Clinical corner answer: September edition
A 3 year old FE West Highland terrier presents with dystocia. The owner reports the bitch has been straining unproductively for 3 hours and no puppy has been produced. You have performed some imaging to assess the case. One of your lateral radiographs is posted above.
What is your recommendation to the owner?
- Emergency caesarian section
- Initiate medical management – oxytocin
- Advise the owner to take the bitch home and give her 4 more hours
- This bitch is not pregnant!
The answer is...
1. Emergency caesarian section - this is a clear-cut case of foetal oversize. This can also be referred to as 'single pup syndrome' which refers to a very large single foetus that will not fit through the pelvic canal. Foetal oversize can be relative or absolute. In this case it is absolute. If this foetus was not so large, what would be your next step in managing this case?
Clinical Corner Pt. 2 Answer
A 4 year old pregnant French Bulldog presents on day 61 of her pregnancy with a history of dark green vulval discharge for the past hour. The dog is a Crufts champion and the client is an experienced breeder. The client is requesting an injection of oxytocin and this generally works well. What is your plan?
- You agree with the breeder and inject oxytocin but will keep the bitch in hospital to monitor her progression, advising caesarian section may be necessary
- You admit the dog for further investigation and you can call your boss for help!
- You advise emergency caesarian section
- You advise giving the bitch another hour or so before taking any action
The answer is...
3. You advise caesarian section – this is a tricky one. This bitch presented with a really important clinical sign which is dark green vulval discharge. This indicates that a placenta has separated from the uterine wall and now we have a foetus without a blood supply. No blood supply = no oxygen supply, meaning that caesarian section should be advised.
Dark green vulval discharge indicating caesarian section is only applicable to bitches that have not produced any puppies. If the bitch has already produced one pup, then a dark green discharge may be from the first puppy’s placenta so cannot be used for decision making.