Owner: Abhimannu Manandhar Address: Koteswor

Species: canine Breed: Japanese Spitz Age: 3.5 year Sex: Female

History
 Difficulty in whelping (Distocia).
 Gave birth to one death pup but others were not expelled out since 24 hours.
Clinical signs
 Temperature: 101.7 F
 Pulse rate: 124/min
 Respiratory rate: 33/min.
Upon physical examination on abdominal region and rectal palpation, the fetuses were palpated.
3 ml of Dicrysticine (Streptopenicillin) IM, three doses of Oxytocin IM and 5ml of Mifex (Calcium
borogulconate) IV was given. Then by inserting fingers via cervix to uterus four live fetuses were
taken out one by one. Again by inserting finger into uterus one fetus was palpated but it was very
difficult to taken out although we used whelping forceps we didn’t get success. Then x-ray was
taken which show the bending of head of fetus from its normal position.
Hematological value Value found Biochemical value Value found
RBC(106×5.5-9.5cu.mm) 5.6x106 Ca(mg/100ml)(9.8-11.6) 7.2
Hb (gm/100ml)(12-18) 12.0 P(mg/100ml)(2.2-4.0) 2.9
PCV (%)(37-55) 35 Mg (mg/100)(2.1) 1.9
ESR (mm/hr.)(5-25) 40 Glucose (mg/100ml) (62-108) 110.3
WBC (103 ×cu. mm (6-17 18.2 BUN(mg/100ml)(8.8-26) 23.7
cu mm)
Neutrophils(%)(60-77) 70
Lymphocytes(%)(12-30) 31
Eosinophils(%)(3-10) 8
(Note: values in parentheses indicate reference values) Source; Merck Veterinary Manual, 2000
Diagnosis: By abdominal radiography it was seen that the head was slightly bent from its normal
posture.

Surgical treatment
  General Anesthesia: Xylazine + Ketamine in 1:2 ratio after premedication with atropine
sulphate.
 Positioning: positioned in dorsal recumbency making ventral part up.
 Preparation of site: Shaving the area with sterilized blade and cleaning with Povidone
iodine solution.
 Operation: The fetus along with placenta was taken out by caesarean section.

Surgical Procedure:
 A long incision was given on the midline beginning over the umbilicus and extended
caudally.
 Skin, subcutaneous tissue, linea alba, falciform ligament and peritoneum were incised
properly.
 After exposure of uterine horns, a long incision was made through the body of the uterus
caudal to its bifurcation. The umbilical vessels were clamped.
 The dead fetus was removed along with fetal membrane.
 The uterine incision was cleaned with gauze and Neosporin was installed on the edges of
incision and closed by double row of continuous Lambert sutures using catgut size 2-0.
 Peritoneal cavity was lavaged with sterile normal saline
 Abdominal incision is closed in the usual manner.

Post-operative care
 Ringer’s lactate solution @200-300ml I/V.
 Mifex(Calcium borogulconate) @5ml I/V.
 Megapen (Ampicillin+Cloxacillin) @ 10mg/kg for 5 days.
 Conciplex (Vitamin B-Complex) @1.5ml I/M for 3 days.
 Skin sutures should be removed after complete healing.

Follow up: Normal

Discussion
The blood test revealed the decrease in PCV and increase in ESR value which might be due to
stress condition. Serum test revealed the decrease in blood calcium level that indicates the weak
contraction power of abdominal muscles to expel out the fetus. There was increase in blood glucose
level which might be due to stress that stimulates the release of cortisol that enhances
gluconeogenesis.
Dystocia means difficult delivery. It is the inability of the bitch to expel the fetus through the birth
canal without assistance. It may be due to a number of causes including large fetus size, small
pelvic size in the dam, malposition of the fetus, uterine inertia, or breed. Brachycephalic breeds
such as Bulldogs, Pugs, and Boston Terriers have a higher incidence of dystocia due to the large
head and shoulder size of the puppies. Many breeders of these breeds have the puppies delivered
by a scheduled cesarean section.
Dystocia is diagnosed based on the owner's observations. It is considered likely in the following
scenarios:
1. 30-60 minutes of strong contractions without delivering a puppy.
2. Greater than 4-6 hours between puppies (and more puppies are in the uterus).
3. Failure to start delivery within 24 hours of the temperature dropping below 99ºF.
4. Crying/licking the vulvar area excessively during whelping.
5. Gestation lasting greater than 70 days from the first breeding or greater than 60 days from
the first day of diestrus.
It must be remembered that Stage 1 labor lasts 3-24 hours and strong abdominal contractions are
not seen during this stage.A physical exam including abdominal palpation and a vaginal exam are
necessary. X-rays are done to determine the number of fetuses, their position, and their size
compared to the bitch's pelvic size. If the puppies appear to be able to fit through the birth canal
and are not malpositioned, she may be given time to deliver on her own. Oxytocin may be given
if indicated. She may also need fluid therapy with calcium or glucose in it if eclampsia or
hypoglycemias are present. If the puppies are large, or a great number are present, the decision to
perform a c-section may be made. The decision is based on each individual case.
Case of distocia Abdominal radiograph of dog