Canine Reproduction lecture and Lochia

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Canine Reproduction lecture and  Lochia Powered By Docstoc
					                                                    Conditions during diestrus/preg

                                                                                                                          Progesterone level



        Reproductive Problems:
        Diestrus and Pregnancy


                                                    0          7        14   21   28         35          42          49            56          63        70
                                                                                   Days of diestrus / preg
                                                                                                  fetal resorption                                    Premat part
                                                        Acute                                         abortion                                       PP eclampsia
                                                        metritis                                      pseudo                                        PP hypoglycemia
                                                                                                     pregnancy                                       Prim UT inertia
                                                                                                     pyometra                                           dystocia




             Subfertility
                                                                        Pseudopregnancy
       Abnormalities of Diestrus
                                                    • Nonpregnant bitch
 • Pseudopregnancy                                        – Physical and behavioral condition
                                                                   • Intensification of diestrus signs
 • Acute metritis                                                       – Mammary development
 • Cystic endometrial hyperplasia                                       – Lactation
   (CEH)                                                                – Change in behavior

      – “Pyometra Complex”                                         • Common nulliparous bitch (2-6 years)
        •   CEH                                           – Triggered at end of diestrus
        •   Cystic glandular hyperplasia                           • Withdrawal of progesterone
        •   Endometritis                                           • Increased prolactin (production or
        •   Pyometra                                                 sensitivity)




             Pseudopregnancy                                            Pseudopregnancy
• Clinical signs                                    • Diagnosis
  –   Occur commonly 4-6 weeks after estrus               – History and clinical signs
  –   Increase in weight or abdominal distention
  –   Mammary development + lactation
                                                          – Rule out pregnancy or pyometra
  –   Restlessness, lethargy, increased affection                  •   Abdominal palpation
  –   Increased or decreased appetite                              •   Radiographs or ultrasound
  –   Minimal mucoid vaginal discharge                             •   Bloodwork
                                                                   •   Vaginal culture
  – Abnormal behavioral signs
       • Nesting
       • Nursing (self or inanimate objects)
       • Anorexia




                                                                                                                                                                       1
               Pseudopregnancy                                                        Acute Metritis
      • Treatment                                                      • Few days after end of estrus
        – Mild signs                                                     – Septicemia
            • Self limiting, regression in 1-3 weeks                          • Hyperthermia
                                                                              • Hyperpnea
        – Intense signs                                                       • Dehydration
            • Symptomatic treatment                                      – Dark red malodorous vaginal discharge
               –   Sedation
               –   Furosemide, until lactation ceases
               –   Mibolerone, suppresses psychological signs          • Diagnosis
               –   Prolactin inhibitors (bromocriptine, cabergoline)     –   History of recent estrus
        – Prevention                                                     –   Vaginal cytology and culture
            • Breed next estrus                                          –   CBC (left shift)
            • Ovariohysterectomy                                         –   Radiograph or ultrasound




                                                                       Cystic Endometrial Hyperplasia-
                       Acute Metritis
                                                                              Pyometra Complex
      • Treatment                                                      • Progressive
        – Systemic broad spectrum antibiotics                            –   Cystic endometrial hyperplasia
        – Fluid therapy                                                  –   Cystic glandular hyperplasia
        – PGF2α 100-250 mcg SQ Q12-24hr x                                –   Endometritis
          2-3 days                                                       –   Pyometra
        – Ovariohysterectomy
                                                                       • Bitches of all ages
                                                                         – More common 5-10 years




               Cystic Endometrial                                               Cystic endometrial
                  Hyperplasia                                                      hyperplasia
• Clinical signs                                                       • Treatment
  – Copious mucoid vaginal discharge (+/- blood)
       • Diestrus and anestrus
                                                                         – Mibolerone x 10-30 days
                                                                              • 30 mcg/d for dogs up to 50lbs
• Infertility                                                                 • 180 mcg/d for dogs over 100lbs
  –   Irregular estrous cycles
  –   Small litter size                                                  – Ovariohysterectomy
  –   Early embryonic death
  –   Abortion
  –   Potential to progress to pyometra
       • Bitches > 6 years




                                                                                                                   2
        Endometrial Hyperplasia                               Endometrial Hyperplasia
            Endometritis                                          Endometritis
 • History                                                • Management
   –   Conception failure
                                                            – No effective therapy
   –   Irregular cycles
   –   Pseudopregnancy                                      – Systemic antibiotics x 2-3 weeks
   –   Embryonic death                                      – Antibiotic vaginal infusion daily for 3-
   –   Stillbirth/fetal mummification                         5 days
                                                            – Ovariohysterectomy
 • Clinical signs
   – Fetid vaginal discharge 30-90 days post
     estrus
        • Cytology: neutrophils, lymphocytes, bacteria,
          parabasal cells
   – Slight increase in body temperature




                      Pyometra                                            Pyometra
• Hormone mediated diestrual disorder
                                                          • Causes
  – Uterine infection overlying CEH
       • Accumulation of pus in the uterus                  – Exposure of the reproductive tract to
          – Open or closed cervix                             high concentrations of progesterone
          – Closed pyometra severe systemic illness           • Uterus
       • Diestrus (most common)
                                                                 – Pathological changes
          – 3-9 weeks after estrus
                                                                 – Predisposed to infection or sepsis
       • Anestrus
          – Range 1-4 months post estrus
                                                              • Secondary to abnormal ovarian function
  – Two syndromes                                             • Exogenous progesterone/progestins
       • Older bitch (8+ years)                               • Exogenous estrogens (mismating)
       • Younger bitch (hx estrogen/progestin tx)




                                                                                                         3
                    Pyometra                                                 Pyometra
• Clinical signs          • Laboratory findings              • Diagnosis
  – Lethargy, anorexia      – Leukocytosis                     – History
  – PU/PD                        • Degenerative left shift       • Previous estrus or exogenous hormone therapy
                                 • 20,000-100,000
  – Vomiting/diarrhea                                          – Vaginal cytology
  – Abdominal               – Anemia
                                                                 • Large numbers of toxic degenerate
    distention/pain              • Bone marrow
                                   suppression                     neutrophils
  – Vulvar enlargement      –   Azotemia                         • Culture: E. Coli (most common)
  – Purulent vaginal        –   Hyperalbuminemia
    discharge
      • 4-8 weeks post      –   Hypercholesterolemia
        estrus              –   Increased ALP
  – Septic
    shock/toxemia
      • Closed pyometra




                    Pyometra                                           Pyometritic uteri
  • Diagnosis
      – Abdominal palpation
      – Radiographs or ultrasound


                                                                           Thin walled                 Post P4 Tx




                                                                           Thin walled                 Unicornual




                                                                                                                    4
            Pyometritic uteri                                                     Pyometra
                                                           • Management
                                                             – Ovariohysterectomy
                                                             – Medical therapy (open pyometra)
                                                                   • Prostaglandins (PGF2α)
                                                                      – 100-250 mcg/kg SQ Q24hr x 5-7 treatments
                                                                      – 20 mcg/kg IM TID

                                                                      – Myometrial contractions, cervical relaxation allowing
                                                                        evacuation of the uterus within 24-96 hours
                  suture                 Lobulated horns              – Side effects: restlessness, hypersalivation, panting,
                                                                        defecation, tachycardia, abdominal cramping
                                                                          » Observed within the first hour of treatment

                                                                   • Parenteral antibiotics x 10-20 days
                                                                   • Breed next estrus




   Uterine Stump Pyometra                                           Problems of Gestation
• Requires ovarian remnant (progesterone)
  – Incomplete removal of uterine body/horns
                                                            • Pregnancy loss
• History
                                                               –   Fetal resorption
  – Estrous behavior after spay
                                                               –   Abortion
• Diagnosis                                                    –   Prolonged gestation
  – Abdominal palpation
  – Radiographs, ultrasound                                    –   Dystocia

• Treatment
  – Resect residual ovarian and uterine tissue




            Pregnancy Loss                                                Pregnancy Loss
• Any stage of gestation                                    • During the first month
                                                               – Resorption occurs
  –   Embryonic death/resorption
  –   Abortion dead or live pups                            • Second half of pregnancy
  –   Stillborn pups                                           – Abortion or stillbirth
  –   Fetal death/mummification
                                                            • Late gestation
                                                               – Fetal maceration, emphysematus, mummification
  – Depends on
       • Cause                                              • Periparturition fetal loss
       • Stage of gestation                                    – Stillbirths
       • Maternal and fetal response                                • Incidence 2-7% (increases with dystocia)




                                                                                                                                5
                Fetal Resorption                     Causes of Fetal Resorption
• Positive pregnancy diagnosis
  at 3-4 weeks
                                                 • Anatomic/genetic                   • Infectious
  – Followed by fetal loss in first
                                                    – Zygotes                            –   Viral (herpes, parvovirus)
    half of gestation
                                                    – Uterine environment                –   Brucella canis
                                                 • Congenital/hereditary                 –   E. coli, Strep spp,
  – Fetus resorption                               defects                               –   Mycoplasma ureaplasma
     • Total loss; no whelping                                                        • Systemic illness
                                                 • Metabolic
     • Partial loss; several implantation
       sites with fewer pups                        – Hypothyroidism                  • Drugs
                                                    – Hypoprogesteronism                 – Exogenous glucocorticoids
                                                    – Ovarian failure
  – Difficult to confirm
     • Most bitches that experience
                                                 • Nutritional
       resorption were never pregnant
     • Reported incidence 10-13%




                Fetal Resorption                                 Fetal Resorption
   • Signs                                          • Management
     – May be none or mild signs                        – Pre-breeding
          • Anorexia, listlessness
                                                           • Vaginal cytology and culture
          • Fever
          • Fetid vaginal discharge                        • Vaccines
                                                           • Thyroid supplementation if hypothyroid
   • Diagnosis                                          – Adequate nutrition
     –   Physical examination
     –   CBC, chemistry, urinalysis                     – Weekly progesterone assay
     –   Radiographs, ultrasound                           • Hypoprogesteronism
     –   Vaginal culture                                      – Progesterone (in oil)
     –   Serial progesterone assays (diestrus)                – Synthetic progestins
     –   Serology                                                 » 17α-ethyl nortestosterone
          • Brucellosis, canine herpes virus                      » Allyl-trenbolone




                        Abortions                                Infectious Causes
                                                   • Brucella canis
   • Premature expulsion fetus
                                                      – Serological incidence 1-10% in all dogs in
     – Living or dead                                   USA
   • Causes                                           – Third trimester abortions (days 45-59)
     –   Uterine disease                                 • Abortion storms
                                                             – 80% of all susceptible dogs within a kennel
     –   Infections
     –   Drugs                                        – Transmission
                                                         • Oral, nasal, conjunctival, vaginal,
     –   Toxins                                            transplacental
                                                             – Mating with an infected dog/bitch
                                                         • Infected aborted fluids
                                                         • Milk of an infected bitch




                                                                                                                          6
          Canine Brucellosis                                                    Brucella canis
                         Target:
                       Reproductive
                         Tissues
                                                             • Clinical signs
                                                               – History of failure to conceive
                                                                  • High incidence of embryonic loss
                                                               – Abortions
          Male         Male / Female         Female
                                                                  • Without premonitory signs
                                                               – Systemic illness
                                                                  •   Generalized lymphadenitis
        Testes         Intervertebral                             •   Splenomegaly
                                          Gravid Uterus
       Prostate             discs
                                              Fetus               •   Recurrent uveitis
      Epididymus            Uvea
                                                                  •   Discospondylitis
                                                                  •   Arthritis/polyarthritis
         Poor          Discopondylitis      Infertility
     semen quality         uveitis       Fetal resorption
                                             abortion




                 Brucella canis                                                 Brucella canis
• Diagnosis                                                     • Zoonoses
  – Serology
     • RSAT, TAT, ELISA, AGID
                                                                • Eradication of infected animals
     • Negative
          – Highly reliable in females                                – Isolate and test any newly purchased
     • Positive                                                         dogs
          – Rapid slide agglutination test                              • One month isolation
             » Cross-reactive with Bordetella sp,                       • Serology test twice
               Pseudomonas sp
             » Use mercaptoethanol tube agglutination test            – Infected dogs should be destroyed
               or culture to confirm a positive result                – Antibiotic therapy poor response




                                                                          CDV, CHV, and canine
          Infectious Causes
                                                                               adenovirus
• Miscellaneous bacteria                                      • All implicated in abortions
  – E. coli, Streptococcus spp,
  – Purulent vaginal discharge                                   – Isolated from aborted fetuses and
  – Systemic illness                                               placentas
• Viral                                                       • CDV and CHV
  – Canine distemper (CDV)                                       – Cross placenta and infect fetus
  – Canine adenovirus (infectious hepatitis)
  – Canine herpesvirus (CHV)                                  • Pregnant bitches
     • Early pregnancy---fetal death/mummification               – DO NOT use modified live vaccines
     • Mid-pregnancy---premature birth
     • Infected during passage through vagina---death




                                                                                                               7
                       Drugs                                       Prolonged Gestation
• Estrogens                                                  • Gestation
  – Requires large doses                                       – >70 days from first breeding
  – DO NOT use during pregnancy                                – >60 days from day 1 of diestrus
• Corticosteroids                                            • Causes
  – AVOID during pregnancy
     • Dexamethasone 5mg Q12hr x 10 days results in fetal
                                                               – Fetal factors
       death                                                      • Small litter size with failure of fetus to
     • Hydrocortisone                                               initiate labor
        – Teratogenic effects                                     • Oversized fetus
                                                                      – Genetics
• Prostaglandin F2α                                                   – Prolonged gestation
  – Abortive in repeated doses for several days                   • Malpresentation




       Prolonged Gestation                                         Prolonged Gestation
   – Fetal factors (cont.)                                  • Maternal factors
      • Mummified fetuses                                     – Excessive nervousness
                                                              – Uterine inertia
                                                                 • Primary (overweight, sluggish dogs)
                                                                 • Secondary (myometrial exhaustion, hypocalcemia,
                                                                   hypoglycemia)
                                                              – Anatomic
                                                                 • Uterine torsion, pelvic stenosis, vaginal mass
                                                              – Metabolic
                                                                 • Hypoglycemia, hypokalemia
                                                              – Iatrogenic
                                                                 • Progestin therapy in late gestation




       Prolonged Gestation                                         Prolonged Gestation
 • Diagnosis                                                 • Treatment
   – History                                                   – C-section
      • Estrous cycle
                                                               – Induce parturition
      • Check ovulation and breeding dates
                                                                  • PGF2α
   – Physical signs late gestation
      • Mammary gland development                            • Prevention
      • Presence of milk                                       – Regular exercise
   – Imaging determine fetal age and                           – Accurate records
     viability
                                                               – Monitor for signs of whelping
      • Radiographs
      • Ultrasound




                                                                                                                     8
                         Dystocia                                                 Dystocia
• Difficult birth or problem with
  parturition                                           • Causes
• Signs                                                     – Increased risk
   – Stage I labor >24 hours                                     • Older bitches
      • Without progression to stage II
                                                                 • Breeds (Bulldog, Dachshund, Chihuahua)
   – Greenish discharge from vulva
      • No pup within 30 minutes
                                                            – Primary uterine inertia
   – Strong abdominal contractions                               •   Lack of uterine contractions
      • No pup delivered within 30-60                            •   Overdistension
        minutes                                                  •   Hypocalcemia
   – More than 4 hours since birth of                            •   Overweight or insufficient exercise
     last pup
                                                            – Secondary uterine inertia
   – Labor with an abnormal degree of
     pain or depression                                          • Exhaustion
                                                                 • Obstruction
                                                                 • Nervous bitch




                         Dystocia                                                 Dystocia
                                                        • Physical examination
   • Management
                                                            – Be clean, quick, but thorough
       – Differentiate between contributing
         causes                                         •   Vital signs
       – History                                        •   Abdominal palpation fetus and uterus
          • Estrous cycle, breeding dated, calculated   •   Mammary chain
            due date
          • Gestation
                                                        •   Digital vulvar and vaginal exam
          • Previous gestational/parturition history
          • Treatments
       – Presenting clinical signs




                         Dystocia                                                 Dystocia
                                                        • Criteria for diagnosis
                                                            – Prolonged gestation
                                                                 • >60 days of diestrus
                                                            – Parturition failure
                                                                 • 36-48 hours after temperature falls in late pregnancy
                                                            – Pelvic obstruction
• Radiographs                                               – Strong contractions
                                                                 • >1 hour without the birth of a puppy
• Ultrasound
                                                            –   Weak or infrequent contractions
   – Heat beats <150-160 bpm = fetal distress               –   Puppy malposition
   – Normal heart rate = 170-230 bpm                        –   Fetal death
• Bloodwork if indicated and depend on timing               –   Large pup




                                                                                                                           9
              Dystocia
                                                                              Manipulations
        Management Strategies
  • Manipulative
     – Manual extraction of fetus
        • Lubrication
        • DO NOT use undue force
        • Concurrent abdominal and rectal palpation




                                                                             Dystocia
            Instrument delivery
                                                                       Management Strategies
                                                                  • Manipulative
                                                                    – Induction of labor
                                                                      • Oxytocin 10 IU/L 5% dextrose IV over 30
                                                                        minutes
                                                                      • Monitor for uterine tetany




              Dystocia                                                       Dystocia
        Management Strategies                                          Management Strategies
• Medical treatment                                              • Medical treatment
  – Uterine inertia                                                – Calcium borogluconate
     • Stimulate rhythmic uterine contractions
                                                                     • 10% Ca gluconate 2-10mL IV slow infusion
     • RULE OUT obstruction, malposition
                                                                        – Given in 5% dextrose/water
  – Oxytocin
                                                                     • Monitor with continuous ECG
     • Endogenous release---feathering vagina
                                                                        – Stop if cardiac arrhythmias noted
     • Exogenous---2-20 IU IM or SQ (alt 2 IU/kg up to 20 IU
        –   Results within 20 minutes                                • Safer alternative 10% Ca gluconate
        –   Repeat in 30-45 minutes                                     – 1-5 mL/dog SQ
        –   Third dose given with 5-10mL IV dextrose (slow)
                                                                   – Calcium can be give before or after
        –   No response after 3rd dose----proceed to C-section
                                                                     oxytocin




                                                                                                                  10
           Dystocia
                                                C-section delivery
        Cesarean section
• Recommended
 – Prolonged gestation
   • Oversized fetus
   • Pelvic obstruction
 – History of dystocia
 – Fetal death/putrefaction
 – No response
   • Oxytocin (3 injections)
   • Calcium gluconate
 – Previous caesarean section




      C-section delivery


                                                     Questions ???




                                                   Complications
                                                 Postpartum Period

                                • Postpartum hysteria                  • Agalactia/hypogalactia
  Reproductive Problems:        • Postpartum hemorrhage                • Galactorrhea
  Postpartum and Anestrus       • SIPS                                 • Postpartum Mastitis
                                  – Subinvolution of placental sites      – Septic
                                • Postpartum Endometritis              • Mastitis/galactostasis
                                  – Acute metritis                        – Nonseptic
                                • Postpartum hypocalcemia              • Mammary gland tumors




                                                                                                  11
       Postpartum Hysteria                                            Postpartum Hysteria
• More common in primiparous animals                          • Treatment
  –   Poor mothering ability                                    –   Sedation/tranquilization
  –   Rejection of pups                                         –   Remove pups between feedings
  –   Biting or mutilation                                      –   Foster pups to another female
  –   Killing of pups                                           –   Treat mammary problems
• Rule out                                                      –   Supplemental feeding
  – Retained pups or placenta
  – Painful mammary glands




  Postpartum Hemorrhage                                       Subinvolution of Placental Sites
                                                             • Post whelping
                                                               – Delay in placental degeneration and
• Moderate to profuse bleeding from birth
                                                                 endometrial reconstruction
  canal
                                                                    • Failure of implantation sites to resorb
• Causes
                                                                    • Bleeding from placental sites
  – Vessel rupture
  – Laceration                                               • Clinical signs
  – Following C-section                                        – Serosanguineous vulvar discharge
• Management                                                        • Persisting from 3-12 weeks post-parturition
  – Oxytocin 5-10 IU, repeat 2-4 hr, x 3                            • Normal lochia discharge persists ~3 weeks
    treatments
  – Exploratory laparotomy                                     – More common in younger bitches
      • Suspect uterine rupture                                – No fever or malaise




   Subinvolution of Placental                                    Subinvolution of Placental
             Sites                                                         Sites
• Diagnosis                                                   • Diagnosis
  – Persistent Serosanguineous vulvar discharge                 – Vaginal cytology
  – Bitch otherwise normal                                           • RBCs, WBCs, parabasal cells
  – Abdominal palpation                                              • No bacteria
      • Enlarged noninvoluted implantation sites in uterus
                                                                – Vaginoscopy
                                                                     • Dark, clotted blood in anterior vagina




                                                                                                                    12
  Subinvolution of Placental Sites                     Subinvolution of Placental Sites
                                                       • Differential diagnosis
                                                         – Metritis, vaginitis, cystitis
                                                         – Trauma, coagulopathy
                                                         – Neoplasia
                                                       • Treatment
                                                         – Spontaneous remission in 5-6 weeks
                                                         – Prophylactic antibiotics
                                                         – Progesterone therapy
                             SIP                            • Rule out infection
                                            Ruptured
                                                         – Oxytocics
                                                         – Ovariohysterectomy
                                                       • Prognosis for future reproduction is good




            Postpartum Metritis                                     Postpartum Metritis

• Acute and severe bacterial infection of               • Clinical signs
                                                           – Systemic illness
  uterus
                                                              •   Fever, toxemia
  – Uterine contamination                                     •   Depression, anorexia
    • During immediate post-partum period                     •   Vaginal discharge (bloody to purulent)
                                                              •   Decreased or no milk
  – Predisposing factors
                                                              •   Bitch has no interest in pups
    •   Dystocia
                                                           – CBC: leukocytosis to leukopenia
    •   Obstetric manipulations
                                                           – Vaginal cytology: neutrophils, debris,
    •   Retained puppy or placenta                           bacteria
    •   SIPS




            Postpartum Metritis                                     Postpartum Metritis
  • Clinical signs                                     • Treatment
    – Radiographs: enlarged uterus                       – Fluid therapy
    – Rule out retained fetus                            – Broad-spectrum antibiotics
                                                         – Open cervix
                                                            • Uterine irrigation
                                                            • Oxytocin 5-10 IU, first 24 hrs post-partum
                                                            • PGF2α 0.25 mg/kg SQ Q24hr x 3-5 days
                                                         – Closed cervix
                                                            • Stabilize and OHE
                                                         – Puppies will need foster care during
                                                           illness




                                                                                                           13
                Hypocalcemia                                                        Hypocalcemia
 • Decreased circulating calcium                                       • Diagnosis
   concentration                                                         – Calcium <7 mg/dL (normal, 9-12)
    – Acute life-threatening disease                                     – +/- hypoglycemia
    – Associated                                                       • Clinical signs
       • Improper perinatal nutrition of the bitch
                                                                         – Restlessness, nervousness, whining,
       • Heavy lactation from large litters                                panting
    – Occurrence                                                         – Hypersalivation, facial pruritus
       • Generally 2-6 weeks post-whelping (large
         litter)                                                         – Muscle tremors, stiff gait
       • Usually after 3 weeks of lactation                              – Recumbent, dilated pupils, decreased
       • Rarely late gestation                                             PLR
       • May reoccur during subsequent lactation                         – Seizures and death




                Hypocalcemia                                                       Septic Mastitis
• Treatment                                                            • Inflammation of mammary gland
  – 10% calcium gluconate
     • Immediate, 5-10mL IV slowly (continuous ECG)                      –   Post-partum or pseudopregnant bitch
     • Muscle relaxation should be immediate
     • A total dose of 20mL may be necessary
                                                                         –   Single or multiple glands involved
                                                                         –   Acute, gangrenous, or chronic
     • Follow up
         – Calcium gluconate in saline SQ TID                            –   Staph, Strep (hemolytic), E. coli
         – Calcium lactate, chloride, carbonate orally until weaning
             » 30-100mg/kg/day                                           –   Increased risk
     • Puppies > 3 weeks                                                     • Poor hygiene
         – Remove and bottle feed
     • Provide high quality, balanced, nutrition for bitch                   • Trauma from pups
• Prevention
  – Prophylactic oral calcium salts




                Septic Mastitis                                                    Septic Mastitis
 • Clinical signs                                                      • Treatment
    – Bitch systemically ill                                             – Broad spectrum antibiotics
    – Mammary glands                                                         • Empirical therapy—ampicillin, oxacillin
       • Swollen, warm, discolored, painful, ulcerated                       • Chronic consider erythromycin,
       • Milk is thin, yellow/brown, clots, WBC, RBC                           clindamycin, TMS
    – Puppies ill, crying (lack of milk, toxic milk)                         • Evaluate milk pH
 • Diagnosis                                                                 • Based on culture and sensitivity
    – Bacteria and/or leukocytes in milk                                 – Cold/hot packs
       • Milk cytology and culture                                       – Strip infected gland(s) 4-6 times per
    – CBC: neutrophilic leukocytosis                                       day
                                                                             • Oxytocin 2-10 IU
                                                                         – Bottle feed pups or foster mother




                                                                                                                         14
     Agalactia/Hypogalactia                          Agalactia/Hypogalactia
 • Failure of milk production or to             • Determine cause
                                                   – Failure of milk production
   lactate
                                                   – Failure of milk let down
   – Congenital defect in mammary gland
                                                • Treatment
 • Failure of milk let down                        – Nervous bitch
                                                      • Tranquilize bitch
   – Blocked teat, mastitis, post-                    • Slow introduction of puppies
     anesthesia                                    – Failure of milk production
   – Psychologically impaired                         • Foster puppies or hand raise
      • Young or anxious bitch                     – Failure of milk let down
                                                      • Oxytocin 5 IU IM (milk flow 1-5 minutes post-
      • Unwilling to allow nursing                      injection)
 • Pups are malnourished




         Non-septic Mastitis
                                                                Galactorrhea
           Galactostasis
                                                • Excessive or inappropriate milk production and
• Milk stasis                                     release
  – Swollen, enlarged, painful mammary gland       – Depends on abrupt decrease in progesterone
                                                      • Luteal regression in diestrual bitch
  – May follow acute weaning of puppies               • OHE (diestrus)
                                                      • Cessation of progesterone treatment
  – Bitch is not ill                            • Treatment
                                                   – Resolves in several days without treatment
• Treatment                                        – Natural manifestation due to acute progesterone
                                                     removal
  – Decrease food intake for 24 hours                 • Resolve in 2-3 weeks
  – Furosemide 1mg/kg BID                          – Block prolactin release and stop lactation
                                                      • Reoccurrence with withdrawal of therapy
                                                      • Megestrol acetate (Ovaban®)
                                                      • Mibolerone (Cheque®)




     Inappropriate lactation                       Mammary Gland Tumors
                                               • Most common cancer in female dogs
                                                 – Older and intact dogs higher incidence
                                                    • Average age 10 years
                                                    • Spay <2.5 years decreases incidence to 12%
                                                    • OHE prior to 1st estrus decreased incidence to 0%
                                                 – 25-50% multiple gland involvement
                                                 – Caudal glands most commonly affected
                                                 – Tumors
                                                    • Benign: Fibromas or adenomas
                                                    • Malignant: Carcinoma, adenocarcinoma, sarcomas
                                                        – Highly metastatic to regional LN




                                                                                                          15
                Mammary tumors                                                Mammary Gland Tumors

                                                                       • Clinical signs
                                                                         – Mammary glands enlarged, swollen
                                                                         – Ulceration, painful
                                                                       • Treatment
                                                                         – Radical mastectomy (+/- regional LN
                                                                           removal)
                                                                         – OHE after 2.5 years, no bearing on
                                                                           progression
                                                                         – Prognosis if malignant guarded




             Subfertility
                                                                                    Canine Vaginitis
       Abnormalities of Anestrus
 • Canine Vaginitis                                                   • Causes
       – Common cause of infertility in the                             – Altered vaginal defense mechanisms
         bitch                                                            •   Vaginal anatomic anomalies
       – Types                                                            •   Clitoral hypertrophy
                                                                          •   Foreign bodies
          •   Prepuberal bitch
                                                                          •   Vaginal tumors
          •   During proestrus, estrus
                                                                          •   Urine pooling
          •   During anestrus
                                                                        – Secondary
          •   Old or spayed bitches
                                                                          • Metritis, endometritis
                                                                          • Ascending urinary tract infection




                 Canine Vaginitis                                                   Canine Vaginitis
• Clinical signs                                                       • Bacteria of the genital tract
   –   Chronic vaginal discharge
   –   Persistent licking of vulva                                       – Normal vaginal flora
   –   Scooting of perineum on the floor                                      • Originate from bowel or skin
   –   Male dogs may show interest
                                                                              • Mixed cultures (2-5 species)
• Diagnosis
                                                                                 – Proestrus, estrus, diestrus, pregnancy
   – Vaginoscopy
        • Vaginal mucosa hyperemic and congested                                     » E. coli and P. multocida
        • Erosions, vesicles, and ulceration                                     – Proestrus, estrus, pregnancy, post-partum
   – Vaginal cytology                                                                » Hemolytic strep
        • Parabasal cells, small intermediate cells                              – Post-partum
        • Large number of neutrophils and lymphocytes                                » Staph intermedius
   – Vaginal culture
        • Heavy growth of pathogenic bacteria and/or Mycoplasma spp




                                                                                                                               16
                                                                     Subfertility
          Canine Vaginitis
                                                               Abnormalities of Anestrus
 • Treatment                                             • Hypothyroidism
   – Correct predisposing factors                          – Prevalence 0.2%
     • Prepuberal vaginitis resolves with first            – Familial disorder
       estrus
                                                           – History
   – Infection confirmed
                                                                • Prolonged anestrus, irregular cycles, short
     • Vaginal flushing with antibiotic infusion                  cycles
     • Systemic antibiotics 14-21 days                          • Prolonged or abnormal proestral bleeding
   – Increase vaginal resistance                                • Poor conception rates, mummified fetuses
     • Low level estrogen therapy (DES)                         • Infertility
     • Estrone Sulphate – Premarin




          Hypothyroidism                                            Population Control
 • Diagnosis                                             • Mismated bitch
   – Resting total T4, free T4, and TSH                  • Prevention of ovarian cycle
     • Low total and free T4, high TSH                     –   OHE
 • Treatment                                               –   Estrus Suppression
   – Levothyroxine 0.01-0.02 mg/kg BID                     –   Vaginal devices
   – Periodic monitoring                                   –   Immunization
                                                                • Antibody against zona pellucida
   – Overdose
                                                           – Pregnancy termination
     • Hyperactivity, panting, and tachycardia
                                                                • Prostaglandins
                                                                • Bromocryptine




           Mismated bitch                                              Mismated bitch
• Diagnosis                                               • Treatment
  – Accurate history                                           – OHE
    • Stage of cycle, evidence of mating                       – Prostaglandins
  – Vaginal smear                                                • Bitch proven 30 days pregnant
                                                                    – U/S or Reprocheck
    • Proestrus, diestrus, anestrus (unlikely fertile)
    • Presence of spermatozoa or sperm heads
                                                                 • PGF2α
       – 24-36 hrs post-mating
                                                                 • PGF2α and bromocryptine
                                                                 • Cloprostenol




                                                                                                                17
        Estrus Suppression                                   Megestrol acetate (Ovaban®)
• Prevents estrus and false pregnancy                        • Anestrus or first 3 days of proestrus
                                                             • Disadvantages
• Steroid hormones
                                                               –   Incorrect timing results in therapeutic failure
  – Megestrol acetate (Ovaban®)                                –   Do not use in pubertal or pregnant bitches
     • Progestin
                                                               –   Risk of pyometra or uterine tract infection
  – Mibolerone (Cheque®)                                       –   Do not use for 2 consecutive cycles
     • Androgen                                                –   Side effects
                                                                    • Insulin resistance, DM (do not use if bitch
                                                                      diabetic)
                                                                    • Lethargy, polyphagia, weight gain
                                                                    • Mammary gland enlargement, lactation




      Mibolerone (Cheque®)
• Anestrus
  – Begin >30 days prior to onset of proestrus
  – Does not arrest proestrus or estrus
• Disadvantages                                                             Questions???
  – Daily administration
  – Do not use in prepubertal bitches
  – No recommended in dogs with liver or kidney
    disease
  – Side effects
     • Clitoral hypertrophy, mating behavior, voice change
     • Masculinization of female fetuses
  – Post treatment
     • Ovarian cycles resume 1-7 months




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Description: Canine Reproduction lecture and Lochia