimes
necessary. A dose of 15 mg/kg aglpristone was subcutaneously administered to Beagle bitches,
in which ovulation date had been determined, on the 58th day of gestation. After 24 hours, either
0,15 IU/kg oxytocin or 0.08 mg/kg alfaprostol were administered for the first time and then
repeated every second hour until all puppies were born. The combination of aglpristone with
oxytocin was found to achieve better survival rates and result in fewer side effects (30). The
owner has to be informed about the risks of induction of parturition.

Medical Management of Dystocia is only indicated if the the birth canal is fully dilated and faulty
fetal disposition, absolute or relative fetal oversize, and birth canal constrictions or malformations
can be definitely excluded. In addition to this, medical treatment may only be considered if the
general condition of the dam and the offspring is still well (fetal heartrate > 180 beats per minute).
If more than two fetuses remain to be delivered, the authors recommend a caesarean section.
Before therapeutic measures are taken, clinical findings and treatment options and their
advantages and disadvantages have to be discussed with the owner.

Medical management of dystocia is always performed while concurrently administering


parenteral fluids, and includes the application of drugs and vaginal instillation of a warm
substitute for fetal fluids as well as manipulative delivery. Several different treatment protocols
(with or without application of a tocolytic agent or calciumgluconate, different oxytocin dosage
schemes) are described (17, 27, 35, 36). At the authors clinic, the dam is infused (Lactated
Ringers solution at an infusion rate of 10 ml/kg/hr, for small patients 2,5 % of glucose may be
added), and a tocolytic agent (denaverin 20-60 mg/animal) is administered. About 20 minutes
later a warmed substitute for fetal fluids is instilled intrauterinely using a soft rubber catheter
(volume instilled should not exceed the estimated volume of one fetus) and 1-2 IU oxytocin /
animal is injected intramuscularly. If necessary, application of oxtytocin can be repeated once to
twice 20 to 30 minutes later. Alternatively, the dam can be infused for 20 minutes with a Lactated
Ringers solution containing calciumgluconate and glucose (mix 250 ml of Lactated Ringers
Solution with 12,5 ml of glucose 50 % and 10 ml of calciumgluconate 10 %) at an infusion rate of
10 ml/kg/hr while the dams heart rate is monitored. If by palpating the dorsal vaginal wall
abdominal straining can be initiated, insufficient labour activity can be treated by intramuscular
administration of oxytocin. Not more than two doses, 20 minutes apart, should be given.
Disadvantages of oxytocin treatment include the short duration of action and the risk of
premature placental separation and of tonic uterine spasm, the latter being especially common if
high or repeated doses of oxytocin are given. Uterine tetany, besides causing interruption of the
placental blood flow and therefore fetal hypoxia, can result in uterine rupture. If failure of

conservative treatment is likely, a caesarean section should be performed without delay to


provide optimum conditions for maternal health and viability of the offspring (1-4, 37, 38).

Manipulative Obstetrical Procedures should only be performed using sterile gloves and
lubricants after thoroughly cleaning the perineal area. Usually, correction of faulty fetal disposition
by retropulsion is only possible if diagnosis is not delayed. If a fetus is stuck in the birth canal,
prompt treatment is required to save its life. After intravaginal instillation of sterile lubricants, for
example using a soft feeding tube, the vaginal vault surrounding the fetus is manually dilated.
Using ones index and middle fingers, the head of the fetus is fixed in anterior presentation, the
caudal body in posterior presentation. Careful traction is applied in a caudoventral direction in the
bitch and in a caudal direction in the queen. By using obstetric forceps or applying traction to a
single limb generally severe injury is caused, therefore these manoeuvres are to avoid. If the
fetus cannot be extracted, episiotomy is indicated. If manipulative procedures are impossible due
to the narrowness of the birth canal or if more fetuses remain to be delivered, a caesarean
section is necessary.

Episiotomy incision is begun at the dorsal commissure of the vulvar lips and extended midline 1-2
centimetres towards the anal sphincter. After delivery is complete, the incision is closed in three
layers: Vaginal mucosa (inverting pattern into the vaginal vault), subcutaneous tissues and skin
(39).

Immediately after birth, the neonates are held head downwards and freed from fetal membranes.
By applying gentle suction, the upper airways are cleared of fluid. Concurrently, the oral cavity is
inspected for presence of cleft palate. The neonate is rubbed on a warmed bedding until it is dry.
By rubbing the perineal region, urination and defaecation as well as respiration is stimulated. The
umbilical stalk is ligated 0,51 cm from the abdominal body wall and disinfected (chlorhexidine
gluconate 3%). In order to optimize oxygen supply, the oxygen tube is hold in front of the
neonates nose. If signs of asphyxia are present, a centrally acting respiratory stimulant can be
applied (Cropropamid - Crotethamid 12 drops given on the oral mucosa or Doxapram 1(5) mg /
animal sublingual, s.c. or i.v.). When examining the puppy / kitten, one should pay special

10

attention to the presence of congenital malformations such as umbilical hernia, hydrocephalus


externus and atresia ani (40).

Figure legends:

Fig. 1: Bitch, first stage of parturition

A Closed cervix

B: Beginning of cervical dilatation

C, Fluidifying of cervical clot

D: Discharge of a smoky mucus

Fig. 2: Queen presented with secondary uterine inertia: Radiographs have to be taken in two
planes for assessing dystocia.

A: Latero-lateral radiograph

B: Faulty fetal disposition (transverse presentation) is clearly visible.

Fig. 1

Fig. 2

11

12

Table 1: Criteria for Estimating Parturition Date in Bitches (6, 13, 41)

Method

Parameter

Days before Parturition (DbP)


Increase from 0,3-0,8 to 0,9-3 ng/ml (pre-ovulatory LH

Ovulation timing

Progesterone surge if progesterone continues to increase the next day)


3,4-6,6 ng/ml (ovulation)

DbP = 63-67
DbP = 61-65

Early pregnancy: >25 Days before Parturition


Vaginal Cytology

Degree of cornification of superficial cells, shift to diestrus

DbP = 51-60

Ultrasonography

Crown-rump length (CRL in cm)

DbP = 38-3xCRL

Chorionic cavity diameter (CCD in cm)

DbP = 45-6xCCD

Late pregnancy: <25 Days before Parturition

Ultrasonography

Radiography

Progesterone

Decline in body
temperature

Biparietal diameter (BPD in cm)

DbP = 45-15xBPD

Body diameter at the gastric / hepatic level (BD in cm)

DbP = 36-7xBD

Biparietal diameter and body diameter (cm)

DbP = 35-6xBPD-3xBD

Mineralized pelvis

DbP = 9-13

Teeth

DbP = 3-8

4,5 0,6 ng/ml

DbP = 5

3,12 0,4 ng/ml

40 - 32 hrs before parturition

1,19 0,36 ng/ml

24 - 16 hrs before parturition

0,55 0,07 ng/ml

12 - 8 hrs before parturition

1C or more

DbP = 0-1

Table 2: Criteria for Estimating Parturition Date in Queens (42-44)


Method

Parameter

Days before Parturition


(DbP)

Mating date
Ultrasonography

DbP = 65 (61 - 69)


Body diameter at the gastric /

2,0 cm

DbP = 18 - 22

hepatic level (in cm)

3,0 cm

DbP = 8 - 12

3,5 cm

DbP = 4 - 8

4,0 cm

DbP = 0 - 1

1,5 cm

DbP = 21 - 25

2,0 cm

DbP = 9 - 13

2,5 cm

DbP = 0 - 1

13,0 cm

DbP = 7

13,6 cm

DbP = 5

14,5 cm

DbP = 0

Biparietal diameter (in cm)

Radiography

Progesterone

Crown-rump length (in cm)

Molar teeth

DbP= 2 - 9

4 - 5 ng/ml

DbP =0 - 2

2 ng/ml

DbP = 0

Table 3: Indicators of Dystocia


Bitch:
1) Before delivery of the first puppy:
a) More than 68 days from day of last breeding, no signs of impending parturition
b) More than 24-36 hrs from rectal temperature drop, no signs of impending parturition
c) Rectal temperature has returned to normal, no signs of impending parturition
d) Passage of fetal fluids before onset of abdominal straining
e) Persistent abdominal straining for more than 30 minutes without delivery of a puppy
f)

Intermittent abdominal straining for more than 4 hrs without delivery of a puppy

g) Green vaginal discharge (beginning of placental separation)


2) After delivery of the first puppy:
a) More than 2 hrs pass between the birth of two puppies
b) Persistent abdominal straining for more than 30 minutes without delivery of a puppy
3) Abnormal vaginal discharge: foul smelling, hemorrhagic
4) Presence of a puppy stuck in the birth canal
5) Maternal compromise (persistent whining or crying, abnormal posture, apathy, tremor,
dyspnoea)
Queen:
1) Before delivery of the first kitten:
a) More than 69 days from day of last breeding, no signs of impending parturition
b) Intermittent abdominal straining for more than 2 hrs without delivery of a kitten
c) Sanguineous vaginal discharge
d) Passage of fetal fluids before onset of abdominal straining
e) Persistent abdominal straining for more than 5 minutes without delivery of a kitten
2) After delivery of the first kitten:
a) More than 2 hrs pass between the birth of two kittens
b) Queen does not take care after her offspring
c) Persistent abdominal straining for more than 5 minutes without delivery of a kitten
3) Abnormal vaginal discharge: foul smelling, hemorrhagic
4) Presence of a kitten stuck in the birth canal (a kitten which protrudes from the vulva should
be delivered within 3 to 5 minutes)
5) Maternal compromise

15

Table 4: Fetal and maternal factors of dystocia (45)


Fetus

Dam

Fetal oversize:
Singleton or twin pregnancy
Small litter size
Prolonged gestation
Genetic predisposition (breed /
brachycephaly)
Broad shoulder / broad head

Pelvic constriction:
Genetic predisposition (breed)
Age (juvenile)
Former pelvic fractures
Neoplasia
Malformation of the pelvis
Diet-related

Abnormal development:
Malformation of the head
(hydrocephalus)
Malformation of the limbs
(number, formation)
Anasarca / ascites
Fetal death
Schistosoma reflexum
Faulty fetal disposition:
Presentation:
o Transverse presentation
o Simultaneous presentation of
two fetuses
Posture:
o Lateral deviation of the head
o Ventral deviation of the head

Abnormalities of the caudal reproductive tract


Cervix:
o Inflammation
o Hormonal
o Congenital
Vagina, Vestibule:
o Stricture, Septum
o Hypoplasia
o Vagina duplex
o Neoplasia
o Trauma
o Hyperplasia / prolapse
o Inflammation / fibrosis
Vulva:
o Stricture
o Recessed vulva
o Hormonal
o Inflammation/Fibrosis
Disorders of expulsion (uterine causes)
1. Primary uterine inertia:
Genetic
Overstretching: large litter, locally: large puppy
Hormonal
Infectious
Hypopcalcemia
2. Secondary uterine inertia:
Prolonged expulsive period
Dystocia
3. Abnormal position of the uterus:
Uterine herniation
Uterine torsion
4. Uterine rupture
5. Uterine neoplasia
6. Placentitis/adhesions
Disorders of expulsion (extrauterine causes):
1. Diaphragmatic hernia
2. Tracheal rupture
3. Pain
4. Fear
5. Drugs (progesterone, anaesthetic agents)
6. Muscle weakness
7. Obesity (excessive perivaginal fat)

16

Table 5: Decision-making aid to managing dystocia


Before birth of the first puppy/kitten
Cervix closed or incompletely
dilated

Good general condition of the dam, fetal heart rate


(HR) > 180/min  wait
Bad general condition or HR < 150-180/min 
caesarean section

Fetus has entered the pelvic


canal, normal fetal disposition
Amniotic fluid passed, strong
abdominal straining, fetus has
not yet entered the pelvic
canal

Lubrication, palpation Initiation of abdominal


straining, manual traction synchronous to
abdominal straining, may use haemostatic forceps
if fetus is dead
Birth canal too narrow, only one fetus episiotomy
more than one fetus  caesarean section
Tentative diagnosis: obstructive dystocia
(abnormal presentation or posture, malformation,
fetomaternal disproportion) caesarean section
Secondary uterine inertia because of obstructive
dystocia  caesarean section

No abdominal straining,
amniotic fluid passed, fetus
has not yet entered the pelvic
canal, cervix dilated

No obstruction:
Primary uterine inertia (age, dead fetuses,
hyperfetation, singleton pregnancy)
Uterine rupture (oxytocin?)
Uterine spasm
Hypocalcemia
Stress, obesity
Good general condition of
the dam and 2 fetuses
and HR>150-180/min  try
conservative management
(infusion, lubricants,
tocolytic agents, oxytocin)

> 2 fetuses, or
HR<150-180/min or
bad general
condition of the dam
 caesarean section

After birth of the first puppy/kitten


Strong abdominal straining,
fetus has not yet entered the
pelvic canal, cervix dilated

Tentative diagnosis: obstructive dystocia


(abnormal presentation or posture, malformation,
fetomaternal disproportion) caesarean section
Secondary uterine inertia because of obstructive
dystocia  caesarean section

No abdominal straining,
normal fetal disposition

No obstruction:
Secondary uterine inertia (uterine fatigue,
exhaustion of the dam)
Good general condition of
the dam and 2 fetuses
and HR>150-180/min  try
conservative management
(infusion, lubricants,
tocolytic agents, oxytocin)

> 2 fetuses, or
HR<150-180/min or
bad general
condition of the dam
 caesarean section

17

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