Any abnormalities must be reported to the VS so an appropriate plan can be devised . Some conditions may be surgically corrected when a pup is older , but until then the pup will require constant care and intervention [ 18 ] . Due to the high risk of neonatal mortality associated with these conditions , affected pups are often euthanised , once consent has been gained from the breeder .
Recovering the bitch
The period of highest risk in brachycephalic c-sections is during anaesthetic recovery and extubation [ 19 ] . Therefore , it is good practice for VNs to have reintubation equipment prepared nearby while the bitch is recovering . These breeds benefit from the endotracheal tube being kept in longer , as the tube widens the airway and improves oxygenation [ 20 ] . However , if extubation is delayed for too long , there is a higher chance of regurgitation . The brachycephalic patient should be recovered in sternal recumbency with their head slightly raised by resting it on a towel . In cases of regurgitation , the head should be lowered to facilitate drainage of contents . It may also be of benefit to the patient to rinse the tongue and suction the oral cavity , if needed .
As with all surgical patients , temperature should be monitored closely on recovery , as hypothermia can lengthen recovery time . However , active warming techniques should be used only until the brachycephalic patient reaches 36 ° C , to avoid excessive panting [ 21 ] .
Once the patient is stable and recovered from anaesthesia , the newborn pups should be introduced and supervised by the VN . This allows for bonding , feeding and thermoregulation of the pups . If there are no concerns then the bitch and pups can be discharged as soon as possible to allow them to settle at home and continue the natural maternal process .
Discharging the bitch and pups
Anaesthetic and wound aftercare should be discussed with owners / breeders at discharge . Postoperative checks and stitch removals should be booked at the time of discussion . Owners / breeders should be made aware that the first 24 hours following the c-section are high risk , due to the possibility of postpartum haemorrhage and aspiration pneumonia [ 5 ] , and that any concerns must be communicated with the practice straight away and out-of-hours care sought if necessary .
Discussions about the pups may also be useful to ensure good postoperative care . If any pups are struggling or the bitch is not producing enough milk , a puppy formula milk may be recommended . Bitches that are lactating require higher-calorific nutrition , so their feed should be adapted accordingly . Hydration levels should also be monitored , as 78 % of the milk produced by the bitch is made up of water [ 22 ] .
On discharge , veterinary professionals can recommend that breeders advise prospective buyers to attend a pre-purchase consultation , as a recent study showed that 86.1 % of respondents had not had professional advice before buying a brachycephalic dog [ 23 ] . Therefore , pre-purchase consultations would help to educate owners about the care these breeds require .
Conclusions
VNs play an important role in providing perioperative care to the pregnant brachycephalic bitch . They are also the first point of contact for the newborn pups and often the person discharging the bitch and pups postoperatively . It could be argued that practices should not be supporting breeds that are incapable of reproducing without veterinary assistance [ 24 ] . However , this can be difficult if the bitches are already pregnant prior to veterinary intervention .
The author suggests strict monitoring of the number of c-sections for each patient , to help veterinary professionals discourage breeders from mating that bitch again . The Kennel Club strongly recommends that VSs report when a c-section is performed [ 25 ] ; although this approach is not mandatory , it is supported by the BVA , BSAVA and RCVS .
The number of litters produced may also be reduced by offering an ovariohysterectomy ( spay ) at the same time as the c-section . A recent survey showed that 31 % of dams had been spayed at the same time as undergoing a c-section [ 26 ] . As veterinary professionals we have a duty to the animal ' s welfare to encourage this and to actively contribute to reducing the need for surgical intervention for pregnant brachycephalic breeds .
30 Veterinary Nursing Journal