learn how to do caesarean section in the bitch or dog.

1. CS in Small Animals
• Background Information
• Indications
• Approaches
• Anaesthesia
• C/S Procedure
• Post-operative care and Discussion

2. Background Information
• Normal Parturition- III stages :
• Stage I- the preparatory phase- approximately 6-12
hour long but can be as long as 36 hours.
• Stage II - active propulsive stage. 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.
• Stage III- the expulsion of the placenta.
• You may see pup-placenta-pup-placenta or pup-pup-
placenta-placenta.

3. DystociaDystocia
• 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 or more hours between pups.
• Obvious problem (pup hanging out etc.)

4. Protocol for Handling Dystocia
1. History
• Predisposing factors such as breed, parity, age, size of litter must
be considered.
• 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.
2. General systemic and genital exam
– Vaginoscopy - Do a digital exam to determine location of puppy.
You can try "feathering" (massaging or tickling) the vagina to
stimulate the Ferguson reflex.

5. 3. Ultrasonography
• 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
4. Radiography
• You can radiograph the abdomen to see how many puppies are left, but it is difficult
to assess fetal viability.
5. Laboratory tests
• 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

6. Plan of Action
• The plan is determined by the etiology and
presenting complaint.
Primary uterine inertia
• 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.
• Prolonged gestation
• Diagnosis of prolonged gestation rests heavily on subjective
information from the owner/breeder.
• 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.

7. Indications
• Uterine inertia unresponsive to oxytocin
• Pelvic obstruction
• Fetal oversize
• Vaginal obstruction that can not be
manipulated
• In utero fetal death
• Planned surgery

8. Secondary uterine inertia
• 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)
• 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.

9. • Obstructive Dystocia
• Obstructive dystocia is when the bitch is pushing
hard but there are no puppies. (not pushing =
inertia)
• 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.)

10. CS-procedure
• General: Surgical removal of pups from
uterus is relatively safe, simple and
succesful procedure.

11. Anaethesia
• Induction & Maintainance
• Isoflurane alone
• Induction protocol:- Xylazine + Thiopentone
• ACP+ Thiopentone
• Barbiturates*
• Halothane*-regulated (0-5)
• the procedure requires significant anesthesia
• the pet will not cooperate and lie still for surgery even if all pain is
relieved. Thus general anesthesia is needed to induce pain relief,
unconsciousness and relaxation. In the usual case, the pet will
receive a pre-anesthetic sedative-analgesic drug to help her relax, a
brief intravenous anesthetic to allow placement of a breathing tube
in the windpipe, and subsequently inhalation (gas) anesthesia in
oxygen during the actual surgery.

12. A photo showing the distinct
gestational sacs

13. A photo showing how the gestational sacs
become confluent,
and therefore difficult to distinguish

14. Placenta

15. Approaches
• Median
• Paramedian
• Flank

16. How is it done-Midline
• Following anesthesia, the pet is placed on a surgical table, lying on her back.
• The hair is clipped over the lower abdomen, the skin is scrubbed with surgical soap to
disinfect the area and a sterile drape is placed over the surgical site.
• a midline incision similar to that used to spay a female; however, the incision line will
be relatively longer.
• Skin is tensed using thumb forceps
• A scalpel is used to incise the skin of the lower abdomen and then open the
abdominal cavity.
• The uterus will be exposed, bifucation located and then incision (s) made to remove
the fetus.
• Pups are removed by milking them out towards the incision
• The pup(s) is (are) handed to an assistant who clears the airway, stimulates
breathing, and gives drugs if necessary.
• The uterus may be contracted with a hormonal drug and then the incision is closed
with sutures (stitches) that dissolve over time.
• Alternatively, the female may be spayed.
• The abdominal incision is then closed with one or two layers of self-dissolving sutures
(stitches). The outer layer of skin is closed with sutures or surgical staples that must
be removed in about 10 to 14 days.

17. C/S Procedure

19. Post Operative and Peripartum Care

20. Video

21. Foster Mother

22. Discussion
• The overall risk of this surgery is very low.
The major risks are those of general
anesthesia, bleeding (hemorrhage),
infection (peritonitis), post-operative
infection and wound breakdown
(dehiscence) over the incision. Overall
complication rate is low, but serious
complications can result in death or the
need for additional surgery.