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Cesarean Section
| Question | Answer |
|---|---|
| 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
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