Gestational considerations
Brachycephalic breed-related pathological conditions may be further impacted by the physiological effects of pregnancy . For example , BOAS may worsen in the final stages of pregnancy , due to pressure from the enlarged uterus on the diaphragm . Aspiration pneumonia , another symptom of BOAS , is worsened in pregnant bitches , owing to increased gastrin levels , slowed gastric emptying and lessened oesophageal sphincter tone causing regurgitation and vomiting ( Meola , 2013 ). It should also be noted that non-breed related gestational conditions can also occur , such as infections , metabolic diseases , genetic and congenital disorders , hypothyroidism and inadequate nutrition . VNs may voice any concerns to the VS and an appropriate treatment plan developed .
Dystocia
A study by Wydooghe et al . ( 2013 ) identified a c-section rate of 94.8 % in British bulldogs . This is due to their predisposition to dystocia , caused by large foetal heads and a small pelvic canal . By contrast , in nonbrachycephalic breeds , primary uterine inertia is the main cause of dystocia . Due to the common need for surgical intervention in dystocic dogs , pre-parturient elective c-sections of brachycephalic breeds may be considered safer than an emergency procedure . However , this is dependent on optimal timing .
Ideally , surgery should be carried out early enough to reduce the dystocia risk , but late enough to ensure the pups have matured to reduce the risk of neonatal mortality . Specifically , surgical intervention should be considered if there is prolonged gestation , no progression between stages 1 and 2 of labour within 12 – 24 hours , signs of toxaemia , or more than 4 hours between puppies .
De Cramer and Nöthling ( 2019 ) state that elective c-sections can be safely performed with a puppy survival rate of 99 % from day 57 after the onset of cytological dioestrus . However , the calculation of dates may not always be accurate , depending on the timings of matings and other hormonal factors . Therefore , each case should be treated on an individual basis with an agreement between the breeder and the VS .
Preparing theatre
In cases of elective c-sections , the veterinary team will be able to prepare for the procedure in advance . This means setting up the theatre appropriately and having all equipment available for use . Depending on the surgical table used , it can either be tilted or a trough can be used for patient positioning if the table is unable to be moved . The purpose of raising the patient at an angle is to relieve added pressure on the already compromised respiratory system ( Reid et al ., 2021 ). There may be a gap at the bottom of the table for blood and placentas to be collected in a bucket , hooked underneath as part of the table ’ s design . If this is not available , a clinical waste bin specifically used for body parts can be placed near the VS . Incontinence pads and towels can be placed on the floor surrounding the surgical table in case of spillage of bodily fluids to minimise contamination in the theatre ( although c-sections are already considered clean-contaminated ).
A surgical kit of the VS ’ s preference should be autoclaved in advance , along with additional instruments that may be useful , such as surgical clamps , forceps , sterile swabs and laparotomy swabs . Extra suture material should also be prepared in readiness for the procedure . Neonatal resuscitation equipment should include clean towels , a whelping box with a heat source , and suture material for tying off umbilical cords . Some practices dispense omeprazole to be given the night before the procedure . Alternatively , it can be given once the bitch has been admitted to the practice , depending on the premedication , induction and analgesic drugs the VS has opted for ( Panti et al ., 2009 ; Downing and Gibson , 2018 ).
Conclusion
VNs play an important role in the nursing care of bitches undergoing elective and emergency c-sections . Prior to breeding , VNs can educate and assist clients to ensure that , where brachycephalic patients are bred from , the owner / breeder is aware of the associated birthing difficulties . If the bitch displays an extreme brachycephalic conformation that impacts on its health , veterinary professionals should strongly advise against breeding .
Unfortunately , not all brachycephalic patients are seen before getting pregnant , so it may be useful to discuss health considerations when the owner / breeder brings them in for PGT testing . From this stage , the veterinary team can utilise time spent with the patient prior to a c-section . Preparation for c-sections requires good communication between the VN and VS so all equipment is prepared and care is tailored to the individual brachycephalic patient . The next part of this article will explore nursing care of the pregnant brachycephalic patient perioperatively .
Volume 37 ( 5 ) • November 2022
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