Impact of decision to delivery time of fetal mortality in canine caesarean section in a referral population

Apgar scores in puppies following the induction of etomidate compared with alfaxalone or propofol for cesarean section

Background and Aim

The Apgar score is a useful assessment of neonatal viability in dogs. The Apgar score in puppies born by cesarean section can be lower than vaginal delivery because all anesthetic drugs can cross the placenta. Therefore, anesthetic drugs with minimal cardiorespiratory effect and rapid elimination are recommended for cesarean section. The present study aimed to compare Apgar scores in puppies born after the induction of etomidate, alfaxalone or propofol, and those maintained with isoflurane inhalation during cesarean section.

Materials and Methods

Thirty-six bitches were equally divided in the three anesthetic drug groups. Modified Apgar scores were assessed at 5, 15, and 60 min after delivery. Intraoperative vital signs and Apgar scores were compared using a linear mixed model and adjusted pairwise comparisons using Bonferroni analysis.

Results

A total of 125 puppies were included in this study. Age, body weight, litter size, type of surgery, delivery time, anesthetic and surgical duration, and intraoperative vital signs did not significantly differ between the groups. Puppies in the alfaxalone and propofol groups had significantly higher Apgar scores than the etomidate group in both elective and emergency surgery. In elective surgery, Apgar scores at 5 min after delivery did not differ significantly between groups. At 15 and 60 min after delivery, Apgar scores in the etomidate group were significantly lower than those in the other groups. In emergency surgery, Apgar scores were significantly lower in the etomidate group than in the alfaxalone group at all time points.

Conclusion

Induction with alfaxalone and propofol resulted in better outcomes with higher Apgar scores and neonatal viability than etomidate. Therefore, alfaxalone and propofol should be used as anesthetic induction drugs in both elective and emergency cesarean sections.

Apgar Score for Newborn Dog Viability Assessment: Differences between English and French Bulldogs Born via Cesarean Section

Even if largely used in canine neonatology, some questions about the Apgar Score (AS) arose. Notably, considering the breed-oriented modifications of the score are needed, slight changes of the score were reported for English (EBs) and French bulldogs (FBs). The present study aimed to evaluate the possible differences between neonatal viability of the two breeds assessed by AS in puppies born via cesarean section. The results obtained from 99 puppies born alive and without malformations (EB = 47, FB = 52) showed significant (p < 0.001) differences in the median AS (seven in EB vs. eight in FB), with Grimace (p < 0.05 for sub-score 0 and p < 0.001 for sub-score 2) and Attitude (p < 0.05) being differently sub-scored between the two breeds. In the 89 alive puppies at 7 days of age, the same difference in the median AS was observed (p < 0.001), and only Grimace was differently sub-scored between the two breeds (p < 0.05 for sub-score 0 and p < 0.01 for sub-score 2). These results suggest that low Grimace could be an intrinsic characteristic of EB newborns, but it could negatively affect the neonatal adaptation process of EBs, providing an indication for focused neonatal assistance. Neonatal mortality at 7 days of age was higher in EBs than in FBs (17 vs. 3.8%, respectively), which deserves further investigations. The study provides further evidence that breed-oriented ASs are needed for a better evaluation and assistance of purebred puppies at birth.

Effect of in situ simulation training for emergency caesarean section on maternal and infant outcomes

BACKGROUND

Emergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas.

METHODS

Data on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation.

RESULTS

Primary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05).

CONCLUSIONS

The DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting.

Canine Cesarean Section: Emergency and Elective

Canine Cesarean Section (CS) is primarily performed to increase survival of newborns and less commonly to save the life or reproductive future of the dam. Conducting proper ovulation timing to accurately predict the due date will allow a planned, elective CS as an excellent alternative to a high-risk natural whelping, and possible dystocia, for certain breeds and situations. Techniques for ovulation timing, anesthesia, and surgery tips are provided.

Sedated cesarean sections are associated with increased kid survival compared to general anesthesia in goats: retrospective cohort of 45 cases (2011-2021)

OBJECTIVE

To determine whether anesthesia type (sedation or general anesthesia) affects kid survival to discharge in caprine cesarean sections (C-sections).

ANIMALS

Retrospective cohort of 99 caprine C-sections (2011-2021).

PROCEDURES

All surgeries were performed via left flank laparotomy in right lateral recumbency. The number of kids alive at presentation, surgery, and discharge was recorded. Kids that were dead on presentation or euthanized intraoperatively were excluded. Goats were classified as "healthy" (American Society of Anesthesiologists status ≤ 2) or "sick" (≥ 3).

RESULTS

Kid survival was significantly higher for C-sections performed under sedation (47/52 [90%]) than for C-sections performed under general anesthesia (16/24 [66%]; P = .004). Relative risk was 1.4 and odds ratio was 4.7.

CLINICAL RELEVANCE

Performing C-sections in sedated goats may improve kid survival rates over those under general anesthesia.

Prevalence of cesarean sections in swiss Bernese Mountain Dogs (2001-2020) and identification of risk factors

BACKGROUND

Dystocia is an important limiting factor in animal breeding due to its cost, stress for the mother and risk of death for the neonates. Assessment of incidence and characteristics of dystocia and the inherent risk of Cesarean section are of major importance. The aim of the present study was to evaluate the reproductive performance of Bernese Mountain Dogs in Switzerland, with a particular focus on the prevalence of Cesarean sections due to dystocia, and identification of possible risk factors.

RESULTS

The investigated population included 401 bitches, 207 sires, and 1127 litters. Litter size was significantly influenced by age and parity of the dam. Incidence of Cesarean section was 30.4%, with 2.0% of procedures being elective. History of previous Cesarean section, age of the dam, and a small litter size significantly influenced the risk for Cesarean section. The stillbirth rate was 12.0%, and the number of stillborn pups was significantly higher for litters delivered by Cesarean sections after birth of the first pup. The inbreeding coefficient had a low to non-significant impact on all reproductive parameters (e.g., litter size, number of stillborn pups).

CONCLUSION

The sample of Bernese Mountain Dogs of our study had an increased prevalence of Cesarean sections compared to the literature, and advanced age of the dam, litter size and prior Cesarean sections in the dam's reproductive history was identified as significantly influencing factors. In order to improve pups' survival rate, elective Cesarean section may be indicated in bitches that have had a previous Cesarean-section/s, are of advanced age, and/or have a small litter.

Risk factors for neonatal mortality prior to hospital discharge in brachycephalic and nonbrachycephalic dogs undergoing cesarean section

OBJECTIVES

To compare neonatal survival to discharge rates between brachycephalic and nonbrachycephalic dogs undergoing cesarean section (c-section) and identify risk factors for neonatal mortality.

STUDY DESIGN

Retrospective study.

ANIMALS OR SAMPLE POPULATION

A total of 480 puppies from 90 bitches undergoing 106 c-sections.

METHODS

Medical records of c-sections performed between January 2012 and September 2021 were reviewed. Data collected included brachycephalic versus nonbrachycephalic breed, elective versus emergency c-section, litter size (c-section and total [including those born prior to and via c-section]), and neonatal survival to discharge. A generalized linear mixed model (univariable and multivariable) was performed to evaluate variables versus neonatal survival.

RESULTS

Overall neonatal survival to discharge was 93.1% (447/480); survival was similar between brachycephalic and nonbrachycephalic breeds (p = .221, 202/213 [94.8%] brachycephalic survival, 245/267 [91.8%] nonbrachycephalic survival). Puppies delivered via elective c-section were more likely to survive compared to emergency c-section (p < .001, 238/240 [99.2%] elective survival, 209/240 [87.1%] emergency survival). Puppies delivered in larger c-section litters were more likely to survive (p < .004) compared to smaller litters. Total litter size had no effect on survival.

CONCLUSION

Brachycephalism had no effect on neonatal survival. Puppies delivered via elective c-section were more likely to survive compared to puppies delivered via emergency c-section.

CLINICAL SIGNIFICANCE

Outcomes following c-section are similar between brachycephalic and nonbrachycephalic breeds. While it is preferable to encourage selective breeding for bitches that are able to whelp naturally, elective c-section should be considered in bitches at high risk for dystocia to maximize neonatal survival.

Incidence and concomitant factors of cesarean sections in the bitch: A questionnaire study

Dystocia in the canine species is a common problem, and elective cesarean sections (C-sections) have become more frequent in breeds that are at risk. The aim of this study was to evaluate the incidence of C-section and contributing factors and to compare data on elective and emergency C-sections (e.g., regarding stillbirth). Using a questionnaire, a total of 423 bitches of 80 breeds and their 899 litters were included. The mean number of litters per bitch was 2.1 ± 1.1 litters. The overall rate of stillbirth was 6.7%. Of all litters, 194 were born via C-sections (21.6%), of which 35 were declared as elective and 159 as emergency due to dystocia. Significantly more C-sections were performed in either small litters (1-2 pups) or large litters (&gt;12 pups) (p &lt; 0.001). Bitches that have had prior C-sections had a 4-fold increase in the risk of successive C-sections (RR = 4.54 (95%CI 2.56–7.70; p &lt; 0.001). Furthermore, primiparous bitches of advanced age had a significantly higher incidence of emergency C-sections (p = 0.004). Stillbirth was significantly higher in emergency C-sections compared with that in elective C-sections (p = 0.003). Also, timing of intervention had a significant impact on stillbirth in emergency C-sections (p = 0.025). Within a breed-specific evaluation, significant differences were observed between breeds regarding incidence of C-section and stillbirth. Lesser-known breeds were represented in the population, and the results showed that the Norwich Terrier had the highest (51.6%) and the Gordon Setter had the lowest (4.8%) incidence of C-section (p &lt; 0.001). The inclusion and evaluation of lesser-known breeds regarding incidence of C-section is of importance as it shows that certain breeds without phenotypical traits such as brachycephaly may also have an increased incidence of emergency C-section and stillbirth. We further conclude that more importance may be given to the age at first parturition concerning the occurrence of dystocia and the decision making regarding possible elective C-sections.

Ethics in canine reproduction - a survey among veterinarians who provide canine reproductive services

OBJECTIVE

Several dog breeds suffer from health and welfare problems due to unfavorable anatomies and high prevalence of inherited diseases. Veterinarians should care for animal health and welfare but they may also be involved in breeding management including the use of reproductive techniques.

MATERIAL AND METHODS

An online survey was conducted to find out how veterinarians who are involved in small animal reproduction regard ethical issues, which services they provide, how they discuss and handle ethical concerns and talk about them with breeders.

RESULTS

In total, 83 participants mainly from Europe completed the online survey. Opinions on which interventions are ethical or not were heterogeneous. Most respondents (79.2 %) found it ethical to perform artificial insemination (AI) in dogs which did not reproduce naturally before. However, 62.7 % of participants stated that surgical insemination is not ethical. Elective cesarean sections are considered not ethical by approximately half of the participants. A closer look at responses to the questions of whether AI is ethical under specific conse quences suggests that most veterinarians are making ethical and value judgments in terms of what is justifiable or not. However, more than 80 % feel at least sometimes compromised by ethical conflicts.

CLINICAL RELEVANCE

This research intended to foster discussion of this topic. International strategies should be developed to support solving conflicts and dilemmas related to ethical issues in dog breeding and assisted reproduction, as well as diminishing physical disabilities and heritable diseases.

Influence of maternal, anesthetic, and surgical factors on neonatal survival after emergency cesarean section in 78 dogs: A retrospective study (2002 to 2020)

Neonatal mortality rate (NMR) may be affected by maternal physical condition, anesthesia, and uterine incision or en-bloc neonate removal. The association of selected factors with number of dogs with dead puppies at hospital discharge was evaluated using 78 records. Data obtained at admittance for emergency cesarean section included: age, small or large body size, rectal temperature, packed cell volume, serum total protein, blood urea nitrogen, glucose, puppy in pelvic canal, and heart rate. Administration of opioids, propofol, alfaxalone, isoflurane, and sevoflurane, and anesthesia/surgical times and surgical technique were evaluated using Fisher's exact tests. There were 238 live puppies and 38 dogs had 58 dead puppies; the NMR was 19.6%. Mortality was associated with puppy in the pelvic canal (P = 0.003) and duration of anesthesia > 80 minutes (P = 0.029). Age > 8 years (P = 0.054) and induction time to start of surgery > 30 minutes (P = 0.17) may be associated with mortality. Expedient cesarean section with obstructive dystocia and an induction time to start of surgery < 30 minutes are important for puppy survival.

Retrospective study on the use of lumbosacral epidural analgesia during caesarean section surgery in 182 dogs: Impact on blood pressure, analgesic use and delays

BACKGROUND

We evaluated the use of lumbosacral epidural anaesthesia (LEA) in dogs undergoing caesarean section over 10 years.

METHODS

Anaesthetic records were reviewed and divided into two treatment groups: LEA and control. Outcome variables identified a priori as potentially affected by LEA were compared between groups. Results are frequency or median (minimum-maximum).

RESULTS

Ninety-five dogs received LEA and 87 did not. LEA consisted of 0.2 (0.1-0.3) ml/kg containing bupivacaine (n = 63), ropivacaine (n = 15), or lidocaine (n = 12) at concentrations ranging between 0.06% and 2%. Morphine, fentanyl, or buprenorphine were used as part of LEA. Groups were similar for demographic variables (all p > 0.06). Intravenous opioids were used more often in control than in LEA (p < 0.0005). Incidence of hypotension (MAP < 60 mm Hg) was LEA 68% and control 56% (p = 0.12). Duration of hypotension was longer in LEA (p = 0.03). Use of crystalloids and vasoactive drugs did not differ (all p > 0.1). Time from induction to operating room was 30 (8-75) min for control and 35 (18-65) min for LEA (p = 0.003).

DISCUSSION

LEA during caesarean section in dogs was associated with lower rates of opioid administration and did not exacerbate the incidence of hypotension.