SA Sx - Hysterotomy (C-section)

drraythe's version from 2017-09-22 05:39

Czs of Dystocia

Question Answer
What are the 3 major reasons there is a 1° uterine inertia? (What makes it 1°?)(1) Oxytocin deficiency
(2) Ca deficiency
(3) Lack of adequate fetal mass....all of these mean that it's 1° bc labor never even starts
What are 3 major reasons for 2° uterine inertia? (What makes it 2°?)Muscular fatigue of uterus 2° to:
(1) Prolonged labor,
(2) Electrolyte deficiency or
(3) Glucose deficiency...2° bc labor started & for some reason stopped
Obstructive → Pelvic-fetal disparity is common in what kinda breeds?Brachycephalic
Obstructive → reasons why the moms pelvis might be the prob?Pelvic mass/ healed pelvic Fx
Obstructive → 2 examples of Uterine malpositionUterine torsion or inguinal herniation
Obstructive → what might be some reasons for an oversized fetus causing obstruction?Incomplete twinning, hydrocephalus, single fetus, etc
How common is fetal malposition in sm animals?Rare
How long of a dystocia will start to correlate w/ higher rates of stillbirth & neonatal death?Prolonged dystocia (greater than ***4 hours) result in higher rates of stillbirth & neonatal death
If the radiograph shows fetal teeth, how old are the fetii?Puppies have developed at least 56 days from conception
How early can a US detect a fetii?As early as 15 days after conception
How early can manual palpation detect fetuses?After about 4 weeks
How long until rads can reliably detect fetuses?Not useful until about 42 to 45 days after the mating
If you radiograph the fetuses, how do you count them?count skulls or spines - don't count both.
Which hormones will maintain lactation, if oxytocin won't be prevalent since you're doing a hysterotomy?Prolactin & cortisol will maintain lactation
Who is most likely to get an ELECTIVE C-section?Brachycephalic & esp bulldogs
What might indicate that the delivery will occur in the next 24hr?"Pre-milk" drops from the nipple - extra sticky

C-section procedures etc

Question Answer
Indications for C-sectionScheduled as per owner's request
Dystocia refractory to medical management
Previous dystocia or hysterotomy
PTxs w/ pelvic Fx malunions
Prolonged gestation
Acute collapse associated w/ parturition
Intrauterine fetal death & decay
Maternal toxemia
Severely damaged or necrotic uterus
2 reasons there would be acute collapse associated w/ parturition?Uterine torsion or rupture
What parameters should you be extra careful about monitoring for a dog undergoing C-section?PTx already has impaired respiration - use pulse ox - & proper O2.
How long until it would be considered prolonged gestation?72+ hours (3d) past due date
If mom has electrolyte abnormalities, when should you correct them?Pre-op
**What is very important to know about analgesic & anesthetic drugs?Will cross the placenta!!!
Which antiseptic should you NOT use for preparing C-section site & why?No iodine - bc toxic to newborns suckling
Will you use local anesthesia?Yes - local anesthetic administered as a line block or via epidural, (however, line block doesn't block entire abd wall esp linea alba. doesnt work as well - he doesnt like this, prefers epidural)
What indicates fetal distress?Fetal heart rates drop below 180 beats/min
Who is most sensitive to the toxic effects of Lidocaine?Cats
How many people do you need for a hysterotomy?Ideally need 2 teams - 1 team to perform Sx & another to receive & resuscitate the newborns
If you are going to pre-op vaginal exam what should you keep in mind?STERILE vaginal exam!
4 things to look at for pre-op PTx EXAM?(1) Physical examination
(2) Rectal & sterile vaginal examination
(3) Abdominal radiographs
(4) Blood glucose & calcium
4 things for pre-op PTx MANAGEMENT?(1) IV fluids & ABx
(2) Correct electrolyte deficiencies
(3) IV Dextrose
(4) Oxytocin - use only if cervix is dilated
When is giving ABx actually merited?No ABx unless fetal death etc.
***What should you know about giving oxytocin pre-operatively?*** CAN ONLY GIVE IF CERVIX IS ALREADY DILATED (otherwise cz rupture of uterine horn)
How effective would just an epidural be for anesthetic protocol?NOT ENOUGH - DONT DO ONLY THIS
How concerned are you about the fact that sedatives & anesthetic drugs can cross placenta?Although you should be aware & cautious, know that they CAN be reversed in neonates
(Step 1) Approach & initial incision?Ventral midline celiotomy, generous incision (like a hand cr to pubis). Linea Alba is stretched & will be very thin - incise carefully!
(Step 2) After you have incised the linea Alba, what do you do?Gently (slowly) exteriorize & pack off uterus, use moistened laparotomy pads
How does a cat's linea Alba compare to a dog’s?Cats is thinner & wider
When making your VM incision, you should be SUPER careful to not...DONT ACCIDENTALLY CUT MAMMAE! Large & filled w/ milk - dont want mastitis. Will be reluctant to feed & newborns might not get colostrum
How quickly should you exteriorize the uterus?NOT QUICKLY!! Not only pulling out uterine horn which is stretched to the max & full of heavy puppies, but also pulling out a lot of blood from "circulation" (one horn at a time to prevent shocky situation)
(Step 3) After uterus is exteriorized, what do you do?Do incision in uterine BODY - but 1st palpate before cutting to make sure puppy not impacted in body or birth canal. Also don't accidentally cut a placenta (if there is one, carefully milk it out, regardless of if it is alive or not (headless baby gonna look bad for owner - don't yank it) )
When you exteriorize the uterus, you see these darkish rings from the outside of the uterine horns. Are you worried?No, that is just where the placenta is (remember zonary placentation)
If the fetus looks like there is greenish stuff, what is happening?That is uteroverdine from the placenta
(Step 4) Once you have made your incision into the body of the uterus, what do you do?Remove 1st fetus by gentle traction, then ‘milk’ each remaining fetus down to incision by compressing uterine horn cranial to each fetus - do 1 horn at a time! Be sure to palpate pelvic canal
(Step 5) You've milked out a fetus & you're holding it in your hands - now what?Detach the placenta w/ gentle caudal traction, then each puppy/kitten is handed off to the recovery team
How do you detach the placenta?Gentle CA traction
Where do you clamp off the neonate's umbilicus?DONT CLAMP IT CLOSE TO THE ABDOMEN. Bc when it falls off & it was too close, it might leave a little hole where you could have an umbilical hernia. Leave a little enough for 2 ligatures
If the placental attachment sites are bleeding excessively, what can you do?Give oxytocin into uterine muscle (contract down & help stop bleeding)
(Step 6) After all of the puppies have been removed, what do you do?Before closing the hysterotomy, any remaining placentas are removed!! (Do the math - make sure same number of puppies & placentas) Then uterus closed in one or 2 layers, w/ either interrupted or continuous -suture patterns (appositional + inverting preferred). Close abdominal incision routinely. *dont go into lumen*
What can you do if the uterus does not start to contact after you have delivered the babies?oxytocin is administered IM or IV if uterus does not contract
How should you close the uterine incision?1 or 2 layers, appositional pattern (interrupted or continuous) He prefers appositional + inverting
If the owner wants the dog spayed also, what are your 2 options?(1) OVH can be performed after hysterotomy
(2) En bloc OVH
(In short) What is an en bloc OVH?You basically do the OVH procedure & the hysterotomy at the same time - clamp off pedicles & cut before ligating to remove entire uterus - ONLY HAVE 60 SEC!!
***Explain the surgical technique for en bloc OVHClamp all pedicles (2 forceps on each pedicle, 3 if big - leave enough room to make ligs later), excise ovaries & uterus quickly (cut btwn clamps) → you only have *****60 sec → Hand tissue off to non-sterile assistant → Ligate pedicles routinely. (Non-sterile assistants open uterus if fetal survival is desired, If fetal survival is not desired, the uterus is not opened) (do not using a transfixion ligature if removing a uterus due to infectious Dz)
When is En bloc OVH usually indicated?ER procedure to save mom/ babies
3 indications for episiotomy?(1) Dystocia (can enlarge vaginal canal but not pelvic canal)
(2) Vaginal hyperplasia
(3) Urethral catheterization
How do you suture closed an episiotomy?Suture closed - layer by layer
Vag mucosa
Sub q
Should you use ABx for hysterotomy?Usually are not necessary
Intra-operative endometrial bleeding can happen - if profuse & intractable, what should you do?Recc an OVH
5 potential post-op complications of hysterotomy?(1) Bleeding
(2) Pyometra
(3) Mastitis
(4) Wound Infxn
(5) Peritonitis

Addressing the newborns

Question Answer
1st thing to do when puppy received?Remove all fetal membranes
What do you do about the umbilical cord?Clamp & ligate
Why do you vigorously rub puppy?Both to dry it off & to stimulate breathing
What are 4 ways to help newborns breathe?(1) Rub vigorously to stim breathing
(2) Nares & nasopharynx are gently suctioned
(3) Possible use of Doxapram (administered sublingually)
(4) Mouth-to-mouth artificial respiration if necessary
Which drug might help stimulate newborns to breathe?Doxapram
Should you shake puppies to make them breathe?Probably not, might accidentally throw them
When do you introduce the newborns to the mom?Only after she has completely recovered from ANx
What is a common congenital defect you should check puppies for?Cleft palate... can go up to soft palate or hard palate. Prevent food going into nose if you can or you risk rhinitis (use a plastic disk until old enough for Sx aka solastic button). Can be fixed surgically.