1. Obstetric and Neonatal
Emergencies
Veterinary Nursing

2. Identifying Canine Pregnancy
Day 21 – a Vet
can diagnose
pregnancy
through a blood
test or
ultrasound
Day 30 –
diagnose
pregnancy
through
abdominal
palpitation
Day 35 – Weight
gain
Day 40 –
abdomen will
swell
End of
Gestation
Period of 9
weeks
• Vulval
discharge
• Semi-clear
fluid from
teats

3. Identifying Feline Pregnancy
• Cats nipples
become enlarged
and red
Day 35 –
Abdomen will
swell
Day 15 –
diagnose
pregnancy by
ultrasound
• Some cats become
more affectionate
but subdued

4. Preparing for Parturition: What Do I Need?
Temp: 25-30 degrees C
Dam can escape
if box gets too
hot

5. 5 stages of Parturition
1. Preparation
2. First Stage
3. Second Stage
4. Third Stage
5. Puerperium

6. Preparation
• Impending parturition
• Shredding and ripping bedding
• Restlessness
• Anorexia
• Nest making
• Mucous discharge from enlarged vulva
• Fall in rectal temperature – caused by a decline in plasma progesterone
concentration. Temp falls 1°C in large breeds, 3°C in small breeds. This
indicates prepartum hypothermia so parturition can be expected to follow 24-
36 hours later

7. First Stage
• Uterine contractions
• Cervix dilates because the head of the foetus is pushed against the
cervix
• Restlessness
• Panting
• Frantic nesting habits
• Milk likely to be present in the mammary glands

8. Second Stage
• On set straining and birth
• Increase in uterine contractions  abdominal contractions 
propulsion of foetus through cervix into vagina
• Important to make a time of the first contraction in case there is any
delay in whelping
• Following birth, the dam will break the amniotic sac over the head
and lick the foetus to stimulate respiration

9. Third Stage
• Passage of the placenta – the placenta is usually delivered during the
second stage but occasionally one or more young may be delivered
without their placenta
• Following whelping, there is usually a dark vulval discharge but it
should decline after about a week

10. Puerperium
• The period after parturition
• The reproductive tract returns to its normal non-pregnant state
• Uterus starts its involution (contracts to its normal size)
• Common to see mucoid vulval discharge which can last up to 6 weeks

11. Obstetrical Emergencies
• Pyometra
• Paraphimosis
• Eclampsia
• Retained Placenta
• Dystocia

12. Pyometra
This is an infection of the uterus most common in older entire female dogs. It occurs secondary
to hormonally induced changes, usually 5-6 weeks after a season.
Clinical Signs:
• Vomiting
• Polydipsia  polyuria
• Weakness
• Lethargy
• Abdominal pain
• Decreased appetite
• Purulent vaginal discharge (if open Pyometra)
EMERGENCY!!!
Diagnosis is usually made through an
ultrasound and possibly radiography. The most
common and effective treatment is to remove
the infected uterus surgically.

13. Paraphimosis
This is the inability to retract the penis into the prepuce. It occurs most commonly in entire male
small breed dogs following an episode of sexual excitement.
Clinical Signs:
• Engorged penis is dry, necrotic
• Dysuria
• Excessive licking
The owner can wrap a bag of frozen peas (for example) in a tea towel in an attempt to replace the
prepuce but if after 20 minutes the penis has not retracted, veterinary attention is needed. It will
usually include manually replacing the prepuce through pain relief and plenty of lubrication! If more
severe swelling is present, hyperosmolar solution can be topically applied or surgery as a last resort.

14. Eclampsia
Eclampsia can occur secondary to pregnancy or more commonly lactation – it is
most often seen in small dogs within two weeks of parturition.
It occurs when the dog becomes hypocalcaemic (low calcium levels in the blood).
Treatment is to intravenously administer calcium gluconate slowly. The dog
should be attached to an ECG machine so heart rate can be monitored
throughout.
Clinical Signs:
• Restlessness
• Muscle tremors
• Tachycardia
• Panting and Hypersalivating
• Hyperthermia

15. Retained Placenta
This is uncommon in both the bitch and the queen as the placenta is normally
delivered following each puppy or kitten.
Clinical Signs:
• Green discharge from the vulva
• Lethargy
• Pyrexia
Diagnosis is usually made through ultrasound and treatment involves injecting
oxytocin to stimulate contractions so the placenta is delivered. If this fails, then
surgery is the remaining option.

16. Dystocia
Dystocia means difficulty giving birth – a problem encountered during normal parturition. It is
very common in the bitch.
Recognising Dystocia:
• Bitch is more than 70 days, Queen more than 67 days with no signs of imminent parturition
• Unsettled dam straining forcefully for more than 30mins but not producing neonates
• Puppy or kitten stuck in birth canal
• Black or green vulval discharge but no signs of parturition after 2 hours (placenta has
become detached so the foetus is getting no oxygen)
• Parturition not occurred within 48 hours of prepartum hypothermia
• Ineffectual straining for more than 1 hour in 2nd stage parturition
• Rests for more than 2 hours between neonates without straining

17. Factors Contributing to Dystocia
Maternal Factors Foetal Factors
Primary uterine inertia Malpresentation
Secondary uterine inertia Malposition
Brachycephalic breed Malposture
History of dystocia Foetal monsters
Obesity Dead foetus
Abnormal pelvic canal

18. Primary & Secondary Uterine Inertia
• Primary Uterine Inertia:
The failure of the uterus to contract effectively or the failure of uterine contractions that
commence normally but end prior to a neonate being born. This can be due to malnutrition
or hypocalcaemia.
Commonly seen in bitches with large litter where the uterus is over stretched or in bitches
with small litters due to inadequate endocrine stimulus to initiate the onset of parturition
• Secondary Uterine Inertia:
When contractions stop after the normal delivery of one or more foetuses. Commonly due
to hypocalcaemia or fatigue.

19. Abnormal Pelvic Canal & Foetal Monster
• Abnormal Pelvic Canal
Disorders of the birth canal. This can include pelvic abnormalities such as narrowing from a
healed fracture of congenital disorders. Bitches with unusually small vulvar openings may
require a partial episiotomy to deliver the puppies vaginally.
• Foetal Monsters
These foetuses are oversized so can cause obstructive dystocia because their head is too
large for the maternal pelvis to deliver naturally. It is usually seen in brachycephalic breeds
such as French Bulldogs and Pugs. This problem is also a result of dead foetuses because
they cannot move down the birth canal.

20. Treatment
Whilst at the practice, the bitch/queen should be kept warm, comfortable
and quiet.
Manual Assisted Delivery  Removal of obstruction, manipulation,
traction
Medical Treatment  Oxytocin
Surgical Treatment  Caesarean Section

21. Caesarean Section
Equipment Needed:
• Gloves
• Towels
• Oxygen and mask
• Haemostats
• Suction bulb/damp cotton
wool
• Emergency drugs
• Clean, warm environment
Neonate Resuscitation
The GA and therefore lack of natural stimulation (uterine
contractions), the neonates are not passing down the birth
canal so we need to resuscitate the neonates once they are
delivered.
1. Use the suction bulb/damp cotton wool to clean foetal
membranes from the mouth – at this point, check for cleft
palate
2. Clamp and cut the umbilical cord 3cm from the puppies
abdomen
3. Stimulate and dry the neonate by rubbing with a warm
towel – check the puppy is breathing and has a heart
beat. Oxygen should be provided if not and rubbing
vigorously should be continued
4. Put in the clean, safe environment

22. Care of the New Born
• Provide a whelping/kittening box in a warm, quiet, draught-free area. Big enough for whole
litter and dam. Sides high enough so puppies cant escape but low enough so dam can
• Clean, warm, dry bedding
• 25-30°C for the first 5-7 days, usually obtained through a heat lamp. After this time, drop the
temperature to 20-22°C
• Wean from about 3 weeks old with semi-solid food. 4-5 small meals per day by the time they
are 7 weeks old
• Wormed from 2 weeks of age (bitch should be wormed with Panacur from day 4 of gestation
until 2 days after parturition)

23. Paediatric Emergencies
The most common problems are hypoglycaemia (low blood glucose levels) or
hypothermia (low temperature).
Clinical Signs:
• Weakness/collapse
• Persistent crying
• Decreased feeding
• Decreased movement
What Can Nurses Do?
• Monitor body temperature
• Warming techniques
• Measure blood glucose,
supplementing if needed
• Assist with feeding
• Stimulate perineum after
feeding with damp cotton wool
to stimulate defecation

24. Congenital Abnormalities
• Cleft Palate  failure of normal fusion of palatine arches
• Umbilical Hernias  Umbilicus fails to close over and fat and
abdominal contents protrude through under the skin
• Foetal Monsters  too large to enter maternal pelvis
• Hydrocephalus  abnormal dilation of ventricular system due to an
increased volume of spinal fluid