oversized fetuses posterior presentation breech presentation lateral or

胎因性難產 • • oversized fetuses posterior presentation breech presentation lateral or downward deviation of the head backward flexion of front legs transverse or bi-cornual presentation 2 fetuses presenting simultaneously

• • oversized fetuses posterior presentation breech presentation lateral or downward deviation of the head backward flexion of front legs transverse or bi-cornual presentation 2 fetuses presenting simultaneously

Obstetrician’s check list How many offspring already born? Approximate time of births and living state of any fetuses delivered Passage of placenta? Visual inspection of the vulva Visual inspection of mammary glands Note any fetal movement The degree of the abdominal distension The presence of milk in the mammary glands

Obstetrician’s check list Gynecological exam: digital vaginal examination Check for presence of an amniotic vesicle or fetus Check presentation of fetus Assess tone and dimensions of the anterior vagina Determine the presence and nature of vaginal fluids Assess dimensions of the bony pelvis

Obstetrician’s check list Diagnosis of the cause of dystocia and treatment Evaluate case history, health, and the results of vaginal and abdominal examinations What is the cause of the dystocia? The basic plan of treatment will be to deliver any presenting fetuses and encourage the uterus to present the remaining puppies at the pelvic Is the litter at immediate risk? Is C-section necessary?

Obstetrician’s check list Treatment options for dystocia case 1. Conservative treatment 2. Assisted delivery of a presenting fetus 3. Ecbolic administration – followed by vaginal exam 4. Monitor the delivery of further offspring – assisted manual delivery as required 5. Assisting the efficiency of straining 6. Forceps delivery 7. C-section 8. Confirm delivery of the whole litter

Obstetrician’s check list Is parturition complete? Maternal behavior – unreliable indicator Vaginal examination Abdominal palpation Abdominal Radiography/ultrasonography

Clinical case • • • Female Golden Retriever 1 -year-old 38. 7 ºC Mating on 4. Oct. and 5. Oct Ask for a obstetric examination on 10. Dec.

All the puppies were delivered on 10. Dec.

Clinical case • • • Female mixed 3 -year-old 37. 4 ºC Mated 64 days ago One puppy was born last night Depression, anorexia, green discharge was seen around vulva

Obstetrician’s check list Gynecological exam: examination of the abdomen Assess fetal hearts is audible Systemic manual palpation of the abdomen Ultrasonographic examination of patient’s abdomen to confirm presence, viability, or evidence of fetal death Radiographic exam of abdomen: possible number or any further fetus, gross maldisposition

Clinical case • • • Taiwan native 2. 5 -year-old 38. 8 ºC Mated 62 days ago Depression, anorexia, no discharge was seen around vulva • Ultrasound: one dead fetus and another puppy with 104 heart beats/ min

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