A 4 year old mongrel bitch was presented with history of dystocia for nine hours after whelping a live pup. Futile attempts of relieving dystocia were made by administering oxytocin, calcium and glucose. Hence, caesarean section was performed and retrieved two dead pups, one in anterior presentation and other in breech presentation. Etiology of this dystocia was diagnosed as simultaneous entry of two foetuses into the birth canal that struck just before cervix.
Dystocia is the inability of the dam to expel the foetus at parturition through the birth canal without manual assistance. In bitches, dystocia may be due to maternal or foetal causes and its rate of incidence was found to be 24.7% and 75.3% respectively (Darvelid and Forseberg, 1994) with an overall incidence of 5% (Jackson, 1995) and the frequency of caesarean in bitches with dystocia was 64% (Bergstrom, 2009). Bitches of 2 – 4 years age were found to be more affected according to a survey (Darvelid and Forseberg, 1994). Foetal causes of dystocia included foetal malposition, foetal oversize, malformation, monstrosities, foetal death, etc (Jackson, 1995). Of these foetal malpresentations, dystocia due to simultaneous presentation and entrapment of two foetuses in birth canal is very rare and no active records are available pertaining to this etiological factor. In bitches, dystocia can be managed medically using, oxytocin, calcium and fluids and as a last resort caesarean operation is performed (Darvelid and Forseberg, 1994, Romagnoli et al.,2004). In the present communication, we report a rare case of dystocia due to simultaneous presentation of foetuses in to birth canal and its successful surgical management in a mongrel bitch.
History and clinical examination:
A 4 year old mongrel bitch weighing 20 kg was presented with history of dystocia for the previous few hours. It gave birth to a live pup about 9 hours before. The bitch was straining to deliver the next pup without any progress.
|Fig.1: Showing two pups struck in the uterus||Fig.2: Showing retrieval of pup in posterior presentation|
|Fig 3: Showing retrieval of second pup in anterior presentation||Fig 4: Showing sutured uterus|
Clinically, the bitch was dull and dehydrated with occasional weak attempts to whelp. On examination per vaginum, the birth canal was found dry and only limb extremities could be palpated at deep pelvic inlet. Temperature, heart rate and haemoglobin values were 99.50F, 84 beats/ min and 12.5 g/ dl respectively.
Treatment and Discussion
The bitch was immediately rehydrated with 200 ml DNS, 50 ml calcium Sandoz and administered oxytocin 5 IU I/V for artificial induction of parturition. No progressive response could be observed even two hours following this treatment. Hence caesarean operation was performed. Mid ventral area was prepared aseptically. Atropine sulphate @ 0.04 mg/ kg was administered intramuscularly as premedicant and general anaesthesia was achieved by intravenous administration of mixture of Ketamine and Diazepam @ 5 mg/ kg and 0.2 mg/ kg respectively. Laparotomy was performed through a standard mid ventral incision and the uterus was exteriorised and 8 cm incision over uterus before uterine bifurcation was made. Two dead pups found struck in the birth canal (Fig 1) one in anterior (Fig 3) and other in posterior presentation (Fig 2) were retrieved carefully. The uterus was checked for presence of pups if any and was thoroughly irrigated with normal saline. The uterine incision was closed by double inversion suture pattern (Fig 4) with chromic catgut no. 1 (Ethicon, Johnson & Johnson) and the peritoneum and linea alba were sutured with polyglycolic acid (Johnson & Johnson) no. 1 followed by sub cuticular sutures and skin wound was closed with black braded silk no. 1 in cross mattress pattern and protective bandage was applied. Post operatively the animal was administered with DNS (Claris healthcare) 100 ml, Metronidazole (Metris, Claris healthcare) 50 ml, Cefotaxime (Intacef, Intas Pharmaceuticals) @ 50 mg/ kg, Ketoprofen (Ketop, Alembic) @ 1 mg/ kg I/V, B – Complex (Tribivet, Intas Pharmaceuticals) 1 ml I/M for five consecutive days with daily dressing and skin sutures were removed on 10th post operative day.
The dog was a mongrel of about 4 years age supporting the findings of Freak (1962) that dystocia was common in mongrels and Darvelid and Forseberg (1994) who found that dystocia was more in bitches of 2 – 4 years age. In the present case, only three pups were born and etiology of dystocia i.e. simultaneous presentation of two foetuses into the birth canal is a very rare one and can be expected with polytocous animals. This might be the due to uneven, forceful contractions in both uterine horns simultaneously during 2nd stage of labour. Posterior presentation of foetuses during delivery was normal in bitches (Concannon et al., 1983). In this case also a foetus was found in posterior presentation. The two foetuses struck before cervix leading to straining; hence that area was inflammed severely. The birth canal also dried up and entanglement was so tight that, even 5 IU of inj. oxytocin, calcium and fluids could not expel the foetus which otherwise most reliable treatment in bitches to treat uterine inertia (Romagnoli, et al., 2004). Caesarean section was performed to overcome the problem as the 2nd stage of labour lasted for more than 6 hrs, the bitch became dull, dehydrated and medical treatment was also failed (Darvelid and Forseberg, 1994) and was performed as per standard procedure. With good peri and post operative measures, the bitch showed uneventful recovery within 10 post operative days.