Journal of Canine Practice and Research (2004) 4: 90-100.

DYSTOCIA AND ITS MANAGEMENT IN THE BITCH AND QUEEN A REVIEW

G.N. Purohit1 and Mitesh Gaur2 Department of Animal Reproduction, Gynaecology and Obstetrics College of Veterinary and Animal Science, Bikaner (Raj.)- 334 001

ABSTRACT Dystocia in the bitch and cat has been poorly described. A wide variation in the whelping/kittening process appears to be present over the various breeds of these two species. The reported incidence shows a wide variation with an overall incidence of 5-7%. The miniature as well as Brachy cephalic breeds of dogs and the Persian cats appear to be more prone to dystocia. The maternal causes of dystocia appear to be more common in the dog and cat with uterine inertia as the predominant cause followed by narrow pelvic canal, abnormal maternal soft structures, uterine abnormalities and nervous voluntary inhibition of labor. The fetal causes of dystocia described for the bitch and cat include fetal oversize, fetal malpresentations and monstrosities. Careful management of dystocia in these two species is an essence often necessitating an emergency caesarean section to save the pups when medical therapy with pharmaceutic agents fails to relieve the dystocia. Key words: Bitch, cat, dystocia, fetal, maternal. Dystocia is the inability of the dam to expel the fetus at parturition through the birth canal without assistance. The incidence of dystocia in companion animals like the bitch and queen are quite low (Jackson, 1995) but when it occurs it may constitute life threatening situations to both the dam and the young ones. Due to a wide number of breeds of different size and due to a variable experience of the breeders, patients may be brought for therapy at a very late stage or at an early stage.
2

Ph.D. Scholar, Deptt. of Animal Reprod. Gynaec. & Obstetrics, College of Veterinary and Animal Science, Bikaner.

Journal of Canine Practice and Research (2004) 4: 90-100. NORMAL WHELPING/KITTENING The gestation period in the bitch is 65 5 days (Concannon et al., 1983) and the first stage of labor is characterized by nesting behaviour, panting, flank watching, restlessness and occasionally vomiting and mild straining (Jackson, 1995). During the second stage of labor, the bitch usually lies in lateral recumbency but sometimes walks around. The chorioallantois of each puppy ruptures at the pelvic inlet. The first puppy should be delivered within 2 hours of the commencement of second stage labor. The interval between puppies being 5-60 minutes (Jackson, 1995). In case of queen, the gestation period is taken as 63 to 65 days on an average. The first stage of labour is characterized by clear vulvo-vaginal discharge, vocalization, tachypnea, pacing in circles, rearranging of bedding and washing itself constantly. The second stage, however, involves lying by side and as contractions become more vigorous, lowering of hind quarters in a semisquatting position, standing on phalanges with the calcaneous bones pointed almost straight up and wide apart; the entry of foetus into the pelvic canal is signaled with groaning or crying of the queen. First kitten should appear within 60 minutes of onset of second stage with time interval of upto 60 minutes between two successive births. Queening is usually completed in 2 to 6 hours but may take 10 to 12 hours in older females (Laliberte, 1986). INCIDENCE The overall incidence of dystocia described for the bitch is 5 per cent (Jackson, 1995). In a clinic report, it was 7.80% of gynaecolocial cases presented (Deka et al., 2003), but it may be higher in some breeds of dogs selected for large heads (Linde Forsberg and Eneroth, 2000). The breed incidence of dystocia is difficult to comment. In one study, it was most common in the Scottish Terrier followed by mongrels, Cocker Spaniels, Corgis, Bull dogs, Pekingese, Boxers, Poodles, Chihuahua and Alsatians (Freak, 1962). In another study (Bennur et al., 2001a), the incidence was highest in German Shepherd

Journal of Canine Practice and Research (2004) 4: 90-100. (29.3%) followed by Pomeranian (17.3%), Boxers (13.3%) and Dachshund (10.7%). Although, Christiansen (1984) and Schachtel (1972) claimed that dystocia mainly occurs in the miniature breeds but Bennur et al., (2001a) noted a higher incidence in medium and large sized breeds. Gaudet, 1985 and Darvelid and Linde-Forsberg, 1994). The incidence is Dystocia comprised considered to be highest in bitches aged 2-4 years (Bennur et al., 2001a; 18.2% of the total cases presented for reproductive therapy in our study (Mehta et al., 2005). It appears that the reporting depends on the type of brood bitches kept in a particular area. Darvelid (1993) and Darvelid and Linde-Forsberg (1994) had therefore found no relationship between dystocia and breed or age in bitches. In the cat, the incidence of dystocia is known to be highest in the Persian cat (Widmann Acanal, 1992, Ekstrand and Linde-Forsberg, 1994) followed by the Siamese type and Devon Rex cats (Gunn Moore and Thrushfield, 1995). CAUSES OF DYSTOCIA Both maternal and fetal causes of dystocia have been described for the bitch (Darvelid and Linde-Forsberg, 1994, Jackson, 1995), however, the maternal causes appear to be more common (Darvelid and Linde-Forsberg, 1994). Uterine inertia constitute the biggest maternal cause of dystocia in cat (Ekstrand, 1993) and dog (Jackson, 1995) the incidence ranging from 36 to 72% of all cases in dogs. Other maternal causes of dystocia include narrow bony birth canal, uterine torsion, vaginal septum formation and hydroallantois. The fetal causes are less common in the bitch and include fetal maldisposition, fetal oversize, fetal malformation and fetal death (Jackson, 1995). Fetal postural abnormalities like those of the limbs are seldom a cause of dystocia in the bitch. (Linde-Forsberg and Eneroth, 2000). The incidence of maternal and fetal dystocia in the bitch is 75.3% and 24.7%, respectively (Darvelid and Linde-Forsberg, 1994). The total incidence of dystocia in the cat is 5.8% (Gunn-Moore and Thrushfield, 1995) whereas, the incidence of maternal dystocia is 83.6 and fetal 16.4% (Dejneka et

Journal of Canine Practice and Research (2004) 4: 90-100. al., 1995), however, it was 67.1% maternal and 21.9% fetal in another study (Moore and Thrushfield, 1995). MATERNAL DYSTOCIA The maternal causes of dystocia described in the bitch and cat include uterine inertia, nervous voluntary inhibition of labor, narrow pelvic canal, abnormal maternal soft structures and uterine abnormalities. The maternal causes of dystocia are known to be common, comprising 75% of all cases in the bitch (Darvelid and Linde-Forsberg, 1994; Stolla et al., 1999) and 67.0% of cases in the cat (Ekstrand and Linde-Forsberg, 1994) Uterine Inertia Uterine inertia in the bitch has been described as primary and secondary (Jackson, 1995) and partial or total. Yet another classification is primary uterine inertia and a failure to progress (Johnston, 1986). The incidence of primary complete and primary partial uterine inertia described for the bitch is 48.9% and 23.1% of the total dystocia cases (Darvelid and Linde-Forsberg, 1994). In another study, the incidence of primary and secondary uterine inertia was 36.3% and 49.8% (Stolla et al., 1999). For the cat, the incidence of uterine inertia described is 60.6% (EIkstrand and Linde-Forsberg , 1994). It is considered that bitches with primary uterine inertia are having normal calcium levels and show no response to administration of calcium or oxytocin. The diagnosis of primary uterine inertia is based on the knowledge of expected date of whelping and by the bitchs failure to initiate labor. If rectal temperature is monitored twice daily, an abrupt prepartum temperature drop can be detected in most pregnant bitches with onset of whelping within 24 hours. In 40 canine pregnancies mean rectal temperature drop was 1040.2 F (0.80.1C) and mean low prepartum rectal temperature was 98.90.11 F (37.10.06C) (Concannon et al., 1977b). The temperature drop has been demonstrated to occur 10 to 14 hours following decline in plasma

Journal of Canine Practice and Research (2004) 4: 90-100. progesterone to less than 2 ng/ml (Concannon et al., 1977a,b).Though the drop is transient and returns to normal range before onset of whelping (Concannon et al., 1977b) A few commercially available kits (Canine Pregnancy Test Kit, Healthy Pets, USA) can now diagnose pregnancy in the bitch as they predict the relaxin levels which are considered to be altered in the pregnant bitch. On physical examination, a bitch with primary uterine inertia is alert, cervical dilation may be detected vaginoscopically in small to medium sized bitches. A green tinged vaginal discharge [reddish in queens) (Rajesh and Rajesh, 2002) with or without a mucous amniotic fluid may be present. Inertia may be partial or complete (Freak, 1962). Inertia has been reported in the Scottish Terrier (Freak, 1962) Cocker Spaniel and Dachshund (Barrett, 1949) and many other breeds. It has been seen in bitches of five years and above (Freak, 1975). Inertia has been observed to be a major cause of dystocia in raccoon dogs in China (Liu et al., 1992). Uterine inertia is prevalent in miniature and poodles, Dachshound, Pekingese, Boxers and Scotties (Bradney, 1969). It is fairly common in many breeds including the Scottish Terrier and the probable causes described include an inherited predisposition, fetal oversize and a faulty nutrition at mating (Freak, 1962). Primary inertia may be incomplete in which case expulsion of fetuses will be initiated but not completed (Freak, 1975). The causes of inertia described include uterine muscular defects due to age, low hormonal output and muscular stretching due to single oversized fetus (Freak, 1975). Other causes of inertia described (Linde-Forsberg and Eneroth, 2000) include failure of uterus to respond to fetal signals because of presence of one or two puppies and thus, there is insufficient stimulation to initiate labor (the single puppy syndrome) or because of overstretching of the myometrium by large litters, excessive fetal fluids, or oversized fetuses. Other causes of primary inertia may be an inherited predisposition, nutritional imbalance, fatty infiltration of the myometrium, age related changes, deficiency in neuro endocrine regulation

Journal of Canine Practice and Research (2004) 4: 90-100. (Linde-Linde-Forsberg and Eneroth, 2000) or systemic disease in the bitch. Primary complete uterine inertia is the failure of the uterus to begin labor at full term. Primary partial uterine inertia occurs when there is enough uterine activity to initiate parturition but it is insufficient to complete a normal birth of all fetuses in the absence of an obstruction. Low fertility can result in primary inertia due to lower hormonal secretions whereas, high fertility can result in inertia because of uterine distension (Freak, 1962). A bitch with an oversized fetus too large to enter the pelvis will often inhibit whelping to prevent pain (Freak, 1975). Secondary uterine inertia has been described for the bitch (Freak, 1962; Jackson, 1995) and known to result because of muscular tiredness following obstructive dystocia (Freak, 1962). It is considered to develop much more readily in the bitch with a pre-existing partial primary inertia (Freak, 1962). It is considered by a few authors that secondary uterine inertia results due to muscle exhaustion of the uterus subsequent to delivery of a few fetuses (Linde-Forsberg and Eneroth, 2000) Management of dystocia In cases of primary uterine inertia, the owners should initially be instructed to try to induce straining by actively exercising the bitch (Linde-Forsberg and Eneroth, 2000). Yet, another means of induction of straining in the bitch with sufficient labor is byfeathering of the dorsal vaginal wall ((Linde-Forsberg and Eneroth, 2000). Feathering is inserting two fingers into the vagina and pushing with them against the dorsal vaginal wall, thus, inducing an episode of straining (Bradney, 1969). The bitch with complete primary uterine inertia is bright and alert, has a normal rectal temperature but shows no evidence of labor. The cervix is often dilated, but the fetus is out of reach because of the flaccid uterus. Before initiation of medical treatment, obstruction of the birth canal must be excluded. Medical therapy advocated include calcium solutions, oxytocin and uterine spasmolytics like vetrabutine hydrochloride. A spasmolytic is given to optimize

Journal of Canine Practice and Research (2004) 4: 90-100. the effect of oxytocin and avoid uterine tetanus (Dreier, 1998). Excessive panting during labor may result in metabolic disturbance of serum calcium levels. Even slight decreases in serum calcium can result in inefficacy of muscle contractions that may slow the progress of labour. However, because of potential dangers of cardiac arrhythmias and sudden death that can follow intravenous administration of calcium, it is only recommended when a bitch presents with clinical symptoms of life threatening hypocalcaemia (indicated by muscle spasms, tetany, muscle rigidity or seizures or if low calcium levels have been confirmed by laboratory analysis, Davol, 2001a). In the absence of the above two, a subcutaneous injection is suggested. Although, a few authors do not suggest administration of calcium (Jackson et al, 1980). Other authors however, suggest a 10 per cent calcium borogluconate 0.5 to 1.5 ml/kg body weight by slow infusion (Freak, 1962; 1975; Linde-Forsberg and Eneroth, 2000; Phogat et al., 1999). The authors while treating inertia in 21 bitches (unpublished data) found a good effect of administration of intravenous calcium and suggest calcium gluconate 5-10 ml instead of calcium borogluconate because of the danger of toxicity of boron. Since hypoglycaemia can rarely cause a similar picture (Freak, 1975; Freak, 1962; Jackson et al., 1980) and since small sized bitches are prone to hypoglycaemia specially after prolonged straining (Linde-Forsberg and Eneroth, 2000), hence, a 5-10% solution (5-30 ml) must be given by slow IV infusion in cases not responding to calcium therapy in a short time. The recommended dose of oxytocin for the bitch is 10 to 12 IU and for the queen 5 to 10 IU (Rajesh and Rajesh, 2002) given IV or 2.5 to 10 IU in case of IM and 2 4 IU if administered S/C (Dejneka et al., 1995). Ten to fifty mg of the uterine spasmolytic vertrabutine hydrochloride (MonzaldonTM) is suggested to avoid the dangers of uterine tetanus (Dreier, 1998). It is suggested that oxytocin can be repeated at 30 minutes (Linde-Forsberg and Eneroth, 2000; Phogat et al., 1999) or 2 hours (Dreier, 1998), if there is no rise in rectal temperature and the amniotic fluid is physiologically normal. The disadvantages of oxytocin include a tendency to cause premature induction of placental separation and cervical

Journal of Canine Practice and Research (2004) 4: 90-100. closure. If there is no response to treatment after a second administration of oxytocin the puppies should be delivered without further delay either with the aid of obstetric forceps or caesarean section (Linde-Forsberg and Eneroth, 2000). Nervous voluntary inhibition of labor Voluntary inhibition of labor forms a fairly large part of the total cases of dystocia seen in the bitch (Freak, 1975) and it usually stems from a failure on the part of the breeder to interpret the needs and wishes of the bitch correctly. Many breeders will for convenience, bring their bitches indoors from the kennels to whelp. Yet other bitches will refuse to whelp in quiet surroundings chosen for them and will insist to go back to their original place near the constant presence of their owners (Freak, 1962). The condition is reversible by allowing the bitch to have her way and whelp in an accustomed surroundings with human interference at a minimum (Freak, 1962). The bitch with an oversized fetus too large to enter the pelvic cavity will often inhibit to prevent pain whereas, the nervous primigravida may inhibit at the stage where vulval tightness is the only barrier to normal delivery (Freak, 1975). The management of voluntary inhibition of labor involves reassurance by the owner or administration of a low dose of a tranquilizer in nervous bitches (Freak, 1948). Narrow pelvic canal Normal canine pelvis has a vertical diameter greater than the horizontal. Congenitally narrow birth canal exists in some brachycephalic and terrier breeds; in addition their fetuses have comparatively large heads and wide shoulders which presents difficulty in the delivery of fetuses (Linde-Forsberg and Eneroth, 2000). Dorso flattening of pelvises is common in Scottish terrier and makes the posterior presented fetus a hazard in this breed (Freak, 1975). Similarly, a lesser inner pelvic area resulted in dystocia in the Boston terrier breed (Eneroth et al., 1997). In the bull dog, the large, deep chest and pronounced waist causes the gravid uterus to drop down. At whelping, the fetuses are presented at a relatively

Journal of Canine Practice and Research (2004) 4: 90-100. acute angle to the pelvic inlet. The bull dogs sometimes also have slack abdominal musculature, leading to insufficient uterine contractions and abdominal straining to lift the fetus into pelvic cavity (Linde-Forsberg and Eneroth, 2000). A narrowed pelvis can also result due to the presence of calluses of previous pelvic immaturity or congenital malformation of the pelvis (Gehring and Schurmann, 1975; Dejneka et al., 1995; Linde-Forsberg and Eneroth, 2000). A narrow birth canal is known to comprise 1.1% of the dystocia in the bitch (Darvelid and Linde-Forsberg, 1994) and 5.2% of the cases in the cat (Ekstrand and Linde-Forsberg, 1994). The management of dystocia due to narrow pelvic canal suggested is a conservative caesarean (Dreier, 1998). Abnormal maternal soft structures Soft tissue abnormalities such as neoplasms, vaginal septa or fibrosis of the birth canal may cause obstructive dystocia (Linde Forsberg and Eneroth, 2000). Vaginal septum formation constituted 0.5% of the dystocia cases in bitches in one study (Darvelid and Linde-Forsberg, 1994). The prepartum relaxation of the vagina often will allow the passage of fetuses. Vaginal septa may consist of remnants from the fetal mullerian duct system (Linde-Forsberg and Eneroth, 2000). Persistence of a mullerian duct in the shape of a pillar of tissue running from the vaginal roof to floor, posterior to the cervix, has been met as a rare abnormality in the Scottish terrier (Freak, 1975). Septa can also occur secondary to vaginal trauma or infection and if extensive, may prevent the passage of the fetuses. Often, however, they are not so extensive and vaginal relaxation may allow the fetuses to pass (Linde-Forsberg and Eneroth, 2000). Hypoplasia or infantile tight vulva is rare and could constitute an indication for episiotomy (Freak, 1975). Cervical or vaginal fibrosis is secondary to trauma or inflammatory processes and in severe cases will cause dystocia (Linde Forsberg and Eneroth, 2000). Cervical bands can result in dystocia in the bitch (Herr, 1978). Small tumours and septa may be removed by vaginal surgery but in cases of fibrosis, surgery is seldom possible. In cases where puppies cannot be

Journal of Canine Practice and Research (2004) 4: 90-100. delivered due to obstructive conditions of maternal soft structures a caesarean is indicated. Uterine abnormalities Uterine abnormalities culminating in maternal dystocia include uterine torsion, rupture, malposition hydroallantois and congenital malformations of the uterus. Uterine torsion and rupture These acute life threatening conditions can occur during late pregnancy or at the time of parturition (Linde Forsberg and Eneroth, 2000; Hajurka et al., 2005). Bilateral uterine torsion has been reported in a bitch with cystic endometrial hyperplasia (Kochar et al., 1996). The incidence of uterine torsion in the bitch described in one study was 1.1% (Darvelid and Linde-Forsberg, 1994), however, in the cat only sporadic cases are encountered (Kudale et al., 1972; Fremann, 1988; Montgomery et al., 1989). The uterine torsion occurs around the longitudinal axis near the bifurcation of the uterus, and thus displaces the other horn, or there is torsion between the bifurcation and tip of the horn (Dreier, 1998). The puppies that remain in utero die due to lack of oxygen and shock. An animal in labor with torsion of the uterus is an absolute emergency. Torsions up to 360 have been seen in the bitch (Dreier, 1998). Uterine ruptures can occur as a result of oxytocin overdosing. Clinical signs A bitch with uterine torsion may have delivered one or more puppies and has strong contractions without delivering any more puppies (Dreier, 1998). The bitch demonstrates evidence of intense abdominal pain and symptoms indicative of shock (Davol, 2001). The abdomen of the bitch is more elongated on one side and on vaginal examinaton, the introduction of the vaginal speculum is impossible because of the fold of the torsion.

Journal of Canine Practice and Research (2004) 4: 90-100. In cases of uterine rupture, the bitch passes a heavy persistent fresh blood from the vulvar lips. If the rupture is more towards the apex of the uterine horn, the bitch may suddenly go down with drop in body temperature. Diagnosis of deep internal ruptures can be done with x-ray or ultrasound but emergency surgical therapy is more important (Dreier, 1998; Linde Forsberg and Eneroth, 2000). Management Both uterine torsion and rupture are an emergency and require immediate medical therapy and surgical correction by laparotomy (Linde Forsberg and Eneroth, 2000). Despite rapid surgery, the changes in uterus are usually so severe that ovario hysterectomy can rarely be avoided (Dreier, 1998). Uterine malposition Malposition of uterus results from inguinal herniation usually detected around 4 weeks of pregnancy and is diagnosed by visible disturbance in the contour of abdomen (Linde Forsberg and Eneroth, 2000). The early stages can sometimes be mistaken for mastitis of the rear mammary glands (Linde Forsberg and Eneroth, 2000). The condition is corrected by repositioning of the uterus and repair of hernia through laparotomy (Linde-Linde-Forsberg and Eneroth, 2000). Congenital uterine malformations Hypoplasia or aplasia of uterus or cervix are rare and cases of unilateral uterine hypoplasia present clinically with a small litter size (Linde Forsberg and Eneroth, 2000). FOETAL DYSTOCIA Foetal causes of dystocia described for the bitch include oversized fetuses, malpresentation and rarely monstrosities (Linde Forsberg and Eneroth, 2000). Fetal causes of dystocia for the cat include malpresentations and deformities (Ekstrand and Linde Forsberg, 1994; Gunn-Moore and Thrusfield,

Journal of Canine Practice and Research (2004) 4: 90-100. 1995; Dejneka et al., 1995). The incidence of fetal causes in bitch is 24.7% (Darvelid and Linde Forsberg, 1994) and nearly similar incidence of 29.6% has been shown for the cat (Ekstrand and Linde Forsberg, 1994). Fetal oversize A puppy weighing 4 to 5 per cent of the bitch is considered the upper limit for an uncomplicated birth (Linde Forsberg and Eneroth, 2000). Fetal relative oversize is a major cause of dystocia in the Scottish terrier breed (Freak, 1962). For other breeds also it constitutes a major proportion (50%) of the fetal causes of dystocia in the bitch (Bennur et al., 2001b). An absolute oversize of fetus is common when single fetus is present (Freak, 1962). In breeds like the Boston terrier, dystocia occurs from the combination of a flattened pelvic inlet and puppies having a large head (Linde Forsberg and Eneroth, 2000). In dystocia due to an oversized fetus, sometimes a portion of the fetus may protrude from the vulva. In anterior presentation the head may come out, however, the shoulders and chest cause obstruction, whereas in posterior presentation, the hind limbs and hips may protrude (Linde Forsberg and Eneroth, 2000). The incidence of fetal oversize in the cat is known to be low (1.9%) (Ekstrand and Linde Forsberg, 1994). Attempts to relieve a dystocia would depend on the location of the fetal parts, condition of the birth canal and condition of the bitch. Single oversized pups and pups located beyond approach must be delivered by caesarean section. Others may be manipulated by fingers and sometimes delivered after proper lubrication. Fetal malpresentations Fetal malpresentations are less frequent in the bitch and cat because of smaller size of the fetal extremities and the normalcy of posterior presentation deliveries. However, their incidence is described to be around 15% both for bitch (Darvelid and Linde Forsberg, 1994) and cat (Ekstrand and Linde Forsberg, 1994). Forty per cent of the canine deliveries occur in posterior presentation (Linde Forsberg and Eneroth, 2000). However, if the first pup is delivered in a

Journal of Canine Practice and Research (2004) 4: 90-100. posterior presentation, it is likely to result in dystocia because of insufficient mechanical dilation achieved by the absence of a fetal head. In one study, the main reason for fetal dystocia was seen to be fetal malpresentation in the bitch (Darvelid and Linde Linde-Forsberg, 1994) as well as in cats (Ekstrand and Linde-Forsberg 1994; Linde-Forsberg, 1994). Although in another study, fetal malpresentation was not seen to be a cause of fetal dystocia in the cat (Dejneka et al., 1995). A high rate of malposition and malposture are seen in dead fetuses because in a fetus dying before it is presented, rotation and extension of the head and limbs rarely occurs (Freak, 1962), Besides posterior presentation the most common malpresentation seen in the bitch is lateral or downward deviation of the head (Linde Forsberg and Eneroth, 2000). The incidence is considered to be 25% of all fetal causes (Bennur et al., 2001a). Lateral deviation is most common with long necked breeds such as rough collies, whereas downward deviation is seen in brachycephalic breeds and long head breeds such as Sealyham and Scottish terriers (Linde Forsberg and Eneroth, 2000). The other less common malpresenatations described include breech presentation (Bennur et al., 2001a; Linde Forsberg and Eneroth, 2000), backward flexion of front legs (Linde Forsberg and Eneroth, 2000) transverse or bicornate presentation (Linde-Linde-Forsberg and Eneroth, 2000; Dreier, 1998) and two fetuses presented simultaneously. Breech presentation can be a serious problem in the medium and small sized bitches. However, pups with one or both front legs flexed can be delivered with ease in large sized bitches. A fetus passing from one horn to the cervix during delivery may accidentally pass to the other horn and results in bicornate presentation (Linde Forsberg and Eneroth, 2000). Management of fetal malpresentations If a fetus is present in the birth canal, manipulation by hand or by obstetric forceps may be attempted. Obstetric for ceups with better grip as the one used in

Journal of Canine Practice and Research (2004) 4: 90-100. human obstetrics need to be designed for canine obstetric use. In bitches of giant breeds, it may be sometimes possible to insert one hand through the vagina into the uterus and thus extract the puppy. If the fetus has advanced into and partly through the pelvic canal, it will create a characteristic bulge of the perineal region, below the tail. Obstetric forceps can be used for grasping fetal head or fetal pelvis after sufficient lubrication and avoiding vaginal wall. It must be assessed if fetuses can be delivered per vaginum otherwise caesarean must be performed immediately. It has been seen that digital manipulation including forceps delivery and/or medical treatment for dystocia is successful in only 27.6 per cent of the cases (Darvelid and Linde Linde-Forsberg, 1994). When attempting assisted delivery, if progress is not evident within 10 minutes, fetuses should be monitored for distress. Any evidence of fetal compromise contraindicates further attempts for vaginal delivery and caesarnean is recommended. En bloc ovariohysterectomy before hysterotomy has been suggested for dystocia in dog and cat (Robbins and Mullen, 1994). Fetal monstrosity Fetal monstrosity is a relatively infrequent cause of dystocia in dogs and cats, however, hydrocephalus (Freak, 1962), incomplete development of brain and skull (Freak, 1962), fetal anasarca (Chakurkar and Arle, 1992; Sharma et al., 2001) and Cyclopia (Jayaprakash et al., 2001) have been reported for the b itch and fetal malformations (Ekstrand, 1993) hydrocephalus and schistosoma reflexus (Dejneka et al., 1995) have been seen in the cat. When medical therapy or assisted vaginal delivery does not seen to deliver the pup, caesarean delivery is the recommended course of action. Breeds like the Hunt Terrier, Border Terrier and Lucas Terrier resent interference to such degree that assisted puppies and caesarean puppies are seldom accepted by the bitch and the whole litter is killed by the bitch under such circumstances (Freak, 1962).

Journal of Canine Practice and Research (2004) 4: 90-100.

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