Dystocia And Obstetrics Theriogenology

Front 1

What is the definition of a dystocia?

Back 1

A slow or difficult labor or delivery
-obstruction or constriction of birth passage or abnormal size, shape, position or condition of the fetus

Front 2

What is the definition of obstetrics in the context of veterinary medicine?

Back 2

Usually limited to the care of the dam and the unborn young during a parturition that cannot be completed, or has slowed to the point that the life of one or both patients is at risk

Front 3

What are 4 possible etiologies for dystocia?

Back 3

1) Uterine dysfunction
2) Too small a birth canal
3) Abnormal fetal presentation
4) Abnormal fetal anatomy
*certain breeds can be 90% (bull dogs)

Front 4

Is dystocia more commonly due to a maternal origin or fetal origin?

Back 4

maternal: 75%
Fetal: 25%

Front 5

Failure of expulsive force is a maternal factor that causes dystocia due to abnormalities in the _____ or ______.

Back 5

Uterus or abdomen

Front 6

What is the primary cause of uterine dysfunction that results in failure of expulsive forces?

Back 6

Primary inertia: uterus has problems where muscles have had trauma and cannot contract efficiently

Front 7

What are 4 causes of primary inertia?

Back 7

1) Myometrial defects
-degeneration, infection, heredity
2) Biochemical deficiencies
3) Hysteria/environemntal disturbance
-if feel threatened, can't relax
4) Deficient amnion (oligoamnion)
-not enough fluids around baby to lubricate it

Front 8

What are 6 types of biochemical deficiencies that can result in primary inertia (resulting in failure of expulsive forces)?

Back 8

1) E2:P4 ratio
2) Oxytocin
3) PGF2alpha
4) Relaxin
5) Calcium
6) Glucose

Front 9

What is secondary inertia?

Back 9

Consequence of another cause of dystocia

Front 10

What are 2 causes of secondary inertia?

Back 10

uterine damage
uterine torsion

Front 11

What are 4 factors that can cause the inability to strain resulting in an abdominal abnormality causing dystocia?

Back 11

1) Age
-too old= muscles not strong enough
2) Pain: prevents animal from having good contractions and pushing
3) Weak
4) Diaphragmatic, tracheal, or laryngeal damage
-if can't close trachea can't hold breath to perform pushing

Front 12

What are the 2 general maternal factors that cause dystocia?

Back 12

1) Failure of expulsive forces
2) obstruction of birth canal

Front 13

What are 2 general issues that can cause obstruction of the birth canal?

Back 13

Boney pelvis
Soft tissue issues

Front 14

What are 6 general causes of a boney pelvis that can result in obstruction of the birth canal/

Back 14

1) Breed
2) fracture
3) Lumbosacral subluxation
-luxate ventrally= acts as a door
4) Immaturity
-pelvis won't open to create a canal
5) Neoplasia
6) Disease

Front 15

What are 3 things that can cause issues with the vulva, resulting in obstruction of the birth canal?

Back 15

1) Congenital defects
2) Fibrosis
3) Immaturity

Front 16

What are 6 abnormalities in the vagina that can result in obstruction of the birth canal?

Back 16

1) Congenital defects
2) Fibrosis
3) Prolapse
4) Neoplasia
5) Perivaginal abscess
6) persistent hymen

Front 17

What are 3 abnormalities that can occur with the cervix that results in obstruction of the birth canal?

Back 17

1) Congenital defect
2) Fibrosis
3) Failure to dilate

Front 18

What are 5 abnormalities that can occur with the uterus, resulting in obstruction of the birth canal?

Back 18

1) Torsion
2) Deviation
3) Herniation
4) Adhesion
5) Stenosis

Front 19

What are 4 fetal factors that can cause dystocia?

Back 19

1) Hormone deficiency
2) Feto-pelvic disproportion
3) Maldisposition
4) Fetal death (doesn't send message so won't come out)

Front 20

What is a hormone deficiency (fetal factor) that can result in dystocia? What can cause this?

Back 20

ACTH/ cortisol deficiency
-pituitary hypoplasia

Front 21

What are 2 causes of feto-pelvic disproportion (fetal factor)?

Back 21

1) Fetal oversize
2) Fetal monster

Front 22

What are 3 causes of maldisposition (fetal factor)?

Back 22

1) Malpresentation
2) Malposition
3) Malposture

Front 23

True or false. All obstetric cases should be treated as emergencies.

Back 23

True

Front 24

What are 7 components of a patient's history that you should collect before managing a dystocia?

Back 24

1) Primiparus (1st birth) vs pluriparus (already had baby)
2) Due date
3) History of dystocia
4) Length and vigor of ongoing delivery
5) Vaginal discharge
-if no, maybe not in labor yet
-quality of discharge
6) Any fetal membrane or parts have been seen
-if fetal membranes are coming out then needs to come out!
7) Has any assistance been provided

Front 25

What is the next step when dealing with a dystocia after collecting the history of the case?

Back 25

General examination & assess mother's condition

Front 26

What are 5 components to assessing the mother's condition when managing a dystocia?

Back 26

1) Demeanor
2) Ability to move
3) Systemic parameters
4) *Stage of delivery
5) Signs of fetal life

Front 27

What is Stage 1 of birthing? How long does it last?

Back 27

Nesting behavior, some abdominal contractions, animal may be restless
-can last hours, a day

Front 28

What is stage II of birthing? When does it start and end?

Back 28

Starts once there's any type of fetal membrane or fetal fluid coming through the vulva
-active delivery= ON THE TIME CLOCK!!
-some animals take a long time but there should be progression
-ends when babies come out

Front 29

What does stage III of birthing begin and end?

Back 29

Starts after puppies come out
Ends after placenta passes

Front 30

What do you do after the physical examination of the dam when you've determined that the dam is in stage II of pregnancy?

Back 30

Obstetric examination

Front 31

What are the 2 steps of the obstetric examination (in order)?

Back 31

1) Restrain and clean the patient
2) Vaginal examination

Front 32

What are the 3 fetal P's that need to be assessed when performing a vaginal examination on a dystocia patient?

Back 32

1) Presentation
2) Position
3) Posture

Front 33

What is the fetal presentation?

Back 33

The relationship between the long axis of the fetus and the long axis of the maternal birth canal

Front 34

What are the 3 fetal presesntations?

Back 34

1) Longitudinal
-anterior
-posterior
2) Transverse
3) Vertical (rarely!)

Front 35

What is a transverse presentation?

Back 35

True breach- have to correct surgically
-Have a perpendicular axis from dam to baby

Front 36

What is a vertical presentation?

Back 36

Fetus spine is perpendicular to dam spine and is vertical- head can be down or up and just feel back or hooves

Front 37

What is the definition of the fetal position?

Back 37

Surface of the maternal birth canal to which the fetal vertebral column is applied

Front 38

What are the 4 fetal positions?

Back 38

Dorso-
1) Sacral
2) Pubic
3) Right ilium
4) Left ilium

Front 39

What is the definition of the fetal posture?

Back 39

Disposition of the head, neck and limbs of fetus

Front 40

*What are the 6 different treatment plans for managing dystocia?

Back 40

1) Conservative treatment
2) Drug therapy
3) Manipulative treatment
-change posture of fetus or pull on it
4) Surgical treatment
5) Fetotomy
6) Euthanasia

Front 41

What are 3 drug therapies that can be used to manage dystocia?

Back 41

1) Calcium to help muscles contract
2) Glucose for energy
3) Oxytocin to help uterine contractions

Front 42

What is using conservative treatment for managing dystocia? When do you want to do this?

Back 42

Upon examination the case is determined to not be quite ready for assistance
-allow patient some time before taking further action

Front 43

What are 3 different formulations of calcium?

Back 43

1) Calcium borogluconate 10%
2) Calcium gluconate
3) Calcium lactate

Front 44

When is oxytocin used for treatment of dystocia?

Back 44

To relieve non-obstructive dystocia in bitches
-administered IM or SQ
-short lived, but too much can cause tetany

Front 45

What should you do if there is no response to the initial injection of oxytocin?

Back 45

Progressively higher doses can be used, with an upper dose limit of 5 IU. After this if dystocia is not resolved, a C section is indicated

Front 46

What are the 3 methods used to correct fetal malposition?

Back 46

1) Mutation
2) Repulsion (retropulsion)
3) Rotation

Front 47

What do you call it when you push the fetus out of the birth canal into the uterus where there is more room to correct the abnormal position of fetus and its extremities?

Back 47

Repulsion (retropulsion)

Front 48

What is rotation (when correcting fetal malposition)?

Back 48

Turning of the fetus on its long axis to bring it into a dorso-sacral position

Front 49

What is the medical terminology for correction of fetal malposition?

Back 49

Mutation

Front 50

What is the best way to place chains when trying to get traction for managing a dystocia?

Back 50

2-point traction: put two loops, one distal to joint and one proximal to joint to distribute this weight and prevent breaking bones

Front 51

What do you do when a fetus has an anterior presentation and the head is resisting passage through the birth canal?

Back 51

Use 3-point traction: involves the use of a head snare, chain, or some other device used to apply traction to the head, neck and eventually the chest of the fetus. The end result is elongation of the head and neck with resulting decrease in fetal diameter.

Front 52

What are 10 reasons that epidural anesthesia is widely utilized in the management of obstetrical problems in the mare and cow?

Back 52

1) Stops abdominal standing and makes correction of breech presentation & uterine torsion easier
2) abolishes or reduces all pain & is therefore more human and should be administered when great power is used in some forced contractions
3) Greatly increases speed, ease and safety to the operator and patient in fetotomy operations
4) The animal stands quiet without moving about or lying down (if give right amount)
5) Defecation is suspended
6) Animal does not rapidly expel lubricants pumped into the uterus
7) When used in C-section, it controls straining and prevents prolapse of the intestine through the surgical incision
8) May prevent prolapse of the uterus immediately after a difficult parturition
9) Aid replacement of prolapse of the vagina, cervix, uterus, rectum or bladder
10) Alleviates straining associated w/ severe vulvitis or vestibulitis

Front 53

What is the definition of a cesarean section?

Back 53

Uterus is opened surgically to allow removal of offspring via laparotomy
-sometimes perform hysterectomy or OVH after offspring evacuated

Front 54

What are 10 indications for a C-section?

Back 54

1) Feto-pelvic disproportion
2) Irreducible torsion
3) Incomplete dilation of the cervix or other parts of birth canal
4) Fetal monster
5) Fractured pelvis
6) Uterine rupture
7) Damaged or severe vaginal prolapse
8) Evidence that fetal life is becoming compromised
9) Failure of uterine inertia to respond to ecbolic (oxytocin) treatment
10) convenience

Front 55

What are 3 reasons to perform an elective C-section?

Back 55

1) Surgical termination of prolonged gestation
2) Avoid existing or suspected fetopelvic-disproportion
3) Termination of pregnancy in life threatening disease of the dam

Front 56

What are 2 examples of life threatening diseases of the dam that could result in an elective C-section?

Back 56

1) Hydrops allantois
2) Traumatic reticulitis or pericarditis

Front 57

What are some possible complications of a C-section (11)?

Back 57

1) Peritonitis
2) Uterine prolapse
3) Wound breakdown
4) Seroma formation
5) Retention of fetal membranes
6) Metritis
7) Vaginitis
8) Infertility
9) Ventral edema
10) Mastitis
11) Sudden death

Front 58

What are 3 reasons an en-bloc ovariectomy or ovariohysterectomy may need to be performed in a dystocia patient?

Back 58

1) Damaged uterus
2) Uterine contents are putrefied
3) Owners request

Front 59

Does spaying an animal after a
C-section impact milk production?

Back 59

NO!!!

Front 60

What is the definition of a fetotomy?

Back 60

Per vaginum division of the embryo into smaller parts to allow for vaginal evacuation of these parts
-salvage procedure for the dam and her reproductive future

Front 61

What are 2 possible reasons to perform a fetotomy?

Back 61

Dead fetus too big for delivery
Arthrogryposis

Front 62

What are 4 advantages to performing a fetotomy?

Back 62

1) May salvage dam's life and subsequent fetus
2) Low chance of trauma if only partial fetotomy needed
3) Only one or two cuts may be needed to allow vaginal delivery of the fetus
4) Economic option to a c-section when no more than 2 cuts are needed

Front 63

What are 4 disadvantages of a fetotomy?

Back 63

1) Time consuming (pending on # of cuts)
2) Possible trauma to repro tract
3) Possible danger to the dam and future fertility
4) Associated w/ an increased incidence of retained fetal membranes and endometritis

Front 64

What are the go home instructions for a mare that just had a fetotomy performed to insure future breeding soundness?

Back 64

Mare needs a rest period of one breeding season

Front 65

What are 2 situations in which euthanasia may be the best choice for management of a dystocia?

Back 65

1) Dam & offspring are in such a bad shape that obstetric intervention is not possible
2) Economy does not allow further obstetric intervention

Front 66

What are 2 things you can't do too much of when dealing with dystocia?******

Back 66

-Be as clean as possible!!!!
-Use copious amounts of NON IRRITATING lubricant

Front 67

How long should you give a dam after the water breaks before intervening?

Back 67

Examine internally after 20 minutes if she has not delivered any offspring or parts of one that can be delivered (head, foot)

Front 68

Why is it important to always trace the legs of the fetus to the body?

Back 68

To verify that the legs belong to the same fetus- check for twins!

Front 69

How can you tell the difference b/w the front and back legs of a fetus upon palpation?

Back 69

Front leg: the first 3 joints bend in the same direction
Back leg: the first two joints bend same direction but 3rd joint bends in opposite directions

Front 70

What should you do if you cannot identify or correct a problem with 15-20 minutes?

Back 70

Summon help

Front 71

What are the 4 things you should do after resolving a dystocia?

Back 71

1) Inspect reproductive tract for any remaining offspring
2) May use ecbolics to help evacuate uterus
3) Assess need for:
-anti-inflammatories
-analgesics
-antibiotics
-fluids
-calcium
4) Monitor passage of fetal membranes