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Cesarean Section

Indications Dystocia- most common, emergency procedure Planned- certain breeds, history of dystocia
Causes of Dystocia mal-developed, mal-positioned, oversized fetus; small pelvic canal, history of pelvic trauma in mother; insufficient cervical dilation, uterine inertia (poor contractility)
Stages of Labor Stage 1- Nesting, Stage 2- Delivery, Stage 3- Placenta Expulsion
Stage 1- Nesting onset of contractions, 6-12 hours
Stage 2- Delivery starts with full dilation of cervix, fetus enters birth canal and membranes rupture, abdominal contractions begin, can take up to 4 hours for first fetus to be delivered, can take 2-3 hours for subsequent fetuses
Stage 3- Placenta Expulsion happens after each fetus delivered
Signs of Dystocia delivery takes > 4 hrs, strong contractions lasting longer than 30-60 mins w/o delivery of fetus
Preparing for Surgery spay pack with extra hemostats, extra people- rub, resiscitate, warm pups, dorsal recumbancy, clip and prep as for spay- incision will be to pubis, empty bladder
Pup Anesthetic Time minimize for pups- more likely to need drugs to resuscitate, some wait for opioids until after pups delivered
Mom Anesthetic Time minimize for mom- faster recovery = nurse pups quicker
Types C-section w/o OVH, C-section w/ OHE, En block resection
Without OVH planned c-sections for certain breeds, female intended to breed again
With OVH most common, prevent future dystocia, needed if uterus badly traumatized
En Bloc Resection entire uterus removed first, fetuses quickly removed by tech
Incision ventral midline- through linia alba
Surgical Procedure uterine horn gently exteriorized- careful not to tear uterine vessels, isolate uterus with lap sponges- avoid contamination of abdomen with uterine contents, uterine body carefully incised- lengthen with metzenbaum scissors
Fetal Delivery rupture amniotic sac manually, clamp and cut umbilical cord, fetus handed to non-sterile personnel
Post Fetal Delivery fully inspect repro tract, OVH, if no OVH- lavage outside of uterus, close uterine incision, return uterus to abdomen; lavage abdomen with warm saline
Closure close abdominal wall same as OVH, intradermal sutures best- less irritation to and from pups
Neonatal Care warm, dry towel, rub vigorously and dry, puppy swing or bulb syringe, assess for umbilical hernia and cleft palate, once stable ligate umbilical cord
Drug Neonatal Care Naloxone- if opioids, Doxapram- if need to stimulate respiration, Epinephrine and chest compression- if no heartbeat
Post Op Considerations mom fully awake before introducing pups, want pups nursing ASAP, observe carefully, want home ASAP, weigh pups daily, supplement if needed
Mom Post Op Considerations mucohemorrhagic discharge norm for few days (odor suggests infection), loose stool norm, should have good appetite, monitor mammary glands and milk production
Complications persistent hemorrhage, peritonitis, pyometra, incisional infection, mastitis
Created by: cheshirecat