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Newsletter 5, March 2018 – True elective caesarean section for high risk breeds (preparturient caesarean section)

Dear dog breeding enthusiasts

More information about breeding matters can be obtained from our website and my book “Breeding is a bitch”. For further details go to http://www.rantendal.co.za

Semen can now be frozen on demand at our premises with as little as 1 weeks’ notice. Contact Gigi at reports@rantendal.co.za to make a booking. 

We can now perform radiographs at reduced cost for pregnant bitches in the last week of their pregnancy. Litter size can be 100 % accurately predicted in cats and small breeds and 90% accurate in medium and large bitches with 100% prediction of whether the litter is small or large in these bitches.

True elective caesarean section for high risk breeds (preparturient caesarean section)

This newsletter follows a previous newsletter on the need for caesarean section. First and foremost, I have to stress again that to a large extent, the need for caesarean section (CS) is a man-made problem. Also, we as veterinarians are complicit in the problem. We as veterinarians however, are confronted on a daily basis with this problem and need to deal with it. This problem will prevail for as long as we have high risk breeds and high risk pregnancies. High-risk breeds are considered those in most brachycephalic (short faced) breeds. High-risk pregnancies are considered those occurring in those with a history of dystocia, those with known large litters, those with singletons, those with small litters (in large breeds) and those with a history of prior CS. Most breeders and their veterinarians are then left with the dilemma of managing this pregnancy. In most of these cases it is then decided to perform an elective CS. The word elective CS implies only that a CS was chosen as the preferred method of delivery of the litter in a given bitch. In women, planning an elective CS is easy as ”staging of the gestation” (how far advanced the pregnancy is) has been well established and is accurate and safe. To date this was not true for the bitch. The way most breeders and veterinarians planned these elective CS was that they would wait until the bitch would show signs of labour. This would include checking for discharges from the vulva and straining. Many have learnt that signs such as nesting, panting and a drop in rectal temperature is however not reliable enough to base a decision to perform a CS. Indeed, most veterinarians would be very reluctant to base a decision to perform a CS on such unreliable symptoms. This is because of the very real risk of delivering premature puppies when doing so. So everyone just waits until they see legitimate signs of labour. Veterinarians with knowledge of determining whether the cervix has dilated have an advantage as this is also a legitimate indicator that labour is imminent. This examination can only be performed using appropriate equipment and experience, and cannot be done by sticking fingers into the vagina! So then what classically happens is the veterinarian waits until the breeder notices signs of labour. This practice is associated with the following problems.

·       The owner may not be available to perform round the clock observation of the bitch

·       By the time that the bitch shows signs of labour there is already foetal compromise and a number of puppies if not all are already found dead

·       The breeder cannot reach their regular veterinarian as their practice may not be available after hours and battles to get after hour help

·       Most after hours clinics do not have a team that is experienced in safely performing a CS. Remember that a team is required to perform a CS

The nett result is that these so called planned elective CS may still result in less than desirable outcome.

It is for this reason that I embarked on a research project to mitigate this problem. Following a 10 year planning and 7 year formal study that resulted in numerous publications and a completed PhD, we have now developed a protocol which safely, accurately and precisely enables us to perform a preparturient CS. The word preparturient means before the onset of labour. To achieve this, we had to establish a method that would accurately predict the date of onset of labour and we had to establish whether it is safe to perform a CS on such date. This work is now completed. For the past 3 years we have performed in excess of 500 CS on such predicted date. The method works as follows. We monitor the cycle of the bitch whilst in heat. We determine the day of cytological dioestrus by taking vaginal smears until the end of the cycle. This can be performed for bitches on which artificial insemination is performed but also for those that are mated naturally. The only condition is that daily (not alternate day) smear are collected correctly. The CS is then planned for the morning 57 days after onset of cytological dioestrus. The bitch owner thus knows 57 days in advance of the day that the CS is likely to be performed. The bitch is then presented 3 days before this due date and monitored for cervical dilatation every 6 hours around the clock. If the bitch does not show cervical dilatation before the morning of day 57 the Cs is then performed. This is termed a fixed day and fixed time planned preparturient CS. Around 72% of bitches will indeed undergo a CS at the designated time and the remaining 28% will undergo a CS in the preceding 48 hours. This method ensures the delivery of mature puppies that have similar chance of survival to those that are delivered by natural labour.

By performing these preparturient CS the following problems are totally avoided.

·       We do not have to guess when the litter is due as we have accurate indicators

·       The owner can plan the delivery of this litter

·       There is no problem with finding a veterinarian as the bitch is already in our care

·       Bitches that go into premature labour (48 hours before the due date) can be identified

·       Pregnancies that go over term, especially those of single pup litters can be identified and avoided

·       Caesarean sections can be performed by competent veterinarians with full staff compliment available to assist

·       Delivery of dead and compromised puppies of bitches that have been in complicated labour (dystocia) are avoided

Mating dates and progesterone levels cannot be used to replace the first day of cytological dioestrus in determining the due date. Smear taken by veterinarians not experienced in determining the day of delivery can also not be trusted. Thus far only a few reproductive specialists have embarked on the path of performing preparturient CS. More are likely to follow as this becomes better known.

Performing preparturient fixed time fixed day caesarean sections has transformed our lives as veterinarians, tasked with managing labour in bitches at the Rant en Dal animal hospital. Caesarean sections are now performed routinely in this fashion.

The purpose of this newsletter is to strongly encourage all breeders of bitches in which a CS is very likely, to present such bitches for vaginal smears during their heat cycle so that accurate prediction of due date can be made and that such date can be used to plan the date and time of delivery avoiding all menaces previously mentioned. It also helpful in managing single pup litters if they result from either natural mating or AI (artificial insemination).