Introduction
Dystocia, known as a difficult birth or the inability to expel the fetus through the birth canal without assistance is one of the common problems in female canine reproduction leading to the maternal inability to deliver a fetus through the birth canal [1,2]. Predisposing factors that often lead to dystocia can be generally divided into maternal and fetal factors. Uterine inertia is the most common cause of dystocia in dogs and may be primary or secondary. In both primary and secondary uterine inertia, the myometrium fails to respond to oxytocin and there is a lack of a Ferguson reflex, which is a neuroendocrine reflex in which the fetal distension of the cervix stimulates a series of neuroendocrine responses, leading to oxytocin production [3]. Nervous voluntary inhibition of labor due to psychological stress may occur, mainly in the nervous primiparous bitches and queens [4].
Conformation of the dam, such as a narrow pelvic canal which could be congenital or from previous pelvic fractures, immaturity or congenital malformation of the pelvis, vaginal and vulvar soft tissue abnormalities, excessive perivaginal fat, and/or pain may contribute to dystocia [5–9].
Previous studies identified breed and maternal age as risk factors for canine dystocia [10]. In 75% of cases, dystocia was caused by the dam [11]. The owner’s lack of basic knowledge about canine reproduction has resulted in some complications in canine reproductive diseases. Dystocia directly affects the health of the bitch, survival of the puppies, and the profitability of the owner [1]. Identification of likely causes may help in prevention, thus reducing the likelihood of undesirable consequences.
This study reports conservative management of canine dystocia in a 2-year-old Lhasa Apso bitch. The findings of the present study might be useful in improving effective treatments as well as preventive measurements in canine dystocia.
Case Management
A 2-year-old Lhasa Apso female dog weighing 6.2 kg was presented to Petcare Animal Clinic, Lagos with a complaint of difficulty in whelping for over 12 hours. Upon physical examination at the clinic, the bitch was stable, having a moderately distended abdomen and she was having intermittent abdominal contractions with slight greenish discharge from the vulva. Clinical examinations were carried out which revealed rectal temperature (38.6oC), mucous membrane (pink), Capillary Refill Time (≤ 2 seconds), dehydration level (moderate < 5%), heart rate (92 beats/minute), pulse rate (90 beats/minute), and respiratory rate (32 breaths/minute).
The bitch was involved in an automobile accident at 6 months old and sustained a pelvic fracture (Fig. 1). The pelvic fracture was managed by cage rest as the dog owner declined fracture reduction by surgical procedure. Spaying was also recommended but the dog owner declined. The dog owner was however advised on contraceptive options, and to separate the dog from male dogs.
Figure 1.
Showing the radiograph of the dog at 6 months with the asymmetry of the pelvis and fracture of the pubis.
Pet was represented at the clinic 18 months later and was confirmed to be four weeks pregnant after ultrasonography was done (Fig. 2). Elective cesarean section was recommended once the bitch is close to term but the owner failed to present the bitch until she had prolonged labor due to the narrowing of the pelvis as a result of the pelvic fracture. Abdominal ultrasonography and radiographic examinations were done which revealed a gravid uterus with matured fetuses (Figs. 3 and 4
Figure 2.
Showing an abdominal ultrasonography confirming the pregnancy at 4 weeks. Red arrow (urinary bladder), blue arrow (amniotic vesicle), and black arrow (fetal heart rhythms).
Figure 3.
Showing abdominal ultrasonography at term. Red arrow (fetal spine) and black arrow (no fetal heart rhythm).
Figure 4.
Showing a radiograph of the dog at term with gravid uterus, revealing matured fetuses.
Table 1.
Showing the result of the haematology examination.
| Haematological parameter | Value | Reference interval | Remark |
|---|---|---|---|
| WBC (x109/l) | 14.7 | 6.0–12.0 | High |
| Lymphocytes (%) | 27.8 | 12.0–30.0 | |
| MID (%) | 2.2 | 5.0–20.0 | |
| Neutrophils (%) | 50.0 | 60.0–70.0 | Low |
| Eosinophils (%) | 0.1 | 0.5–10.0 | Low |
| Basophils (%) | 0.1 | 0.0–1.3 | |
| Lymphocytes (x109/l) | 3.7 | 1.5–5.0 | Low |
| MID (x109/l) | 0.1 | 0.2–2.1 | |
| Neutrophils (x109/l) | 13.9 | 3.0–11.0 | High |
| Eosinophils (x109/l) | 0.1 | 0.04–1.62 | |
| Basophils (x109/l) | 0.0 | 0.00–0.12 | |
| RBC (x1012/l) | 5.04 | 6.0–12.0 | Low |
| Haemoglobin (g/dl) | 11.2 | 10–18 | Low |
| HCT (%) | 37.8 | 35.0–55.0 | Low |
| MCV (Fl) | 75.1 | 60.0–70.0 | |
| MCH(Pg) | 22.2 | 13.0–19.0 | High |
| MCHC (g/dl) | 29.6 | 31.0–37.0 | |
| RDW-SD (Fl) | 33.4 | 37.0–54.0 | Low |
| RDW.CV (%) | 11.3 | 11.0–15.5 | |
| Platelets (x109/l) | 182 | 140–400 | |
| MPV (Fl) | 12.4 | 7.0–12.0 | |
| PDW (%) | 15.9 | 9.0–30.0 | |
| PCT (%) | 0.22 | 0.1–9.99 |
Table 2.
Showing the result of the serum chemistry.
| Serum chemistry parameter | Value | Reference interval | Remark |
|---|---|---|---|
| Sodium (mmol/l) | 143.6 | 140.3–153.9 | |
| Potassium (mmol/l) | 4.8 | 3.8–5.6 | |
| Chloride (mmol/l) | 117.7 | 102.1–117.4 | High |
| Bicarbonate (mmol/l) | 19.0 | 18.1–24.5 | |
| Total calcium (mmol/l) | 2.3 | 2.3–2.9 | |
| Ionized calcium (mmol/l) | 1.2 | 1.2–1.4 | |
| Ph | 7.46 | 7.32–7.42 | |
| Anion gap (mmol/l) | 6.8 | 8.0–16.0 | |
| BUN (mmol/l) | 5.3 | 3.1–9.2 | |
| Creatinine (mg/dl) | 1.1 | 0.5–1.6 | |
| Total protein (g/l) | 70.0 | 55.1–75.2 | |
| Albumin (g/l) | 35.0 | 25.8–39.7 | |
| Globulin (g/l) | 35.0 | 20.6–37.0 | |
| AST (U/l) | 31.7 | 10–40 | |
| ALT (U/l) | 49.6 | 7–56 | |
| ALP (U/l) | 139.6 | 44–147 | |
| Total bilirubin (mmol/l) | 2.5 | 1.71–10.3 | |
| Direct bilirubin (mmol/l) | 0.4 | 0.0–5.1 | |
| Indirect bilirubin (mmol/l) | 2.1 | 1.7–5.1 | |
| GGT (U/l) | 6.7 | 1.0–9.7 |
The dog was stabilized through slow intravenous administration of 100 mls Ringer’s lactate. Obstetrical manipulations were carried out via traction and retropulsion to remove the dead fetus (Fig. 5 and 6) occluding the birth canal. The bitch was able to deliver the three other live fetuses in quick succession of about 5 minutes intervals to each other after administration of ecbolic (0.5 IU).
Figure 5.
Showing traction and retropulsion of the dead fetus.
Figure 6.
Showing the dead fetus that caused the birth canal obstruction after evacuation. Fetus was mutilated during traction and retropulsion.
Post-whelping radiographs were taken to ensure she did not have any retained fetus (Fig. 7). The 3 live puppies were cleaned up, and placed in the incubator (Fig. 8), and breast-fed (Fig. 9).
Figure 7.
Showing post—whelping radiograph of the bitch with fetuses within the intra-uterine space.
Figure 8.
Showing the live puppies in the incubator.
Figure 9.
Showing the 3 surviving puppies while breastfeeding.
The bitch was monitored for 24 hours and was discharged with the puppies. She was, however, placed on the following medications for 7 days to help her during her puerperium; 10 mg /kg Amoxicillin + Clavulanate syrup bid x 7/7, 100 mg /kg Ascorbic acid syrup bid x 7/7 and 50 µg /kg Folic acid syrup bid x 7/7.
Discussion, Conclusion and Recommendations
Dystocia is a common reproductive issue in bitches, often primarily in primiparous bitches [12,13]. Various factors have been implicated in its pathophysiology, which could be maternal, fetal, or a combination of both [14]. Maternal factors that can result in dystocia include narrowing of the pelvis which is either congenital or due to trauma, pelvic defects, exostoses, osteomalacia, and hypoplasia or degeneration of the vagina and vulva. Dystocia frequently develops when some physical obstacle or functional defect impedes the birth process. Pelvic abnormalities of the bitch can result in dystocia [15,16].
Dystocia in this case resulted from pelvic deformity in the bitch due to a trauma the dog had 18 months prior. Pelvic fractures account for a great percentage of traumatic injuries in dogs and cats, comprising at least 25% of all fractures seen by small animal hospitals [17–19]. Pelvic fractures are managed either by surgery or conservatively. Surgical repair is the management of choice in cases of displaced acetabular fractures, involving the cranial 2/3 of the acetabulum; more than 25% narrowing of the pelvic canal diameter by fracture fragments; neurologic impairment; ipsilateral fractures of the ilium, ischium, and pubis, resulting in an unstable hip joint; or contralateral orthopedic injuries requiring early weight-bearing on the pelvic fracture side [20–23].
The pelvic fracture in this case however was not managed surgically as the dog owner declined the surgical procedure. Animals with minimal hemipelvis displacement and no significant pelvic canal narrowing, stable ilium fractures, and minimally displaced fracture separation of the sacroiliac joint could be managed conservatively by imposed cage rest [5,24]. A previous study has also shown that smaller dogs recovered from pelvic fractures without surgical management [25].
Management of dystocia in this case involved gentle obstetrical manipulations via traction and retropulsion to remove the dead fetus which was occluding the birth canal. The bitch was able to deliver the three other live fetuses in quick succession of about 5 minutes intervals to each other by self after administration of ecbolic (0.5 IU). In an earlier study, there was a report that 55% of bitches started on medical conservative management eventually needed a Caesarean section due to response failure [26]. However, there had been a report of successful outcomes with medical conservative management alone in 27.6% of cases [14].
In conclusion, dystocia is a challenging condition in bitches and is often regarded as a reproductive emergency. Pet owners need to be well educated and monitored closely especially when the bitch is predisposed to dystocia. Effective management is essential for the survival of both the bitch and the fetuses. However, in as much as conservative management can be deployed to help in some cases, surgery (caesarian section) might be the best option to prevent the death and reproductive complications of the bitch and or the fetuses.
