March

/
THE
VETERINARY
CLINICS OF
NORTH
AMERICA
SMALL ANIMAL PRACTICE
Clinical Theriogenology
AUTUMN P. DAVIDSON, DVM, GUEST EDITOR
V I ,UME 3l .\ NUMBER 2 MARCH 2001
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THE VETERINARY CLINICS OF NORTH AMERICA:
SMALL ANIMAL PRACTICE
March 2001
Editor: John Vassallo
Volume 31, Number 2
ISSN 0195- 5616
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CLINICAL THERIOGENOLOGY
GUEST EDITOR
AUTUMN P. DAVIDSON, DVM, Diplomate, American College of Veterinary Internal
Medicine; Associate Clinical Professor, Departments of Medicine and Epidemiology,
School of Veterinary Medicine, University of California, Davis, California; ,and.
Director, Veterinary Clinic, Guide Dogs for the Blind, Inc., San Rafael, Califorma
CONTRIBUTORS
JANICE 1. CAIN, DVM, Diplomate, American College of Internal Medicine;
Staff Internist and Consultant in Small Animal ReproductIon, BIshop Ranch
Veterinary Center, San Ramon, California
AUTUMN P. DAVIDSON, DVM, Diplomate, American College of Veterinary Internal
Medicine; Associate Clinical Professor, Departments of Medicine and Epidemiology,
School of Veterinary Medicine, University of California, Davis, California; ,and.
Director, Veterinary Clinic, Guide Dogs for the Blind, Inc" San Rafael, Califorma
JONI 1. FRESHMAN, DVM, MS, Diplomate, American College of Veterinary Internal
Medicine; Director, Canine Consultations, Colorado Springs, Colorado
MELISSA GOODMAN, DVM, Veterinary Referral Center, Frazer, Pennsylvania
DEBORAH S. GRECO, DVM, PhD, Diplomate, American College of Veterinary Internal
Medicine; Associate Professor, Department of Clinical Sciences, College of Veterinary
Medicine and Biological Sciences, Colorado State University, Fort Collins, Colorado
CLAUDIA A. KIRK, DVM, PhD, Diplomate, American College of Veterinary Nutrition;
Diplomate, American College of Veterinary Internal Medicine; Veterinary Clinical
Nutritionist, Advanced Research Department, Hill's Science and Technology Center,
Topeka, Kansas
BRUNO J. MASSAT, DVM, Diplomate, American College of Veterinary Surgeons;
Ithaca, New York
KYLE G. MATHEWS, DVM, MS, Diplomate, American College of Veterinary Surgeons;
Assistant Department of Clinical Sciences, College of Veterinary Medicine,
North " rolin. tat Uni vcrsity, Raleigh, North molina
III\NII 1\ I.. MI !'('I\I.l .INOH, I IVM, Ph!), I\1 1fl lH11I 111 I I' PI"'II11l'111 ) f I opu lati on
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I II ,ylli. I II I 111111 II
PAULA F. MOON, DVM, Diplomate, American College of Veterinary Anesthesiologists;
Assistant Professor, Section of Anesthesiology, College of Veterinary Medicine,
Cornell University, Ithaca, New York
PETER J. PASCOE, BVSc, Diplomate, American College of Veterinary Anesthesiologists;
and Professor of Anesthesiology, Department of Surgical and Radiological Sciences,
School of Veterinary Medicine, University of California, Davis, California
MARGARET V. ROOT KUSTRITZ, DVM, PhD, Diplomate, American College of
Theriogenologists; and Assistant Clinical Specialist, Department of Small Animal
Reproduction, University of Minnesota College of Veterinary Medicine, S1. Paul,
Minnesota
MARION S. WILSON, BVMS, MVSc, MRCVS, Director, Glenbred Artificial Breeding
Services Ltd., Feilding, New Zealand
I I " . II 11 11111 ii i'
CLINICAL THERIOGENOLOGY
CONTENTS
Preface
Autumn P. Davidson
An Overview of Canine Reproductive Services:
Getting Started
Janice L. Cain
A veterinarian desiring to increase proficiency in canine reproduc-
tion needs to become proficient in a variety of reproductive proce-
dures. This article describes commonly performed procedures
and gives an overview of how to develop a practice in canine
reproduction. Once a veterinarian develops expertise in this area,
the base in breeder clients in the practice will rapidly grow.
Ovulation Timing: Concepts and Controversies
Melissa Goodman
While the luteinizing hormone (LH) surge has long been accepted
as the key event in the estrous cycle of the bitch, historically,
there has been no practical way to identify it. In the past, the
veterinary practitioner had to rely on general and/or subjective
information received from vaginal cytology, physical examina-
tion , and observations. With the recent development of in-clinic
pro" sterone and LH assays, and the wider availability of labora-
t ry quantitative progesterone assays, the LH surge can either be
id ntifi ed directly or estimated by the detection of changes in
I rOt-; '::i t ronco As a r ' ult, ovulation time can now be predicted
wil'l1 hi gh n lira in a I rivot pra ti ctting.
( I INII ' \ I )I I N( Will AMI IIW ' /I.
' ,1\1 I ,I 1' 1'1\ ( III I'
1'1 11 ' 1111 1
xi
209
219
\'
A Logical Approach to Infertility in the Bitch 237
Janice L. Cain
This approach to infertility in the bitch describes what diagnostic
methods to perfurm and what thought processes to consider at
different phases of the estrous cycle,
Disorders of the Canine Penis 247
Margaret V. Root Kustritz
Function and anatomy of the canine penis are reviewed, Func-
tional abnormalities of the penis described include lack of erection
and lack of ejaculation, Physical abnormalities of the penis also
are described, including paraphimosis, Diagnosis and treatment
options are described,
Clinical Management of the Sub fertile Stud Dog 259
J ani L. Freshman
Breeders invest a great deal of time and money in developing a
stud dog; successful breeding is important in making that invest-
ment worthwhile. Sub fertility in the stud dog can occur because
of lack of libido, inability to breed, or poor semen quality. A
detailed history, complete physical examination, and semen eval-
uation, along with other selected diagnostics can result in success-
ful treatment or management of the sub fertile stud dog.
Surgery of the Canine Vagina and Vulva 271
Kyle G. Mathews
Accurate diagnosis of canine vaginal abnormalities often requires
anesthesia, vaginoscopy, and contrast radiography. Ab-
dommal ultrasonography, thoracic radiography, computed to-
mography, and histopathology may also be advised for the work-
up of mass lesions prior to surgery. Many procedures such as
episioplasty and resection of pedunculated vaginal masses or
tissue are easily performed with proper planning and
eqUIpment (e.g., electrocautery). Consideration should be given
to referring more complicated procedures, such as resection of
large vaginal masses or vaginal stenoses, to a board certified
surgeon, Finally, preoperative placement of a fentanyl patch and
pre- or postoperative epidural are highly recommended
for any vulvo-vaginal surgical procedure.
Transcervical Insemination Techniques in the Bitch 29'1
Marion S. Wilson
fntralll'l' l'iIW inHI'lIlillilli o l\ 11II fl lll" '11 IIIII V" 11 11" , 1)11" \I I 11 11' 11111, Ii
rn(' lol'l1 i,l Iii, ' II I " ',"'/ilri ,rI 11111' 11 1111 111' 11 ' IlI d,Il ' 11 ' 11 11 ' 11 '1'11 111 111 1' 1 1/' II I
, I II Ill i I
insemination enables intrauterine deposition of semen, to be
achieved without the risks, time, and costs associated with anes-
thesia and surgery The results achieved with this method of
insemination are on a par with the best results recorded following
the use of frozen semen, Endoscopic transcervical catheterization
has many other applications that make it a valuable technique in
canine theriogenology, The overwhelmingly positive reaction
from clients makes this a technique well worth learning,
Uterine and Fetal Monitoring in the Bitch
Autumn P. Davidson
The use of uterine and fetal monitoring improves the outcome of
canine obstetrics, Much of the guesswork of managing whelping
can be eliminated, At normal term, absolute indications for cesar-
ean section are detected with monitoring, before multiple fetal
deaths or any serious maternal compromise occurs. Bitches with
previous history of cesarean section may be able to whelp vagi-
nally successfully, having medical intervention based on monitor-
ing. The anxiety level of owners during whelping is diminished,
and the level of participation of the veterinarian improves.
Periparturient and Neonatal Anesthesia
Peter J. Pascoe and Paula F. Moon
Small animal patients may need to be anesthetized in the peri-
parturient period for emergency, nonobstetric reasons, elective
ovariohysterectomy, or cesarean section. In each case, the physio-
logic changes in the dam must be accounted for in designing an
anesthetic protocol, but the requirements of the fetuses will be
different. Subsequent to birth, the neonatal animal may need to
be anesthetized, and the unique physiology and pharmacology at
this age is described.
Neonatal Critical Care
Paula F. Moon, Bruno J. Massat, and Peter J. Pascoe
The quality of the first few minutes of a newborn's life has
important and lasting consequences on its entire life. Hence,
the care a newborn receives is critical. Recommendations for
po tdelivery resuscitation techniques are reviewed. The remain-
der of the article focuses on the critically ill neonate, possible
lInderlying diseases, and methods of supportive therapy.
N('w COIl C pi N In 1'(1(1/ llri c Nutrition
( ' 1111111111 1\ , I 11'1
II, rl ld /'I I', 1/ 11' 1""11 , 111 11' ''11", 111, ,1(0"/', Iwnll'h and rnaximallongev-
Il y 11 11 " , IriI I111 ,11,' I'"" d Iii 1l1I111i 1, 1l11l 11l1.11I1)', (nw nl of the neonate.
11111 1111 1'
305
315
343
369
vii
Nutritional considerations must therefore begin before conception
with optimal feeding of the dam. This article reviews key nutri-
tional considerations for reproduction in the queen and bitch
and discusses the impact of common nutritional deficiencies and
excesses throughout perinatal growth. Factors important in ma-
ternal milk for optimal development of the neonate as well as
functional foods that show promise toward enhancing the health
of growing puppies and kittens are discussed.
Congenital and Inherited Renal Disease of
Small Animals
Deborah S. Greco
Congenital renal diseases are present at birth and may be deter-
mined genetically; familial renal disorders occur in related ani-
mals with a higher frequency than would be expected by chance,
and frequently are inherited. The most common familial disorders
in dogs include renal amylOidosiS, renal dysplaSia, poly-
cyshc kidneys, basement membrane disorders, and tubular dys-
function (Fanconi's syndrome). This article alerts the veterinarian
to commonly observed congenital and hereditary conditions of
the kidneys in small animals.
Diagnosis and Treatment of Juvenile Endocrine
Disorders in Puppies and Kittens
Deborah S. Greco
Endocrine and metabolic disorders affecting puppies and kittens
from birth until 6 months of age may manifest as clinical prob-
lems related to growth, water metabolism (polydipsia or poly-
uria), or as episodic weakness. Endocrine and metabolic disorders
that affect stature, such as pituitary or hypothyroid dwarfism,
present to the veterinarian for assessment of delayed or aberrant
growth. Conversely, juvenile-onset diabetes mellitus and diabetes
insipidus cause excessive thirst, urination, and difficulty in house-
breaking.
Frustrating Case Presentations in Canine
Theriogenology
Autunm P. Davidson
The practice of small animal theriogenology is rewarding, but
frustrations exist concerning teclmologic advan as ornpnrcd
with other species. Reproductive lini cian ' Siri ving lo prn Ii 'l'
good quality medicine r ad il y id nlify topi H of (0111111 0 11 ' On t\' m :
causes that ar not id nli ficd or I'il l'rlll 1l' lIli" fl li1 ,ll lll'" Jlol IIVl1 iI.111 11
or appli abl . Imprnv(' " , 'o ll ,llllll'l! l llI l\ 11111111'11', liJ" I'I(1)',I' ,\,Ii(l) ',1 1I 11
sp' 111 IlI ll,ill 111\ 111 1111 1'1'1 1, ' 1 "" I ,'v lll" I)( '1'1i I ly ,', 11'1'\1 11 1',
, Il l'llli 111 1', ' 1\1 1\1 \1 11111111 111111 11111'1 11 1111 11 111 11 Iii Il' liI II, 11 11'1 ' 1111 )'" I II
\' 1'1'11/ 11'11 1\ ' " 111 1 \ 11I d" 1111 1'l l lrl , 111 \11 111 1' 1111'11111 1111 111 11 11 11111111/
393
401
411
III III I ,
Canine Molecular Genetic Testing
Danika L. Metallinos
Inherited diseases are common among dogs. Recent advances in
molecular genetics provide the groundwork for the development
of genetic tests for the diagnosis and prevention of inherited
diseases. As a result of this progress, genetics should become an
integral part of veterinary medicine. DNA tests are safe, easy to
perform, and reliable if interpreted correctly. Genetic tests only
need to be performed once in a dog's lifetime, because the results
of DNA testing never change. Veterinarians should be prepared
to understand genetic testing and counseling because they are
becoming increasingly important to veterinary medicine.
Index
421
433
Subscription Information
Inside back cover
1111,lllj l
FORTHCOMING ISSUES
May 2001
VACCINES AND VACCINATIONS
Richard B. Ford, DVM, MS, Guest Editor
July 2001
ENDOSCOPY
Lynda Melendez, DVM, MS, Guest Editor
September 2001
ENDOCRINOLOGY
Ellen Behrend, VMD, MS, and
Robert Kemppainen, DVM, PhD, Guest Editors
RECENT ISSUES
January 2001
LAMENESS
Walter C. Renberg, DVM, MS, and
James K. Roush, DVM, MS, Guest Editors
November 2000
RESPIRATORY MEDICINE AND SURGERY
Philip Padrid, RN, DVM, Guest Editor
September 2000
INFECTIOUS DISEASE AND THE EYE
Jean Stiles, DVM, MS, Guest Editor
VISIT OUR WEB SITE
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PREFACE
AUTUMN P. DAVIDSON, DVM
Guest Editor
Organizing this volume of The Veterinary Clinics of North America: Small
Animal Practice has been a rewarding experience, and I look forward to its
publication. Managing the voice mail system for small animal reproduction
consult calls at the School of Veterinary Medicine, Davis, California, has given
me insight to practitioners' areas of interest and concern. It was easy to identify
clinicians within the field of small animal theriogenology with expertise in these
areas, having worked in concert with them for many years. To my amazement,
they all agreed to take time out of their very busy schedules to contribute to
this volume. I wholeheartedly thank each one. We all look forward to referring
practitioners to this well recognized text.
The field of small animal theriogenology is uniquely diverse, encompassing
board certified theriogenologists, internists, surgeons, anesthesiologists, and nu-
tritionists, as well as doctorates of genetics; all have participated in this volume.
Additionally, general practitioners with a special interest in and practice limited
to theriogenology contributed their excellent knowledge to the effort. These
authors illustrate the exciting diversity present in our practice of small animal
reproduction. Collaboration among veterinarians practicing small animal repro-
duction, both nationally and internationally, is increasing. Attendance at scien-
tific meetings devoted to small animal theriogenology reflects this growing
interest. Veterinary students and residents in theriogenology and internal medi-
cine seek additional time on small animal reproduction rotations, anticipating
future caseloads. The demand for knowledgeable reproductive clinicians is fa-
miliar to anyone in small animal practice.
While contemplating this preface, I reviewed the comments of Drs. Shirley
J olmston and Stefano Romagnoli prefacing The Veterinary Clinics of North America:
SInaI! Anirl'/a/ Practice 21(3): Canine Reproduction, 1991. They enthusiastically
a ll d fo r fu rth'r 8tud i in th ar a of early chemical pregnancy diagnosis,
nnil (" I'yol rl,!l-lc rvn linl\ ('<1I' ly hill d/ xtended semen breedings,
11 1'l')',1 1111) 1' 1('I' II1 111 l1 11011 wil li IlI Ii 'onl l oun b;, and optimizi ng re-
I' rndll l' lIvI' 1'1 " ' /(11' 11 11111 \ '1' \ 11 1.1 wl \\ ,ll dil ll / 111'('\' /111, i\ 111 11J',i n )', 1 , W\' 11 1-1 n HI (' eioll y,
I III V, ' 11I 'I'OIIl I'I Ir "lie! ill lI il ll I wi ll .I "il i. il l ' Iidl 11 111 1111' , Il y 1',1 II I)" Ill y (' 111' 1)\1 1'''1',1'
ment for further studies in assisted reproductive technology, especially for ovum
harvest and preservation, molecular genetic screening, immunocontraception,
early detection of congenital defects, and fertile estrus induction. We should
continue to educate our clients and the public about the pet overpopulation
problem and strive to gain control over irresponsible production and problematic
placement of pets. We will debate and study canine cloning, and I admit,
although I have concerns about the long-term outcome of developing this tech-
nique, if I could clone the perfect Guide Dog, I would!
Small Animal Clinic
Veterinary Medical Teachlng Hospital
1 Shields Avenue
University of California, Davis
Davis, CA 95616
Guide Dogs for the Blind, Inc.
San Rafael, CA 94915
AUTUMN P. DAVIDSON, DVM
Guest Editor
1'1 J I I I
CLINICAL THERIOGENOLOGY 0195---5616/ 01 $15.00 + .00
AN OVERVIEW OF CANINE
REPRODUCTION SERVICES
Getting Started
Janice L. Cain, DVM
Veterinarians offering services in canine reproduction are in de-
mand. Dog breeders are willing to travel considerable distances to obtain
quality care for their animals and often look for veterinarians who have
expertise in reproductive procedures. The field of canine reproduction
has changed over the past decade, and breeders are increasingly aware
of new techniques. Developing an expertise in canine reproduction can
be challenging and rewarding.
POINTS TO CONSIDER BEFORE STARTING
The veterinarian must become proficient with the knowledge and
techniques used in canine reproduction before trying to promote this
area of interest. Attending continuing education lectures and keeping
abreast of the recent veterinary literature can help to achieve this. Many
reproduction procedures such as semen collection, vaginal palpation,
and vaginoscopy can be "practiced" on client-owned animals with the
owner's consent. Most breeders appreciate the veterinarian's admission
that a new procedure is being tried; they can be patient and quite
helpful. The same breeders, however, can become extremely upset and
critical if the veterinarian is not available when the reproductive services
are needed. Many reproductive procedures are performed on weekends
VI" I )/ I I ', 111 11\11 11 ' 111 1v1l ' 1' J( ;.lvl I I , ANIMA l , I' I,A( '')'1( ' I(
VI II 11fl. 11 II ' II II '11111
210 CAIN
and holidays. Breeders seem to prefer availability over expertise, sensing
that the latter can be learned over time.
As is the case with any aspect of business, communication between
the an<Ii is important for success. This is especially
true wIth camne reproduction, because time can be a critical factor. Some
suggestions include (1) promptly return telephone calls, (2) educate the
reception personnel regarding proper scheduling of appointments and
procedures, and (3) have handouts available explaining common proce-
such as ovulation timing (aT) and planning a breeding with
chIlled or semen. These handouts can include general cost esti-
mates. It IS helpful to send this information to the client before a
scheduled appointment.
EQUIPMENT NEEDED
. It is ideal to have a microscope, slides, coverslips, and stains kept
m the area where semen collection is performed. Use Diff-Quik stain
Pa.rk, IL) .for vaginal cytology
and eIther Dlff-Qmk or Eosm-Nlgrosm stams (SocIety for Theriogenol-
ogy, Nashville, TN) to examine sperm.
A Unopette dilution kits (catalog number 5853,
Becton-Dlckmson, Franklm Lakes, NJ) are used for counting sperm as
part of complete semen evaluation. A slide warmer is important for
evaluatmg sp.erm that has been chilled or frozen, and it should be kept
next to the mlCroscope. A warm water bath is helpful for thawing frozen
semen and warming chilled semen, and it should also be kept next to
the microscope.
A rigid pediatric sigmoidoscope is used for performing vaginos- '
copy, which can be performed easily on nonsedated bitches. Artificial
collection tubes, and insemination pipettes are used for per-
formmg semen and insemination. All reusable equip-
ment that comes mto contact WIth the sperm should be washed, rinsed,
and thoroughly dried before each use.
Ultras?nography is used for performing pregnancy diagnosis and
for evaluatmg the female and male reproductive tract for disease. Finally,
scope (HOPKINS Telescope with Cysto/Repro Sheath and Bridge with
mstrument channel; Karl Storz Veterinary Endoscopy, Goleta, CA) is
used for transcervical insemination if the veterinarian is interested in
developing expertise with this procedure.
REPRODUCTION SERVICES TO OFFER
Proficiency with .th 8 pl:O (' ciI I n'l-! Ci l l) V!ll'y i '() I1 t1 idl' I'Ilhl d (' IWnd i ng
on til lcvel of ( IW IWI 1(II ' il l III\' () I H'1'1I 11 II', T i ll ' t' II' I'I "II' ii I W, II t\II II', I()
<I evI' lop " I lI' l' l l l l ' III "I I I I ii ' 1"111111 1111 11111 1 11'I ',I't1 III 111 11/1 11 ' 1 ,til I II'IH'I '
d l ll 'I ' 11,, 1(11'1' lill Y " ' 1"1111111 11 \'1' 111111 "dllll ' II Iltlllllll l', 11 IIlI I,l ll ti II 1111 y
OVERVIEW OF CANINE REPRODUCTION SERVICES
211
and physical examination are conducted as the first step. Reproductive
services are recommended only for animals in excellent health.
Prebreeding Examination of the Bitch and Stud Dog
A veterinarian with a special interest in canine reproduction needs
to perform thorough prebreeding examinations. Allow time to recom-
mend genetic screening tests appropriate for a given breed such as
detection of orthopedic, cardiac, ophthalmologic, coagulation, and thy-
roid diseases. All breeding dogs are screened for antibodies to Brucella
canis, regardless of their breeding history. Many breeders are incorrect
in their assumption that only frequently bred dogs require testing or
that the disease has been eradicated. This organism can be transmitted
by oral contact with contaminated fluids such as urine, semen, or vaginal
discharges and does not require natural breeding for transmission.
9
, 10
Typically, bitches are tested before each breeding, and stud dogs are
tested every 3 to 6 months. Antibody testing for B. canis is highly
sensitive but not specific; a negative test is reliable, but a positive
test can indicate antibodies to another organism. All positive tests are
confirmed by more specific testing performed at Cornell University.
Bitch
The veterinarian must develop proficiency with vaginal palpation
and vaginoscopy to detect vulvar or vestibular strictures or septa, any
of which can interfere with natural breeding and whelping. When the
bitch is palpated during anestrus, a normal anatomic narrowing at the
junction of the vestibule and vagina (i.e., vaginovestibular junction,
which is just cranial to the urethral papilla) can be detected and mistaken
for a stricture.
6
This perceived narrowing can relax during estrus, and
repalpation during estrus is recommended. For bitches with a tight
annular ring (i.e., stricture) at the vulvar opening or at the vaginovesti-
bular junction that persists during estrus, natural breeding and whelping
may not be possible. The owner is counseled regarding management of
the breeding (artificial insemination [AI]) and whelping (cesarean sec-
tion) that may be required with such bitches. Alternatively, surgery can
be considered before breeding. IS
A vaginal septum is a dorsal-to-ventral-oriented embryologic rem-
nant that ori.ginates at the vaginovestibular junction and can extend
crani.all y by a variable length.
13
Thin pillars or bands of tissue can be
brol '11 down t1 igi tn ll y in ma ny a s. A longer septum of several centi-
lIl e l'I' I' , or 1 1'0 1111 k i t' , LIlt'll l! tending to th ' post ervical area, creating
n dl Hl hh' VIII',ill" , if! pO' 'ihlt-, ,' l lq', ien l rvHl' ' li on i f! I't'cplirnd i n Bt l h as s.
1\ .I I l ' I IIII Ji() 11 wilit 1111 ' (I Wllt ' l' l'i 'I',ll I'd I " I', Iht ' JlO 11111 ' gvn \'l ir tl ' II1HIlli H i on
t ll Vill',ll lil l 11 11111 11 111 I tll ' I"I ' 1 1 II) 1" 111 111 1' 11 11 I II 111',1/1 Illl jl' lI 'lllIlI ; tllhllll)',1t
1'1' / 111 II 1,11 11 III " Iii 11/11 111 1 ' fi l l I III VI' 1 II) I II "1 11 '. l lI d II I JI '" II Y, 1I\ IIIl y 111/11'/1
li il 1\,lIi III II, II lld 1\ 1i' 111'\", " ' tllll I wlil l' 111 ,' I V '1111I 1'11t!
212 CAIN
If the bitch is in good general health and free of anatomic defects,
the upcoming breeding is discussed and planned. The owner is informed
about the advantages of OT and is instructed to return the bitch during
proestrus.
Stud Dog
. E.xamin.ation of dog includes a complete physical examina-
tion, u:cludmg exammation of the testes and epididymides and rectal
palpatIon of the prostate gland. The scrotum is evaluated for derma to-
logic A e."aluation is generally performed to complete
of the stud dog. !f a chilled-semen breeding
IS a IS recommended durmg the prebreeding exami-
nation. Semen IS collected, evaluated, and extended as for a chilled-
semen shipment. The extended semen is then kept by the veterinarian
at refrigeration temperature and re-evaluated after 24, 36, and 72 hours.
allows a determination as to whether chilled-semen breeding is
for the n:ale dog. Additionally, it is a good idea to
semen colle:tlOn WIthout a teaser bitch if it is likely that one is
not gomg to be avaIlable at the time of collection for a chilled-semen
shipment. This the to determine that good-quality
semen can be obtamed from a gIven stud dog without using a teaser
bitch.
Ovulation Timing
Evaluating a bitch during proestrus and estrus to determine when'
is. most likely to occur is referred to as ovulation timing. This
senal evaluation of parameters such as serum progesterone and
lutemIzmg honnone concentrations, exfoliative vaginal cytology, and
appearance of the vaginal mucosa via vaginoscopy.2,3 The goal of OT is
to detect the preovulatory .luteinizing hormone surge. The breeding is
then :planned to occur. durmg the period of peak fertility, The days of
breedmg vary dependmg on whether natural breeding is planned or
whether the bitch is to be inseminated with fresh, chilled-extended, or
se.men. Gaining expertise in OT is extremely important for the
vet:rmanan who wants to gain success in developing a practice in
canme reproduction. (Additional information on OT is presented in
another article in this issue.)
Semen Collection and Evaluation
Th v t rin ll ri nn lnuHI' hI' l' m fil'iI' 111 11111 " "" ' 11 1'll ll ill ' lllI ll 111 '111 '1'.1 111 '1'11 ,
SOIl1(' Iw ll (1/11 (l in!. 1/ '(' II fll l! 'l Wt '
OVERVIEW OF CANINE REPRODUCTION SERVICES 213
1. Use a teaser bitch in estrus to increase the stud dog's interest in
the procedure,
2. Allow the stud dog to mount the teaser bitch whenever possible.
3. Be sure to fully retract the prepuce behind the bulbus glandis
before complete erection,
4. Use an artificial vagina to collect the semen,
5, Collect the semen into fractions during the ejaculation process to
aid proper evaluation,
6. Allow the dog to complete the copulatory turn during the collec-
tion process.
It is advised to perform the semen evaluation immediately rather
than submitting it to a reference laboratory. Evaluation of motility is
enhanced by use of the slide warmer. A Unopette dilution set and
hemocytometer are used to perform the spenn count.
6
A slide is pre-
pared to evaluate sperm morphology. Careful inspection of sperm for
abnormalities is essential.
ll
It is possible to have a normal semen evalua-
tion in a dog with a history of poor fertility. Obtaining a second opinion
on the semen morphology from a clinical pathologist with a phase
contrast microscope is recommended in these cases.
Artificial Insemination
Many dog breeders request an AI for their dogs that do not breed
naturally. Before performing the AI procedure, it is important to thor-
oughly examine the bitch and stud dog for underlying problems. It is
also important to determine if the bitch is in her peak fertile period by
assessing OT at the time of presentation. When these procedures are
followed and semen is collected, evaluated, and inseminated properly,
the success rate using this method of breeding can be quite high and
similar to that expected with natural breeding.
Most bitches presented for AI are bred using a standard vaginal
insemination technique.
14
The key to success with this procedure is
accurate placement of the insemination pipette. Placement as close to
the cervix as possible is desired. Elevating the bitch's hind end immedi-
ately after insemination for 5 to 10 minutes aids pooling of semen
around the cervix. Stimulation of the bitch's caudal vaginal tract, vesti-
bule, clitoral fossa, or perineal area can cause pelvic thrusting of the
bitch and i thought to be an outward sign of uterine contractions that
mov th sP ]"111 ranially.
Chiliod-Ext nd d m n Broodlngs
1;1' 1111'11 I III hi ' "tl lI l'I I,.I , " 1111 , .1 111 ,1 "I YII IIIII II'I ' II"" ,111.1
11111'1 '1 '.1 III II , llllI llI iI lilt III 11 11 1111 11111 ' 11 111 1,1111 111 '1' 1,, 1111 111 111 lid 11111 11)'.1'
II I II I I 1111 ., .11 11 )', IIII ' IIi ".1 I IllId "ill' l ' "I', III" Itll. 11 1111 1'" llldli ll', I 111 \ 11 '
214 CAIN
avoided. OT is essential to determine the insemination dates, because
chilled-extended sperm can have decreased longevity. Another im-
portant factor to ensure success with this breeding method concerns the
semen handling before chilling. It is extremely important not to have
prostatic fluid in the sperm fraction that is chilled.
14
This is achieved
either by careful fractionation of the ejaculate components during collec-
tion or by centrifuging the semen and retaining the semen pellet. Centrif-
ugation in round-bottomed tubes at a relatively low speed for 3 to 5
minutes is recommended. A protective solution is available to add to the
ejaculate before centrifugation (Semen Separating Solution; Synbiotics
Corporation, San Diego, CA).
Kits that contain all the materials necessary to perform a chilled-
extended semen shipment, including semen collection materials, sepa-
rating solution, cryoprotectant extender, and packaging materials, are
available for purchase (e.g., Fresh Express, Synbiotics Corporation). The
veterinarian performing semen collection must have the kits available,
and specific ice packs must be frozen before the date of semen collection.
It is advisable to "practice" with the stud dog before the date of semen
collection (see section on prebreeding examinations).
The final point to be emphasized regarding chilled-extended semen
collection is the availability of the veterinarian. It is not at all unusual
to perform semen collection for this purpose on holidays and weekends.
If an overnight carrier service is not available (e.g., Federal Express),
counter-to-counter service via an airline often can be arranged.
Insemination with Frozen Semen
Canine semen freezing is a service provided by veterinarians who '
have obtained specialized equipment and have invested considerable
time in learning the process. Any licensed veterinarian can perform
inseminations with frozen semen, however. Owners can find the veteri-
narian in their area who has the most experience with the techniques of
thawing and handling frozen semen. The most challenging aspect of
using frozen semen for breeding is the careful OT that is needed to
determine insemination date(s). Semen has limited longevity after thaw-
ing, and the bitch must be inseminated when ova are mature and
available for fertilization. Thawing and handling of frozen semen are
not difficult provided that the veterinarian has the needed equipment
and is willing to follow directions closely.
Insemination with frozen semen can be performed by a variety of
methods.
s
,15 Routine vaginal insemination can be performed if the semen
is of excellent quality after thawing. Often, intrauterin in eminati n
(lUI) is performed. This method ensure thai' !'Il l' s perm b P(l SH the
cervix, which can be an adva ntage if S(' l11 t' ll i:-; of Ill dr)', ill,li qlldlil nf lt'r
thawing. A ls o, , 0 111 (' ,' (' nw n fn'l, y,ill l', 1' () IIIJ I, lId l' : 1'll( lI lllI'l y l'I' I'III IIIlH'llti
lUI when ,'{, Illl'11 iH 11'11/,,1'11 l1 y 1111' 11 1111' 111 1111 Wltl ' ll 1" ' IIIIi ' lldll l', 11 11, II I I
1111( 1111' 111111 III Iii 1'111 '1\1\11 ' 1111111 ;0" \1 ,l.ll h "I , II l> tll \ 11 1111111 , .. 1 1'1 11 1' 11 1'1111
1111, ' h I I, I .. ' II 1I1 I (I, ll. " \ , tilllll ll) II I 1 111111 I' , 11 11 11 .1 1111 111 " .1 11 11 11
sized breeds; any increase in volume only flows out of the cervix,
because the potential space within the uterine lumen is limited. Two
methods are currently available for lUI. Surgical lUI is relatively easy
and is performed via laparotomy. Semen is thawed and drawn into a
prewashed and dried 3-mL syringe with a 23-gauge needle. Semen is
then transferred from this syringe to a similarly washed 3-mL syringe
that has been resterilized. The transfer is performed using sterile tech-
nique so as not to contaminate the surgeon. A new 23-gauge needle is
then attached to the syringe containing the semen. The uterus is exteri-
orized, and 1 mL of semen is injected across the uterine wall into the
uterine lumen of each horn. It is advisable that veterinarians practice
the precise placement of the tip of the needle within the uterine lumen.
This can be done on other bitches at the time of ovariohysterectomy
using a saline solution.
Another method of lUI is via transcervical insemination (TCI) . The
major advantage of TCI is the avoidance of surgery and anesthesia. The
procedure of TCI is discussed in another article in this issue.
Evaluation of the Bitch or Stud for Infertility
A logical and practical diagnostic evaluation is well accepted by
breeders wanting to try to preserve a genetic line. The most "treatable"
cause of apparent infertility is improper breeding management. Typi-
cally, the next cycle can be managed using OT procedures and ensuring
that the breeding occurs at the correct "time." Compete semen evalua-
tion is recommended for the subfertile male dog. Ruling out underlying
disease and prostatic disease is important. Both of these topics are
addressed in other articles in this issue.
Pregnancy DiagnOSis, Peri parturient Care, and
Cesarean Section
Pregnancy diagnosis can be performed accurately with ultrasonog-
raphy.19 If a bitch has a history of suspected litter resorption, ultrasonog-
raphy is the only method to monitor early gestation. Recommendations
for using Whelpwise (Veterinary Perinatal Specialties, Wheat Ridge, CO)
can be discussed, and availability for performing a cesarean section can
be assessed. Details of this topic can be found in another article in
thii ' U .
Troatmont of PYOITI trn flnd Metriti s
I' 11 11 11' 11 11 11 11"11 11 ' 11 l it 11111 Il\' 11I 'I III'd 1111 .11 1' tll v lli d ll )', IlI 'l)t 1111',1.111.1 111
Il wl 'lill \, 11111 ' 1/ 11111 11', 1 !JIII \ 1/ lill "11"111 11111 IllId 11'1 1" lldl lll tlll )', II" , II 1i) ', 11l1
til IlIlilll ltI" III )', I" 111111 ' 1' III 1111 '1' '1 1\ 1111'1'1\ 111 I II' 11 '\ ' d ld lil l', , II \ ' III
216 CAIN
treat-not only for the immediate health of the bitch but in terms of her
future fertility when she produces a litter. Case selection must be consid-
ered carefully, because medical therapy should be reserved for animals
that are medically stable and have future reproductive potential. Ovario-
hysterectomy, after appropriate medical stabilization, remains the treat-
ment of choice for bitches over 7 years of age or if signs of systemic
sepsis are present.
Many protocols have been proposed for the effective treatment of
open-cervix pyometra and postpartum metritis using prostaglandin F
2a
(PGF2a).4 These protocols use the natural hormone dinoprost trometha-
mine, which is marketed as Lutalyse or Prostin (Pharmacia, Kalamazoo,
MI). Dosage recommendations range from 0.1 to 0.2 mg/kg of body
weight administered subcutaneously every 12 to 24 hours for 5 to 7
days. Some bitches require a longer duration of therapy to eliminate
uterine luminal fluid as determined by ultrasonography. Concurrent
administration of antimicrobial therapy, either broad-spectrum or based
on the culture and sensitivity results from the cranial vagina, is indi-
cated.
Alternatives to the Management of Mismating
Treatment with estrogen products, including diethylstilbestrol, is
contraindicated for the management of misbreeding; other reliable and
safe protocols are available.
I
,16 Prostaglandin therapy early in diestrus
can cause transient or permanent luteolysisand prevent continuation of
pregnancy. Fetal contents are absorbed and outward signs of abortion
are not detected when PGF2a is administered in early diestrus. In one '
controlled study, PGF2a was administered to bitches (0.25 mg/kg subcu-
taneously twice daily for 4 days) beginning between days 5 and 19 of
diestrus.
12
Pregnancy was not detected after therapy in 25 purposefully
bred bitches. It is important to realize that this protocol uses PGF
2a
therapy before the detection of pregnancy. Because not all bred bitches
become pregnant, some nonpregnant bitches would be unnecessarily
treated with this regimen.
Owners may elect to wait until pregnancy can be diagnosed in their
mismated bitches. After day 30 of gestation, PGF
2a
can be administered
to induce abortion. Ultrasonography is performed to confirm the preg-
nancy and is repeated during the treatment period to determine the end
point of therapy, because some bitches can partially abort their litters
and carry remaining pups to term. The following protocol ha be n
reliably successful: 0.1 mg/kg of PGF
2a
administ red sub utaneoll Iy
three times daily for 2 days; then increase I'he dos to 0. 2 n g/ kg
administered subcutan OLl ly three l'iln ' 8 linil 1IIIIil tl horiiol1 ii' ('(lill
plete.7 Admini stration or mi ,' opl'ol' ioi , II 111'1l11.1 1', llIlld lll I': 1'11 IIII HlIlilil ,
intravaginnll dnil l ( I :\ 11,/', / 11',) ,'!IIIi' IIIII ' IIII " IV III, 1111' II( :1
1
", 1" 11 1111 '11 1
wn, ((lIIIHI 10 dl 'I ' I'I'I I II' 111" 11 1,,, 11111 ' 111 11"li ll d 11\ I III I d ,, \ ' 11 11 ' l till
posed action of the misoprostol in this regimen is to soften and open
the cervix, thus encouraging evacuation of uterine contents.
Another method of pregnancy termination in the bitch is to adminis-
ter products that decrease prolactin production.
16
Prolactin is luteotropic
in the bitch, and decreased production of prolactin during the second
half of pregnancy can induce luteolysis. Prolactin is under negative
control by dopamine such that dopamine agonists decrease prolactin
production. The dopaminergic products bromocriptine and cabergoline
are luteolytic when administered after day 30 of gestation in the bitch.
The use of bromocriptine failed to gain acceptance because it can induce
protracted emesis at doses effective to induce abortion. The recent avail-
ability of cabergoline (Dostinex; Pharmacia) in the United States has
rekindled interest in this method of pregnancy termination, because
emesis is uncommonly induced. The use of cabergoline (5 J-1g/kg/ d for
5 days) after day 40 of gestation reliably terminated pregnancy in one
preliminary studyF Results were less favorable when administration
was begun after day 30 of gestation. Additional studies to determine
optimum dosing of cabergoline are needed.
SUMMARY
A veterinarian desiring to increase his or her proficiency in canine
reproduction needs to become competent in a variety of reproductive
procedures. This article describes commonly performed procedures and
gives an overview of how to develop a practice in canine reproduction.
Once a veterinarian develops expertise in this area, the base of breeder
clients in the practice should rapidly increase.
References
1. Bowen RA, Olson PN, Behrendt MD, et al: Efficacy and toxicity estrogens commonly
used to terminate canine pregnancy. JAVMA 186:1467, 1985
2. Cain JL: Introduction [Section on Reproductive System]. In Morgan RV (ed): Handbook
of Small Animal Practice, ed 3, Philadelphia, WB Saunders, 1997 p 579
3, Concannon PW, Hansel W, McEntee K: Changes in LH, progesterone and sexual
behavior associ ated with preovulatory luteinization in the bitch, BioI Reprod 17:604,
1977
4, Davi d.s .n AP: M di cal b,'ea tment of pyometra with prostaglandin F2a in the dog and
at, III l3onagllJ'i.1 JD (cd) : Kirk 's lIrrent Veterinary Therapy XII, Small Animal Practice,
Phil odcl phi n, wn il UI1dcrs, '199>=, I 'I OS'I
!'i, I Il vidH'''1 II I', N,' lfill l1 RW, fll' ldmol1 r. : Indll tion of abor tion in 9 b i tches with
Irlll 'II VIl)"i ll ll l 11Il rlll jll'Otl l ol ,md P' II'I' III ('I'1 11 lilhHII'ocl' 771, III Proc'cci ingB of t1, 15th
i\ 111I1I 1l 1 V""'I' 11111 MI,.! "' III" tI'"IIJll , i\ llh' ricll l1 ' (l Il I'I'," of VI' I""ill ll l' Inl<'1'1111 1 M 'di inc,
( li'IJllltl o, 1'1'17, I' l ,jllI
(I 1I"ld II 11 11 I 1': ( ', NI,lllI lIl I'W , '" ,11 111 ' 111,,11
1
,,11111' 11 ,1""1'1 1I111111',y 111,,1 1\I 'I"'lItlllI'l llI l), " l l ',
1'111 1,,,1
,
,11 ,1" ,1, \'VII I IJI/II
, 11, .1" " ,, "1 I I 11,II' lrI " " 1I \I ' II\V 1'1 " I l ' II III"I,,1 ' I1Ir1 111 1,101111111,,1 " , ,, 1'111 1',11 1 III
\
111 ' /" 111111 I " I, 111I 1 I 11 11 ,tll ll ll l' I I \\ II I \ 'II ' 1/ 1',
1
, 1' 1' 1 I
1\ ,, "11 ''''111' \ " ' II IIII ' "Ir1 I I 111 1" , ,III II, I II Iii 1\ 111111111111 11 \ III I " I , II ",, II I " " '1 ,, 11 1
218 CAIN
son of intravaginal and intrauterine deposition of semen. J Reprod Fertil Suppl
47:325, 1993
9. Johnson CA: Management of Brucella canis outbreaks in breeding kennels. In Bonagura
JD (ed): Kirk's Current Veterinary Therapy XII. Small Animal Practice. Philadelphia,
WE Saunders, 1995, p 1094 .
10. Johnson CA, Walker RD: Clinical signs and diagnosis of Brucella canis infection.
Compend Contin Educ Pract Vet 14:763, 1992
11. Oettle EE: Sperm abnormalities and fertility in the dog. In Bonagura JD (ed): Kirk's
Current Veterinary Therapy XII. Small Animal Practice. Philadelphia, WB Saunders,
1995, p 1060
12. Romagnoli SE, Camillo F, Cela M, et al: Clinical use of prostaglandin F
20
to induce
early abortion in bitches: Serum progesterone, treatment outcome and interval to
subsequent oestrus. J Reprod Fertil Suppl 47:425, 1993
13. Root MV, Johnston SD, Johnston GR: Vaginal septa in dogs: 15 cases (1983-1992).
JAVMA 206:56,1995
14. Root Kustritz MV, Johnston SD: Artificial insemination in the bitch. In Bonagura JD
(ed): Kirk's Current Veterinary Therapy XIII. Small Animal Practice. Philadelphia, WB
Saunders, 2000, p 916
15. Silva LOV, Onelin K, Lejeune B, et al: Comparison of intravaginal and intrauterine
insemination of bitches with fresh and frozen semen. Vet Rec 138:154, 1996
16. Verstegen, J: Overview of mismating regimens for the bitch. In Bonagura JD (ed):
Kirk's Current Veterinary Therapy XIII. Small Animal Practice. Philadelphia, WB
17. Verstegen J, Onc!in K, Silva LDM, et al: Abortion induction in queens and bitches
using cabergoline, a specific dopamine agonist. Ann Med Vet 137:251, 1993
18. Wykes PM, Soderberg SF: Congenital abnormalities of the canine vagina and vulva. J
Am Anim Hosp Assoc 19:995, 1983
19. Yeager AE, Concannon PW: Ultrasonography of the reproductive tract of the female
dog and cat. In Bonagura JD (ed): Kirk's Current Veterinary Therapy XII. Small Animal
Practice. Philadelphia, WB Saunders, 1995, p 1040
Address reprint requests to
Janice L. Cain, DVM
Bishop Ranch Veterinary Center
2000 Bishop Drive
San Ramon, CA 94583
CLINICAL THERlOGENOLOGY 0195-5616/01 $15.00 + .00
OVULATION TIMING
Concepts and Controversies
Melissa Goodman, DVM
Left to their own behavior and responding to nature's signals, the
majority of dogs will breed at a time appropriate to result in conception.
Nevertheless, improper timing is the most common reas?n !hat
ings fail.
15
, 32 This phenomenon is a result of two In
canine reproduction. The first is that the true penod of bItch
is short, since mature, fertilizable ova are only VIable for a penod. of
48-72 hours.
4
,3O In addition, sperm longevity in the female reproductive
tract is often extended (6-11 days),9, 10, 18 allowing breedings that
considerably before the fertile period to pro.duce preg:r:ancy. However, If
sperm longevity is compromised even slIghtly, or If the number of
breedings is limited, matings timed by nature's signals alone
result in live sperm present during this critic?l As a .IdentlfI-
cation of the true fertile period will maXlffiIze the probabIlIty of a
successful breeding.
INDICATIONS FOR OVULATION TIMING
Apparent Bitch Infertility
The most common cause of failure to conceive in the bitch is poor
breeding management (lack of viable seI?en in the ?itch'.s .rep'roductive
tract at a tirne that will support conceptIOn). Thus, IdentlfIca.tlOn of the
fertile p riod will ensur that breedings occur at the proper hme.
11,'11111 1111 ' V,'I, ' ,I'IIII )I 1' 1,1,', "III ( " ' Ilt."" I " ' nltl,y l v 1111"
"I tvll I II 1\ Ir-- I I I
, II I I I I. I ' II '1111 1
220 GOODMAN
Abnormal Estrous Cycles
Many bitches ovulate normally, but variations in the estrous cycle
sometimes make it difficult or even impossible to identify the correct
time to breed by traditional means.
Split heats involve the onset of proestrus with accompanying vulvar
swelling and vaginal discharge. Instead of progressing to estrus and
standing heat, however, these signs abruptly stop, only to reappear in
2- 10 weeks. These shortened cycles may recur several times, and it is
usually the last of these cycles that result in ovulation and fertilityY
Ovulation timing procedures will identify the fertile period and the
correct time to breed.
Early or late ovulation occurs frequently as a variation from the
expecte.d norm. This is a common cause of apparent infertility. Although
these bitches are fertile, breedings timed by traditional means will often
miss the fertile period.
Silent heats occur when the observable signs of proestrus (e.g., swell-
ing, discharge) are minimal or absent. Ovulation timing procedures will
identify these cycles and indicate the correct time for breeding.
Nonovulatory cycles occur when a bitch has a rise in estrogen with
all the accompanying signs of proestrus, but never has a luteinizing
(LH) surge or rise in progesterone. Hormonal assays will
identify those cycles and give the information needed to document the
problemY
Breeding with Chilled or Frozen Semen
When performing breedings with chilled or frozen semen, it is
imp?rtant to recognize that sperm longevity is compromised by pro-
cessmgP, 23, 26 Thus, ovulation timing becomes crucially important to the
success of these breedings. Inseminations must occur during the actual
fertile period for conception to occur.
Breeding with a Subfertile Stud Dog
Often, a stud dog with reduced fertility is still desired for breeding.
Accurate ovulation timing will maximize the number of viable sperm
during the true fertile period and increase the chance of concep-
hon.
Breeding with a Subfertile Bitch
A ompromi sNI f(' lIll1l(' 1'i ' III'otill! 'l i v(' 1, ", 1'" W 111 111 I Ij'PI'1I1 1111 1)',1' li y
::) ftl' r 1: 1'( '( ,11111) '" /\ 1'(' (11',111 ' II II Ii II 11 111 11111 II )', W II 11 1.1" li lt' !l li l 11111 111 1 1\1 1111
11( ' 1' Il f 11('1 '111 1'1' 111'11 Il l! ' il l, ' II I 111 11 . " I " 11 11
OVULATION TIMING 221
Limited Breeding Access
Occasionally, a stud dog is only available for one or two breedings.
Since most bitches will allow mating at times other than the true fertile
period,33 the successful accomplishment of one or two matings cannot
be relied upon as an indicator that timing was correct. Ovulation timing
will ensure that the breeding was accomplished at an optimal time to
allow conception.
Disinterested Bitch and/or Stud
Many dogs are presented for artificial insemination because they
would not voluntarily breed on their own, frequently because the at-
tempt was either too early or too late. By identifying the fertile period,
usually a natural breeding will occur.
Artificial Insemination with Fresh Semen
Artificial insemination is sometimes necessary for either physical or
behavioral reasons. Ovulation timing will identify the best time to per-
form AI to give the best chance of conception.
Shipping Bitches for Breeding
There is some indication that the stress of shipping may cause a
release of glucocorticoids. Since glucocorticOid administration has been
shown to decrease the level of LH in the serum of dogs,2 it may be
prudent to identify the LH surge and ship bitches only after the surge
has occurred.
Predicting Whelping Date
Since gestation length is determined by the LH surge/ identification
of th LH surge will allow accurate prediction of whelping date.
Owner Information
Mli ll y 11I '1' I.rll ' I': win" 10 IIIII W 11 11 ' 1I 1111III , rI l i ll!! ' III !I n'' 'd II /lil ch It)
11 1,11' 1111'1 111 11 11' 11 '11 11 Idlill 111111 1 II I d PI ' I" ' IIIl I' 1111 ' 1111 111 \11' 1 III VIII ' Ilhl" 11 Ihlli
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I II II I'IIII\ P
222 GOODMAN
REPRODUCTIVE PHYSIOLOGY
The Estrous Cycle
The estrous cycle of the bitch consists of four stages (Fig. 1). Proestrus
clinically begins with vulvar swelling and the onset of a bloody vaginal
discharge. Endocrinologically, it is characterized by rising estrogen lev-
els. This is the stage of the cycle that prepares the bitch's reproductive
tract for the upcoming copulation and conception. Behaviorally, the bitch
will attract males but refuse to let them mount. In estrus, bitch behavior
will consist of full sexual receptivity. Endocrinologically, estrus begins
with the LH surge and is characterized by rising progesterone and
declining estrogen levels. This stage is when ovulation and conception
occur. Diestrus begins 7-10 days after the LH surge
18
and marks the end
of standing heat. An abrupt decline in the percentage of cornified cells
is seen on vaginal cytology, and progesterone levels remain elevated. In
anestrus, progesterone levels drop, either abruptly just prior to parturi-
tion or gradually with corpora luteal regression in a nonpregnant bitch.
Once considered a quiescent period, it has been shown that both the
pituitary gland and the ovaries are active since fluctuations and small
surges of follicle stimulating hormone (FSH) and estrogen occur
throughout anestrus.
S
Major Hormones Involved in the Estrous Cycle
Estrogen
During proestrus, developing ovarian follicles produce increasing
amounts of estrogen, resulting in a slow rise in levels from a baseline of
Estrogen

LH surge
/ ....... /\
First rise in Progesterone
progesteronEj rise continues
, .'
,.'
.. -\
,
,
,
.. -;;
.....
rFertll8l
D ys - 1- ---111----1-1 ---+-1 ---+-1 ----1- 1
25 20 15 10 5 0 2 4 5 7 10 15
0,,,,10 I
OVII IIIIIIIII'O
Pl nur 1, II( il lmll l nyolo Ilf 1'11 11 hlloll (l\"II/l llnl llll//i ( ,III10l llllltill 1
10
IIIIPI IIt IiII Ii VIl
"ll y/ lll loI IY 1\11111111(11 )11111 11 1 l il lllIlIll lit I/ irl /111 1 Ii ( .11111 11 11 Vl llli lli li ll Y I " IIIIIIIY, 11 111 11 1\111/1 1111
1'11 1111111111\.1 1111 1111 , 11/1:1, wl ll i l ltl llil l 11111)
2-10 pg/ml over a 10- to 14-day period. Estrogen then peaks approxi-
mately 2-3 days before estrus, reaching levels of 50-120 pg/ml, followed
by a rapid decline that begins about the time of the LH surge. The
increase in estrogen causes the observable signs of proestrus, such as
bloody vaginal discharge, vulvar swelling, and attraction of male dogs.
In addition, increased estrogen causes an increased turnover rate of
vaginal epithelial cells, resulting in the progressive cornification seen on
vaginal cytology. Also seen is progressive edema of the vaginal mucosa,
which can be visualized with endoscopic examination.
S
Luteinizing Hormone
At the end of the follicular phase of the estrous cycle, a marked
increase in LH over usual baseline values occurs over a 24- to 48-hour
period, followed by a return to baseline values? 27 This surge in LH is
thought to take place in response to the decline in the
one ratio that occurs as estrogen levels decrease and progesterone nses.
The LH surge triggers ovulation and thus makes it the central endocrino-
logic event in the reproductive cycle of the bitch, all follow-
ing being consistent between bitches? Therefore, dally measure-
ment of LH to identify the exact date of the LH surge IS the most
accurate diagnostic tool for timing breedings.
Progesterone
At the end of the follicular phase, progesterone-secreting corpora
lutea are formed in the ovaries. Progesterone levels begin to rise at
approximately the time of the LH surge (prior to ?vulation). and continue
to increase during the first 15-30 days of gestation, reachmg a peak of
15-90 ng/ml. During the last third of pregnancy, progesterone levels
slowly decrease to a plateau of 4-16 ng/ml which is maintained for 1-2
weeks and then drop abruptly to a value below 2 ng/ml 12-24
prior to whelping. Progesterone is needed to maintain pregnancy m the
bitch, both by supporting development of the endometnum and placer:ta
and by inhibiting uterine contractions. Rising progesterone acts
tically with declining estrogen to reduce edema of the vulva and vagma,
which can be appreciated on vaginoscopic examination. Other observ-
able clinical signs are minimaI.S Serial blood samples
2-3 days may be used to identify the rise in progesterone whIch mdlcates
that the LH surge has occurred; routine breedings may be timed by this
para meter.
Ovul ation and the Fertile Period
() IILII IIIi I )'I ' III' I'lI ll y 111 '1' 111 '/1 11i1 1' 1' 11 /1' /1[' 1' 11111 I ,l l 11 11 1')',1 ' ," 'd.
ii i I' l ' I,II III III'd "1:11111 ' Il VII" y l ,. 1111 1/1/ 1111111 ' 11',(\ II 1""1111.1 1111' I1 l i, ' di v lll l!)ll ,
IV l ill" 1\ 1'Il illl l Ill " 1 1111111 , 11/ ' 11111' II ' " I ;,' , ililil 1IIII 111i, 1' I l b 'I ' 11"d II
224 GOODMAN
able ova then remain viable in the oviducts for only 2-3 days.8, 22, 30 Thus,
the fertile period begins 4-5 days after the LH surge, when the ovocytes
are mature, and terminates 6-8 days after the LH surge, when the
ovocytes degrade (Fig. 2). Although a bitch is generally thought of being
in season for a period of 3 weeks or longer, the true fertile period, when
eggs can actually be fertilized by sperm, is actually quite short (only 3
days in duration).
Gestation Length
Normal parturition may occur anywhere from 56 to 69 days after a
fertile mating. This large range exists because of the variability in longev-
ity of sperm in the reproductive tract, allowing conception to occur
significantly after the date of the breeding. In the bitch, gestation is 65
days (+ 1 day) from the LH surge.
9
This is true regardless of what days
the bitch is bred; thus, the most accurate way to predict whelping date
is to know the date of the LH surge. This information is invaluable when
planning an elective cesarean section, or when deciding if intervention in
the whelping process is necessary.
DIAGNOSTIC PROCEDURES
As in any diagnostic procedure, as much information as possible
should be gathered; no one test alone will pinpoint breeding times with
100% accuracy. In most cases, a single evaluation, whether it is an
examination, a hormonal assay, or cytology, for example, will provide
very limited information. Therefore, the bitch should be examined re- -
peatedly.
Behavior and Observable Signs
Typically, the bitch will show willingness to accept copulation dur-
ing estrus.
6
Standing heat is caused by the combination of a peak and
subsequent decline in estrogen levels acting synergistically with the
Start
of
Heat
"
Estrogen
Peak
"
~ From 3 to 28 Days
l
progeste. rone I
Rises and
LHPeak
,, :
Ovulation
Occurs
"
Fertile
Period
Begins
_"L
Fertile
Period
Ends
y
~ ~ 2 Dnyo - . . . - ~ 3 OilY. ~ ___ ~ Cllty _
... II"""IIIIU )I"y. ___ +
preovulatory rise in progesterone. This behavior, however, is not directly
correlated to the LH surge and so cannot be used to accurately indicate
the fertile period.
Observation of vaginal discharge and vulvar turgidity may also be
an aid to staging the cycle. Rising estrogen levels during proestrus cause
the vulva to be swollen and tense, and vaginal discharge to be heavy
and hemorrhagic. As estrogen decreases and progesterone rises with the
occurrence of the LH surge, the vulva becomes soft and pliable; at the
same time, the vaginal discharge may become scant and straw colored.1
3
,30
While easy to identify in some bitches, in others these changes may be
subtle. In addition, many bitches deviate from this typical pattern, show-
ing the typical changes but at a time other than what is expected.
Exfoliati ve Vaginal Cytology
Examination of the cells on the surface of the vaginal epithelium
will give information about the stage of the estrous cycle.
2l
, 28, 34 Under
the influence of rising estrogen levels, the number of layers making up
the vaginal epithelium increases dramatically, presumably to provide
protection to the mucosa during copulation. Therefore, as estrogen rises
during proestrus, the maturation rate of the epithelial cells increases, as
does the number of keratinized, cornified epithelial cells seen on a
vaginal smear.
Proper technique is important so that the cells obtained are represen-
tative of the hormonal changes occurring. The sample should be col-
lected from the anterior vagina because cells from the clitoral fossa and/
or caudal vagina are not as indicative of the stage of the cycle. The slide
should be prepared with minimal distortion to the cells, and stained
with a modified Wright-Giemsa stain (Diff-Quik, American Scientific
Products, McGraw, IL). Emphasis should be placed on determination of
the percent cornified versus noncornified cells present; the presence of
red blood cells, white blood cells, and bacteria may also be noted.
During early proestrus, when estrogen levels are low, a large num-
ber of immature vaginal epithelial cells are present (parabasal and inter-
mediate cell types). As estrogen levels rise during late proestrus, the
cells cornify, becoming superficial epithelial cells. Full cornification is
reached when greater than 80% of the cells present on the vaginal
smear are cornified superficial epithelial cells. This coincides with peak
estrogen levels, but is not related to the fertile period since ovulation is
triggered by the LH surge, not an estrogen peak. Full cornification
continues throughout estrus, until the "diestral shift" that occurs 7-10
days aft r the U-I su rg ,signi fying the first day of di -strl.lS.' 8 The vaginal
8m ' lr tiwn ch, n)!; 'H ( ) ~ I' ll I II from filii corn iCi ' nli OI1 I'() 40- 60'X, immnt ur
(I il r:lbil Hnl nml illll ' I'II H'dill l l ') 1'111 \lVI')' II './1 to :16 hplir pl' ri nd. If vn)',i nnl
I ' 1()ll l)', iii PI'I' flll 'II Hld 11111 11 I I II' d I ' 111'.iI I il i l J/l III II II'I ' Ild, ,1 n ' II 'I )! 11II( ,tivl'
d l lidYil l1 II I 11 11 ' 1.11 11 111 'f', " , 1l l' l d lllllll , 111111 I I I" 11 ' 111(, I "dl"l W II 1,( ,
ll i li llll il d
226 GOODMAN
Hormonal Assays
Measurement of canine LH, available as an in-clinic assay (Status LH,
Synbiotics Corp, San Diego, CA) identifies the preovulatory LH surge
and thus, the time of ovulation and the true fertile period. This testing
is the most accurate means of ovulation timing, and thus should be
considered a "gold standard." Accurate identification of the LH surge is
recommended in those instances where there are factors present that
could adversely affect conception rates. These include chilled extended
semen breedings, frozen semen breedings, breedings with bitches with
a history of infertility, breedings with stud dogs with low semen quality,
breedings with limited access to the stud dog, or breedings to heavily
booked stud dogs. Knowledge of the LH surge will also allow accurate
planning of an elective cesarean section. Samples must be drawn daily
for LH testing, since the LH surge may have a duration of only 24 hours
in many bitches and could be missed if one day was skipped?
Estrogen assays are performed by radioimmunoassay (RIA) by many
laboratories. However, the information given is of little value for ovula-
tion timing, since peak estrogen levels are variable from bitch to bitch,
and even relative changes do not correlate to ovulation or the fertile
period.
s
, 19
Progesterone assays focus on using changes in progesterone levels to
identify the occurrence of the LH surge, ovulation, and the fertile pe-
riod.
6
Progesterone levels may be determined by RIA at many private
laboratories; the clinician should verify in advance that the assay has
been validated in the low range important for canine ovulation timing,
and that the turnaround time for results is practical. When quantitative
assays are not available, in-clinic semi-quantitative assays offer a reason-
able alternative; several are currently available in the United States.
n
,17
Basal progesterone levels typically range from 0 to 1 ng/inl during
anestrus and proestrus. At the time of the LH surge, serum progesterone
rises rapidly (0.8-3.0 ng/mL), continues to rise at ovulation (1.0- 8.0 ng/
mL) and is even higher toward the end of the fertile period (4.0- 20.0
ng/mL).3 By day 21 post-LH surge, progesterone levels range from 15
to 50 ng/mL and should remain elevated for 2- 3 months in all normal
bitches, whether pregnant or not.
5
, 19
By examination of the range and overlap of progesterone values at
different points in female reproductive physiology, it becomes clear that
no one absolute value of progesterone correlates to any particular stage
of the cycle. However, if accurate serial quantitative progesterone assays
are obtained, the LH surge may be estimated as the day a di tinct
increase in progesterone level is seen. Although thi s will not be as
accurate as actual identification of th ' Lli Sli I')\l' h II , ' (' of nn Lli nHsn ,
estimation by progesteron r sulC:-l iH slill 11 :-1(' flll 11111 1. nfll' lI II) OI'V wi dd
available to th pra lili ol1(' r who II pI '/ oVIdlil \( \l1 11111 II )', (l ll III ) 1H'l' lli 1011 ,11
ba 'i , Wlwn timin)', hnlld lll )',:J II/li ll i', 11' 111 1 '11111111 1111 VI ' 11 1'11111 ' !' IlII',I '
I'('ron(' ,),14.1 Il l, Ilid ,11'1)11 )',1 ' II I 11111)',1".11' 111 11 1' 11111 01 11 Ill'd, \ It I'll IlI ld' l'l
d il'fll 'llil III 11i '1'11I '11\1 ,1" tl l'IlIlI\ 1111'1 111\ 111 1IIi ' 11I1 ,till l !' II 1"Il' I',1'111 ' "ill" '
or the true fertile period. Therefore, these assays should only be used
for routine breedings where a wider margin of error is acceptable. A
safe rule of thumb to follow is that when testing indicates progesterone
has risen above 2 ng/mL, breeding should begin. Regardless of which
assay is used, an additional test should always be performed 2---4 days
11fter the first rise is detected to indicate that the cycle has progressed as
expected, a functional corpus luteum has been formed, and ovulation
has occurred.
When doing progesterone testing for ovulation timing, it is im-
portant to remember that at best, detection of changes in progesterone
will give an estimation of the LH surge and the fertile period, and thus
is not as accurate as actual identification of the LH surge with an
Ll-:I assay.
Vaginoscopy
The vaginal mucosa, as a target organ for reproductive hormones,
reflects changes in their levels as the estrous cycle progresses. The
observation of these changes via vaginoscopy can be a quick, useful tool to
t Ise in ovulation timing
19
, 24 but requires practice by the operator for correct
it I terpretation of findings. As with vaginal cytology, the anterior vagina
:_ hould be examined to provide reliable information. However, it is not
11(, essary to enter the vaginal fornix (anterior to the dorsal fold) to ade-
quately visualize these changes. A rigid endoscope is recommended, but
Iwither fiberoptics nor a small diameter scope are required; a 10-inch Welsh-
All en juvenile proctoscope is ideal. Therefore, this procedure may be per-
limned repeatedly without risk of trauma to the cervix or the introduction
III potentially pathogenic bacteria into this area of the reproductive tract.
I n proestrus, the vaginal mucosa becomes markedly edematous as
"HI rogen levels increase. The vaginal lumen will be obliterated from
Vil'W, and the mucosal surface is smooth and shiny. Vaginal folds are
I Ii n k a nd billow out into the lumen as a result of fluid retention, As
1\1 1 I'll approaches, declining estrogen and rising progesterone levels
1', III S' the edema to subside. The vaginal tissue, however, is stretched
.Il1d ' 11 nnot r bound quickly enough to accommodate the loss of fluid. As
,I l'I'Hll lt, vagi nal folds collapse, and subtle surface wrinkling/crenulation
1lI'l'ol11('s appa l' nl on the vaginal mucosa at the time of the LH surge.
' I'ltl' 11111 ('0:-;8 b om s progreSSively more crenulated, the lumen more
dl :J lil)gui:-l li nb l(', ond tb vaginal folds more fl attened as the edema
li lllil1i , lw8. Mn il1'1 nl 'ffe ts arc n d ur ing the fertile period 4-7 days
,tlll'I' IIIl' I,ll , I II');\' . Il die's ITlI s, tlw tnll 0 50 i fl at and variegated. Since
Iltl' 1l'lIil'Vlivl' III v I'S ur \'pi ll wlillr11 IHlv(' di ll1ini Hhed, I'h tnu osa is
1IIIiI,I,, dl)t! 11 (1 11 Ik lll' /1 or Hlqw ri lrj, d 11(' 11111 1'1'1111)',1'. ' 11'( oflvll 14\,(' 1).
htl d ll' l 11111 II III ' 1(l lI m"' I'" 11 11'(1 11 )',h II \(' 1'/l II '1) 1I 1 I'YI,II' ill 1l1'1I, '\'
1111 1111' 1"'111 ' 1 1111 11'1 II) )', 11111 1'111 11 1"1 '111'1' II I V I) ',I IIII II'II I' V ' I'lli' Itl ll' dlll i
1' 11'111 II I \iI)',l llI d 111111 1),, 1' ' 1'1'11\\, ,,1 \ tll\ 111' 111' 1'1'111 111)', 1, 11 111111111 1, " '11 11 111
111111 11111111 ' 11 1111 11 11i\ 111 ' 111111 11'1 1111 ' III 111111 111 ' 1 III Ijl It ' III 1111'1 ' Il ld lll
IIIIll r III 111 ill I ' " 1111111111 1'1 I 1","1" ,01111" I III )', 1 I' ll II " lilllIJlloI lllIl1
\ ,111 ' 11 II I,d Ii' til l lIilllllll 11111 1 II I' 1IIIIII tl ii I,ll IPI
228 GOODMAN
Other Diagnostic Tools
Ultrasonography may be used to identify ovulation in the bitch. Early
attempts were discouraging; the small size of the ovaries and their
similarity to close structures make them difficult to visualize. However,
recent reports have identified ovulation as occurring when a detectable
decrease in the number of follicles is seen during serial imaging. The
data have shown a close correlation to the ovulation time established by
LH and progesterone levels.
31
,35 While additional research and refinement
are necessary before this method of ovulation timing becomes practical,
the results appear promising.
The measurement of glucose in vaginal secretions has been used as a
crude guideline for timing breedings by many dog owners. Increased
glucose has been identified in vaginal secretions as an inconsistent
finding; it is thought to be a result of insulin antagonism that occurs
due to altered hormone concentrations at the time of the progesterone
rise. This finding is not reliable, however, and so is not recommended
for ovulation timing.14
Measurement of electrical conductivity of vaginal mucus is used rou-
tinely to time breedings in foxes and has been studied in several other
species, including the dog. It was found that electrical resistance in-
creases as estrus approaches and then plateaus at a maximal level for
several days, which has been proposed as a result of rising estrogen
levels. While it appeared that ovulation occurred at some point during
this period of maximum electrical resistance, it has not been shown to
be correlated to the LH surge or the fertile period and so cannot be
recommended for accurate ovulation timing.
16
,25
PROTOCOL FOR OVULATION TIMING
Remember that no one test will pinpoint breeding time with abso-
lute accuracy; therefore, always utilize as many diagnostic tools as
possible. It is also important to understand the benefits and limitations
of each diagnostic tool; individually, the information they reveal is
limited. Used in conjunction with each other, according to a diagnostic
plan, they can accurately identify the fertile period of the bitch.
Ovulation timing should begin at the first observable signs of proes-
trus (e.g., vaginal discharge, vulvar swelling) (Table 1). At this time, a
breeding history should be obtained and a prebreeding xamin.a hon
should be performed. In addition, the pl ans for thi s pnrti ul nr br cding
should be discussed to determin m di e' ll nnd / or Ingi s li ';:) 1 fn tors that
may influence the accura y of () vlil nlion linli/I)', IIi 'V(' Hi ll' ii , w(' 1I :1/1 IIw
choice of breeding dfl H. Pm (')o, lI1\l1lt ', . 1 1', ,(, '1, \ ' /1 " IIWII I l't"dlll)', will
require th mOl'l l (1('(' 111'111(' Id( ' 111 11, 111 1( 111 (I I 1111 ' 1"1'/ 1( , 1"' 1' IHI , WIIt'I'I 'Ii /
Sl' imnliOI1 of 1111 ' I ,ll 1111')',1' r I11I1 ( 11' ,d I,,, II I ," ,(.d 11 )', 11 1'1'1111'1" ' 1l l ltll , y
11.11111'11/ rlt ' l l it 1 ... 1, 1'1' 1\ l "'II I " I 'lIlI llI t 111' , l v 11"1111 Ii li t II', 1
1
11 " " 1IIIII'rl llll r
hllliloll ,tI d \II I II I I" ld,.t! .iI Iit ' /l I I I II I ill l l 1\ 111 1 111 1', Il l d \, 1111 "/ ',\ (1, '1 1 11 11 111
Table 1. OVULATION TIMING PROTOCOL
Pre-breeding examination first 5 days of heat onset
Assess general and reproductive health
OVULATION TIMING
Determine degree of accuracy of ovulation timing desired
Stage cycle with vaginal cytology + / - vaginoscopy
Establish progesterone baseline
Re-examine every 2--4 days until approaching LH surge (> 70% cornification)
Stage cycle with vaginal cytology + / - vaginoscopy
Begin hormonal testing
229
Every other day progesterone testing for routine breedings between normal dogs
Daily LH testing for breedings requiring higher accuracy, plus progesterone assays
every third day
Repeat vaginal cytology + / - vaginoscopy periodically
Identify or estimate LH surge and plan breeding days
Check progesterone level 2--4 days after LH surge to document sustained rise
Continue vaginal cytology to identify first day of diestrus, if possible
50% cornification) and a baseline progesterone level established (usually
0-1 ng/mL).
Vaginal cytology should be performed every 2---4 days until a sig-
nificant progression in cornification is seen, usually above 70%. At that
point, serial hormonal assays should begin. For routine breedings, pro-
gesterone testing may be done every other day, until a rise in progester-
one above 2 ng/mL is identified. Breeding should then be done on an
every-other-day basis for two or three breedings. When increased accu-
racy of ovulation timing is necessary (e.g., frozen or chilled semen
breedings, infertility cases, breedings with sub fertile stud dogs), daily
LH testing is recommended. Once the LH surge is identified, breeding
days may be planned. It is useful to perform vaginal cytology each time
a blood sample is obtained; cornification should progress to 80- 100%.
This maximal cornification usually occurs prior to the fertile period is
reached and continues until the onset of diestrus, which is usually a few
days after the end of the fertile period. Vaginal cytology may be contin-
ued until the diestral shift is identified, which gives a retrospective
evaluation of the breeding just completed. In addition, at least one
progesteron assay should be performed after the LH surge/initial rise
in proge terone i identified to document that levels continue to rise.
'I'hi illustrat ustained corpus luteum function and strongly suggests
I'hat an ovul e tory ycl has occurred.
V8ginOf-J 01 y may b p rformed throughout the cycle as an adjunct
10 vnglnnl c tology and hormonal a says, especially when evaluating an
111)11, II nl l' cl(,. II(> i1n vior fi nd oth r ob ''rvations hould also be made at
(,. ll' I, ( . II II II Il .t l 1011, 11111 I('HH W(i g hl should be put on th's paral11 et 1's.
TIMINe 1m DING.
111 111 11 1', 11 Ill l lll V " 11)1, IV 111 '1 ' 1III ,d 11 1111 '1 "dl y 1111111"1 11 )" III 11 11 1111 1"
'1',111 .1 1\1011 \ ' II III', I'I "I .,It 1 hll\l ' 111 " "1 111 ,01 111 1" 1111 It/ti l il 01"1',( \\ II
230 GOODMAN
be bred together and when. In most situations, the bitch is being trans-
ported to the stud dog, sometimes over long distances and at consider-
able expense. Often, the number of breedings that will be performed is
limited, making it even more important that they take place on the
correct days. Sometimes, the stud dog has several bitches to breed at the
same time; correct information about which bitch to breed on which
days will maximize the stud's sperm count and increase the chance of
conception for the most females. Other times, a bitch will never show
receptivity, or a stud will never voluntarily breed; it is crucial to know
when to intervene and perform artificial insemination. In addition, there
are bitches that are receptive for an extended period of time; when an
unlimited number of breedings is not possible or will decrease the stud's
sperm count, the fertile period must be narrowed down to achieve
conception (Table 2) .
Semen quality can also determine the necessity for accurate ovula-
tion timing. Since the true fertile period of the bitch is short (the last 2-3
days of the cycle), these are the only days that fertilization can take
place. However, most breedings occur before that time; the bitches
conceive because a young, healthy stud dog's sperm may live 6-11 days
inside a healthy bitch's reproductive tract.lO Therefore, the sperm will
still be viable during the fertile period even if the mating took place
days previously. With poor quality sperm or low sperm numbers, prop-
erly timed breedings can enable an otherwise infertile dog to produce
litters. Likewise, a bitch with a compromised reproductive tract might
not support sperm for a sustained period of time, so that early breedings
will not result in conception, but breedings during the fertile period will
be successful.
Normal Stud/Normal Bitch
Efficiency of reproduction is high so little assistance is necessary.
This is the only case in which vaginal cytology alone may be used 'as a
Table 2. INDICATIONS FOR OVULATION TIMING
Apparent bitch infertility
Abnormal estrous cycles
Split heats
Early or late ovulation
Silent heats
Nonovulatory cycles
Breeding with chilled or frozen semen
Breeding with a subfertil e stud dog
Breeding with a subfcrtil bi lch
Limited br d il1!\ a ( ' H ~
DiRinl' I'C'H I(t1 I ii<' h tl l1d / 1lI' 11 111 , 1
Al' linl'i ld 1111 1" llI lIlI il l'l ll wi lli 11I ' !I I I1 I' II II "1
~ : I il l ' I Ii Iif'. I tilt 111'11 1111 1111 ' I '1IIII fl,
1'" ,,1 1, li lli ', \ '111 ' 11 dllf', rI ,I I1 '
'" ' 111 ' 1 IliIl"III" I I'OII
general guideline; begin breeding when vaginal smears reach maximal
cornification, then breed every 3 days until diestrus is identified. Since
the stud is young and healthy, with good semen quality and normal
sperm numbers, and the bitch has a healthy reproductive tract that will
support sperm for several days, it is not necessary to breed more often
than every 3 days. Avoid breeding before full cornification is seen;
remember that the bitch's highest fertility is at the end of the cycle, and
an excessive number of early breedings will reduce the stud's sperm
count for the most fertile days.
Many clients will prefer to better identify the fertile period, whether
for reasons of convenience or to increase the chances of conception and
maximize litter size. Every other day progesterone testing can be used
to estimate the LH surge, with breeding initiated when progesterone
rises above baseline (usually greater than 2 ng/ mL). Usually two or
three breedings at 2- to 3-day intervals are performed.
Normal Stud/Bitch Who Will Not Allow Mating
The most common reason for a normal bitch to refuse to stand for
breeding is that attempts are being made either too early or too late in
her cycle. Ovulation timing techniques will identify this situation, and a
natural breeding will often be accomplished at the appropriate time.
There are, however, some bitches who will never show true estrous
behavior, whether for an individual stud or in general, and artificial
inseminations will need to be performed. Testing protocol and breeding
' chedules should be performed as above.
Disinterested Stud/Normal Bitch
The most common reason for a stud to show little or no interest in
breeding a particular bitch is that attempts are being made either too
l'ndy or too late. Some studs have poor libido in general and will never
br' 'd on thei r own; they can usually be trained to accept semen collec-
lion and br 'd by artificial insemination. Occasionally, a stud will show
d isin te rc l in an individ ual bitch alone, so that artificial insemination is
I't'q llir d. ' lb Lin )' .is recommended using every-other-day progesterone
I,, 'HA H, il l d il br cd ing schedule should be followed as above.
Bitch with n History of Apparent Infertility
' 1'1\1' 11 \111 I 1'\1 11111\ \ 111 1'( '1\11(\ 11 (01' l'Olh '(' pl io n f lilliI'l' i,' illli I"() p t' l' lill1ing
(I I 1II'(",d (1) ',1 MII I I Y 11111'111 111 lil li'lli' I II I I VI ' 11I 11' 1\ 111'(,d I II 11 0 1' ll ll ii ~ I I I " d ogM
II' " " I II III I)', III" I II , ,t! III , I 111 1 \I " Ii Ii ,." I I Y 1111 ' III ( '( ,Ii , ' 1, w III II I ii I I I (' 1111 I I)',
1' 11')', 11 11111 \' ' I 'lil ' I II 11 11)',1' 11111 \' I",,, 1111111111'" \ 1111 " \'1'1 \' '1 11 11 ' 1 li l l \, 1"(1) '," I
II IIlIl, I, 1111 1', 111111 1111'10111 II 1'II .d III . dlll \ I '
232 GOODMAN
Bitch with True Infertility
Bitches that have not conceived after breedings to a fertile stud
timed based on progesterone testing warrant further infertility investiga-
tion. This should include documentation of the LH surge and accurate
identification of the fertile period. In some bitches, there may be a
significant "mismatch" between the LH surge and expected progesterone
changes that can result in inappropriate breeding times based on proges-
terone assays alone. In addition, certain medical conditions will warrant
more accurate ovulation timing than provided with progesterone testing.
In bitches with uterine disease, for example, the uterine environment
may support sperm for only a short period of time. Therefore, accurate
identification of the fertile period with LH testing is recommended, with
breedings done during the true fertile period (days 4, 5, and 6 post-
LH surge).
Stud with Low Sperm Count but Normal Sperm Quality
Although the number of sperm necessary to impregnate a bitch has
not been identified, it is generally believed that a minimum number
exists, although this number is probably different for different breeds.
Since normal sperm live for several days, breeding several days in a
row will accumulate enough live sperm to reach this critical number.
Early breedings should be avoided since they will only decrease an
already compromised sperm count for the most fertile days. Accurate
ovulation timing with LH testing is recommended with breedings done
on days 4, 5 and 6 post LH surge.
Stud with Normal Sperm Count but Poor Semen
Quality
The number of sperm is adequate, but their reduced vigor indicates
decreased longevity. Therefore, early breedings prior to the true fertile
period are not likely to be successful. Accurate ovulation timing with
LH testing with breedings on days 4, 5, and 6 post LH surge should be
performed.
Stud with Low Sperm Numbers and Poor Semen
Quality
Accurate ovul ation l'iming willi 1.11 l v, (111 )', 11 111)11111 11( ' dUIII ' , wi lh
breedings p 'rfornl('d Oil do 1 ' I, 'I, dill! () I'ilil l 1.11 1111 1'1', 1' , Wil li" lid I 1)('
or 1(\14 1 ill)', Hil ol lld ,lid I II Ihl' I I 'I HI IIII IIII 11 11 11 1111 IIIV 1" ' 1111 1'1)1 1111 illd () w
'111.tlil y 11I 1I 111I I y, 11\1 ' 11\1 ' 11' 11 11 ' 11\ I lI l lh 1"lti dl ' lll ( .11,1 ,1\, . I t l lll i II I"dl l ll'd
, II Ii III I ' I Ii 11' 1 I I I \ .I " II ii , I I" " I " " I, 'I I
Breeding with Chilled Extended Semen
Chilled semen is usually somewhat compromised in terms of motil-
ity quality and longevity as compared with a fresh semen sample from
the same dog.
26
In most cases, the sperm will live for 2-3 days after
collection, with 1 day used for transport. Therefore, there is little room
for error when timing inseminations. As a result, accurate ovulation
timing with LH testing is suggested. Two inseminations are usually
recommended to cover the fertile period effectively, performed on days
4 and 6 post LH surge.
Breedi ng with Frozen Semen
Frozen semen, once thawed, lives an even shorter period of time
than chilled sperm12, 23, 26 (probably only a few hours) and so must be
inseminated only when the ovocytes are mature and ready for fertiliza-
lion. Accurate ovulation timing with LH testing should be done to
identify the true fertile period. Inseminations should be performed dur-
ing days 5 and/or 6 post LH surge, the period of highest fertility.
CONCLUSION
While the LH surge has long been accepted as the key event in the
l'strous cycle of the bitch, historically there has been no practical way to
identify it. In the past, the veterinary practitioner had to rely on general
,I nd/ or subjective information received from vaginal cytology, physical
I ' nminations, and observations. With the recent development of in-clinic
progesterone and LH assays, and the wider availability of laboratory
qu antitative progesterone assays, the LH surge can either be identified
directly or estimated by the detection of changes in progesterone. As a
rvs ult, ovulation time can now be predicted with high accuracy in a
private practice setting.
REFERENCES
I. Andvl'Sll ll 1< : Ar li fi ial minati on and storage of carune semen. In Morrow DA (ed):
( ' 111'1'(' 111 '1'11 (' 1'11(1 in '1'11 ri QI' n logy. Philadelphia, WB Saunders, 1980, pp 661-665
I, ( 'O')l '[IIII1() 1I PW: I)iolllg of gonndntrophin s r 't ion in adul t and prepubertal femal e
d" )" II, I 1{"p"(11 1 1i" I'l i l '17::1 7, 199:1
('1 1111 '1 11 111 1>11 I ' W: A I'('v i(' w 101' hl'I 'I'di I1f\ n I arlifi cinl insC' minati on with
,hl ll .. dl il I'<I",I'II III' II11 'II , I 'I'III ',' Ii'l'( ',II 1i 'II' M" I" S 111 (111l1 i II 111 1997: 1 17, 1997
t 'II II1 '1 1I1I111I1 I 'W: ('1111 III' 1' " 'I', III1I1" y ,, ",1 1" 11'111 1'1111111 , V, ' I ( ' 1111 N, " 'I" AI11 1(, :'1:;. 117B,
11/11(,
I, 1'11 11 111 111 11111 I 'W 1'11 \',1111 1111 '.1' II I " ' i ,,".1 II I 111111 /11111111 1' '1'1 (1' ,1) , 'i lll ll il AI,(' I"II 1\1 '1"I,dllo'
111111 1111,( 11111'111111 \ l 'I ,( llI dl ,II.\II ' 1 11'" S, 111'11\ 1\1 '1 1'111( " I'I ' 'I '/'I
II I 1'1 1' "11111111 I ' 11 ,111 11 ,1 IV 1\ 1,111\11' I I 111 1111',1'" III I II 1' " 11',1' 111'111 111 ' 1111,( 1I " li ,, '11 1I 1111
, III I,ll , .I \ 1111 I'" " 111 ,11 11 1 \ 1111, 111 1 ,dlll ll II lilt I dl> i l l ili d I', 1'1111 1 I 1,111 III \ 1'1
234 GOODMAN
7. Concannon PW, Hansel W, Visek WJ: The ovarian cycle of the bi.tch: Plasma estrogen,
LH and progesterone. Bioi Reprod 13:112-121, 1975
8. Concannon PW, McCann JP, Temple M: Biology and endocrinology of ovulation,
pregnancy and parturition in the dog. J Reprod Fertil 39 (suppl):3-25, 1989
9. Concannon PW, Whaley S, Lein D, et al: Canine gestation length: Variation related to
time of mating and fertile life of sperm. Am J Vet Res 44:1819- 1921, 1983
10. Doak RL, Hall A, Dale HE: Longevity of spermatazoa in the reproductive tract of the
bitch. J Reprod Fertil 13:51-58, 1967
11. Eckersall PD, Harvey MJA: The use of a bovine plasma progesterone ELISA kit to
measure progesterone in equine, ovine and canine plasmas. Vet Rec 120:5-8, 1987
12. Farstad W: Bitch fertility after natural mating and after artificial insemination with
fresh or frozen semen. J Small Anim Pract 25:561-565, 1984
13. Feldman EC, Nelson RW: Canine female reproduction. In Canine and Feline Endocri-
nology and Reproduction. Philadelphia, WB Saunders, 1987, pp 421-422.
14. Feldman EC, Nelson RW: Canine female reproduction. In Canine and Feline Endocri-
nology and Reproduction. Philadelphia, WB Saunders, 1987, p 423
15. Freshman JL: Clinical approach to infertility in the cycling bitch. Vet Clin North Am
21:427-435, 1991
16. Gunzel AR, Koivisto P, Fougner JA: Electrical resistance of vaginal secretion in the
bitch. Theriogenology 25:559-570, 1986
17. Hegstad RL, Johnston SD: Use of a rapid, qualitative ELISA technique to determine
serum progesterone concentrations in the bitch. Proc Soc Theriogenol 277-287, 1989
18. Holst PA, Phemister RD: Onset of diestrus in the Beagle bitch: Definition and signifi-
cance. J Vet Res 35:401-406, 1974
19. Jeffcoate IA, Lindsay FEF: Ovulation detection and timing of insemination based on
hormone concentrations, vaginal cytology and the endoscopic appearance of the vagina
in domestic bitches. J Reprod Fertil 39 (suppl):277- 287, 1989
20. Kemppainen RI, Thompson FN, Lorenz MD, et al: Effects of prednisone on thyrOid
and gonadal endocrine function in dogs. J Endocrinol 96:293-302, 1983
21. Linde C, Karlsson I: The correlation between the cytology of the vaginal smear and
the time of ovulation in the bitch. J Small Anim Pract 25:77-82, 1984
22. Linde-Forsberg C: Achieving canine pregnancy by using frozen or chilled extended
semen. Vet Clin North Am 21:467-485, 1991
23. Linde-Forsberg C, Forsberg M: Fertility in dogs in relation to semen quality and
the time and site of insemination with fresh and frozen semen. J Reprod Fertil
39(suppl):299- 310, 1989 .
24. Lindsay FEF: The normal endoscopic appearance of the caudal reproductive tract of
the cyclic and non-cyclic bitch: post-uterine endoscopy. J Small Anim Pract 24:1-
15, 1983
25. Lofstedt R, Richardson G, Gilbert R, etal: Examination of vaginal mucus in mammals.
Therio Handbook 1991.
26. Morton DB, Bruce SG: Semen evaluation, cryoperservation and factors relevant to the
use of frozen semen in dogs. J Reprod Fertil 39 (suppl):311-316, 1989
27. Nett TM, Akbar AM, Phemister RD, et al: Levels of luteinizing hormone, etradiol and
progesterone in serum during the estrous cycle and pregnancy in the beagle bitch.
Proc Soc Exp Bioi Med 148:134-139, 1975
28. Olson PN, Thrall MA, Wykes PM, et al: Vaginal cytology. Part I. A useful tool for
staging the canine estrous cycle. Compend Contin Educ Pract Vet 6:288- 297, 1984
29. Phemister RS, Holst PA, Spano JS, et al: Time of ovulation in the beagle bitch. Bi oi
Repro 8:74-82, 1973
30. Tsutsui T: Gamete physiology and timing of ovul ati on and fertili zation in dogs. J
Reprod Fertil 39 (suppl):269- 275, 1989
31. Wallace SS, Mahaffey MB, Mill er DM, t a l: "I IW' "", lI1L'I' of 111('
of dogs during the folli ul ar ["' I' nl ph"H('H of II ". ,,11""11" I'y,'I. " 1\ ," 1 VI' I 1{ I 'il
53:209- 215,1 992
32. Van li n, fl 'l'n II, ni"I i" ' '' '" 1:1, ()I. I " II " /I I " ,' I il l '1'1" 11 ,1 /,, 11 1, , 1111111 111', " I d"I'i' I' " IIII' I,"/ii i'
of hiliod 1" 'II )',I' liI, " ' "'' ' ' ",11 "11 1, "111111 V,' I Il", ",I, ' I 1, '(, 1' 1/111
'I:\, Wl ldl 1)1 (, ( '1", 1, " 1'",1 \' 1' 1 1'11 11 1" lVII, , 1 ,1\ p, 111 1111 1, 111 1' II I " ' I,,", Ii I, I( . 111 ,1,01 ,1, 11
serum luteinizing hormone and time of ovulation in the bitch. Bio Reprod 18:561-
570, 1978
34. Wright PI, Parry BW: Cytology of the canine reproductive system. Vet Clin North Am
19:862- 874, 1989
35. Yeager AE, Concannon PW: Association between the preovulatory LH surge and the
early ultrasonographic detection of pregnancy and fetal heart beats in beagle dogs.
Theriogenology 34:655-665, 1990
Melissa Goodman, DVM
Veterinary Referral Center
9 Coffman Street
Frazer, PA 19355
e-mail: Info@vetreferral.com
CLINICAL THERIOGENOLOGY 0195- 5616/01 $15.00 + .00
A LOGICAL APPROACH TO
INFERTILITY IN THE BITCH
Janice L. Cain, DVM
Most discussions of infertility in the bitch describe differential diag-
noses considering the classification of the estrous cycle as follows: (1)
normal estrous cycle, (2) abnormal estrous cycle (abnormal interestrous
interval, persistent anestrus, or prolonged estrus), and (3) failure to
breed.
2
,5, 10 The approach to infertility in the bitch presented here differs
by describing what diagnostic procedures are performed and what
lhought processes are considered at different phases of the estrous cycle,
Some breeders contact the veterinarian months in advance of the next
estrus, and a prebreeding consultation can be arranged, Other times, the
veterinarian is not consulted until the bitch is entering her peak fertile
period during estrus, For some bitches, the first indication of infertility
is apparent at the time of pregnancy diagnosis, The goal of this article
is to help the veterinarian approach the problem of infertility in the
hi tch by describing what steps are taken at different stages of the
l's trous cycle. After initial presentation, the bitch is evaluated through
subsequent phases of her estrous cycle to optimally manage her fertility.
Regardless of which estrous cycle phase the bitch is in at presenta-
t ion, a thorough medical and reproductive history is obtained and a
complete physical examination is performed. A detailed medical history
\' i1 n help to any reveal medical illness that might be an underlying cause
of infertility. Important reproductive history information to consider
in ' Iudes e trous cycle data such as age at puberty, interestrous interval,
,l ppl'oximate length of proestrus and estrus, and whether the bitch
I I ti nil y has signs of p udo yesis. Additionally, for any bitch in which
bl' Vl'ding h. s b 'en att mpt 'd, inf rmati on hould be obtained on (1)
V I I I ' I ' I ~ I I ' 1IIIj ll ' I I II ' tJl II ' III .\t\ III " 1I \ ',t\ I \ 11 \tj l t\ 1 11 ' 1'\1 III I
I I I I I ~ I I \I I , I I ~ I I \ I I " ~ I I 11 '11111 'I
238 CAIN
fertility of stud dog(s) used, (2) prior breeding management and ovula-
tion timing (OT), (3) details of individual breedings (i.e., natural or
artificial insemination [AI], shipment of the bitch), and (4) diagnostic
method used to detect pregnancy (i.e., ultrasonography, palpation, radi-
ography).
A general physical examination is essential before breeding. Bitches
with an ongoing significant illness may not be suitable candidates for
breeding. The breeding examination also includes digital vaginal palpa-
tion and vaginoscopy. Vaginoscopy is performed on nonsedated bitches
with a rigid pediatric sigmoidoscope. Vaginoscopy can be performed
adequately with an otoscope only in bitches weighing less than 5 kg.
Vaginal palpation and vaginoscopy can detect vulvar and vaginovestibu-
lar junctional strictures or septa, which can interfere with natural breed-
ing or whelping. IS. 18 Strictures are annular rings of tissue, and septa
attached in a dorsal-to-ventral plane can range from thin friable bands
of 1 mm in length to a nearly complete wall dividing the vaginal
canal. Confirmation of a significant annular strictur,e of the vulva or
vaginovestibular junction is made by subsequent examination during
the next estrus; hormonal influences of estrus allow many of these
narrowed areas to "relax." If a vaginal septum is found, surgical correc-
tion is best attempted during anestrus.
PRESENTATION DURING ANESTRUS
It is ideal to have a bitch in anestrus presented for a prebreeding
examination. This allows time for a thorough evaluation of previous
breeding attempts, and the breeder can be advised of the best breeding
plan for the next estrus. There is also time to have the potential stud
dog evaluated, and genetic screening tests can be perfonned.
History and Physical Examination
These procedures can be 'performed optimally during anestrus. If
the bitch has been unable to breed because of a vaginal anomaly, anes-
trus is the time during which to consider surgical correction. For the
bitch with persistent anestrus, underlying medical illness is considered.
Primary anestrus is suspected in a bitch over 2 years of age that has
failed to exhibit a pubertal estrus. For this situation, karyotypi ng to rul
out an intersex condition is advised.
13
Some normal f rt il b it heR an
have irregular and infrequent estrou y I ' So Be c lI SC 1'1, I' ~ ii-! no sn Fe
and reliable method to indu (, HITII H in n hil e\) will ) P" I\ L 11'(1 111 1)( ' Ii'lL ,
there is no spe ifi thcr" p In rl'(' 0I1 111 11' 11(1. II In illIPI)1' 11I 111 II) d l ' lt- l'lllill l '
whether the bitch cOllid Ill ' h,l III)', "/ 111'111 1II ' I il il /I 1111 11: 11)', 111I ' l li lt' h wi lli
Ol'lw r do)'" I w l j 1 ~ II I dl IIIII II III ' 1 1'11111 1 I 1111 1111 1111', wl ll ll )11I I II I I\oVI II'I I
rli )" III I. 1\ 1I1I1 11 1I ,lIl y, \'1 11',lI lI il l \' lldlll'" 11 111 1 hl l 11111 11(11)', l' il li' I'II!I! ' 1IIIII 'I"I' iI
11)11 1'1 111 I,, 11111' 11.1 11'/', 111 ,, 1 I" III '/ ,' 1" 11 111 111
1
I I' 11 11 111 1," lit II, 1/ III
INFERTILITY IN THE BITCH 239
curring. If persistent anestrus is confirmed, possible ovarian disease
should be evaluated by abdominal ultrasonography and possibly an
exploratory laparotomy.
Genetic Screening and Population Management
Anestrus is the ideal phase of the estrous cycle during which to
perform genetic screening tests pertinent to the particular breed. Also, if
a "pet quality" bitch is presented for a prebreeding examination, the
veterinarian can advise the client of the pet overpopulation disaster in
I he United States.
Laboratory Evaluation
A minimal database (complete blood cell count, serum biochemistry
profile, and urinalysis) is suggested for any bitch before breeding. Breed-
i ng is not recommended for any bitch with significant medical problems.
/\. screening test for Brucella canis is also obtained.
Abdominal Ultrasonography
Examination of the ovaries and uterus can be performed.1
9
This
I' valuation is strongly recommended in bitches with an abnormal inter-
('strous interval 4.5 months or >10 months), persistent proestrus or
,'strus lasting longer than 23 days, a clinical history of abnormal vulvar
discharges, or fetal resorption. Abnormalities, including ovarian cysts,
Ill' oplasia, and uterine disease, can be identified. Normal structures are
(J ft n not identifiable during anestrus.
Planning the Breeding
Advice is given regarding stud dog selection and whether natural
hI" '(.'d ing or an assisted reproductive procedure is recommended. It is
Illl portant to bre d aU bitches with questionable fertility to a known
Ivrlilc stud log that ha had a recent semen evaluation. If any question
o( 11 1nlc ferti lily xis ts, <'moth r tud do i recommended.
()VIII IlI 11 TImIng
( )' I' I: l'I " 'I) IIII) II ' II ;lI 'd I I I ,ill /l 1'(lI ' ti ill ),I . l\i 'i ' (I I' il i ' ( )'I ' ,'I II ) "Hlil)) il l'
1111 ' ti l l Y II I 111 1' 11I '1'( )VII Lil lli Ilill ' II '1, 1/1 1', 111 11 '11\( 1111' (1.11 ) Pl'ltI , whit 'li iH
ti" /I )', II,dl'" 11 11 ti ll , II '1' 111 ' I"t'," II )', " " II' iI" I II 'Ildll t ill 1111 ' 11I 1"'illl l', plllli
I I il l ' 1" 11,, ," / 11 1111 \1 (/11' 1' 1' 111" ' 1 I ' ll II li t! 111111 1' /111 11 111 11' 111111 111 11/ 1111 1
llil t 1' 1' )
240 CAIN
Shipping the Bitch for Breeding
It is not unusual for owners to "ship" their bitch to be bred via the
airlines. This is often stressful for the bitch and can interrupt her proes-
trus or estrus. If a bitch has been bred and apparently failed to conceive
in the past, it is not recommended to ship her for subsequent breedings.
The owners should also avoid boarding the bitch at the stud dog's
kennel if she is stressed by being away from her home environment,
even if she is driven rather than shipped to the location.
Natural Breeding
Natural breeding of the bitch to a known fertile male remains the
best chance for fertility. Breedings are planned for days 2, 4, and 6 after
the LH peak (which is assigned day 0). If the pair cannot complete t?e
breeding event and achieve a successful "inside" tie, fresh semen artIfl-
cial insemination (AI) is recommended.
Fresh Semen Artificial Insemination
If natural breeding does not occur by day 3 after the LH peak, AI
is recommended to ensure delivery of semen to the cranial vagina. When
performed correctly, fresh semen AI has conception rates comparable to
those of natural breeding. Semen is collected from the male dog, evalu-
ated briefly, and immediately inseminated into the bitch.
16
This allows
examination of semen at the time of breeding, which is helpful if any
question of male fertility exists .. If semen optimal quality, the
addition of a semen extender can Improve motilIty (Fresh Express semen
extender; Synbiotics Corporation, San Diego, CA). Ideally, improve
the chance of fertility, an alternative male dog that can provIde normal
semen is selected.
Chilled-Extended or Frozen Semen Artificial Insemination
If a bitch has a history of questionable fertility and does not seem
to conceive, the use of chilled-extended or frozen semen is not recom-
mended. Breeders often choose this breeding method because of stud
dog selection even though they realize that chance. of conception is
decreased. Conversely, if a bitch has been shipped prevlOus.ly for
ing and has failed to conceive, keeping her .at home and tmg
with chilled-extended semen can be a smtable alternatIve. hlll d-
extended inseminations are typicall y performed 0 1 days 4 and t1 after
the LH peak, and frozen sem 11 is ins min, I'l' d on 1<1 t' 5 (l nt! ) .
Intraut rin In 1/1/11 tile /I
' 1II I IYP Il I 1 11 11 ' II ' 1\' 1 11 111 1 , 11' )1\ "1 11' 111, ' 111111 111' 111" 1111,1111 111 11,11111 ' 1 II, '
II I ''! II II1o'' ,III ( 1111) I I " 11 111 11\1 111 1)11, 11
1
\111 11111"11111 ' .) \ 111'11 III II I',
chilled-extended semen on apparently infertile bitches and when using
frozen semen. Breeding by lUI is also recommended when using fresh
s men for a bitch with no explainable cause of infertility when other
breeding methods have failed. Two methods are available for lUI in the
bitch: laparotomy and transcervical insemination. (For details on the
Hurgical method of lUI, the reader is referred to the overview of canine
reproduction in this issue. For a discussion of transcervical insemination,
the reader is referred to other articles in this issue.)
PRESENTATION DURING PROESTRUS OR ESTRUS
Initial Evaluation
Often, the bitch is already in proestrus at the time of initial evalua-
I ion. This typically removes the veterinarian from the decision-making
process of planning the breeding; there is generally not enough time to
:dter the breeder's own plan. Hopefully, the appropriate genetic screen-
II1g tests have been completed before this presentation; if not, it is
prudent to advise the owner to wait and breed the bitch at a subse-
q uent estrus.
At this time, procedures similar to those performed in the bitch
pr sented in anestrus include obtaining a complete medical and repro-
ductive history; complete physical examination, including digital vaginal
pa lpation and vaginoscopy; minimal database; and B. canis screen. Ex-
.lInination of the vaginal canal by vaginoscopy at this phase of the
('sl rous cycle is obscured by vaginal edema but can rule out significant
olhnormalities, and examination of the vaginal mucosa aids OT.12
Ovulation Timing
l3reeding management error is the most common, and correctable,
1 'il LI se of infertility in the bitch. The life span of sperm after
IlollLlral br dmg can be up to 6 days.4 This is not depended on, however,
wh n managing a bitch for optimal fertility. To ensure the highest
1'011 'pti on rate, the bi tch should be bred when mature ova are available
lilI' fer ti liza ti on, whi. hi referred to as the fertile period. The fertile period
I. dC'l' rmin 'd by T.
l:Jr ding Managomont Assistance
1\ 11 , 111. 1' 1' ('\ II'(' IlH' l y 1' 1' II I' I, d 1111 1\' In l' i ll vol vvlll( ' lIl of Il w V(I II'ri n Irinn
/ 11111 Ii 11', Ih, ' I II 'Pll d iI II', Tit /1 I (111\,1 ,1111 II litl' 111 11111 11 111 11 WIIl ' I'I' /\ 1 (Ii'
11111 )/11 '1' 1\, , ' 111 Ii 1111' 111 Il il lhil l 1/1 111' 11 111 11 11 ' 11, ) 11 11 i l I , il l II 11'1 1111111 111 11 11 I II\'
\' 1' 1, ' "1\ 111111 11 III II VI' I I"" 1) 1, ' ) 11"1
1
.1 111 )', 1" 11 11 III 1II IIIII , d 11 1.1 1 " I', 1\ 1 11 11 '
11111 11" 1' 111 111 11 111 11 , 1111
1
1',11 11 1', I " 1 1111 11 \1' 11\1111 ' 1 I 111 1111 , 11,11 11111'111 11 1 I II! '
242 CAIN
bitch far pregnancy diagnasis via ultrasanagraphy approximately 21 ta
25 days after breeding.
PRESENTATION DURING DIESTRUS
Initial Evaluation
If the initial examinatian is during the bitch's diestrus phase, it is
advised ta evaluate far pregnancy by ultrasanagraphy. Owners wha
suspect that their bitch is nat pregnant and realize that they need help
.often request ultrasanagraphy. Pregnancy diagnasis and manitaring are
alsa advised in the seemingly pregnant bitch ta evaluate far fetal demise
and ta ensure that the pregnancy pragresses narmally. A minimal data-
base is .obtained, and breeding management is evaluated retraspectively
far the nanpregnant bitch.
Pregnancy Diagnosis
Early pregnancy detectian with ultrasanagraphy is impartant? An
indicatian .of litter size and fetal well-being can be determined. Ultrasa-
nagraphy is the .only methad by which ta accurately dacument fetal
resarptian. If the bitch is pregnant and has a histary .of fetal resarptian,
ultrasanagraphy can be repeated every 1 ta 3 weeks thraughaut gesta-
tian. If the bitch is nat pregnant, ultrasanagraphy is impartant ta help
diagnase uterine and .ovarian disease as a cause. Beyand.50 days .of
gestatian, radiagraphy is helpful ta caunt fetal ThIS
is nat entirely accurate but can give a reasanable estlmatlan .of htter Size.
Radiagraphs .obtained after day 55 .of gestatian can be more'accurate far
caunting. Knawing the expected size .of the litter can aid in m.anageI?-ent
of whelping and thereby decrease neanatallass. Pregnancy dIagnasis by
palpatian alane is nat recammended to manage the bitch far .optimal
fertility. It is impassible to detect fetal demise in mast cases when
pregnancy diagnasis relies an palpatian.
Fetal Resorption and Spontaneous Abortion
Diagnosing the cause .of fetal resorptian and abartian is the Ina t
difficult challenge in evaluating a bitch for infertility. Cause af.f tal
resarptian and abartian include uterine diseas ; ath r "mat rnnl fa tors"
such as underlying illness, stress, trauma, or toxin eXI OSlIr('; f ' L< I <1110 111 (l -
lies; infectious diseas (i . . , B, en /liR, nnill\' IlV"l1L' I-lV i I'll , \<' 1 IV\); il llll , IL ,'< '
cOlnmon1.y, lut -,d inRlIffi ci('l1l' , wlddl 1'1111/11' / 11) llIllI'lII IIl I' IlI'O)',('/1 ("I'U
I
)i'
S rction.'" I\, I,' S('l'olo)',h' 1' '1 .11111 \111 111 111111 11111 11111 111' 1(1 /I 1'l/l/ i:1 11\11 ( ' II V
i 1'l'I 'OIIlIIlI 'l ldI 1d, 1111.1 vii II III Iil l1l11111 1111 ( ' II V 111 1111 II ' '' )', III1t1 I IY II II 111 11
II. ' '11I1 ' IIIIII I.d }', II " "I".! \ .tI 11 II" , ' 1III dl" , I}',I III I 111 11 III ' ' lil lIl lllll '"
for bacterial culture, althaugh it is difficult to determine pathogens from
narmal flara,u Fartunately, bitches that experience lass .of the entire litter
during gestatian can have a successful pregnancy with the next attempt
even when the cause .of fetal lass is nat determined.
Progesterone Measurement
Serum progesterone cancentration can be assessed during nanpreg-
nant diestrus ta determine if luteal functian is adequate and ta canfirm
that avulatian has accurred.
3
The detectian .of functianal carp .ora lutea
does nat prove that narmal ova were physically .ovulated, hawever. It is
possible that if fetal resorptian is detected and a law serum progesterone
concentratian is faund (i.e., < 2 ng/mL), the low progesterone secretion
did nat cause the fetal loss. It is often difficult to determine which came
first, the low progesterone or the fetal compromise. If a low progesterone
' oncentratian is detected at diestrus and fetal viability is confirmed,
lreatment with progesterone in ail injected intramuscularly (3 mg/kg)
can be attempted to maintain serum pragesterone secretians above 5
ng/mLY Same bitches require daily administratian, although .others
I' 'quire treatment every 2 to 3 days. There is concern that inappropriate
administration .of progesterone during pregnancy can induce fetal devel-
opmental abnormalities; as a result, progesterone supplementatian is not
recammended unless it is dacumented ta be necessary.
If the bitch has a low serum progesterone cancentration within
S 'veral weeks of breeding, .ovulation failure can be the cause. The bitch
hn preovulatory luteinization of follicles, which causes progesterone
/'l 'cretian in advance of .ovulation. Measuring progesterone production
l i S done during OT can detect this. If the progesterone is then measured
dgain several weeks later at the time .of pregnancy diagnosis and is at
Iwsal levels (i.e., <2 ng/mL), ovulatary failure is suspected. The bitch
('; 111 be experiencing a "split-heat" and may re-enter proestrus or estrus
/'l oon, when ovulation can .occur. This is not uncammon in young puber-
1.11 bitches. Careful monitoring with serum progesterone concentrations
hdore and after breeding can be helpful to detect ovulatory failure.
'1'1' 'atment is difficult. The administration of human chorianic gonadatro-
pi n (1000 JU daily intramuscularly [IM] for 2 days) or ganadotropin-
I'd 'I) ' i n h nnone (50 f.Lg 1M) can be considered.! Success rates using
('i lher produ t to treat ovulatary failure have nat been reported. Addi-
lipn; II I innpi ropriat ad illini tration of human chorionic gonadotropin
I II' gOll fldoll'tl 1 in-rclc:1 si ng hormone an aLi e avula tory failure.
Pr( flll IiIcy M mug ill nt nlld WI) Ip nq A IstAnco
I''' '/', III II II '\' I ') 11 III ' 111 111111 111. ,,, , .1 1111111111111111111111 I, ),, 1\' 1'11 III 1111 ' 11 WII I' I'
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1
li t', II' " " 1111 '1 ,iI " ,lIld
244 CAIN
health of the bitch as well as to offer advice for whelping management.
Monitoring of the periparturient bitch is recommended via the
Whelpwise system (Veterinary Perinatal Specialties, Wheat Ridge, CO).
An elective cesarean section can be planned if advised because of the
breed or previous history of the bitch. The expected whelping date is 65
days ( 1 day) after the preovulatory LH surge as determined by OT,3
and an elective cesarean section can be planned for 1 day earlier than
the whelping date. Also, if the Whelpwise system is used, the onset of
labor can be determined, and a cesarean section can be performed at
that time. Either of these methods is far superior to monitoring rectal
temperature or counting days from breeding dates.
Future Plans
The first step is to analyze the previous breeding attempt and
look for possible errors. Were the appropriate prebreeding evaluations
performed? Was underlying disease missed? Was OT performed prop-
erly? Did the bitch have a normal estrous cycle? Was the bitch bred
naturally to a known fertile stud dog? Was the bitch examined with
ultrasonography during early diestrus to diagnose pregnancy? Were
appropriate measures taken to ensure that neonatal loss did not occur
in the periparturient period? If the answer to any of these questions is
no, the entire process can be repeated for another estrous cycle. Also, a
different male dog can be used for a subsequent breeding. If either
chilled-extended or frozen semen was used, the bitch should be bred
naturally to a proven fertile stud dog at the next estrus. Also, IUI with
fresh semen should be considered.
When it seems as though everything was done correctly and the
bitch apparently failed to conceive or repeatedly loses the litter during
gestation, an additional diagnostic evaluation can be considered. During
anestrus, uterine biopsies and cultures of the uterine lumen can be
obtained via laparotomy or transcervical catheterization. This evaluation
can diagnose cystic endometrial hyperplasia or low-grade chronic metri-
tis.
9
Persistent degenerative changes to the endometrium are not likely
reversible.
As is the case with other species, some bitches remain infertile
despite an aggressive logical approach to fertility management. Fortu-
nately, many seemingly infertile bitches can be managed; the v terinar-
ian can either find an underlying cause why the bitch houid not b
,bred or affect a change with a positive outcome.
SUMMARY
Thi :-l npprOill 'il In 11!t ' I'llIli y II IIII' 11 11'1\ ti l' h' l 111'1 wh,\l " 11)', 1\1111 11, '
Ill('lilodl 1111'1'1'111 1' 111 111\ . 1 WII . tllllllll )', IIIIIIIII 'I'II " 1 11111 11\ ' ,11 ' 1 11 1 , 111"\"111
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References
1. Cain JL: The use and misuse of reproductive hormones in canine reproduction. In
Bonagura JD (ed): Kirk's Current Veterinary Therapy XII. Small Animal Practice.
Philadelphia, WB Saunders, 1995, p 1069
2. Cain JL, Davidson AP, Wallace MS, et al: Disorders of canine reproduction. In Morgan
RV (ed): Handbook of Small Animal Practice, ed 3. Philadelphia, WB Saunders, 1997,
p 627
3. Concannon PW: Clinical and endocrine correlates of canine ovarian cycles and preg-
nancy. In Kirk RW (ed): Current Veterinary Therapy IX. Small Animal Practice. Phila-
delphia, WB Saunders, 1986, p 1214
4. Concannon PW, Whaley S, Lein D, et al: Canine gestation length: Variation related to
time of mating and fertile life of sperm. Am J Vet Res 44:1819, 1983
5. Feldman EC, Nelson RW: Canine and Feline Endocrinology and Reproduction, ed 2,
Philadelphia, WB Saunders, 1996
6, Freshman JL: Current therapeutic recommendations for pregnant dogs. In Bonagura
JD (ed): Kirk's Current Veterinary Therapy XIII. Small Animal Practice. Philadelphia,
WB Saunders, 2000, p 931
7. Gradil CM, Yeager AE, Concannon PW: Pregnancy diagnosis in the bitch. In Bonagura
JD (ed): Kirk's Current Veterinary Therapy XIII. Small Animal Practice. Philadelphia,
WB Saunders, 2000, p 918
8. Hashimoto A, Hirai K: Canine herpesvirus infection. In Morrow DA (ed): Current
Therapy in Theriogenology, ed 2. Philadelphia, WB Saunders, 1986, p 516
9. Johnson CA: Cystic endometrial hyperplasia, pyometra, and infertility. In Ettinger SW,
Feldman EC (eds): Textbook of Veterinary Internal Medicine, ed 4. Philadelphia, WB
10, Johnston SD: Infertility in the bitch. In Kirk RW, Bonagura JD (eds): Kirk's Current
Veterinary Therapy XI. Small Animal Practice. Philadelphia, WB Saunders, 1992, p954
1'1. Linde-Forsberg A, Bolske G: Canine genital mycoplasmas and ureaplasmas, In Bona-
gura JD (ed): Kirk's Current Veterinary Therapy XII. Small Animal Practice. Philadel-
phia, WB Saunders, 1995, p 1090
12. Lindsay FEF: Postuterine endoscopy in the bitch. In Tams TR (ed): Small Animal
Endoscopy. St Louis, CV Mosby, 1990, P 327
13. Meyers-Wallen VN: CVT update: Inherited disorders of the reproductive tract in dogs
and cats. In Bonagura JD (ed): Kirk's Current Veterinary Therapy XIII. Small Animal
Practice. Philadelphia, WB Saunders, 2000, p 904
14, Purswell BT: Differential diagnosis of canine abortion. In Kirk RW, Bonagura JD
(eds): Kirk's Current Veterinary Therapy XI. Small Animal Practice. Philadelphia, WB
Smmders, 1992, p 925
. Root MV, Johnston SD, Johnston GR: Vaginal septa in dogs: 15 cases (1983-1992).
JAVMA 206:56, 1995
16. Root Kustritz MV, Johnston SD: Artificial insemination in the bitch. In Bonagura JD
(ed): KiJ:k' s Current Veterinary Therapy XIII. Small Animal Practice. Philadelphia, WB
aunders, 2000, p 916
17. S ott-Moncri eff JC, Nelson RW, Bill RL, et al: Serum disposition of exogenous proges-
,. ronc aft cr intramuscular adm.inistration in bitches. Am J Vet Res 51:893, 199
I fl. Wyk s PM, od rberg SF: ongenital abnormalities of the canine vagina and vulva. J
Am Ani", Il osp Asso J9:995,1983
II) , YCllg<' " AI\, 'on onnon PW: Ultrasonography of the reproductive tract of the female
dn!) I1 ll d Cil i. III Ih'n(lgrrra )1 (eu): Kirk's l ilT nt V teri nary Th rapy XII, Small Animal
I" ',II' I!,'" . 1'IIII II dl'lplrl.l , WII ,'ll rr"li l' rN, 199'i, p I O ~ ( )
!itltl/'/':I:: /'('/ll'i lll 1'('(1"(', Is 10
IlI lI k,' I" n d'l, I)vM
II llil llI l' I{"", " V,' I,'" 'lol' Y ( '",1 1, ' 1'
'1 IIIIl 111 ,11 " 'I' II, V"
'11 " 1 1" 11 """ I /I "1',11 \
CLINICAL THERIOGENOLOGY 0195-5616/01 $15.00 + .00
DISORDERS OF THE
CANINE PENIS
Margaret V. Root Kustritz, DVM, PhD
NORMAL ANATOMY AND PHYSIOLOGY OF THE
CANINE PENIS
The canine penis is made up of the root, body, and glans (Fig. 1).
The root, or crura penis, is composed of the corpus cavernosum, covered
by a thick tunica albuginea, and the ischiocavernosus muscle. It is
adhered to the ischial arch between the ischial tuberosities.1
6
The body,
or corpus penis, is made up of two separate erectile bodies separated by
a connective tissue septum. The urethra lies ventrally within the body
of the penis, enwrapped by the corpus spongiosum; the two sides of the
penile body fuse at the base of the os penis.
16
The glans of the penis is
made up of the bulbus glandis, a globoid or barrel-shaped expansion of
the corpus spongiosum, and the pars longa glandis, which contains the
os penis overlying the penile urethra. 16, 40 The major vessels supplying
l"il.e penis are the internal pudendal and perineal arteries, and venous
return is by the internal and external pudendal veins and the dorsal
v 'in of the penis. Parasympathetic innervation, via the pelvic nerve, and
:-;Yl1l.pathetic innervation, via the hypogastric nerve, are present,
Erection of the penis is mediated by the pelvic nerve and primarily
nrfects the glans penis.
lo
Parasympathetic stimulation causes relaxation
of month muscle fibers in the corpus cavernosum, with subsequent
\ I . r ased intracavernosal resistance, Arterial flow is increased as a result
or ompr sion of the root of the penis and bulbus glandis by the
i. ' d io a v rn su and bulbospongiosus muscles, respectively. Erection is
('(lInpl ,t cI by 0 lusion of v nou outflow by obstruction of the venous
PII IIlI 1111 ' 11\' I'III'I'II('1i1 Il( ,' 111,.1 1 AIl IIIIIII \{I 'I"'(,,hH'i lol1,
VI ,Ii " 111 ,1, \' Mlld ll ' llll' , HI. 1'11111 , Ml lllh'tlll ill
I' I III JII 'I I II III -\1\ 11 I ' ll ',1\ 1'\1 1 1' 1' ( Iii I ,
I I 11 '1111 1
, 1'/
248 ROOT KUSTRITZ
,
"
A
Bulbospong;osus m.
" Bul b of penis
" Urethra
r Retractor penis m.
I Corpus spongiosum penis
I Corpus cavernosum penis
" I Bulbus glandis
I I lPrepuce
, f
I I : Pars longa gland;s
: , Os penis
I Fibrocartilaginous end
, of os penis
E
Figure 1. Parasagittal section of the canine penis. (From Christensen GC: Angioarchitecture
of the canine penis and its role in the process of erection. PhD Thesis, Cornell University,
Ithaca, NY, 1953: with permission.) .
lumen at the tunica albuginea and compression by the ischiocavernosus
muscle.lO, 42, 63 The pars longa glandis doubles in diameter and elongates.
The bulbus glandis doubles in thickness and triples in width when
erection is complete.
20
Detumescence of the penis is mediated by the
hypogastric nerve, which increases arterial resistance, causing a decrease
in corpus cavernosal pressure.
10
Smooth muscle contraction in sinusoidal
walls of the corpus cavernosum permits venous outflow.63
Ejaculation of semen through the penile urethra is mediated by the
sympathetic nervous system. Stimulation of the hypogastric nerve causes
emission, movement of spermatozoa and seminal fluid into the prostatic
urethra, and closure of the neck of the urinary bladder.3, 19, 62 Rhythmic
propulSion of semen through the penile urethra is facilitated by contrac-
tion of the bulbocavernosus and ischiocavernosus muscles, which are
innervated by the somatic pudendal nerve.
62
FUNCTIONAL ABNORMALITIES OF THE CANINE
PENIS
Erection Failure
Erection failure in dogs may be the r u lt of b hnv iora l or rhysi al
causes. Intact male dog that onsist ' ntl hflw hl'\' 11 for
mounting behavior ar unlil c' l In Wi llil1) ily 11('1' 1\ 11'111 Ihh I H 11' 11 11\ I \l1'(1('d
ing b havior on COlIl ll) lIl1d . i' 1\\ il l' li ll i',1 II) .IY i h
l
tlll W 11 11'1', III
den n\1l-;! I'I III ' 111 11'11 11 11 I lI " 'I ,ti iI I)', /11 ,1111 ,, \11 1 111111 ' 1' 11 " 1'1111 ' III I I 11 111i, ' dp)', Ill '
1111111 11 11 i ll ' It ,)" Il lI' v 1'1' 11 '1' \ " 1111,, ' , llI llIll lI llilllI 11111 11111 ,1111 '1 111 " 1" I'Ii "'"
DISORDERS OF THE CANINE PENIS 249
,1 bitch they to be dominant. Finally, unwillingness to breed
Inay seen If a has been aggressive toward the male dog, as may
() cur If dogs are mtroduced too early in the bitch's season .
causes of erection failure in dogs include pain and andro-
Pain at. the time of mounting and thrusting caused by
or. may prevent n?rmal erection in male dogs.
I I dIsease .orchitIs may cause pam at the time of ejaculation;
(togs WIth chrome dIsease become unwilling to breed after repeated
pCl inful episodes.
Androgen insufficiency is an uncommon cause of erection failure in
dogs. The author has never demonstrated decreased serum testosterone
concentrations in dogs with abnormal breeding behavior. Normal intact
l11ale dogs may have nondetectable concentrations of testosterone in
Hc rum; challenge testing is (gonadotropin-releasing hor-
mone [GnRH]; 2 /-Lg/kg admmistered mtramuscularly, with a blood
f; <l mple drawn 1 hour later). Normal intact male dogs have a serum
ll'st?sterone concentration of greater than 3 ng/mL 1 hour after adminis-
I rA tIOn of reports exist of castrated male dogs being
l\ lpable.of achlevmg erection and a copulatory lock with estrous bitches,
that serum androgen concentrations may not be
Il c.cessary for erection. and to occur in all cases. Male dogs
lI 1<lY have androgen msuffiClency secondary to testicular atrophy, in-
I('rsex states, or hypopituitarism.
of the cause of erection failure requires observation of
?r by manual ejaculation. If the dog seems
III be m pam, of the pain response is indicated. If the dog
,toes not seem to be m pam, semen collection in a comfortable environ-
ment and in the presence of an estrous bitch is recommended.
Ejaculation Failure
Ejaculation failure in dogs, also called anejaculation or aspermia,
l11ay be caus.ed by .lack of sexual maturity, pain, psychologic factors, or
!"l liro rade eJaculatIOn. Young male dogs that have not reached sexual
lIla lurity may not ejaculate even if capable of normal erection of the
jl(' I1I S. l11all -bre d dogs generally reach sexual maturity earlier than
I.ll'g '- or giant-br d dogs.
Pilin., .'sP.' iall y. that call d by contraction of an infected prostate,
1I 1l ! Inhlb ll' (' 1<1 ill ation. III th dog.',o.
65
Joint or spinal pain may prevent
1I 1" ll' dog,' from l11 ountll1g 's lrOli S bit he and howin normal thrusting
'"Id (' j'II 'lil ll lio" ,
1,1 1(' 1 of ('I I(' lIl l1 lioll ill I I liI,ll ,' dll)) Ih:1I is willing Lo mount a bit h
",11''11 II IIII' I'" " ill (II II 1,11 '1 ,II ,IP\l I'\l I' I"I.II,' 1',' cil nillgil ' Hlinilil li lion.
I" l'I ' dl 'II""" 1IIId dll)',1 Ill II y 11 11111 (' III "101"1 11 111" II) IIII' ,il l/ II ' III '(' of ,Ill
' ''111 11 11 1\ 1" ' 111 ' 1, 111 11 1 II I" III' 01 ' II I" " IIl ldl' dll )', 11 111'1 11' 11111 ' I"" 11 '1,, '1' II i' .1'1
1"1\ ' 1'"1 llil i ll ,II 111 '1 " 1"IIII ,d 11I1 ".dlll i', I 1111 ' "III,'ll tl ll ll 111 11\ "I'" Id,lIl '
11111'"11"1' 1, 1 111" ,\ 11 11 ' ' 11'1," 111 ' 11 11 111 ' 11 1111 1' 1III II IIIIIIIII ' III ,tll" 111\ 11/ ,, 11
T
250 ROOT KUSTRITZ
may cause incomplete ejaculation include too much activity or too many
people in the room, presence of an owner that the dog views as domi-
nant, absence of the owner with a dog that is used to breeding with the
owner's assistance, fear of the veterinary environment, and wearing of
white laboratory coats. If a negative environmental stimulus is present,
the situation in which semen collection is attempted should be changed,
and the circumstances in which semen collection is successful should be
recorded in the dog's chart for future reference. In dogs with incomplete
ejaculation that do not respond to a change in environment, ejaculation
may be effected by treatment with GnRH (1- 2 J.Lg/ kg administered
subcutaneously 2-3 hours once before attempting collection or once
weekly for a month before collection or attempted breeding).51 GnRH
causes synthesis and release of endogenous luteinizing hormone, with
subsequent release of testosterone. This method should not be used
routinely in valuable stud dogs; frequent artificially enhanced serum
testosterone concentrations may exert negative feedback on the pituitary,
which may cause an eventual decline in serum testosterone concentra-
tions and decreased spermatogenesis.
Retrograde ejaculation is flow of semen into the urinary bladder,
with a significantly decreased semen volume and total number of sper-
matozoa in the antegrade ejaculate. Retrograde ejaculation has been
reported to occur in the dog, but the cause of this condition has not
been defined.
47
, 52 Diagnosis requires collection of a urine sample by
cystocentesis after semen collection and comparison of the number of
spermatozoa in the antegrade ejaculate and urine sediment. Similarly,
urine can be collected by cystocentesis before and after semen collection,
with the number of spermatozoa in the urine sediment compared be-
tween the two samples. Normal intact male dogs have a few spermato-
zoa in the urine sediment; dogs with retrograde ejaculation have many
spermatozoa in the urine sediment. Treatment with sympathomimetic
drugs may effect antegrade ejaculation. Possible therapies include phe-
nylpropanolamine (3 mg/kg twice daily per os) or pseudoephedrine
(4-5 mg/kg three times daily or 1 and 3 hours before semen collection
or attempted breeding per OS).52
PHYSICAL ABNORMALITIES OF THE CANINE PENIS
Congenital Abnormalities
Penile congenital anomalies described in the dog in l ude d ipha lli ,31,
49,67 penile frenulum,s, 6, 26, 32, 55, 57 hypospad ias,l , I ~ p n il e hYI 01 los io,l , :17, 11(,
and penile immaturity. 50, SR
Diphallia, or d li pli cCl liol1 of [I l(' 11' I)i H, hoi 1 111 '1'1) l'I'PI )I t('li ill 1111'(' 1'
dog in' the vcl'(' rinnl' 1111 ' 1'1 1111 1'\ ,. 11 1'1, 1.'/ 1\ 11 1I IId ('01 11'11 1'1'(' 1)1 ,11 11 )01'1 11 111 1111'
of l'll(' gl 'IJiI( III l'i II III 'Y li'I II '1 I ill 'll ') di ll dll 'llI lll ll II I IIII' 1111 11 111 Y 1,1111 111 1' 1,
"11[11 1I 'dlllll) 1)1 lit l' 111 '111 111 11 ', III 11'11111 11 1' 11t ' ld ll ' II ) " 11 '111'1111 111', 11'. "1 II I
dll' lllI ll J, I \\'1' 11' 1, ,11' 111 1011 ' III 111l ' 111111111\ 11 111 1 Il1ld 111 111I11 ,tI III ill.l111 1 ,I,
pollakiuria, and inappropriate urination. Diagnosis is by visual inspec-
tion.
A penile frenulum is a band of connective tissue joining the ventral
portion of the pars longa glandis to either the corpus of the penis or the
prepuce.
5
, 6, 25, 32 It is formed by incomplete dissolution of the androgen-
dependent balanopreputial fold.
25
Dogs with a penile frenulum may be
asymptomatic or may present with excessive licking of the penis and
prepuce, dermatitis between the rear limbs, phallocampsis (curvature of
the penis when erect), and pain when breeding with inability to achieve
a copulatory 10ck.
6
, 26, 32, 55, 57 Diagnosis is by visual inspection. Treatment
in symptomatic dogs or those intended for breeding is transection of the
frenulum.
Hypospadias is abnormal termination of the penile urethra along
the ventral surface of the penis proximal to the normal urethral open-
ing.
1
, 25 It is classified as glandular, penile, scrotal, or perineal, with
increased severity associated with proximal location of the urethral
opening. Concurrent genitourinary defects reported include cryptorchi-
d ism, penile hypoplasia, ventral deviation of the penis, and abnormal
development of the ventral prepuce.
1
, 22 Dogs with hypospadias may be
dsymptomatic or may present with urinary incontinence and associated
inguinal dermatitis.
25
Diagnosis is by visual inspection. Treatment varies
with location of the urethral opening; glandular hypospadias may re-
quire surgical repair of the defect only, penile hypospadias may require
partial amputation of the penis and urethra to the level of the urethral
orifice, and scrotal and perineal hypospadias necessitate scrotal or peri-
Ilea 1 urethrostomy, which may be accompanied by penile amputation. 1, 25
Penile hypoplasia, or abnormal shortening of the glans penis, often
is seen in intersex dogs and may be seen concurrent with cryptorchi-
d ism" l, 37, 46 Penile immaturity, also called infantile penis or micropenis,
iH the presence of an abnormally small penis relative to the size of the
I log.50 A decrease in penile size may be acquired; in a study comparing
!,l'n il size in 13- to 15-month-old mixed-breed dogs that had been
g() nadectomized at 7 weeks or 7 months of age or left intact, it was
1'(' 1 ort d that those dogs gonadectomized at 7 weeks of age had imma-
III r' g ni talia characterized by significantly smaller penile diameter,
ti(' erc s'd ize and radiodensity of the os penis, and immaturity of the
III'(' PUC ompa red wi th male dogs gonadectomized at 7 months of age
(II' Idt Intel t.
0ll
The li nical significance of acquired penile immaturity
1\1 11'1 II () I bet' n r ' por t d.
'I' ll!' o('cM,ioll ol 111 , I dog has an apparently normal penis that does
1101 1H' (, ()I11L' VII );{ )I 'M\' r! Huffi i ' ntly to all ow formation of the copulatory
IIH 'I , () I' Iii' , it) which 11ll' engol');('d bltl bus glZl nd is is augh t within the
I [III II" tl ](' vlil v,1 IIi' II IV ,'HII'OII fl' ll ll ll l " i)1Iri ng th ' 'opul ator 10 k,
11111 '1,1111 i'\ [l lil l Ili l (I I WI I 1'1 II I 1II'Ili ll.l lll' lii tid hy IIH' 11 )<) 11 ' dpg I1 llli
11)1 111 '.11 '111111 Iii 11 Jt' VIII', hll t! IIII HIo 'ltl l!l III 'I' 1')1 tl 1l' hill'l l I' I'I) II) () I!' ,' I'l lltill l
11111 \1 /'1111'111 III 11j'I '1I1 1 11 11'/ 111 IV III II III I' 1111 11'/ " 'I"IIi II Ii 'll vl' 11 ,11 I 1'1"",
IloI li' \' 1111 1'1'111 11 11 '\, 1'" \\'1 11 11111 1 Ilill lltlll ll lllilllll ' 1111'I il lll1lll' 1111 11 1, 11 '1
101 11,11111111.111 1111111' 11'1'111111 11 11 11 11 1 1l1l1l htld \' II IIII' 11' 1/"1 Id II 11.1111111 1
252 ROOT KUSTRITZ
variation in relative penile and vulvar size in these animals. Artificial
insemination can be used to ensure deposition of semen within the
bitch's reproductive tract.
Phimosis and Paraphimosis
Phimosis is inability of the male dog to extrude the penis from the
prepuce. It may be congenital or acquired, with inflammation, edema,
neoplasia, or cicatricial constriction after wound healing causing a stric-
ture at the preputial orifice.
4
27
. 30, 50 Diagnosis is by visual inspection.
Treatment is surgical enlargement of the preputial orifice.
Paraphimosis is inability of the intact or castrated male dog to
retract the nonerect extruded penis into the preputial sheath. Causes
include sexual arousal without erection, neurologic disease (encephalitis,
intervertebral disk disease), fracture of the os penis, balanoposthitis,
constriction at the preputial orifice by a hair ring or scar tissue, abnormal
penile swelling (trauma, neoplasia, malicious strangulation), and entrap-
ment of the penis outside the prepuce during penile detumescence. 15, 30,
35 The exposed penile tissue undergoes ischemia, drying, and excoriation,
and it is increasingly compromised with prolongation of paraphimosis.
Diagnosis is by visual inspection. Conservative forms of therapy, which
are most appropriate when the tissue is not severely compromised,
include lubrication and replacement of the penis within the prepuce by
digital pressure and isolation of the male dog from estrous female dogs
or other causes of sexual excitement. Paraphimosis may occur as a
learned behavior secondary to penile licking; owners should be cautious
not to correct the dog excessively so as not to promote parap'himosis by
positive reinforcement (P. Mertens, DVM, MS, personal communication,
2000). Treatment of castrated male dogs with progestogens may alleviate
recurrence of the problem. Progestogen therapies recommended include
megestrol acetate (Ovaban; Schering: 0.5 mg/ kg once daily per os for a
maximum of 30 days or 2.0 mg/ kg once daily per os for 8 days),
medroxyprogesterone acetate (2.5 mg/kg subcutaneously every 5
months for a maximum total length of treatment of 1 year), and prolige-
stone (10 mg/kg subcutaneously with a 3-month interval between the
first and second doses, a 4-month interval between the second and third
doses, and then every 5 months for a maximum total length of treatment
of 1 year) (S. Romagnoli, DVM, MS, personal communication, 2000).
General side effects reported with long-term proge togen therapy in-
clude temperament changes, increased thir t or t ppclit , 111 , 111111 (1 1' en-
largement or lactation, Ii tle n Sfl, Fi n I fl rnll wgn l . Slirgic;)1 Il wn1 pil 's
that may be requir d in Iml l' widVllill l', or Il l<' pi"l'Ilill i,iI (lrin! ,,' r(l r d()g: 1
with a gros Iy norl1l ;lI IWlli :1 111 ,11 ,'1 11111 ,, 1 lli' 1"'ldlll 'Jl d III IIII' I Irl'\ 1I 1('1' Ily
d igital I n'S,' III '(' dlHI IlI' ldl(' 11111 1111 11 1 (III II11 dill',' willi ' I'V.II ' 11 1111111 11 11\ '
,1I ' jpl'ili'llril ' .1 11111 11)'," 1,1 1111' 1'1 ' 111 , 1111'1
Persistent Erection (Priapism)
. Persistent penile erection, or priapism, is prolonged penile erection
WIthout sexual arousal, causing discomfort and difficult urination.
66
Pria-
pism may occur secondary to prolonged or excessive parasympathetic
stimulation or as the result of decreased venous outflow from an occlu-
sive thromboembolism or mass lesion.
66
Stagnation of blood with subse-
quent low oxygen and high carbon dioxide concentrations within the
corpus cavernosum penis causes edema with further venous occlusion
and eventual irreversible fibrosis in the main venous outflow tracts of
the penis.
66
Ischemic necrosis of the penis results. Reported causes in the
trauma :vhile .mating, chronic distemper encephalomyelitis
WIth dIstemper-assocIated mflammatory lesions in the spinal cord, penile
thromboembolism, administration of amphetamines, and apparent de-
creased venous outflow after castration (J. Winsor, DVM, A. Valenti,
DVM, personal communication, 1999).17, 18 There is one report of idio-
pathic in the dog.
53
is by visual inspection. Diagnosis
of the underlymg cause of the dIsorder may require extensive evaluation
of the animal, including assessment of general health with a complete
blood cell count, serum chemistry profile, and coagulation profile; com-
plete evaluation of the genitourinary tract with urinalysis, aerobic urine
ulture, and radiography or ultrasound; and assessment for mass lesions
in the caudal abdomen. The workup must also be. timely, because treat-
ment options become limited as the penis undergoes progressive ische-
fmc change. In the dog, the underlying cause of persistent penile erection
may not be identified, and the penis usually is irreparably damaged by
lhe time of presentation. Castration usually is not effective as a sole
Ireatment. Reported treatments include re-establishment of venous out-
flow by removal of sutures left in the vaginal tunica at castration (J.
Winsor, pVM, A. Valenti, DVM, personal communication, 1999), incising
I he pems over the bulbus giandis and pars longa glandis through the
1,lInica albuginea and applying pressure to expel free blood and thrombi
I rom the corpus cavernosum penis,44 and penile amputation and perineal
1I r throstomy.s3
Balanoposthitis
l3a lanop sthiti is inflammation of the glans penis (balanitis) with
l'Il ll ol11itnnt infl ammati on of the preputial mucosa (posthitis). The re-
1\()I' lc' (\ of bFl IAnoposthiti s in th dog j opportunistic infection with
111 1,'II' ri li l or vil'nl ngl' nts I'hnl 1I1 n or may not b normal preputial flora.
2
,
I ' ll , ' I , 'I, '11, H, 11 , 01 11,'101 /\ 1, 11 il' dl' I' III.ll ili:-; fi nd bchllv iornl s If-l11 lltil ati on a1. 0
1IIII y 1lJ' ('.III : II lvI' ,
1;1I1'i1l ' 11I'11;1I ('11 /1 Wil l 11 11' 11 11111 1 . '11 111111 1111 1IIII Ili l(' In )!11 . 11'1 '11/1 1, ' 1'1'I' I " l i,lI
I l ril l ll" 1 I ii \'/ rilll',1 \ 11 11 l 'dL II IIII'!1 ri ll I I I I (11111 ' 1 1J('1I1111 , ' I'II' I!' I'III 1'('
1'1 11 11'11 11 11111 1"I ' I ,"l lrl , (ti l lll l' ,d lll ,ti l' I IIII',! \\ III I II, il lli llt l tlll ll lll r 111 ,1111 11'
" ' /'/I, /IIlIliI/III ' ,/I/IIS"liI' ", ''' ' 1' / (/1111 111/1 l'I/Ii,I' I/l1 , ',If/ / (It I/ I" lilll" ,1//1 "/1 ', d ll,1
254 ROOT KUSTRITZ
Klebsiella Sp.28 All these bacteria are normal preputial flora. Mycoplasmas
and ureaplasmas have been cultured from the prepuce of dogs with
balanoposthitis.
14
, 34, 54 Mycoplasmas and ureaplasmas also are normal
flora of the preputial mucosa of dogs,54 confounding the ability to defini-
tively diagnose these organisms as causative of balanoposthitis in a
given animal. In two surveys, Mycoplasma species were cultured from the
prepuce in a significantly larger percentage of dogs with balanoposthitis
(92%- 95%) than from reproductively normal dogs (64%-70%).14, 54 Myco-
plasma canis is the most common isolate.
14
,34 The significance of ureaplas-
mas as a cause of balanoposthitis is less well defined; in the one study
reported, Ureaplasma species were cultured from 69% of dogs with bala-
noposthitis and 70% of reproductively normal dogs.
54
Reported viral
causes of balanoposthitis in dogs are canine herpesvirus (CHVY 21, 23, 49
and, more rarely, calicivirus.
12
The predominant clinical sign of balanoposthitis caused by infection
with aerobic bacteria or Mycoplasma species in the dog is preputial
discharge, which varies in character from purulent , to sanguinopuru-
lent,14,41 The discharge may have a fetid odor.41 The penile and preputial
mucosa is erythematous and may be ulcerated or covered with caseous
material. Penile lymphoid follicles may be prominent.41 Viral balanopos-
thitis is characterized by the presence of vesicular or lymphoid nodular
lesions on the preputial mucosa and near the preputial reflection on the
penis.
2
, 12, 21, 23, 48 The penile mucosa may be hyperemic, and petechial or
submucosal hemorrhage may be presenU,23
Dogs with balanoposthitis as a component of atopic dermatitis may
show concurrent pruritus of the feet, ears, and ventrum or may present
with excessive licking of the penis as their only sign. The penile and
preputial mucosa is erythematous, and penile lymphoid follicles may be
prominent. The author is aware of one case of balanoposthitis caused by
behavioral self-mutilation; the penile and preputial mucosa was severely
erythematous, and the dog had chewed away a portiori. of the ventral
surface of the penis.
Diagnosis of balanoposthitis is by visual inspection. Aerobic and
Mycoplasma cultures of the preputial and penile mucosa should be per-
formed. Mycoplasma species and many aerobic bacteria, including E. coli,
Pasteurella multocida, and l3-hemolytic Streptococcus species are normal
flora of the preputial mucosa; thus, culture results should be evaluated
with caution.
8
CHV is a poor antigen that does not produce long-lasting
antibody titers after infection. Definitive diagnosis of CHV requires
demonstration of a change in titers in paired serum samples or virus
isolation.
Treatment of bacterial or mycoplasmal balan.opo thiti in ludes ad-
ministration of systemic or topical antibiotics bos I on dtur' nnd
sensitivity testing. Enrofloxa in is the nnliilioli(' or clloic(' for Ir(',)llll '111
of Mycoplas1'l'W infc t:ion . iI\(lIlid 1)( ' 1,11' 1111\ '(\ frllll) III\"
p ni and II'(' !'I II' I' h 1111111 ' 1'11 ' 1"1<'1' 1\1 III WIIIIII Wrl ll"I', Wlilill
(\1' lii !IIII 'd lli' l.lcllllI
l
III ,lilllIll" Itl llllIl 111 111111 1111 Illd.l ll ll l
'
ll 1111 11 11
1'IIII II I,d I, v 111 1'1 11 1 " " 1111111 11 11 10 1\ 111 ' 11 1'1 11 1<1 \ 11 11 cl ltilil ll lllll il lI (I Iii , 1111
Behavioral self-mutilation may be controlled by detecting
and eliminating the trigger for the behavior or may require therapy with
antianxiety drugs.
Urethral Prolapse
Prolapse of the distal urethra may be idiopathic or may occur
secondary to sexual excitement or urethral infection in the dog.
n
,60 The
most common presenting clinical sign is intermittent bleeding from the
penis,u, 24, 38, 60 The prolapsed urethral mucosa usually has a pathogno-
monic "red pea" appearance at the tip of the penis, which allows ready
differentiation of urethral prolapse from fracture of the os penis, urethral
stricture or calculi, and persistent penile frenulum.
60
The prolapse may
occur only when the penis is erect.
38
Conservative treatment with tran-
quilizers, isolation from estrous female dogs or other causes of sexual
excitement, cage rest, and antibiotics usually do not effect a cure. Surgi-
cal replacement or removal of the prolapsed tissue is the treatment of
choice.
60
Efficacy of concurrent castration as a means to prevent recur-
rence is equivoca1.
6o
Intact dogs with urethral prolapse that respond well
to surgical treatment may be used for breeding successfully.u
Fracture of the Os Penis
Fracture of the os penis in the dog is uncommon. Occasionally, the
dog may present with a history of known trauma, but the cause is most
often unknown.
29
Dogs may present with clinical signs either at the time
of the fracture or months to years later after nonunion healing of the
rrG cture or excessive callus or fibrous tissue formation at the fracture site
hfl s exacerbated displacement of fracture fragments or caused urethral
obstr uction.
9
, 29, 33, 56, 61 Clinical signs of an acute os penis fracture vary
with degree of the fracture (simple or comminuted) and extent of soft
I issue injury, and they include obvious ventral deviation of the penis,
dysuria and hematuria, pain and crepitus on penile manipulation, dis-
Il' nti on of the urinary bladder, and abdominal pain.
29
, 30, 56,61 Clinical
, ign referable to excessive callus or fibrous tissue formation at the site
of fl h aled os perils fracture include dysuria, distention of the urinary
bl.ldd r, and ventral deviation of the penis?' 9, 33, 61 Postrenal azotemia
11111 he PI' ' S 'nl: s condary to urinary tract obstruction.
9
, 41 Definitive
di llgll (lsis o( rra lure of Ih os I ' ni s by r adio raphy.9, 29, 63 Treatment
Iii : r(ducli!lIl o( III(' (1'1Iv l II 1'(' ,
PI nllo 1 r lLIIIl 1
1, 11 '1' 11111 11 111 Iii 11)1 11"'111 '1 II Il ldl 1111 111 1'1 II 1111dl \ III 1I I\lIII lei 111 11 11 1
1', 111 II : 1\ IJ 1( ' 11 1. I,d 1"'1 dll' 1. 11 I 11111' 1111 1111 ' I , Iii Ie cI 1111' 1111 \ I II I , 111 1111 I
256 ROOT KUSTRITZ
recognizing that the penis is a well-vascularized tissue. With deep penile
lacerations, reconstructive surgery or penile amputation may be required
if cavernous tissue spaces have been invaded.
Penile Neoplasia
The most common penile neoplasm worldwide is the transmissible
venereal tumor (TVT).36,41 Other penile neoplasms described include
squamous cell carcinoma of the penile or preputial mucosa, squamous
cell carcinoma of the penile urethral mucosa, malignant mast cell tumor
of the penis, and chondrosarcoma of the os penis.
45
,64 Preliminary diag-
nosis is by visual inspection; definitive diagnosis requires biopsy or
conclusive cytology. Treatment options for TVT include surgical removal
of the mass; if the mass is inoperable or surgery is undesirable, chemo-
therapy with vincristine alone or in combination with cyclophosphamide
and methotrexate has been reported as a successful treatment for TVT
as have radiation therapy and cryotherapy. Therapeutic options for other
types of penile neoplasia depend on the tumor type and location.
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Il l' 111I' I III)'. 1'111 11111 ,, 11 ,111 11, WII' 1'111 I I' " , I
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d I, t ,) IHOn I' N, y RH., Thrall NA, et a1: Disorders of the canine prostate gland:
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'
1,1. ( )I'I 11I 11 II , Wnl l ' 1; ,'I ItI : SIII')\ Il'll 1 Irl' lIlll'l e nl of I ri np is l11 obs rved in a dog
III \ d ,I I 'II L 11 \11 1 Vl'I .ol'i ti l : 1 .'// IIiIN
1' 1 1'11 11 1111 " 1\ 1 I 1\11 ,,,111 111 11' 11 Y. llwl ,. I )1\ : ' I VII ,'11 111 '/1 \If 1'1,,, illl' 111' 11 111' Iwopl nAI1l : , qLl n-
111111 1/1 ,',11 "111, 1'1 11 11 11 1 ,,, "l ''' !'IIi 'II Ilt VI,, " 1 1'IIII "tll 'litl llI"'11I 11,1 , I 1\ '1 1 1\ 111 111 1i 0li P I\ H,'I(11'
' d:oI l1, I, 1
1
"111
If I 1'1 " 11 1" ' 1',111 1 ' I \AI 11 11 I 'll I ltv! I " \' Id ,, " 111 .1 111 111 ' " 11 1 " ",111'.1 .1 1' 1", Iii III " ' 1/ \11 /
1
1""1 " 11111
1111 \1111111 11 1,11 1111 11,' W Iii 111 11 11 11'111 111\ 111 \1' I I' tI / 111'1,
258 ROOT KUSTRITZ
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English Bulldogs. J Am Anim Hosp Assoc 9:450, 1973
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62. Thomas AJ: Ejaculatory dysfunction. Fertil Steril 39:445, 1983
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Send reprint reques ts to
Margaret V. Root Kustritz, DVM, PhD
Department of Small Animal Clinical Sciences
C339 VTE
1352 Boyd Avenue
St Pau l, MN 55108
'- mni l : 1"(l\l I:kOO'1 tc. 1 1111 11. tllI
CLINICAL MANAGEMENT OF
THE SUBFERTILE STUD DOG
Joni L. Freshman, DVM, MS
Sub fertility is defined as "the state of being less than normally
fertile. " This may result from a variety of abnormalities: lack of libido,
inability to perform the breeding, and abnormalities of the semen. Sub-
fertility may be suspected if a stud dog fails to produce litters in over
75% of breedings when bred to normal bitches using adequate breeding
management protocols.
s
This situation is frustrating and costly to breed-
who typically have invested a great deal of time and money to
jll"oduce, campaign, and advertise their stud dog. Inability to consistently
l)f'oduce litters can be terminal for a dog's breeding career.
Evaluation and management of sub fertility begins with identifying
(h stage of breeding wherein the problem exists. Further diagnostics
dnd management are based on this underlying identification.
LACK OF LIBIDO BUT NORMAL EJACULATE
Libido may be subnormal or completely lacking. A complete history
Il ould be obtained, with particular attention to the dog's breeding
I' pCl" ience and how his sexual behavior during puberty was managed.
( )( )gs that are harshly disciplined for inappropriate mounting may later
I' hibit a lack of libido in desired breeding situations. With a specific
11(% li bido m.ay either be enhanced or inhibited by the owner's presence.
log have pronounced mate preferences.
23
These dogs can have
'11'1 1)('1) 011 ted LI ' in a preferred teaser; the chosen bitch is then artifi-
1 I. il ly insul11 inut -d . Rstrus wab that have been previously frozen and
\IVII ' I! II ,\ I t\ 1/\ 11 AII IIVI I 1' 1' ( 1'11 '1'
\ III I I ' I' '. III II '1111 1
260 FRESHMAN
thawed for use can provide the scent cue when applied to or held near
the teaser's vulva.
Young or aged dogs may have inadequate libido. Underlying medi-
cal conditions that affect the dog's energy level and attitude can produce
a secondary lack of libido. A complete blood cell count (CBC):
istry profile, and urinalysis should be performed for of
eases. Because hypothyroidism can produce a lack of lIbIdo, a thyroId
profile to include free T4 by equilibrium and canine thyro.id-
stimulating hormone should be evaluated. DImInIshed olfactory functIOn
may inhibit libido by altering the dog's perception of pheromones.
Canine parainfluenza virus has been shown to negatively affect olfactory
functionP Return to normal function ultimately occurs.
Some dogs require repeated exposures to positive breeding situa-
tions with willing estrous bitches to exhibit normal libido. Some dogs
may be reassured by having the bitch manually restrained, alth?ugh
others prefer a minimum of human assistance. An adverse expenence
such as being bitten in a first breeding exposure may have serious effects
on a dog's libido. Anecdotally, gonadotropin-releasing' hormone (GnRH)
injections can be given to increase libido.
16
This stimulates luteinizing
hormone (LH) release from the anterior pituitary, which, in turn, causes
testosterone release from the Leydig cells in the testes. Injections of
GnRH (3.3 /-Lg/kg intramuscularly) are given once weekly for 1 month
before breeding.
16
Different formulations of GnRH are available, and
choice of product is apparently important. In one study, gonadorelin
hydrochloride (Factrel; Fort Dodge Animal Health, Fort Dodge, IA)
resulted in an initial rise in serum testosterone followed by a 3- to 4-day
trend of decreased testosterone, although gonadorelin diacetate tetrahy-
drate (Cystorelin; Merial, Iselin, NJ) resulted in elevated serum testoster-
one for 5 days.16 Gonadorelin diacetate tetrahydrate would thus be the
preferred product. Testosterone and related androgenic drugs should
never be given to a breeding male dog because of their feedback
effect on the pituitary, resulting in decreased LH productIon and de-
creased intratesticular testosterone production, leading to decreased
sperm production.
20
INABLITY TO PERFORM BREEDING BUT NORMAL
EJACULATE
Dogs with significant systemic disease or a variety of
and neurologic abnormalities may be unable to mount, thrust, or a In v
and maintain intromission. A complete history of any PI' vi ous no 'd i al
problems and injuries is importan t. A B, iSlry I roCil c, n.nd
urinalysis are perform d to v, Ili alt' for H 101 1('1111< ' <l ira'll. I' . /\ 1) I' hUlI . ll v\,
orthopedic and n I'vn ill nli,)l l : III HlIti III' 1'1' 1'II)I'IIII 'ti , wil h p.lI 'li,
l.l l ar attention til 11)(' 111 '1 '1, /I11t '1" 1IIId 1'\'1 11' II')', I ,I Ilid 111/ dl 'l,d d 111'1 1/11',
s\' ven' 14 1111(111 ), 11 1111: , 1/ "1'," 11"1111 VI' 111111 " 11 ', 111 ' III 1111 ' Idl ll II I ' 111,,/, Ili id
IIlld llll', llIl/ I.1i ,11 111' 11111 ' 11 11 ,11 1' l illI/Ii iI' 1111 ' ,"1 1111 111 11 11I 11 111 11I dll "1111 ' 1'
CLlNlCAL MANAGEMENT OF THE SUBFERTILE sTUD DOG
261
for inability to breed. Partially protruding intervertebral disks and de-
generative myelopathy should be searched for in the neurologic exami-
nation. Prostatic disease can cause pain with ejaculation and should be
evaluated for by means of a rectal examination and prostatic ultrasonog-
raphy.
Should the underlying orthopedic or neurologic problem not be
correctable, semen can be collected with the dog placed in a comfortable
standing position, and the semen can be used via artificial insemination.
Consideration of the heritability of the underlying condition should be
part of the decision with regard to use of the stud dog.
ABNORMALITIES OF THE SEMEN
Semen abnormalities frequently result in sub fertility. To appreciate
abnormal semen, it is necessary to be familiar with normal semen
quality. Proper collection of semen is necessary to obtain a representative
sample to evaluate.
Semen Collection
Before collection, the dog should be allowed and encouraged to
'mpty his bladder, as urine contamination of the semen is detrimental
1'0 motility. The presence of a friendly teaser bitch in estrus is of great
h lp in obtaining a complete ejaculate. In lieu of an estrous bitch, a bitch
the dog likes is used in conjunction with thawed estrous swabs.
The bitch should be held in a standing position, with the handler
on her right, to keep her standing and restrain her head. Ideally, an
II ggressive bitch should not be used; if this is unavoidable, a muzzle
HI ould be applied. If the dog is nervous or reluctant and the bitch is
friendly, they may be allowed to play before collection.
A quiet location with excellent footing is necessary. Ideally, a room
I h' dog does not associate with other veterinary procedures is used.
If physical examination, venipuncture, or other diagnostics are to be
pI' rf nned the same day, semen collection should be performed first.
I' of the white laboratory coat or other "doctor" signals can help
to Ket th dog at ease. Excellent footing for the dog can be ensured with
lil t' 11 :4 of a ru bb r-backed mat of appropriate size. Over time, a mat
III (' li fo r t r c ling d 'v lops a c nt that also acts as a cue and stimulant
1M lli l' dog. , (,'m ' 11 frOI1l toy brC' d thnt a r u ed to being bred on a
11 \1/, ' Il UI lWKI l)(' coll ('clt'd on II ruhlw r-mn lt'd g rooming table. Any
l'qll ipllll ' lll 11 )(' dOl) 01 1-1 , Ild,ll t' 1l willi hn'(d ing ,' '' ould lw I rOll ght by the
IIWIIl' I' In 11i 1" 1'1 , 1, 1\ " 'Id I'lli' Ih, ' .1(1)" . 1,111 11'11 '. 11 11 1)', 1,' lI y (I Y; Itl llll H(111 nnd
/11 1111 /11111 ( '11 1111 '1 111 , Ntw 1IIIi llll Wl, I. , Nil 11 II ld l'I'I'II IIIII \(' IHI, .d, Ill' 1II 'I. dl' tI ,
.1 111/111', \ ,, 11 "1 11, 111 II I 11 11 ' ,'1111 111 1111 ' f\ 11I 1111 \' It! 11 ' 11 \1 '11 II ' 11 1" '1 1I ,Iy 1III "I 'I"d
\\'11 /1 1I 1'111 11 111 I lil li" II I I', III 1111 1" , IV III 11 11 ' ,.11 \ II
: ,1 ' 11 11 '11 ,11111 '111"'1 1"1"1 /"111 I ii ,,111 111 1 i l,j 1111 11111111 ,t! \ ,1/', 1111 ( V )
262 FRESHMAN
(canine artificial vagina; Synbiotics, San Diego, CA) and clear 15-mL
centrifuge tubes. The first tube should have a small hole in the side near
the top to prevent vacuum formation. Tubes can be changed between
fractions; if this is done, the subsequent tubes do not have vent holes,
and the tip of the AV is inserted into the top of the centrifuge tube. For
a right-handed collector, the AV is held in the left hand and the cuff is
folded over the hand to create the appropriate size AV for the patient.
The AV is held at the tip of the prepuce while the right hand massages
the penis within the prepuce. As the bulbus glandis begins to enlarge,
the AV is pushed up over the penis, pushing the prepuce behind the
bulbus glandis. Once in this position, the left hand is held tightly over
and behind the bulbus glandis to simulate a tie while the right hand
continues to stimulate as needed. Should the bulbus enlarge too quickly
to allow the prepuce to be pushed behind it, simply stop the collection
process, walk the dog to allow his erection to subside, and begin again.
Complete erection and ejaculation with the bulbus inside the prepuce is
painful and may result in an incomplete collection dislike of the
collection process.
Canine semen is ejaculated in three fractions. The first is a relatively
clear presperm fraction, which can be 0.5 to many milliliters in volume.
The second sperm-rich fraction is normally milky white and approxi-
mately 0.5 to 2 mL in volume. The third prostatic fraction is again
normally clear and can be a few to many milliliters in volume depending
on the length of time that pressure on the penis is maintained. Aged or
insecure dogs may not have easily defined fractionation of their semen.
Once semen collection is complete, walk the dog away from the teaser.
A cool compress or lubricating jelly placed at the junction of the penis
and the prepuce may be helpful to ease retraction of the penis into the
prepuce. Care must be taken in long-haired dogs that no hair is wrapped
around the penis or trapped inside the prepuce. The dog should not be
kenneled or placed with other dogs until his penis is completely back
within the prepuce.
Semen Evaluation
Initial evaluation of semen consists of recording the volume and
color of each fraction. A yellow color indicates urine contamination, and
red blood cells may indicate prostatic disease.
Motility
Motility is immedi atly ass ssvti n drop of seill en,
preferably from th spcrm-ril' h fl":1 (' lioll wi lhol ll IlI'O:: lldll ' 1III Id I'()llldild
nation, pIa 'd on [) . 7"(' WIII'II)('tI II dt', ( ' \I V' ' I" ,Ii willi II I '(l VI' I'H111" ,llld
Xc minvd wilh :)0 111111 110111111', 11 111' ,, 111111 ' '1'111 ' 1'(1111 1('11' (' I 1111 11"" III
Illwt'I'Id 10 I ' I li vid" 1111 ' IH'I I \ 1111 111 1' 11 1 (Ill III 1" ' 1111 lill 1111 I I 11 1' 1111 ,1,
1'(1 111 '1' 1111 1111 ' " 1(' I()o '1\ 11l ,1, 111 '1,01 1( 1 III 01 11111 1 Ii I I \ 1111 \' ", Idl ll 1"1,11( '
CLINICAL MANAGEMENT OF THE SUBFERTILE STUD DOG 263
buffered saline (7.5 pH) to allow visualization of motility. Normal semen
should show at least 70% progressive motility, with spermatozoa moving
rapidly across the field of view.
18
Normal spermatozoa maintain motility
for hours; rapid loss of motility is associated with poor fertility. 4 Serial
evaluation of motility can be performed by repeating this procedure at
varied time intervals.
Concentration
Concentration of spermatozoa is measured with the use of a hemo-
cytometer and a Unopette (Becton-Dickinson, Rutherford, NJ) counting
system for white blood cells.
18
The sperm-rich fraction is gently agitated
and then drawn into the Unopette capillary tube (0.02 mL), dispensed
into a diluent chamber (1.98 mL), and mixed. The diluent-semen mixture
is loaded into the hemocytometer and allowed to settle for a few mi-
nutes. Because the spermatozoa are no longer motile, they are readily
counted. The number of spermatozoa in one of the nine primary squares
in the hemocytometer grid is counted. Counting and averaging the
spermatozoa in three squares can improve accuracy. This number equals
the number of spermatozoa in millions per milliliter of semen. This
number is multiplied by the total milliliters of sperm-rich fraction col-
lected to give the total spermatozoa in the ejaculate. On average, a dog
should have at least 250 million spermatozoa in the ejaculate, although
this number can be several billion.
18
Various factors may affect the
number of spermatozoa per ejaculate, including age, degree of arousal,
testicular size, and frequency of ejaculation. The number of spermatozoa
produced by a normal dog is directly related to the weight of the testes.
3
This, in turn, can be estimated by measuring total scrotal width (TSW).
This can be performed using calipers, pressing the testes down into the
s ' rotum, and holding them parallel to each other without altering their
shape. Three to five measurements are taken and averaged; the testes
should be repositioned between each measuremenP As a general rule,
lIormal dogs with a body weight of 10 to 34 Ib should have a TSW of
Ilpproximately 36 mm, dogs with a body weight of 35 to 39 Ib should
have a TSW of approximately 50 mm, and dogs with a body weight of
( () to 84 lb should have a TSW of approximately 56 mm.
3
Toy-breed
dog ' m y hay normal ejaculates with less than 250 million spermato-
!',on. I og with less than 200 million spermatozoa per ejaculate after
HtXllf.l l resl' may b subfertile when used for breedingY Total scrotal
circumference nn b tn asured Similarly with a tape measure to monitor
.1 111 1 for a Irl'llll of dC('I"('8s ing t 'sl'iul ar size, whi.ch may be associated
wi lli prot' .. ,' l" ' .
1'1'1' ,\11 ( ' 11 1' Il l' ('i.l clll ril ioli ,11'1'1 '1' 1. Ihl' Iltllnhvl' or Hp el' rn8t07.0fi in th
1' /,, 1',11 , 111 ' , III d O)',1 1'1'11 111 wl d,' 11 It'll 11' 1 I 1/ l'OIl I' I' It' d d,li l , 11ll' Illlilli w l' or
1'1'1 ' 1'111 11111'1,( 111 III lil ( 1'1111" ,11 (' 1'111 " Vill i /1 "11j1l '1l 1I1 1!I , ' ly '.111% 1(,IItI Ihnil
11 11 1 I ' II lill y II ' 111 ,d (I, '/ tI ,IV ) d" f', I Wil li 111111'. 111( ' l l' lil ll III'i W(\(' 11 (' /111 ' 111 11
11t1l1 , 1/11 ' j\ 111 11 \' 111 dll( Ir 11'1111111111 11 "11. Ititl"1 ' 1' 1' 111 11 1111 ( 11 1 ( 11 1' 1' 1II ,II (.d
III IIII' 1111111 ' , I III " 1(.11" 1111111 lOll " "' II I 1111 - III 11 11 I ' I 11 11 11 1((11111 tl l llI \
264 FRESHMAN
sperm output; this is what the dog produces on a daily basis and is over
80% correlated with body weight in a normal dog.
3
Determination of
daily sperm output may be helpful in a heavily used stud dog to
determine the frequency of breeding that still provides an adequate
concentration of spermatozoa. Healthy dogs caged in new surroundings
may show a transitory drop in spermatozoa per ejaculate, possibly
a result of the adverse effect of increased endogenous glucocorticoid
secretion.
4
This seems to be reversed after 6 months.
4
Dogs with good ejaculatory behavior but no sperm in the ejaculate
should be evaluated for retrograde ejaculation. This can be done by
collecting urine before and after ejaculation and examining it the
microscope with the condenser on low for the presence of a sIgruficant
number of spermatozoa in the postsample ejaculate as compared with
the presample ejaculate.
Morphology
Semen morphology is evaluated by placing a drop of eosin-nigrosin
stain on a glass slide, adding a drop of semen, smearing the drops,
and examining the stained semen at X 100 magnification under oiU
8
Alternatively, a Wright-Giemsa type stain can be used (Harle co Hemaco-
lor; EM Diagnostic Systems, Gibbstown, NJ).19 One hundred sperm are
evaluated for primary and secondary defects (Table 1). Primary defects
represent abnormalities in formation of the and
ered more serious than secondary defects, whIch occur durmg transIt
through the ductal system, collection, or processing of the semen. Dogs
that have been sexually rested for over 10 days may have an increase in
detached heads and distal droplets as a result of prolonged storage.
14
Secondary defects may also result from trauma or glucocorticoid admin-
istration.
7
Normal semen should have at least 70% morphologically normal
spermatozoa.
4
Abnormal morphology greater than 2?% can result in
subfertility.4 Calculating the total number of morphologIcally normal and
motile sperm per ejaculate can assist the clinician in assessing fertility.
Table 1. SPERMATOZOAL DEFECTS
Primary
Abnormal head shape
Abnormal mid piece
Double
Swollen
Coiled tail
I'nil
l'roxinlll l l 'yl l ll"" l lI l iI. "" ' I<i I' 1
Secondary
Detached heads
Bent mi Ipi c '
Bonl I:n il
l ) i:41111 ,' y l ()pldHlll k "" 01'1"1
I{,' II II I /It'd 11\ I t 1111 11111 1
Additional Evaluation
The number of white blood cells in the semen can also be deter-
mined using a hemocytometer and Unopette .system: The count
be performed on the sperm-rich and prostatic fractIOns. To obtam the
count, white blood cells are counted in the four corner primary squares
of the hemocytometer and the total number is multiplied by 250 to equal
the number of white blood cells per cubic millimeter.13 Normal values
are less than or equal to 2000 per cubic millimeter.
The pH of each fraction can be measured with pH tape. Normal pH
is 6.3 to 6.7.
7
A drop of semen should be pipetted from the sample onto
lhe pH tape, because inunersion of pH tape into the sample may ad-
versely affect motility.
Cytology of each fraction should be evaluated using a smeared drop
stained with a Wright-Giemsa rapid stain. The presence of red blood
cells, epithelial cells, or any other abnormalities should be recorded:
No dog should be diagnosed with abnormal semen on the baSIS of
f1 Single collection. Multiple collections on different days may be needed
10 obtain an accurate assessment of a dog's semen quality.
Management of Dogs with Abnormal Semen
Depending on the underlying cause of the problem, many dogs
with abnormal semen can be successfully used for breeding. An effort
'i1 ould be made to determine and correct underlying causes. Additional
diagnostics appropriate for this ,include a chemistry
profile; urinalysis (including after ejaculation m azoospermIc dogs); pros-
Io\ ti c ultrasonography; cultures of semen and prostatic samples for bacte-
rin, Mycoplasma, and Ureaplasma; and hormonal evaluation.
M dication and Environment
1\ number of drugs can affect spermatozoal production and repro-
II (Ictive function, including prednisone, betamethasone, methyltestoster-
111$', imetidine, clomipramine, and ketoconazole.
9
, 19 These drugs
1)(' el iminated, and semen should be evaluated 3 months after cessation.
VI' I(' rinari an working with stud dogs should use caution in administer-
Ill)' m 'di ali on to th e dogs, Testicular degeneration can occur second-
I II ' I In (' l1vironm ntal temperature (e.g., dog sitting on hot surface),
III'I IV III ,till s, ml'r uri al ompounds, and other toxins.
2
The owner
,llllI ild Iw qUl'. ' li oncd <1 bout [he dog's hOll sing and any environmental
III ill: lit,11 (' (lIild lw pres(' l)[ I Vl'. lll. ' l' of Inndfill s, h mi cal plants, well
w $ 1' (l ili l' !' ilulil slri,iI
111 111 11 )',11 111'011', 11' 1, 111 ' 1' 111 11' 11 11 1 ,iI II 1111111 11 1' 101 111', 1', lil l'\' 1\' ,1111 I
IllI illll i' 1, \, ,1 I ii 1" ' 11 1111111 1111 111 ' \ I Jill 11 111 \1' tI I I, I II 111 11 1111 11111 I tl ' 11',1' I
266 FRESHMAN
Large- or giant-breed dogs may reasonably reach this level at an older
age. For a young sub fertile dog with no other problems, time may be
the best treatment.
Testicular degeneration also occurs with age. Senile atrophy is un-
likely to respond to treatment. Older dogs with low sperm numbers are
best managed by conserving their spermatozoal reserves. Bitches to be
bred should undergo accurate ovulation timing. Insertion of the semen
directly into the uterus using a surgical or transcervical technique may
also be indicated in cases with low numbers or poor motility.
Retrograde Ejaculation
Male dogs that are azoospermic but have a large number of sperma-
tozoa in the postejaculate urine can be treated successfully. At 1 and 3
hours before collection or breeding, they are given pseudoephedrine
(4 mg/kg orally).15
Testicular Hypoplasia
Although no experimental data have been published,
reports indicate that gonadotropins may be helpful as symptomatic
treatment. Human chorionic gonadotropin (hCG; 500 IU subcutaneously)
is given twice weekly.2 Caution is indicated in the use of hCG; in other
species, abnormal testicular steroidogenesis has been present for 10 days
after injection.
3
GnRH (125-250 ng/kg) may be tried in place of hCG.3
Testosterone or other anabolic steroids should not be used for reasons
previously noted.
Normal endocrine function can be evaluated using a GnRH stimula-
tion test. GnRH is given (1 J.Lg/lb intravenously), and samples are taken
immediately and 1 to 3 hours later.I,B Baseline serum testosterone values
are 0.4 to 10 ng/mL (average, 1-4 ng/mL), with a 100% increase after
stimulation in a normal male dog.
l
Serum testosterone and LH values
can be measured via the GnRH stimulation test; because of their episodic
release, resting levels are quite variable.
3
Prostatic Disease
Approximately 80% of intact male dogs over the age of 5 years have
some level of benign prostatic hypertrophy or hyperplasia. Thi incr ases
, the risk of prostatic infection, particularly chronic prostatitis.
with chronic prostatitis exhibit no overt clinical igns; how 'v ' r, Inf ' tl on
in the prostate readily extend to th p id id rniti <' s nnd I l'Stt ,S." Nor11lfl l
prostatic fluid transports sp rmnto:t;oCl fi nd ,' I iJ III iI (I 1(", HI ll" 1"11\ 11l 0 Y. ll, d I) )()-
tility. Abnormal Fro, lil li e flllid (' I II) .. d vl' rfll 'ly IJlII '!'1 !ll ll lilily: ' II, I!'I!) I",
involv(1 I in Ih(" ,,1'1 1, '1 111 1 1111 11 II 111\ 111 .1. , . 11'1'1'1'1 1 d 1111 1\ 1 H,'I'I'
li ll n, illt ' I'I 'IIH'" 1I " 'II1I.1 I1 I \, il l ' I I ' I 1/ 1I 1 1'1!1 ' II I I.l I Il IlIi I , 111 1' 11 ' l lil ' lll l hl, ' I I ' ll n ,
01 11.11 ' " ' 1\ '1 1"" I ii 11111 11' 111 11111 111111 ,111\111 111 111 \ .1. ,1' 111" '11\1' 111111t .11 111" 1' 1"1)1 1 '
sees older dogs with spermatozoa that have poor initial motility or
normal motility with rapid deterioration secondary to chronic prostatitis.
Diagnosis of chronic prostatitis is best made by a combination of
semen evaluation, urinalysis, cultures of prostatic samples, prostatic
ultrasound, and possibly fine needle aspiration or biopsy. Semen evalua-
tion often reveals abnormal motility, an increased number of white blood
cells, epithelial cells, and increased secondary defects. Results of a CBC
are usually normal. Bacterial cystitis is a common finding.
Various opinions exist on the ideal method for obtaining accurate
material for culturing of the prostate, One method is to collect an
ejaculate as previously described and then to collect a small amount of
prostatic fluid directly into a sterile vial for culturing. IS The sample
be submitted in appropriate media and in a timely manner for
detection of bacteria, Mycoplasma, and Ureaplasma. Bacteria and Myco-
plasma may be present in the urethra of a normal dog. Greater than 10
5
olony-forming units per milliliter or heavy growth of a single organism
from a sample with an increased number of white blood cells is sugges-
tive of infection.
21
Alternatively, fine needle aspirates or tissue biopsies
of the prostate can be submitted for culturing. Quantitative cultures of
the semen and urethra can be performed. A greater than 3 log increase
in the number of bacteria isolated from the semen as compared with the
II rethra indicates a significant infection as opposed to normal flora.
Treatment of chronic prostatitis in an intact male dog is a long-term
process. Antibiotics should be chosen based on their ability to penetrate
into the prostate and the pH of prostatic fluid as well as on sensitivity
Il'sting. The pH of the blood and interstitium is 7.4, and that of the
110rmal prostate is acidic.
6
This can change with infection, but in the
,HI thor 's experience, most dogs with chronic prostatitis have acidic pros-
l.1l ic pH. Good antibiotic choices for acidic pH include erythromycin
oI nd trimethoprim-sulfa combinations.
6
Trimethoprim-sulfa combinations
,I\, ' not an ideal choice for long-term use because of the risk of keratocon-
11111 tivitis sicca and polyarthritis. Frequent monitoring of tear production
IS indicated if this drug is used. Chloramphenicol and fluoroquinolones
" I'l' good choices because they penetrate the prostate well regardless of
pi 1. " Fluoroquinolones are commonly used because of their excellent
Ill'Os tati penetration and spectrum of activity. Appropriate antibiotics
' il ould b giv n for 6 to 9 weeks, and the prostate should then be
I'pn tllu r d without cessation of antibioticsY Mean duration of antibiotic
1I\I'I'il py to on troJbronic b acterial prostatitis in intact dogs is 9.5
wl' I'b;." On " I'hl' inf ' ti on is controlled, long-term low-dose antibiotic
Ihl' I'. )1' i,' in ilinl.l' I wil'h one thi rd of th total daily therapeutic dose
1',1 ,' II in Il l\' ('veil ing ufll ' l' voidi ng,l) Thi s is conlinued for at lea t 6 to
I I Il\Jl lilli H, III Il il l ,! IIII H) I"" (1' 111' 1'11' 1)(' (', long l(' rn low-dose th ' rapy i
1>1 1"11 1'I' Ipdl'C' d 111 1' I l l1' 1'1 ' 111 .1 Ihll' l' 0111 11 ' do)'. ' illlll\'l lil'l ' 10 Il Hl inl'n in
' 1\ )1 ' 1 I tj II , " II
II ILIII I ' 1"1' 111111 111 ' 1l" lldl ll 11 d ll)',' \ 111 1 1111111 '111 ' 11 110 11 11 /,11,"
111. ,1 1111\ l il li / lId 11\ 1111 1 111 111 I III "1' 11 111 1' 1111 ' 1"'111 11 11 1'1 1.1 111 111 1 11 11 '
1"11 !.lI ll 1111 01 I )11 11 11 1', 1,, 11 "1 11111 1 " II " ,1111 111 11 I,, 111 1, II 111'1111 ,, I II 111 11.,
268 FRESHMAN
of the prostatic fluid as possible. The sperm-rich fraction is then gently
layered on top of 1 mL of a semen-separating solution (Semen Separating
Solution; Synbiotics, San Diego, CA) and centrifuged at low speed (100-
50 G) for 5 minutes in a round-bottomed centrifuge tube. Most of the
supernatant is carefully removed and discarded. The remaining soft
pellet of spermatozoa is resuspended in the small amount of superna-
tant, and a semen buffer (for fresh or chilled semen; Synbiotics) is added
at a 1:2 to 1:4 ratio depending on the concentration of spermatozoa and
the method of insemination. This frequently results in improved and
prolonged motility in vitro; similar results are anticipated in vivo, but
controlled studies have not been performed.
SUMMARY
Many subfertile stud dogs can sire pups with appropriate manage-
ment. Determination of the area of the problem (libido, ability to breed,
semen quality) is the first step. Each of these areas can often be improved
or managed. A complete history, physical examination, and semen evalu-
ation should be performed on every patient. In specific cases, additional
diagnostics may be helpful, including a CBC, biochemistry profile, uri-
nalysis, semen cultures, ultrasonography, and biopsy. Management of
breeding, including ovulation timing and intrauterine insemination, can
be vital in dogs with low spermatozoal numbers or motility.
Treatment of underlying prostatic disease can dramatically improve
semen quality and fertility.
References
1. Amann RP: Reproductive physiology and endocrinology of the dog. In Morrow D
(ed): Current Therapy in Theriogenology 2. Philadelphia, WB Saunders, 1986, p 532
2. Barsanti I, Finco D: Canine prostatic diseases. In Morrow D (ed): Current Therapy in
Theriogenology 2. Philadelphia, WB Saunders, 1986, p 544
3. Beach FA: Coital behavior in dogs: 8. Social affinity, dominance and sexual preference
in the bitch. Behavior 36:131, 1970
4. Cowan LA, Barsanti JA, Corwell W, et al: Effects of castration on chronic bacterial
prostatitis in dogs. JAVMA 199:3, 1991
5. Dorland's Illustrated Medical Dictionary, ed 25. Philadelphia, WB Saunders 1974,
p 1487
6. Eilts BE: The canine breeding soundness examination form: Its practical role in your
clinic. In American College of Theriogenology and Society for Theriogenology, Pro-
ceedings of Canine Male Symposium, Montreal, Canada, ] 997, p 37
7. Fayrer-Hoskin R, Smith F: Infertility, male-dogs. (II Til l Y LP, l1lith FW ( Is): '1' 11(' 5
Minute Veterinary Consult Canine and Fl in . l3o llil1l ol' L' , Wi lli :lIIl H & Will inH, 1997,
p 90
8. Feldman Ee, Nlson RW: lini cnl 11 1111 .i illr, llI lllI h' " Vl d'l il llil ll " I III " lli .d, I'1' jll'IHhl l'il vl'
tract. In anine And IIl,lIlll' 1': lld'II 'I'llllli lll 'ol' iliid 1{I' IIII ,dlll 'II" " , ".I ' I l' ldl lldllldllll , WII
Dl lI1d\'I'H, 1'1'16, J11' 1t7 \ (,1 10
II, 1I" I'li lllll,l'III ' I 111I }',I1 1111 1" 11 111', 1' <11 1111 , 11\ lit , l' I,d, .IIII'. 1/1 1 111 ("d) \ " " ' III V,' II< I 111 ,11 I'
'1'111'1 11 1 ' I' 1' ldlll'! " lloI l1l1 lVII ' "Ililll l, I 1""'1 I' I ' ' I
10. Freshman JL: Effects of drugs and environmental agents on fertility in the stud dog.
In Society for Theriogenology Proceedings of the Annual Meeting, San Diego, 1991,
p 226
n, Freshman JL, Amann RA, Soderberg SF: Clinical evaluation of infertility in dogs.
]2. Freshman JL, Olson PN, Amann RP, et al: The effects of methyltestosterone in male
greyhounds. Theriogenology 33, 1990
13. Johnston SD: Performing a complete canine semen evaluation in a small animal
hospitaL Vet Clin North Am Small Anim Pract 21:3, 1991
14. Johnston SD: Reproduction case workups in the male dog and cat. In Society for
Theriogenology Proceedings of the Annual Meeting, Kansas City, 1994, P 190
15. Larsen, R: Testicular degeneration and hypoplasia. In Tilley LP, Smith FW (eds): The 5
Minute Veterinary Consult Canine and Feline. Baltimore, Williams & Wilkins, 1997,
p 1094
16. Ling GV: Diagnosis and medical management of prostatic infections in dogs. In Society
for Theriogenology, Proceedings of the Annual Meeting, Toronto, 1990, p 255
17. Meyers-Wallen V: Clinical approach to infertile male dogs with sperm in the ejaculate.
Vet Clin North Am Small Anim Pract 21:3,1991
I . Meyers-Wallen V: Diagnostic approach to infertility in the stud dog. In Society for
Theriogenology, Proceedings of the Annual Meeting, Coeur d' Alene, 1989, p 327
19. Myers LI, Nusbaum KE, Swango LI, et al: Dysfunction of sense of smell caused by
canine parainfluenza virus infection in dogs. Am J Vet Res 49, 1988, P 188
2(). Purswell BJ: Pharmaceuticals used in canine theriogenology. In Society for Theriogenol-
ogy, Proceedings of the Annual Meeting, Baltimore, 1998, p 92
21. Purswell BI, Wilcke JR: Use of GnRH in the intact male dog. In Society for Theriogenol-
ogy, Proceedings of the Annual Meeting, San Antonio, 1992, p 140
21, Soderberg S: Infertility in the male dog. In Morrow D (ed): Current Therapy in
Theriogenology 2. Philadelphia, WB Saunders, 1986, p 544
2. . Wallace MS: The diagnosis of infertility and subfertility secondary to prostatic disease
In the dog. In Society for Theriogenology, Proceedings of the Annual Meeting, San
Diego, 1991, p 229
Joni L. Freshman, DVM, MS
Canine Consultations
3060 Woodview Court
Colorado Springs, CO 80918
CLINlCAL THERIOGENOLOGY 0195-5616/01 $15,00 + ,00
SURGERY OF THE CANINE
VAGINA AND VULVA
Kyle G. Mathews, DVM, MS
Surgically treatable conditions of the canine vagina and vulva have
n biphasic age distribution. Conditions that primarily affect younger
dogs include perivulvar dermatitis, rectovaginal fistula, anovulvar cleft,
vaginal edema or prolapse, and vaginal stenosis or stricture. Older dogs
,1 re primarily presented for diagnosis and treatment of vaginal neoplasia.
Surgical management of these conditions often results in resolution of
clinical signs and can be simple or extremely complex. This article
d 'scribes the approaches and specific techniques required for manage-
ment of these conditions.
SURGICAL APPROACHES TO THE CANINE VAGINA
Most vaginal surgeries are performed via a caudal approach. Episi-
I,[omy is frequently required to improve exposure of vaginal or vestibu-
1.11' abnormalities. The caudal approach to the vagina requires the follow-
Ii 19 preparatory steps:
1. Consideration should be given to placement of a transdermal
fentanyl patch or epidural anesthesia. IS If elected, an appropri-
ately sized fentanyl patch (4 /-Lg/kg/h) should be applied the
day before surgery.
2. A purse-string suture (2-0 to 3-0 nylon) is placed around the anus
to prevent intraoperative fecal contamination. A sign (white tape)
is placed on the dog's head with the words "purse-string" clearly
v.i si.bl (Fig. 1). This is to remind the surgeon and anesthetist to
Jilll ll\ II I\' 1)"I ' III'II\1I' ,I( of' (, lll1i ('1I 1 ,' d,'<1e('II, 'oll !')\l' or V"i('l'inaI' Y M eli ine, North Carolina
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272 MATHEWS
Figure 1. A piece of white tape placed in a highly visible location is used to remind the
surgeon to remove the circumanal purse-string suture and rectal sponges at completion of
the procedure.
remove the suture at the end of the procedure. Preoperative
enemas should be avoided, as this increases the likelihood of
contamination by liquid feces .
3. The perineum, ventral surface of the tail base, and perivulvar
region are liberally clipped and then scrubbed with povidone-
iodine (Fig. 2). . .
4. The dog is placed with its pelvic limbs hanging over the edge of
the surgical table. The edge of the table is well padded to prevent
ischemic or neurologic injury (Fig. 3).
5. The dog's thorax is placed in a padded trough or held in place
with tape to prevent rotation. The table is tilted 30 (head down)
and then elevated so that the vulva is at a comfortable working
height. Because of the head-down position, these animals are at
increased risk of regurgitation and subsequent aspiration. The
stomach must be empty (a minimum of 12 hours off feed). A
cuffed endotracheal tube should be used to prevent aspiration.
Finally, the pharynx should be examined a t the end of th pr -
dure and suctioned if needed before r Coy ry from nn slh 'sia.
6. The tail is taped forward ov ' r the l on.;n l micllin ' .
EPISIOTOMY (CAUDAL APPROACII)
1
1
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SURGERY OF THE CANINE VAGINA AND VULVA 273
Figure 2. Following placement of the purse-string suture, the perineum and perivulvar skin
Is liberally clipped and scrubbed in preparation for surgery. Note the infantile vulva.
1llIlIlh 'l 11 111 1111 1111 111' 1II1 1 I 1111'"11 IIllWlll oi II Vill 11111 til II 1111 1111111111 11 111 I II Il il ll l 11110111
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274 MATHEWS
made in a dorsoventral direction ventral to the anal sphincter through
the dorsal vestibular mucosa.
8
, 28
Placing a flat instrument such as a scalpel handle in the vestibule
while the incision is made helps to stabilize the tissues (Fig. 4). If the
surgeon plans to resect any ventral vaginal tissues, the urethra must
be catheterized to prevent iatrogenic urethral damage. Hemorrhage is
controlled with electrocautery and ligation of larger vessels such as the
dorsal labial branches of the perineal artery. As is the case with any
perineal surgery, hemorrhage can be profuse. Exposure is improved with
Gelpi perineal retractors or by placing stay sutures on either side of the
incision. Vaginal surgery in general is greatly facilitated by using an
assistant, who can provide retraction, cauterize, and handle a suction
tip while the surgeon proceeds unencumbered. An instrument holster
decreases the risk of dropping the electrocautery and suction tips. A
sterile 60-mL syringe case with umbilical tape threaded through a hole
near the mouth makes an excellent holster. The umbilical tape is clamped
to the surgical drape lateral to the field. Hoses and cords are draped
over the dorsal aspect of the patient to keep them sterile and out of the
way. Closure of the episiotomy is performed in three to four layers
depending on the size of the dog (Fig. 5) . Mucosal apposition is achieved
with either simple interrupted or continuous 3-0 to 4-0 absorbable su-
Figure 5; The episiotomy is continued into the lumen of the vestibule/vagina. The dorsal
vaginal mucosa (arrow) is closed first. A three- to four-layer closure is recommended.
tures. In smaller dogs, the subcutaneous closure is combined with the
mucosal closure in the same suture pattern. Interrupted nylon skin
utures are then placed. To prevent postoperative licking and premature
suture removal, an Elizabethan collar is placed. As previously men-
tioned, postoperative pain relief can be greatly enhanced with a fentanyl
patch or epidural anesthesia before recovery.
VENTRAL APPROACH
A v ntral approach to the canine vagina is required less frequently.
Il may b n cary, and is sometimes combined with an episiotomy, for
lot<l l vl.lgin' tomy (e .. , vagin.al neoplasia and strictures that are not
11111 'nabl ' to 1'1'1' alldal approC1 h). Th ventral approach has also been
11 ,' t' d 10 I l'rf()f"n l colOl l' y and in addi.tion to ovariohysterec-
1(11)) il) .l ('; 1, I ' pf vi. 'vv l'o ll hVI' Ili.ll ion 1l ,,,' oci8tccl wi th vaginal prolapse.
19
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276 MATHEWS
vagina and urethra, pelvic osteotomy may be performed.
2
The ventral
incision is extended caudally over the pelvic symphysis. The adductor
muscles are freed at their origins with a periosteal elevator to expose
the pubic and ischial rami (Fig. 6). Holes are drilled on either side of the
four proposed osteotomies. Additional holes are created so that the
musculature may be sutured to the pelvis at the completion of the
procedure. The obturator nerves are identified and protected. An osteot-
omy is made in the pubic and ischial rami, thus freeing up the floor of
the pelvis. The osteotomies are created with a Gigli wire, rotating burr,
or sagittal saw. The origin of the left internal obturator muscle is cleared
from this pelvic segment with an elevator. The surgeon can then swing
the pelvic floor out of the way to expose the entire pelvic canal. After
vaginectomy, the pelvic floor is wired back into position (18- to 20-gauge
Figure 6. Ventral approach to the female urogenital system vi p Ivle t t my. (D 9 I
In dorsal recumbency.) Ventral musculature I I vat d I I'omll y (1\); 11t11< , Ir pl'ocll'lll ( LI III
the pubis and ischium and will act a an h r p In It; 101' Olll' 11[J1l Will i II HI t 111111 111 (II), I hI
pelvic symphysi I I votod (Inti rool(O(I 1111 1 II,IIV (G) II I III IIIIIIV" lI)(jlll 111 /1 pi 111/ 1 iI<ll vh,
canal. (From All n , W, , IOWI II WA' VIIIIII II 11j1i11 11 11l1J III 111 11 !,,,lvl, IHIII II iii 11 \1 1 /111 11 !I II
do J. VI)I lli n ;' () : II II 1: ' 1, 111 11 wi lli 11111 111 11111
stainless-steel cerclage wire) using the predrilled holes. Adductor muscle
fascia from either side is sutured to its contralateral partner. The rest of
the closure is routine. Exercise restriction for a minimum of 4 months is
recommended to promote healing at the osteotomy sites.
SPECIFIC PROCEDURES
Vulvoplasty (Episioplasty)
Recurrent urinary tract infection (UTI) has been associated with
perivulvar dermatitis. Overweight bitches with infantile vulvae may
develop perivulvar skin folds that are prone to urine trapping and
subsequent dermatitis.
24
Concurrent abnormalities such as vaginal stric-
ture should be ruled out before surgery. Preparation is identical to that
for episiotomy. The amount of skin to be removed should be estimated
and outlined with a sterile marker before excision. Two inverted U-
shaped incisions are made lateral and dorsal to the vulva. A horseshoe-
shaped section of skin is removed, often along with extensive amounts
of subcutaneous fat (Fig. 7). If complete elimination of skin folds is not
achieved when the skin edges are apposed, more skin is trimmed away.
A double layer of interrupted sutures is then placed for closure (absorba-
ble sutures subcutaneously and nylon sutures in the skin).
Closure of an Anovulvar Cleft
This is a rare congenital anomaly in which a trough exists between
the ventral anus and the dorsal vulva. The defect results in fecal contami-
nation of the vestibule and is corrected by creating either an H-shaped
or inverted V-shaped incision between the anus and vulva. The dorsal
vulva or vestibule is then closed in multiple layers similar to the closure
of an episiotomy. This completely separates the anus and vulva.
6
, 27
Rectovaginal Fistula Closure
omll1LU'lications between the rectum and vagina are rare; when
p r ' ~ nt, they a r usually associated with atresia anP, 7, 17, 20 Puppies with
1\ re t ov ginal fi stul a pass feces from the vaginal orifice, The location
i\ l)d Hi:;: ' of th ' fistuln ar dctcnn ined by vaginography or a barium
1' 1)(' 11) 11 . ' 0 1' 1'('(' 1 ion on(oJ it'! tH of 1m) I i ng an incision between the anus (if
IllI'l'I ' j !lilt') ilnd /11(' don'Hd vtll va l' ('ommi SflUI' '. Blunt di ection is
, ' II'I'II'd otll III Ill(' Ivvl'l pi IIH' 11 11 1,lil . ( 'r ""l'I('ri :;:nlion of fhe fi stLil a may
,.i d 1\ il t Id, ' ltl lli,',Jfllll\, ' )'il, ' l it Iitl il 111,l lil"I' li
l
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278 MATHEWS
Figure 7. A, Typical appearance of a hooded vul va. B nd C, P rlvul var I<l n nnel f t I
excised dorsally and laterall y until eli mi n ti n of p lll<ln f I II III n 111 0v d,
tion is continued around the distal (blind) end of the rectum, which is
grasped and pulled caudally. The rectum is then incised and sutured to
the skin incision (anal orifice).
Resection of Edematous Vaginal Mucosa (Vaginal
Edema, Type 1-11 Vaginal Prolapse), or Pedunculated
Vagi nal Masses
After episiotomy and urethral catheterization, the mass or edema-
tous or redundant mucosa is isolated, and a fusiform incision is made
around its base (Figs. 8 and 9).28 The base of this edematous tissue
originates from the floor of the vagina just cranial to the urethral papilla.
Partial-thickness incisions and single-layer closure are performed if re-
secting edematous vaginal mucosa. Electrocautery is quite useful when
performing this procedure (see Fig. 9C). The urethral orifice is easily
visualized for catheterization by elevating the protruding tissue. Pedun-
c
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280 MATHEWS
Figure 9. A, Edematous vaginal tissue protrudes (Type II vaginal prolapse) through the
vulvar cleft. A urinary catheter (c) is placed within the urethra ventral to the mass (8) to
prevent iatrogenic trauma to the urethral papilla during excision (C) . Electrocautery facili-
tates the excision of the highly vascular vaginal tissues. (Courtesy of E.A. Stone, DVM,
MS, North Carolina State University, College of Veterinary Medicine, Raleigh, NC.)
culated vaginal tumors are remov I with full - I'hi el n'SN in iHioll s fol-
lowed by a double-lay rlosurc. M0f4 1 b 'ni gn (IIII1\)I'S lH' vn, il i!i'('('HHi
ble with th aid f nn LI i,' inlom l 10 iIi,! roVl ' 1''< 1'1 1/ 1111"[ ' , 1\1'(lll d Ildll(' "
rnali g n a nl' vflgin,l l IIIIll lll'H 1"\'1 11 "1'(' VlIl', III , ' l llI I I Y II I "I vov I I', IIII '\'Itl tll Y
(kl (' ndill )', OIl Il lI'i l I II" III '11 '11', II
VlIl',l l ll d ,' d"111 11 (1'11 '1- 111 111, 11'11 ' 111 ' ''['''' \ ill',l l ldl ll \' I" ' II'] '" ,j) III 1 111'
in young intact bitches during proestrus or estrus.
28
Large and brachyce-
phalic breeds are frequently reported with this condition. It may also
occur late in pregnancy or during parturition. Edema in the submucosal
tissues at the floor of the vagina just cranial to the urethral papilla
results in elevation and stretching of the overlying mucosa. In mild cases,
the tissue does not protrude through the vulvar cleft, and treatment is
usually not required. This is referred to as type I vaginal prolapse by
some authors.13, 23 Vaginal edema regresses at the end of estrus, however,
and the recurrence rate is high. When the pear-shaped mass of tissue
protrudes through the vulvar cleft (type II vaginal prolapse; see Figs. 8
and 9), it is prone to trauma and self-mutilation. Dysuria may also be
reported. Conservative management consists of placing an Elizabethan
collar on the dog and keeping the tissues lubricated until they regress
after estrus. Hypertonic solutions can also be applied (e.g., 50% dextrose)
in an attempt to shrink the tissues to some degree. Hormonal therapy
may also be attempted.
13
, 28 Ovariohysterectomy is curative and should
be considered to prevent recurrence. If the dog is intended for breeding
or if the tissues are traumatized, surgical excision is recommended. In
severe cases, there is circumferential involvement of the vaginal mucosa
with protrusion of a ring of tissue through the vulvar cleft. This is
r 'ferred to as vaginal prolapse or type III vaginal prolapse (Fig. 10).1
3
,
'1, 28 Although the vaginal lumen lies dorsal to the mass of tissue in dogs
with less severe forms of vaginal edema (type I-II vaginal prolapse), the
vaginal lumen of dogs with type III vaginal prolapse lies within the
t' 'nter of the mass of tissue. Resection of this edematous ring of tissue
lhus requires a different technique.
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282 MATHEWS
Thankfully, tumors of the vulva or vagina are uncommon (2%-3%
of canine neoplasms), and most are benign and pedunculated.S, 26 Bitches
with vulvovaginal neoplasia frequently are presented with a history of
vulvar discharge or because the owner noticed the mass protruding
between the labia. Other clinical signs such as dysuria, stranguria, polla-
kiuria, tenesmus, and vaginal bleeding occur less frequently.
Before tumor excision, either incisional or needle (Tru-Cut; Travenol
Laboratories, Deerfield, IL) biopsy should be strongly considered. A
complete workup should be completed, including urinalysis (with cul-
turing if suggestive of a UTI), digital rectal and vaginal examination,
vaginoscopy, abdominal palpation, and palpation of regional lymph
nodes. Thoracic and abdominal radiography and abdominal ultrasonog-
raphy should be considered to look for evidence of metastases. Exfolia-
tive cytology may aid in the diagnosis of transitional cell carcinomas or
transmissible venereal tumors. In addition, vaginourethrography may
aid in preoperative planning. 1, 11, 12 Pneumovaginograph
y
l has been de-
scribed, but positive-contrast vaginography is performed more com-
monly.lO, 12 This technique is also useful when evaluati'ng incontinent
dogs with potential ureteral ectopia, vaginal strictures, or pelvic bladder.
General anesthesia is required. A Foley catheter filled with iodinated
water-soluble contrast media is inserted into the vestibule, and its bulb
is inflated. Contrast media is infused while the vulvar labia are held
shut with sponge forceps or Allis tissue forceps. A total volume of 1.0
to 1.5 mL/kg is typically used.lO, 12 This process is aided by the use of
fluoroscopy if available.
Brodey and Rosze15 retrospectively evaluated 96 uterine, vaginal,
and vulvar tumors in dogs. Thacher and Bradley26 evaluated 99 vaginal
and vulvar tumors. The mean age of the dogs at the time of diagnosis
was 10.8 years for both reports. Results from these studies showed
that most tumors in the female canine reproductive tract (ovarian and
mammary neoplasia excluded) are benign (73%-84%). Leiomyomas oc-
cur most frequently and originate from smooth muscle layers within the
wall of the vagina or vestibule.
s
, 14,26 Multiple leiomyomas may occur in
the same . animaP, 14, 26 Leiomyomas may develop intraluminally, in
which case, they are usually pedunculated and originate from the wall
of the vestibule.
s
Extraluminal leiomyomas are much less common,
usually originate from the dorsal vestibule, and present as a firm peri-
neal swelling.
s
Leiomyomas seem to be endocrine dependent. 14 Dogs
with vaginal or uterine leiomyomas may have concurrent ovarian follicu-
lar cysts, estrogen-secreting tumors, endometrial hyp rplasia, or mam-
mary hyperplasia or neoplasia.
14
Bi tches thGll" GI l" spay 'd 'ti dy in li fe 10
not seem to develop genital I iOI11 YOI11 C1K.II Ovol"iohyslvrl' l'i OIll 111:1y
result in tum.or sbri nkag,.I'1 Pibrol11Zl S, p() 1 I H, Hild lipnlll ll , 11 \[1' :lI lm
occur in thi al" 1:'1. Surgic: 1I l' (' i, iOI\ in IIHtl dll y' 'liI'lI llvl' If' 111(' 11 11 1, H I
b n ign. Mnli gn,JIlI Vlil vl)Vd)', li lld 11I 111lI l'/ (I I"" 1'1"11 ) 11, 11'1' 111 10 IWI' II 1'\'
I orl'ed, wi ll. II'ioIII YIIII ,II'I'llI lhl l 111111 11 111 )', 1111. / 1 1II Iqll. ll ill v" I" M, d )', 1111 111
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amount to approximately 10% of the tumors in this region, should also
be considered as a differential diagnosis.s,26 TVTs may be removed
surgically, but are highly responsive to radio- and chemotherapy.21,2s
Spontaneous remission of TVTs may also occur. Transitional cell carci-
noma originating from either the bladder or urethra results in typical
urinary tract signs (e.g., stranguria, pollakiuria) and may progress dis-
tally to form a palpable vaginal mass.
I8
Partial Vaginectomy for Necrotic or Traumatized
Vaginal Prolapse
In cases of long-standing 360
0
(type III) vaginal prolapse, damage
to the vagina may be too severe to allow more conservative management
(i.e., cleansing with hypertonic solutions, replacement and temporary
suture closure of the dorsal vulvar commissure) (see Fig. 10).13,28 Prepara-
tion for this procedure is similar to that for episiotomy. As is the case
with any procedure requiring vaginal resection, the urethra should be
catheterized first. The prolapsed vaginal tissue needs to be elevated to
visualize the urethral papilla. An episiotomy may aid this process.
Partial vaginectomy as described here is analogous to the technique
used for rectal resection after rectal prolapse. The procedure involves
the removal of a "donut" or collar of traumatized tissue. The vaginal
lumen is in the center of this tissue. Placing a sterile lubricated syringe
case into the vaginal lumen helps to orient the surgeon and allows the
surgeon to apply counterpressure during excision. The initial mucosal
incision is made dorsally proximal to any damaged mucosa. The scalpel
blade passes through the muscular and outer connective tissue layers of
the everted vagina. The blade then passes through the layers of the
noneverted portion of the vagina in reverse order, finally coming to rest
on the intraluminal syringe case. If a circumferential incision is made to
1'l' 1110Ve the damaged tissue, the cranial vagina retracts into the pelvic
I'[l nat where it is difficult to retrieve. For this reason, the incision is
1l18de in a staged manner. Starting dorsally, no more than one fourth of
I ht' ircumference is incised. A two-layer closure of this section is per-
forme I. with absorbable suture material. This process is repeated until
I hr 'n ti re ring has been resected. The suture line is then allowed to
1'('\ nl \ into the pelvic canal.
Correction of Vaginal Septa, Bands, Stri ctures, and
t no os
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MA'I'III (WS
A
Figure 11. Some of the more common forms of congenital vaginal anomalies include
vaginal bands (A), vaginal septa (B), annular strictures just cranial to the urethral papilla
(C), and vaginal hypoplasia/stenosis just cranial to the urethral papilla (0). (From Wykes
PM, Olson PN: Vagina, vestibule and vulva. In Slatter D (ed): Textbook of Small Animal
Surgery, ed 2. Philadelphia, WB Saunders, 1993, pp 1308-1316; with permission.)
or dystociaY 16. 22, 28 Urinary incontinence may also be reported and may
be true incontinence as a result of coexisting congenital abnormalities
such as ureteral ectopia or pelvic bladder. On further questioning, it
may become clear that the dog is not truly incontinent but dribbles urine
when lying down, presumably as a result of passive release of a pool of
urine that has collected cranial to a strictureY28 It is this pooling of
urine and vaginal secretions cranial to the stricture that thEwretically
predisposes these animals to UTI. A complete workup should include a
digital vaginal examination, vaginoscopy, and vaginourethrocystogra-
phy (see section on diagnostics for vaginal masses). Other congenital
anomalies (e.g., ureteral ectopia, pelvic bladder) should be ruled out. A
urethral pressure profile should be considered.
Vaginal septa are the result of incomplete medial fusion of the
Mullerian ducts. They run parallel to the long access of the vagina and
may extend from the vestibulovaginal junction to the cervix. Septa may
be incomplete or may form a blind-ended pouch (double vagina). 22. 28
Episiotomy is generally required to gain adequate access for septal
resection. The septum is excised from the floor and roof of the vagina.
The vaginal mucosa is then sutured to prevent adh ion or slri tur '
formation. Long-term follow-up da ta on dogs [l rh.: r S(' I 1'<-1 1 C ision , rl'
lacking.
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and til(' IIl"o);(, l1il.ll 111.11 1I :I I I,rll \, d11" '1 'I 11'111'1 II I Id l' l i! III 111 111 1' d PI',II,
inc() l1)pl l' l l' 1"' 1' 111 1'1111 1'11 " I li li l il l (1111 1( 1' II ' li ti l l iii Ii II I' I llIrI" II ' l ill lri 1 11)',1
11 1I 11I 11'i1 ' 1111 '1' lillll lI 'ill ,ri l,1 , 111111 111 [II IIii' 111, ' 111111 11 ' 111,, 11 11 II I II ),. I.d 1 >1 )'1 Ilil l
examination, vaginoscopy, or contrast radiography may reveal a circum-
ferential narrow fibrous ring of tissue in this region (Fig, 12), Vertical
bands are also caused by incomplete perforation of the hymen but
are easier to treat (Fig. 13). Resection of single vertical bands may be
accomplished with the aid of a vaginal speculum. Under general anes-
thesia, the band is stabilized and retracted caudally with a spay hook or
long forceps. The band is then transected with Metzenbaum scissors. If
the band cannot be adequately visualized, an episiotomy is required.
Further examination of the vagina cranial to the band is then performed
before recovery from anesthesia. Vaginal hypoplasia results in a broader
area of narrowing than that caused by an imperforate hymen and is
generally referred to as vaginal or vestibulovaginal stenosis.
n
, 28
Simple bougienage of vaginal strictures or stenoses has met with
little success as the tissue healsY 16 Dilatation of a simple stricture or
persistent hymen is easily performed at the time of diagnosis and results
in success in some cases. Dorsal incision of strictures or stenoses via an
episiotomy followed by a T-shaped closure (vaginoplasty) to increase
the vaginal diameter has also met with generally unfavorable results.n, 16
Good results have been reported for a few cases with complete ring
resection. This technique involves episiotomy followed by urethral cathe-
terization and 360
0
dissection of the stricture or stenosis. Resection of a
vaginal stenosis is technically more difficult than resection of a stricture
or persistent hymen because of the amount of tissue that must be
I' 'moved. Two circumferential incisions are made, one cranial to and one
II,IUI I.' VI( IIIIIII l rilll ll llill vl"wllillllllilIIIII II VIlI IIIIIl I Ii" " 11111111 (I 1\ ' Ii 11111 ,
II VM, M'. , 11111111 1 111 11 11111 ',li li ll 1IIIIV' lI l1ll y, I , 11 111 1" li t V" llI llll l il V Muilll ill " II ""liill l III )
1'16 Mi\' J'IIIiWS
Figure 13. A vertical vaginal band (within the circle) as viewed through a vaginal speculum.
(Courtesy of E.A. Stone, DVM, MS, North Carolina State University, College of Veterinary
Medicine, Raleigh, NC.)
caudal to the stricture or stenosis. Resection of the submucosal fibrous
ring of a persistent hymen does not require a full-thickness and
the mucosa is easily sutured so that none of the deeper vagmal tIssues
are exposed to the lumen. Full-thickness excision of vaginal stenoses is
required. Catheterization and protection of the urethra are of
importance during this technically demanding procedure: LIgatIon of
vessels on the external surface of the vagina may be necessary. Once the
ring of tissue has been resected, end-to-end anastomosis of the vaginal
segments is performed (Fig. 14). Vaginectomy is the final option
correction of problematic vaginal stenoses in bitches that are not m-
tended for breeding. Results with this technique seem to be favorable.
Complete vaginectomy with removal of the stenosis can be performed
via a caudal approach in spayed bitches or combined with a standard
ventral midline ovariohysterectomy.16 Partial vaginectomy v ia a a Llda I
ventral midline approach may also be performed, II Th vagina is li gat d
and resected as close to th stenosis a possibl' I:(J jirnini:-; h I'he poss ibi l-
ity of urine pooling. Of '10 clogs Ir ' ai'ccl wilh Ihi !> k chniqlll', 7 li nd 'ood
results.
11
Complete Vonln ctomy
( 'OI'lltil ' II ' voIl'. IIII '1 1111'1 \ I' 1"' 11 11 11111 '11 ill .1111',1 \ ' 111 1111,"11 1111'\1 '" \d)', 1
11 .1 1111111111 11 11 l it , llll d ' Iolll ' I IlltI, ,iI 1)', 11 ", 1' "' II!I",I 1\ III, \ 1)',1 11 ' .1 ,I'II II,I!
Figure 14. Circumferential excision of a vaginal stenosis has been completed. Urethral
catheter (c), and circumferential interrupted mucosal sutures at the level of excIsion (arrow
heads).
The best exposure is gained via the ventral pelvic osteotomy
discussed. After careful dissection, clamps are placed across the vagma
just cranial to the urethrovaginal connection, the vaginal vessels are
ligated, and the vagina is transected. A or other
inverting suture pattern is used to close the can
olso be performed via the caudal approach (epISIOtomy reqUlred), !" full-
thickness circumferential incision is made caudal to the stenOSIS and
vranial to the catheterized urethral papilla. The vaginal vessels are Ii-
I' a ted, and cranial dissection continues along the. outer surface of the
l'I'onial vagina and cervix ';lntil the uterine. IS and resectable,
' I'b caudal vaginal lumen IS then closed WIth absorb-
dbl . sutures cranial to the urethral papilla. The epISIOtomy IS closed as
I'rav iOLl ly discussed. In sexually intact female dogs, a combination of
lilt' lwo (v ntral midline and caudal episiotomy) approaches may be
1I 1'l('d flO tha t i t11ultaneous ovariohysterectomy may be performed.
Vulvovaglnectomy with Perineal Urethrostomy
'I'ldH 11 'l'illliqll\' h,\ , 111'1' 11 1'1'1 ()I' \vci in I'hr 'c with advan ed
1' 11 1 IlVdl,.I I) ,tI 111 '(1 111 1111 1" Ih"l " III ' I'(1,l(' llI'd I ,ll I (II ' ilicililkd , Il w 1I,1'l'I'hr. 1
1'1'1 ,111 ,\ I II 11\1 ' ,I,))" II II I' II ,tll illld"I , IlV,\ I' lllh YH II'I'I 'I' III I)) In PI ' r\tlrt)I( ' ti
\ ,,01 I.llIti ,"d I'I' III" ,t! 1'1 ' 1'"1011 II '1'1" , ,I, I)', III IIii'll 1'1.11 "',1 III 1, ' 111 ,11
11'1 111111 '1 ' 111 \ III 1II I' I'I\'Idlllll I," 11 11'1, 111 11.11 ' '1 ' 1111 111 1,1, ' II II' dll "', Ih 'll II '
2/lH MA'J'I IEW '
quired for this procedure is somewhat analogous to that performed for
a rectal pull-through (Fig. 15). A fusiform incision is made around the
labia. Dissection continues along the external surface of the vagina. The
urethra is catheterized and dissected free, clamped, and transected from
the vagina. In spayed bitches, the cervix and uterine stump are also
removed. Once the vulvovagina has been removed, the defect is closed.
The urethra is incorporated in the closure to create a perineal urethros-
tomy. Survival times in these three dogs were 9 weeks (transitional cell
carcinoma, died of unspecified causes, no necropsy), 7 months (fibroleio-
myoma, euthanatized because of metastatic mammary carcinoma, no
local tumor regrowth at necropsy), and 10 months (anaplastic spindle
cell sarcoma, euthanatized because of tumor regrowth first noted at 7
months after surgery). Postoperative complications were minimal and
(one of each) mild urine scalding, transient stranguria,
parhal stomal necrosIs, UTI, and mild stress incontinence. Because large
numbers of dogs have not been evaluated with this technique, owners
B
stay sutures
on urethra
ligated branches of
vaginal a. & v.

1.. 1.\\\ , . If: t
--L;
, 11
i.t[',

I
I I
Figure 15. Vulvovagln lamy, 1111 1 lilli /III VII/VI IV 1,/11 11 / II 1I11 1Vlu il lY II/nllllli/" I 11 /011,1111
serosal sl lrl (')(l 1\1)(1111111/111 v 1 Iii II II VI Hili /II llill lll il l/il i i/ II/ III 1I1l" 11/ 1111/ Plllli id III II III iI/ y
Into I'h liIOlu/OIlICl PI IIIIlIIII 1111 11 1111 11 II IIIIY (/ 1,1, " I 1/ 11 li lly ',A, WII/II IIW ' ,I, 1/11/ 11 MI , 111 It!
Vll lvoVlllllll lilllllllY 111111 jl ll lli llill /II III l1l1 111 IIIII IV 1111 1I 11"/ lll ft Iii II / llill Vii/VII 111111 Vill i/II I V"I
: 11 11 I III" 1(1 ,//,' 1, /111 11, willi /111 1111/ /11111
should be warned of all possible complications associated with aggres-
sive surgery in this area.
SUMMARY
Accurate diagnosis of canine vaginal abnormalities often requires
general anesthesia, vaginoscopy, and contrast radiography. Abdominal
ultrasonography, thoracic radiography, computed tomography, and his-
topathology may also be advised for the workup of mass lesions before
surgery. Many procedures such as episioplasty and resection of peduncu-
lated vaginal masses or edematous tissue are easily performed with
proper planning and equipment (e.g., electrocautery). Consideration
should be given to referring more complicated procedures such as resec-
lion of large vaginal masses or vaginal stenoses to a board-certified
Hurgeon. Finally, preoperative placement of a fentanyl patch and pre-
or postoperative epidural analgesia are highly recommended for any
vulvovaginal surgical procedure.
References
I , Adams WM, Biery DN, Millar NC: Pneumovaginography in the dog. A case report. J
Am Vet Radiol Soc 19:80- 82, 1978
", Allen SW, Crowell WA: Ventral approach to the pelvic canal in the female dog, Vet
UL'g 20:118- 121, 1991
I, Amand WB: Nonneurogenic disorders of the anus and rectum. Vet Clin North Am
mall Anim Pract 4:535-550, 1974
'I. Uilbrey SA, Withrow SJ, Klein MK, et al: Vulvovaginectomy and perineal urethrostomy
for neoplasms of the vulva and vagina. Vet Surg 18:450-453, 1989
r" Brodey RS, Roszel JF: Neoplasms of the canine uterus, vagina, and vulva: A clinico-
pa thologic survey, 90 cases. JAVMA 151:1294-1307, 1967
II. Burke TJ, Smith CW: Vulvo-vaginal cleft in a dog, J Am Anim Hosp Assoc 11:774-
777, 1975
'I, ( :1' ' in r TP: Surgery of the rectum and anus. Vet Clin North Am Small Anim Pract
:'167- 180, 1972
K, Il nr Ii EM: S l ected surgeries of the male and female reproductive tracts, Vet Clin
NOI'th Am mall Anim Pract 14:109-122, 1984
" Il l'l1dri x PK, Raff MR, Robinson EP, et al: Epidural administration of bupivacaine,
Ill orphin " or th ' ir combination for postoperative analgesia in dogs. JAVMA 209:598-
W7, 1996
III 1111 11 1'1\: l'OHIli v'- onlrost vaginourethrography for diagnosis of lower urinary tract
dIH\' ,' H\' , 1/1 Kirk I{W (<' eI ): IIrr ' nl' V t ' rinary Therapy X- Small Animal Practice.
1' l dll1 d" lphl,i , Wil S1l 11i111v1'H, 19K'!, I P 1142 1'145
II I lnll 1' 1\, Silyll' 1\: ( '() n)jt' nll il l vl' Hllbldn vngl n.II in th' bit h. J Smal l Anim Pract
1" 1177'" 1'/11 1
I ' llidl 1' 1\, (; 11 ,1111 ( ', 1"IIIi " I'1 " All "", III"ll itll l II I jloli ll vl' \'III II",i HI V' \I\I 'HI III'(' lhl'ngl'aphy
111' 11 dlllHl llll dl. "I d III 1111 ' " Iii Ii / il lll l"l 111 1111 '1'11, '1 ' 11, ,'1 ' \ 1 ',,1'1, 1'111"
1\ /,,1'1111 111 '1 ': 11 VI I)II II II II 'III I' II 'III ' 11/ I " I 'W ("d) 1 11111 ' 111 VI, I,,, III I1 I Y '1'ItI '"'1 ly \ :: 111 11 11
11 11'1 11 1 I 'll" I 'I ' l ' hll llll " I/ " "" IVII ' II lIlll dl 111(\'1 I II ' I III ' I 111
1
,
II /11 111, I VI' I 1' 11 111 '" '' 1'1 1'11 111111 N (, Ii ) I ',d/IIIIII)\ \' " I II " \ 111 ,,,, ,, ,, l ,tI I \ " I
\ 'I", I I 111')',11 \, 111/' lill, I 'll I 'll/ \ ,"d
290 MATHEWS
15. Kyles AE, Papich M, Hardie EM: Disposition of transdermally administered fentanyl
in dogs. Am J Vet Res 57:715-719, 1996
16. Kyles AE, Vaden S, Hardie EM, et al: Vestibulovaginal stenosis in dogs: 18 cases
(1987-1995). JAVMA 209:1889-1893, 1996
17. Louw GI, Van Schouwenburg SJEM: The surgical repair of atresia ani in a Doberman
bitch. J S Afr Vet Assoc 53:119-120, 1982
18. Magne ML, Hoopes PI, Kainer RA, et al: Urinary tract carcinomas involving the canine
vagina and vestibule. J Am Anim Hosp Assoc 21:767-772, 1985
19. McNamara PS, Harvey HI, Dykes N: Chronic vaginocervical prolapse with visceral
incarceration in the dog. J Am Anim Hosp Assoc 33:533-536, 1997
20. Rawlings CA, Capps WF, Jr: Rectovaginal fistula and imperforate anus in a dog.
JAVMA 159:320-326,1971
21. Rogers KS, Walker MA, Dillon HB: Transmissible venereal tumor: A retrospective
study of 29 cases. J Am Anim Hosp Assoc 34:463-470, 1998
22. Root MV, Johnston SD, Johnston GR: Vaginal septa in dogs: 15 cases (1983--1992).
JAVMA 206:56--58, 1995
23. Schutte AP: Vaginal prolapse in the bitch. J S Afr Vet Med Assoc 38:197-203, 1967
24. Scott DW, Miller WH, Griffin CE: Muller and Kirk's Small Animal Dermatology, ed 5.
Philadelphia, WB Saunders, 1995, p 887
25. Singh I, Rana JS, Sood N, et al: Clinico-pathological studies on the effect of different
anti-neoplastic chemotherapy regimens on transmissible venereal tumours in dogs. Vet
Res Commun 20:71-81,1996
26. Thacher C, Bradley RL: Vulvar and vaginal tumors in the dog: A retrospective study.
JAVMA 183:690-692, 1983
27. Wilson CF, Clifford DH: Perineoplasty for anovaginal cleft in a dog. JAVMA 159:871-
875,1971
28. Wykes PM, Olson PN: Vagina, vestibule and vulva. In Slatter D (ed): Textbook of
Small Animal Surgery, ed 2. Philadelphia, WB Saunders, 1993, pp 1308-1316
Kyle G. Mathews, DVM, MS
North Carolina State University
College of Veterinary Medicine
4700 Hillsborough Street
Raleigh, NC 27606
;
j
CLINICAL THERIOGENOLOGY 0195-5616/ 01 $15.00 + .00
TRANSCERVICAL INSEMINATION
TECHNIQUES IN THE BITCH
Marion S. Wilson, BVMS, MVSc, MRCVS
The technology to freeze and inseminate frozen semen has been
ilround for over 30 years, but it is only relatively recently that there has
heen an upsurge in its use as breeders take advantage of the benefits it
offers to their breeding programs. This increased use is mainly because
of the improved conception rates now being achieved as a result of
Il ctermining the critical factors for success. Defining the optimum time
1'01' insemination and developing methods for determining this critical
I i me have had a significant impact on improving the success rate; also
Important has been the recognition that thawed semen should be depos-
Itl'd by intrauterine means rather than vaginally. 1, 2, 4, 10 This overcomes
I he effect that processing has on the ability of the sperm to migrate
Ihrough the cervix and reduces the sperm dose perceived as required
11\ ' 1' bitch.
The options to achieve intrauterine semen deposition are by surgical
I II' transcervical insemination (TCI). In many parts of the world, the
'tiI rgical option is the method of choice because it is easy to perform and
II ,IS no major learning period. Surgical insemination has some draw-
I'dei " in.eluding the risk associated with general anesthesia and surgery
oIl ld the fact that only a single insemination is realistic (and ethically
111 ' ('(' 1 table). Many owners and veterinarians prefer a nonsurgical trans-
1 l' l'v ica l opti.on; in some countries, it is considered ethically unacceptable
II I Iwrform int ra uterine insemination surgically. Previous reports have
Ill tli( 'i ll'cci th, t T T is not possible or that it is feasible only in the
lilli' 11H'li zc I bil: 'h. Mol" recntly, techniques that contradict these opin-
I I II ' IN \ 1' I II IJII ',I II NI II ' I I I t\ 1I1 ' 1I ',I'l l II \NII'I I /\! 1'1' \1 I II I
I I I I I ~ I I I I I I I I ~ I I I I I " ~ I 1111 ' 11111
292 WILSON
ions have been developed.
ll
The problems faced in any attempt to
catheterize the canine cervix relate to its relative inaccessibility.
In addition to frozen semen insemination, the ability to catheterize
the cervix in the bitch provides clinicians with the opportunity to access
the intrauterine environment without the need for surgery. This means
that an extended range of procedures can be performed and that they
can be done routinely and repeatedly if necessary, without undue stress
to the bitch.
ANATOMY OF THE CANINE REPRODUCTIVE TRACT
To catheterize the cervix, it is essential to be familiar with the
anatomy of the reproductive tract of the bitch and the features pre-
venting routine access using standard equipment.
Length of Vagina
The vagina of the bitch is comparatively longer than that of most
species; the total length from cervix to vulva, including the vestibule,
has been reported to be 10 to 14 cm in an ll-kg bitchY
The practical significance of this distance to the cervix means that
relatively long equipment is required; in large breeds such as the Saint
Bernard and Newfoundland, this length can be up to 29 cm.
Paracervix and Dorsal Median Fold
The cranial vagina, described as the paracervix/ is dominated by a
well-defined fold, the dorsal median fold (DMF) (Figs. 1 and 2). The
DMF extends caudally from the vaginal portion of the cervix, which
cranial
o
dorsal
ventral
vaginal
lumen
Figure 1. The anatomy 01' 111 11 p/ll /ltll ll VI I Ill IWlll l ll ll i dill 11 1111111 11 111 1 rilid (I IMI ) 1111 11111111 111 1
caudAll y In tl1 fll UHl ll llill lt lll lli (I I), 11 111 Vl li llt ll ll i ll illllill " I II IIII IIIvl III IIIIIVIIlIl IIIlIiIll IlI" ( ,)
wi ll i Vllll l1 /llll li llll ll ll l Vlllll l 'l I I) 111111111" 1111111- (I )
TRANSCERVICAL INSEMINATION TECHNIQUES IN THE BITCH 293
Figure 2. Ventrolateral view of the paracervix. This anestrous reproductive tract illustrates
the position of the dorsal median fold (arrow), cervical tubercle (C) and extemal cervical as
(0). During estrus the dorsal median fold undergoes marked enlargement and the caudal
tubercle becomes more pronounced.
l' xists as a distinct tubercle, and then ends in a smaller caudal tubercle.
When viewed through a speculum, the caudal tubercle and narrow
crescentic vaginal lumen have been described as giving the misleading
nppearance of the vaginal portion of the cervix and external uterine
ostium. When insemination catheters are introduced into this area, there
is often some resistance and then a distinct "give," which may explain
why some clinicians believe they do intrauterine inseminations routinely
wh n, in fact, they are only inseminating into the paracervical area; the
I r ue cervix is to be found approximately 2.5 cm cranial to this pseudocer-
vix. Cranially, the paracervix is limited by the fornix, a slit-like space
CI'< nioventral to the vaginal cervix, which appears as a blind end when
v il' wed through the endoscope.
The paracervix has particular relevance to cervical catheterization,
1 H.' <l LlSe reduction of the vaginal lumen by the DMF limits the size of
t' lj uipment that can be passed through this area. The size of the lumen
vdri' m.arkedly between bitches and is not directly related to the size
01 lh bi tch; it tends to be narrower in maiden bitches and in certain
lin' ,ti s or lin within breeds.
C nine Cervi x
' l'lw 1'l' l'vi li ('. di agonnll n ross th Lit rova inal junction, with the
, ,11 11 11, 11 II 1\' , '( ' I' i \ dln,('\(' d t' I'III )i() dors. lI y from the Vc gin, to th uterus
( 11(' 1111 '" I ) ( '( III III " l' lI' llIl y, II I" IIlI I' I'll n l Ol'i ri {' l ' or I'Iw t\' I' Vi l ' lI I I'n nni fn s
l il lI l(I/1 1 d l l 'I 'I '11 d,,, di y, w lll'i " 11I 1111 ' I ' I t'l' lidl lll'i ri ,'" Iii din','l t'd I II 11 11'
\ "r, 11 111i 11 ,111 1 ' I 'l l I ' 1" 1 I II Ii III 1/1 111, 'I II " d V" I II I' dl I I 11 1i ' , " 'I' l 'l ti I l d ll ' I'I ' I"
II I I I! ' " " 111' 1 I" " I II 1' 11 , " I 1III I I II ' II I 1111 I1I I II 11'1 I" (II 1'1 ' I " I II I \ )
294 WILSON
Figure 3. The position of the external cervical os within many furrows on the cervical
tubercle can be identified by the fluid issuing from it.
The angle of the canal means that passing a catheter through the
cervical canal is not without its problems; the diameter of the canal also
has a bearing on the technique. Recent work by Watts and Wright13 has
revealed that the cervix is patent throughout the reproductive cycle of
the bitch but that cannulation can be performed more readily at some
stages of the cycle than at others. Experience in performing TCI has
shown that the cervical canal varies in diameter, with maiden bitches
presenting more often with a narrower lumen.
In summary, the length of the vagina, narrow paracervical area
because of the DMF, position of the cervical os, and angle and diameter
of the cervical canal present significant obstacles to the routine catheter-
ization of the cervix with standard equipment.
TRANSCERVICAL INSEMINATION TECHNIQUES
There are currently two methods described that allow intrauterine
insemination to be performed routinely in the bitch via the tran rvica 1
route; they employ different equipment and tecluli que to ov r om tb
obstacles presented.
"Norwegian" Method
Thi H IIll ' lhud Wil li I I/I I dl ' I ill,, 'd I Ii' 111111 1',111 ' 1 1' 1 , il l , II I I 1I,, 11I11 1!'11'
d, ' 1, I' l l ,, ' d 1111 II ii' 11111 1111 , -,1 111 ' 11I ' 1" 111i11111l1l1 1l 1 III " 111 1.1 \\111 ' Itl ll " 11I1"d
by Andersen
l
for the intrauterine insemination of frozen semen in the
bitch. The equipment consists of a nylon sheath and metal catheter;
these are produced in three sizes to suit bitches of different sizes (Fig. 4).
An assistant holds the bitch in the standing position on a table of
convenient height. The sheath is passed along the dorsal wall of the
vagina as far as it easily goes; it is often too wide to be introduced
into the narrow paracervical area. The sheath is palpated through the
abdominal wall, and the cervix is usually found 1 to 2 cm in front
and slightly above the sheath. The cervix, which undergoes marked
enlargement during proestrus, is fixed through the abdominal wall be-
tween the thumb and forefinger, and the metal catheter is introduced all
the way through the sheath to the cervix. Manipulation of the cervix
changes the angle of the cervical canal to a more horizontal position,
and the tip of the catheter is brought into contact with the cervix while
carefully searching for the os. Once this has been located, the catheter is
advanced through the cervical canal; the ease with which this is achieved
varies between bitches. There should be no resistance to the flow of the
semen, and there is a distinct sound associated with the introduction of
the final small amount of air in the catheter when the catheter is intra-
uterine. If the catheter position is incorrect, there is significant backflow
between the sheath and catheter. Sedation is usually not required, as
most bitches in estrus are happy to stand for this type of handling. With
this method, it is important that the bitch should have an empty bladder
,l nd stomach to facilitate palpation?
"New Zealand" Endoscopic Method
This technique was developed as part of this author's degree pro-
gra m.
16
The equipment used is a rigid cysto-urethroscope (Storz Ex-
I 11111 ' " N' II WII jlll i ll 11111 11 1111 111 11 11 111 111 1111111111 111 1 11 11111 111 III 1 111 11 1111 1 11111 11111 I IVII IlI
1"111 11111111 111'" 111 11111 1111 11 11 11111
296 WILSON
tended Length Cysto-urethroscope, Coleta, CA), which consists of a
telescope with a 30 oblique viewing angle, a sheath, a bridge, and a
cold light source; the working length of the assembled endoscope is 29
cm (Fig. 5). A video camera can be attached to the endoscope, but this
is not essential. When this technique is being used for insemination, an 8-
French gauge urinary catheter is appropriate in most bitches for cervical
catheterization, although a 6-French gauge is sometimes required in
small or maiden bitches.
The bitch is restrained in a standing position on a specially designed
platform on a hydraulic table; the platform provides a tie point to the
dog's collar and a canvas band around the abdomen, which restricts
sideways movement and discourages any attempt to sit. The use of the
hydraulic table and chair ensures the optimum position of the bitch
relative to the operator during the procedure and is helpful but not
essential (Fig. 6).
The endoscope is introduced into the vagina and advanced through
the vaginal folds by observing the direction of the vaginal lumen. In
proestrus and early estrus, the rounded vaginal folds can make advanc-
ing the endoscope more difficult, because they tend to fill the lumen; as
estrus p:r:ogresses, dehydration of the folds results in a more obvious
route for advancement of theendoscope.
9
The caudal tubercle of the
DMF is usually a prominent landmark, and the lumen can become quite
narrow in some bitches at this point, requiring manipulation of the
endoscope to the widest space. This may result in the endoscope being
Figura 5. f: ncl (Jpln I fl ll lpl ll llI ll 1111 11111 \1 11 I I vll )I" 111 111111 1111 1111111 1)1 11 1 111 111 II I II II I/II 11111 1111
111 (1 G (1)1(1 (1\ ), : 1( )" I 1111111i 1l 1/ 1111 1\/i "v .111 11 1111111 11 ' li ll il l (I ), 11111111111 (I I), 111\l hll l (I ), 1\11111 1
' 1I 111f 11i 111 11 I" III IIUII Y 11111101 111 (II)
Figure 6. Endoscopic transcervical insemination. The bitch is restrained on a specially
designed stand; the abdominal band limits sideways movement and attempts to sit. The
endoscope is advanced through the vaginal folds by observing the direction of the vaginal
lumen. Catheterization of the cervical canal is achieved by manipulating the cervical
tubercle, making use of the rigid endoscope and the catheter.
pushed to one side of the DMF rather than continuing ventrally under
the DMF. The vaginal portion of the cervix appears as a distinct tubercle,
hut as the cervical os faces caudoventrally or ventrally, it is usually not
i II1mediately obvious. To locate the os, the scope must be advanced
Iinder the cervical tubercle; the os is situated in the center of a rosette of
furrows in most bitches, but in some, its position can only be identified
hy observing serosanguineous fluid flowing from the cervix (see Fig. 3).
'I' h position of the os can seem to change through estrus with dehydra-
I iLm of the vaginal folds. The catheter is advanced into the cervical os
hy manipulation of the endoscope and catheter. The rigidity of the
(' ndoscope is used to move the cervical tubercle, line up the os, and
vhe n e the angle of the canal. Once the tip of the catheter is introduced
1nl'0 the os, it is steadily advanced using a twirling movement to aid its
pnssag through the cervical canal.
1"0 1' semen deposition, the catheter is passed in as far as it is able to
,;() wit hout for ; it is important to observe the semen being inseminated
III l' 11SLlr' that tb' catheter is correctly placed and that backflow does
1101 occu r. In th ' ev ' nt of ""111. n ba kflow, the insemination is stopped
fili d I Ill' r ll l'h ' 1,('1' is r 'F osil:ioncd I' i th ' I' Furth r in or withdrawing slightly.
( \ )1\1 1\ 1, I Il ll'di n (' 11 11 lw svCl1 Ih r(l( I)', holil both horns irnm.edi ately after
IIII' Ill jl 'I'liull i. : IHrCUI' lll l'd II) ill)il rd,' .\ 11 iII SI' lninil l'illll (Ii i)'" 7 ).
111\ 1'hl'l 111 1'11 11'111 I'\ l li l l1 11111'. 1I IIII d 11 11', 1lt'/jd v i()1' HiJ() W " ('"II(' nl Inlcr-
i llll 'I ' I II 111 1' 11 11'/ 11 11'1 111 ', III d 11 11 11111011 II I 'VI '" 11( 11' 1) 1\1 11 111 1 111 111' 11 (1,'1'111 ,1I' y for
111/ 1' 11\/iI,1I11111
1\ I 1)/ 11 11 1. Ii II " I ) I I " pi ' I" h' II " d I I II I (II 111 \ 'Il l \\' 1 I I I , ' II II Ii II ( 'I ""
298 WILSON
Figure 7. Contrast media is evident throughout both uterine horns immediately following
intrauterine deposition.
techniques, but when the procedure is used in the estrous bitch for
insemination and general vaginoscopic assessment, air insufflation
been found to be unnecessary. During the early development of this
technique, a deflecting mechanism was used to aid in the manipulation
of the catheter, but with experience and acquisition of the current endo-
scope, the deflecting mechanism is no longer. used. Air can
be achieved by connecting intravenous tubmg and a synnge WIth a
three-way stopcock to one of the channels, is per-
forming routine vaginoscopy in the nonestrous bItch to .Improve vIsual-
ization of the vaginal lumen.
EVALUATION OF TRANSCERVICAL INSEMINATION
TECHNIQUES
The Norwegian method has been described in several previous
reports, so it is not discussed further here.
I
3. 6. 17 Only limited information
exists in the literature on the endoscopic technique,13. 16. 17 and several
questions warrant further explanation.
"Is It Easy to Learn Endoscopic Transcervical
Insemination?"
The t c11ni Itl l' itl IIH' ol'l'lil '. lIl y I illlpl, ' hili lid, ' lilli" , Ihil ll' III "', .Il1d
1 rnelici' to PI 'I'(III'I ; II 1'1"1" II ' II 111 (11111 1)', 11 111111 ""tl l',I' 1)1 lilt , 1I 11, dllll\ V Itl
the reproductive tract, and time spent studying anatomic specimens is
invaluable,
The attachment of a video camera to the endoscope allows direct
training by an experienced operator, because it is possible to see what is
happening, The trainee can visualize what he or she is trying to achieve,
Most find the prospect of getting the catheter into the os a challenge
that can be confidently achieved in a relatively short time; mastering the
peculiarities of all breeds and sizes, however, takes longer.
"Is the Equipment Easy to Clean?"
The equipment can be readily cleaned and disinfected; early reports
of long drawn-out procedures for endoscope cleaning are misleading.
Consult the manufacturer for specific cleaning and disinfection recom-
mendations.
"Can All Bitches Be Inseminated This Way?"
For the technique to be widely adopted, it is essential that it can be
applied successfully to all (or at least most) bitches, and because the
'quipment is expensive, it is important that most bitches can be insemi-
nated using the same endoscope. Looking at the vast array of breeds
presented with regard to size and shape, this would seem unlikely but
is, in fact, possible for the most part,
It is important to appreciate the limiting factors for each part of the
procedure.
Reaching the Cervix
The maximum length of the vagina is a critical dimension; however,
110 bitch whose cervix is beyond the reach of the equipment described
has so far been examined; thus, vaginal length is not a limiting factor.
1,0 r e breeds examined include the Great Dane, Saint Bernard, Mastiff,
Il'ish Wolfhound, Newfoundland, Borzoi, Afghan, and Pyrenees Moun-
Iili n Dog. The external size and shape of a bitch does not accurately
pI" Ii t the internal situation-some medium-sized bitches (i,e., German
Sh 'I h I'd ) have vaginas as long as much larger bitches, Borzoi and
Mghnl1 it'll '8 have urprisingly short vaginas.
' I'h(' one limiting fa tor id ntifi ed i the amount of space in the
1' 11'.)1 '1'l'vi ; in n li mnll I Vl'c ' nt ogc' of bit h s, it is impossible to advance
Ill(' (' IHl n, ('() liI' Ihmll )',h Ih i, ,11'( '. 1, 'I'hi , Ol't'lll'i-l in some maiden bitches of
11111 11 (I I' II H'dill lll :il '/,I'd 1II'I'I, d:l, .llll l itl :Itlllll ' 10 I I'(,(di-l (i ,I'" hihuFl hua).
'1'111 '1'1' .11'1' Wd I Itl tl 1'1'1'11 111 II )', lid/I Ill'olli l' !!1 III :10111\ ' hlll'll(" ; how('vI' r,
III Illlli ' l'l (1"'tll,,,ll lv 11'/1/ II IIil l I'i,,), 11'1 '1' 1 III 11\1' l't' l V I, 111 '1'1 11 11 lilli ',
I ,' III I (II I II I II ' I III 1111 " II ' I Ii II 1I1l! '11' 1 Ill" II \ ' " II"",', I" II 111 1' \ Ii II ' ,tI II I , 'I II I ' Ii " I ' I'
Id,l v IllItll ' l 111111 111111 "" I 1111 111111.11111 111 1 Itl\ 111I 'I,tl lI \ III ' I! ' II,,
300 WILSON
vaginal length is short. The standard endoscope described here has
been used successfully in many small-sized and toy breeds (i.e., Pugs,
Pekingese, Griffon Bruxellois, Cavalier King Charles Spaniel, and Minia-
ture Dachshund) and is suitable for most bitches. Where toy breeds are
a significant part of the reproduction workload, investment in a smaller
scope may be necessary.
With the smallest toy breeds, restraint of the bitch while trying to
manipulate a relatively long scope is a large part of the problem, and
sedation may be the answer.
Identification of the Cervical Os and Cannulation of the
Cervix Canal
Theoretically, once the endoscope has been passed through the
paracervix, it should be possible to catheterize all bitches. The ability to
identify the os, position a catheter at the os, and pass it through the
cervical canal comes down to operator skill and experience and is not
limited by the equipment or the bitch; sometimes, 'a smaller gauge
catheter is necessary.
Most of the problems encountered result from not appreciating the
anatomy of the tract and not having developed the knack of manipula-
tion of the endoscope and catheter together. Another significant problem
relates to vaginal discharges causing poor visibility; there are several
tricks to deal with this. Not all bitches are easy to catheterize because of
difficult anatomy, ongoing poor visibility, or fidgeting patients; occasion-
ally, some dogs defy all attempts from even the most skilled operator.
"Is the Insemination Definitely Intrauterine?"
With visualization of the cervix, there can be no doubt that the
catheter is intrauterine (Fig. 8). Continued viewing of the insemination
process ensures that the semen is deposited in the uterus without back-
flow occurring; a video camera allows the client as well as the operator
to observe the intrauterine deposition of the semen.
"Is the Technique Safe?"
The risk of trauma or infection is an important consi derati on, With
the endoscopic technique, it is difficult to con ci v the t the plas ti c
urinary catheter could perforate th vagina l or [lI'crin ' wull during ('slrus
unless a pathologic conditi on already l' isiS. Til l' P:IJ'il t'l' l' vil' llnrV,l COlt! I
be traumatized by the' Wi(' of ill nppropl'i.III ' rll l'I'(', Ilt lw(' v(' I' ; i/ ,Id vdll l'ill !'.
the endos o ~ c ,lI, Vii U/! ViUII H di :i('(l lld l lli 111 II\(' Iii it'll , lit( , 111'(1('(,11111 '('
sholiid 1)(' slOl l l,1I Wllt 'li I ' .1 11111111 111 111' 11111 ' 1"' 11 11 11111,11 tll ll ill )', 1111 .. ,11 11111
, )II" tl ll': IIII I, Ihl < \d)',I' III I IV, III , Iii" 1I t1 111 1 .. 1 dlld II Jl111 ' 11 111'1,,111 1, . II I
Figure 8, The catheter can clearly be seen in the cervical os and no backflow of semen is
evident as the insemination is performed, confirming intrauterine insemination,
lrauma, and the bitch is likely to be sedated so does not react to
inappropriate handling; extreme care should be taken in these situations.
It has been suggested that this technique could introduce infection
10 the uterine environment. During proestrus and estrus, bacteria are
routinely isolated from the uterus and vagina without causing any
,lpparent problems, perhaps because of a greater resistance to infection
I1t this timep,15 It is reasonable to assume that advancing a catheter
from the vagina to the uterus at this time is not going to cause any
problems. Nevertheless, care must be taken to ensure that no new
infections are introduced as a result of inadequately cleaned equipment
or from the environment through poor technique. During diestrus, the
Hi I uation changes; under the influence of high progesterone levels, the
II I 'ru may be particularly susceptible to trauma and infection, requiring
IJw ial ar and aseptic technique at this stage.
13
, 15
"What Results Can Be Expected Using This
T chnlque?"
Thi s Iv(' illliqll l' lli'll vitil's illll'll llU' ril\l' ti c'pos ition of sem n, which is
II 111111' '' 1'1111 11'lI iI, ('11 :11' 11\1 '11 it ,(' I II 1()1 1l)', , 1': '11,,111 illlp()rl.lll1 i'l l lh(' SLI SS-
Iitl II PI' Iii 11 1l'/,1'1i 111' 1111 ' 11 .11 '1< IIii'I lilill )', I tl 1l lliI' lilill.llillll , HI'I))!,11 \l11 ;1Iil I
dll ll hll l,11 1I' II IIII y 111111 111'111' 11 '1'1 ' 1 III, ,' dll \, 11 11 11' 1' Idl' IIIII ' I'ill" ill llt' lnill ,1
1111 11 1111 ,111 11" II 111 11 \ Ii II I I' 1111 II ,til 11 11 "1 Idl lil l <I II' I,d I'l l illl lllIl' 1I 1111i ,
302 WILSON
The use of TCI does mean that the bitch is likely to be less stressed by
the insemination procedure and permits repeat inseminations.
Results from a trial comparing the Norwegian and New Zealand
ndoscopic Tel techniques demonstrated that conception rates of 83.3%
and an average litter size of 7.5 were possible in bitches of unknown
breeding history.16 These results compare favorably with results from
other trials using frozen semen, indicating that there are no undesirable
effects from Tel. There are no trials making a direct comparison between
surgical insemination and TCI; thus, it is impossible to know if the
results are better using Tel, and it is difficult to compare results from
different workers because of the multiple factors involved in the success-
ful use of frozen semen.
The ability to do repeat insemination has been reported to increase
conception rates and litter size.
2
, 8, 17 Where the post-thaw motility of the
semen is low, repeat inseminations allow more semen to be inseminated
over an extended period. Repeat inseminations are also useful if the
bitch was difficult to time or not presented in a timely enough manner
to permit proper timing.
"Are There Other Uses for the Technique and
Equipment?"
The endoscopic equipment carries a significant cost, which may be
hard to justify for frozen semen insemination alone; however, the other
uses to which it can be put makes it indispensable in any practice with
a significant canine reproduction workload.
Although this technique was developed to deposit frozen semen
into the uterine lumen, it can be used equally well for all fresh and
chilled inseminations and for performing repeat inseminations when
appropriate with no apparent stress to the bitch. It is an excellent tool
with fresh semen of poor quality, as intrauterine insemination seems to
make a positive difference to the outcome. The technique has been
used for the hysterographic examination of the bitch and for diagnostic
microbiology and cytology.
Recently, Watts et aP4, 15 have used the method to study the intrauter-
ine environment with respect to microbiology and cytology throughout
the reproductive cycle of the bitch, giving us valuable research informa-
tion. Use of this method during anestrus and diestrus requires som
modification to the technique. The vaginal mucosa is thinner and more
susceptible to damage, and bitches may not tol -r at th ndos op so
' well when not in standing heat. The r quir m nl: fo r s('dnti n haR be '11
reported as well as the need for air inflllffi nliol1. Wilh Ih(' nhi l il In
catheterize the cervix and foll owill l', "I 1111 W,lfl li' 1'\' 111'.11'\'1, " OI1l\ '. 11ll'
possibility of dev loping new Ii il l)',I]( lr I II ' 111111 1"1'1'1 '1 H' I II II' I II', H,,t! III ', 'rI ,
The endoscope nn ni Hil II\' Iii t '.! l i lt IP,il l ll l' v, I)',I IIi IIt '1l 11 III "I'I I' IIIIII\( '
the prop,f'(' H, iUIl 1III 't ltl )', I, 111"11
'
1,, " .111 1 1" ' 1' I \' 1 11 ,01 I I/ \\' 1,11 11'1 II1 1 Ii 11)', 11 11111 I'
TRANSCERVICA L INSEMINATION TECHNIQUES IN THE BITCH
303
vaginoscopy and cystoscopy. The optics compare favorably with those
of other vaginoscopic equipment.
SUMMARY
The benefits of using endoscopic Tel for frozen semen come from
being able to achieve the same or better .without the need and
risks of general anesthesia and to do all and
chilled inseminations this way WIll certamly Improve
without the owner having to make a decision about exp.osmg theIr bItch
to the risks of anesthesia and surgery. The other potential uses open up
a whole new field for canine theriogenology. Above all, the cllent re-
sponse to the technique is overwhelmingly positive .. At times the learn-
ing process will be discouraging, but the end result IS worth the effort.
The endoscope should not be treated as something fO.r frozen
semen insemination but should be used at every opportumty m order
to develop experience and expertise in all situations.
References
'1. Andersen K: Insemination with frozen dog semen based on a new insemination
technique. Zuchthygiene 10:1, 1975 . . . ... .
2. Farstad W, Anderson-Berg K: Factors mfluencmg the success rate of artifiCIal msemma-
tion with frozen semen in the dog. J Reprod Fertil Suppl 39:289, 1989 .
3. Fontbonne A, Badinand F: Canine artificial insemination with frozen semen:
son of intravaginal and intrauterine deposition of semen. J Reprod Ferti! Suppl
47:325, 1993 .
4. Fougner JA, Aamdal J, Andersen K: Intrauterine insemination with frozen semen m
the Blue Fox. Nord Vet Med 25:144, 1973 .
5. Fllnkqllist B, Lagerstedt A-S, Linde C, et al: Hysterography in the bitch. Vet RadIOI
26:12, 1985
6. Linde-Forsberg C: Achieving canine pregnancy by using frozen or chilled extended
semen. Vet Clin North Am Small Anim Pract 21:467, 1991
7. I,inde-Forsberg C: Artificial insemination with fresh, chilled extended, and frozen-
thawed semen in the dog. Semin Vet Med Surg 10:48, 1995 .
H. I, inde-Forsberg C, Forsberg M: Fertility in dogs in relation to semen quality and the
lim Dnd ' ite of insemination with fresh and frozen semen. J Reprod Fertil Suppl
:\ '1989 . f
t) . I III,: F: 'rhe normal endoscopic aflpearance of the caudal reproductive .tract 0
Ih ' Y Ii nnd non- y Ii bitch: P st lit nne endoscopy. J Small Anlffi Pract 24.1,1983
Ill, 0 1,11' ' IT, !low ' 11 RI\ , Pi k It BW: II flu n of extender, cryopreservative and semmal
1"'\)('I' :lHlng j1r<1('(' dllrl'H Oil Ihow I1l ll lilil y of anin p rmatozoa frozen ill straws.
' 1'11\' 1'1(1)',(' 111 110)', 3 1:II S I, IIJIl') . .
I I. 1'IIII ,d,1 M il , 1, ,,I IIt' I' 1,1\ , 1111\11 11 '11 ' " 1,1): 1)I II'HIIi n\l 'dl " l1 fold In the anine
vllr,l ll ll 1\ 111 I VI' I I'I'H I I' I' IH'I, III I' \
I ' 1{1I11\f,111 III 1\ 111 11 111 \1\' II I 1111 ' " Illi lll ' 1I 11,tllIl ' 11'1\' ( '111 111" ' 1111 ( '1I 1l1 111 1
/
,.11 11' 1'1'111' 1 VI'I
I 1,'/
1
" , l illi"
II W' III M Ii ', Wl ll'. l iI 1' 1 111 \ ' 1\1, .,, 11111,', 1111 1 III """'I IMI \11 Iii ,' Idll \1 \ 11111111 1' '"ll l lI il lil l"ll IIII'
1\ 1111111\1' II lh 1' 111"'\"1 I 11111 \ III tI, III 11 1\ '1 I " "l1dl II III 1'11111 \1, 'II I 1'1'1',
304 WILSON
14. Watts JR, Wright PI, Lee CS: Endometrial cytology of the normal bitch throughout the
reproductive cycle. J Small Anirn Pract 39:2, 1998
15. Watts JR, Wright PI, Whithear KC: Uterine, cervical and vaginal microflora of the
normal bitch throughout the reproductive cycle. J Small Anim Pract 37:54, 1996
16. Wilson MS: Non surgical intrauterine artificial insemination in bitches using frozen
semen. J Reprod Fertil Suppl 47:307, 1993
17. Wilson MS: Some aspects of artificial insemination in the bitch, using frozen semen.
MVSc Thesis. Palmerston North, New Zealand, Massey University, 1992
Marion S. Wilson, BVMS, MVSc, MRCVS
Glenbred Artificial Breeding Services Ltd
The Glen
RD 9 Feilding 5600
New Zealand
UTERINE AND FETAL
MONITORING IN THE BITCH
Autumn P. Davidson, DVM
The standard approach to labor management in the bitch has in-
volved client subjective monitoring of behavior, rectal temperature, pro-
gression of whelping, and the physical condition of the neonates. Little
accurate and timely information is made available to the clinician con-
cerning actual uterine activity or prepartum fetal viability. Telephone
consultations between the veterinarian and breeder usually entail inter-
pretation of indirect information, such as time between deliveries, color
of vaginal discharge, presence of externally visible abdominal contrac-
tions, and occurrence of stillborn puppies.
6
Although generally accept-
able for the uneventful delivery in a young, healthy bitch, whelping
associated with fetal and maternal morbidity and mortality are familiar
to most clinicians in reproductive practice.
Many veterinarians also are reluctant to encourage the expense and
risk for a potentially unnecessary cesarean section early during labor.
With higher-risk pregnancies and valuable litters, better monitoring,
similar to that which is the standard of practice in human obstetrics, is
desirable.
PERINATAL MONITORING
Recently, such systems for monitoring labor and delivery in the
bit h have become commercially available and affordable. These systems
i l l"' intend d for use by veterinarians in the clinical setting when evaluat-
III
~ 1 1 j I I ~ I I I I . N I I ~ I I I I I ' "1\1 II II '11111
hool of Veteri.nary Medicine,
li ni , ,Ll id Dogs for the Blind,
306 DAVIDSON
ing a bitch in labor or by breeders at home with veterinary guidance.
Their design is based on labor monitoring systems used routinely in
human obstetrics?' 11, 13, 14
Inexperienced breeders, and breeders with bitches having histories
of whelping difficulties, above-average age (older than 6 years), and
small or large litters should be encouraged to use the equipment. With
veterinary guidance by telephone, after previous demonstration of
equipment in the clink clients at home can perform monitoring of
bitches. Such demonstration should take place during a prepartum office
visit. Light clipping of the hair coat over the gravid area of the lateral
flanks allows proper contact of the uterine sensor and fetal Doppler.
Proper technique for the subcutaneous administration of injectable drugs
also is taught during the prepartum visit. Calcium gluconate, 10% solu-
tion with 0.465 mEq Ca
2
+, and oxytocin, 10 United States Pharmacopeia
(USP) U/mL can be dispensed in predrawn syringes for later use on
veterinary prescription. Specific orders (Fig. 1) concerning the frequency
of administration and dosage of medications (calcium and oxytocin) are
written for each bitch by the attending veterinarian and/' are faxed to the
service. A lateral abdominal radiograph may be obtained at the prepar-
tum visit to estimate litter size best.
20
The uterine monitoring system consists of a tocodynomometer (sen-
sor), a recorder, and a modem (Fig. 2). The uterine sensor detects changes
in intrauterine and intra-amniotic pressuresY The sensor is strapped
over a lightly clipped area of the caudolateral abdomen with an elasti-
cized strap. The recorder of the sensor is worn in a small backpack
placed over the caudal shoulder area (Fig. 3). Bitches should be at rest
in the whelping box or in a crate during the monitoring sessions. The
monitoring units also can be used on gravid queens (Fig. 4). The moni-
toring equipment is well tolerated (Fig. 5). Subsequent to each recording
session, data are transferred from the recorder to the service by a modem
connected to the clients' telephones. Fetal Doppler monitoring with
acoustic coupling gel is performed with a hand-held unit on bitches in
lateral recumbency (Fig. 6). Directing the Doppler perpendicularly over
a fetus causes a characteristic amplification of the fetal heart sounds,
distinct from maternal arterial or cardiac sounds, which enables determi-
nation of fetal heart rates.
Uterine and fetal monitoring should be initiated at least 1 week
before predicted whelping dates, and is generally performed twice daily,
approximately 12 hours apart. Obstetric personnel (licensed human ob-
stetric nurses) are available 24 hours a day to receive and to int rpret
uterine contractile recordings, and subsequently to ommuni at u h
findings by telephone to the attending v t r in, ry lini ii:l l . 11 (, ' a bi t h
enters the first stage of labor, th SUb8('qucn l' frl'qll l' ll r' ()f IIl cri lll' :lIId
fetal monitor.ing i. based 011 1:111' r('(" )tn ll H' llti ll l inl) of Hll Ch Ilh/ll pl ric I (' I'
sonnel and the ntl:('ndi ng v<'I cl' i ll l ll' !. II) ('vdh l! tI 11)', I Ill' 1' 1'1))'."" f i()!) o lll l iJOl'
and neoni'l I:nI (' ol l(/ iliol ). (>il ll l, l t'I" 1"' 1' l(l ll ll' ,I )'," I II ' I'l lil IIl l iI, ' 1" I"pl' Ol li'
COl) ,tl i.l l l,lt) wil li I II " vl ' Ii ' I'illll l' , 'I IIi,i ,1l1 l 'Olti llllllll l l " dlldll)', 11I '11 11t!
j, ,, l()I' II II )I Ii /111 i l ll',
UTERINE AND FETAL MONITORING IN THE BITCH 307
WhelpWise Veterinary Orders
Please circle all that apply
Client Client Phone' _ ______ Date, _______ _
Anima-l-N-am-e------ - - Breed, _ ___ ________ Wt .. ____ _
1. Initiate the Whelp Wise service. Instruct client in use of equipment. Encourage client to monitor uterine
contractions twice daily, preferably 1 0 to 12 hours apart. At the onset of an actIve labor pattern, chent and
Whelp Wise staff will detellline the frequency and duration of subsequent monitor sessions.
Notify me of onset of labor: YES NO After hours: YES NO
2. In the presence of inertia as documented by the external uterine contraction monitor, begin labor
augmentation per protocol. YES NO Notify me before beginning medications: YES NO
3. All medication doses are based on the uterine contraction pattern, and used to treat inertia only.
Medication will not be given in the presence of a strong, regular contr action pattern
Oxytocin: __ to ___ UNITS administered Sub Q or 1M every minutes (Usual dose .25 to
4 units every 30-90 min.) to maintain an adequate uterine contraction pattern.
Calphosan Solution (lOOmg/lOcc or a 1 % calcium solution) ee's, subcutaneously every
hrs. (Usual dose: Y, cc/pound every 4-6 hours.) .
Dopram: I-S gtts PO or 1M as a respiratory stimulant for depressed puppies. May be repeated m 15 to 20
minutes. Dosage will be based on puppy weight and level of depression.
CicaDout shot of: , after deliveries are complete.
Suggested breakdown: ........ .
Oxytocin: 2 syringes with .5 units (oTIe half umt), 3 synnges With 1 UnIt, 3 syrInges .':lth 2 um.ts, 2 s y n n g ~ s wlth 3
lIll its. In breeds over 701bs; add 2 syringes with 4 units, breeds over 100lbs; add I addltlOnal syrmge of 5 UllltS.
Calci um: 112 cclI 0 pounds drawn into 3 syringes. Example: Dog's weight 30 pounds; 3 syringes of I.Scc's
Oopram: .3 ce, in a TB syringe.
,\. Encourage client to monitor the fetal heart rates a minimum of once a day prior to labor, and every 1-2 hours or more
I'l'cquentl y during active labor. Notify me if decelerations or absence of fetal heart rates are noted. Recommend that the
' Ii on! assess the fetal heart rates prior to administration of any medication.
S. I f the case being monitored is a planned cesarean section, notify me at the onset of labor.
G. NOlify me of the outcomes at the conclusion of service by --"hone _ fax
Olhcl' Instructions:
Hi gHut,II I'C Veterinaria nl_____________ _
( 'lI nie Nll 'IlI --C----------- Address _ ____________ _ _
('lI nie Phonc
______ Fax.________ After honrs _ _ ______ _ _
I' PI' P r d b for whelping during the pre-whelp consultation, faxed to
I1 V d In th I tI nt r cord. Orders Indicate the interval at which the
to b( II tlillor! , pMI nl 111" tory nd p rtinent findings, and drug
308 DAVIDSON
Figure 2. Whelping monitoring equipment includes a sensor, tran,sducer, modem, and
hand-held Doppler.
Figure 3. Uterine monitor placed over a lightly clipped region of the canine caudolater
abdomen, with the recorder in a harness worn over the scapula
Figure 4. Uterine monitor placed on a gravid queen. The recorder is situated adjacent to
the crate.
I lfJllr I. 1111011 II I 10 11 II I 111 11 wlllllplll q !lox lilll ll1 I n I' ol'clln I " ,Ion.
310 DAVIDSON
Figure 6. Hand-held fetal Doppler directed perpendicular to a fetus' trunk.
The administration of medications is initiated as indicated by moni-
toring information, and is initiated with authorization from only the
attending veterinary clinician. Unresponsive uterine inertia, . obstructive
dystocia, aberrant uterine contractile patterns, or fetal dis-
tress without response to medical management are indications for cesar-
ean section.
The active, early management of labor is accepted in human obstet-
rics as a method of reducing dystocia and increasing vaginal deliveries
without increased maternal or neonatal morbidity.lO Key to successful
obstetrics is an accurate diagnosis of the onset of labor, facilitated in
human obstetrics by patient communication.
12
Predicting parturition in
the bitch is straightforward if ovulation timing has been performed.
Whelping should occur 56 to 58 days from the first day of diestrus or
64 to 66 days from the initial rise in progesterone above baseli ne, or
from the day of the luteinizing hormone surg . Without ovul ati on tin -
ing, whelping can occur 58 to 72 days from b n.' (' ding, 111 :1 1 ing th ' li Se of
uterine monitoring useful in iden tifying the' n ll :;I' 1 or
Elevated prostaglandins fi n 11(' dd (', 'lI d i l l 11 11' lllt !'i I H' Vl'i 11
hours before the onsel' of . 1:11\1' I 1.11 )( 11', 111 d lll illl ' i d l lllli wll h , I .1 "( ' 1111 ,,1 11
prog te r OIl C ivv(' I1'1 10 1" 111 111 ,1 11 '11/'.1 1111 oli id , I dlll l' III IHl dy 11'11\1'1' 1'11
hire, ?' I" !llIf!) I' illll .l I , l v, 111 ' 1111'111 011111 11111\' (', 111 111111 (' l illi/'ll ' II ' IIII\! ' 1111 111'1 '
not highly accurate in the range of 2 to 3 ng/mL, and the 24-hour
turnaround time for quantitative progesterone testing submitted to a
commercial laboratory makes the reliability of predicting impending
labor from progesterone levels poor. A temperature drop of 99 F or less
often, but not always, occurs 24 hours before the onset of labor. Normal
stage I labor is characterized by intermittent uterine contractions associ-
ated with cervical dilation and behavioral changes. Normal stage II labor
has intensified uterine contractions accompanied by abdominal efforts
and Ferguson's reflex, resulting in fetal expulsion. Normal stage III labor
is characterized by placental expulsion.! The length and quality of hu-
man labor correlates closely with the number of live-born, vigorous
neonates.
7
The canine uterus exhibits characteristic patterns of activity during
late gestation and labor, varying in strength and frequency,17 18 Interpre-
tation of the contractile pattern in strips produced by the uterine moni-
toring system requires training and experience. Commercially available
monitoring devices currently transmit recorded information by modem
to obstetric personnel capable of interpretation and subsequent consulta-
tion with the attending veterinary clinician. Interested veterinary clini-
cians or technicians could develop this expertise.
The use of a uterine monitor permits proactive identification of
labor for planned cesarean sections when gestational length is not accu-
rately known and surgical intervention is deemed necessary because of
maternal-fetal mismatch.
3
4. 8. 9 The presence of fetal distress is reflected
by sustained deceleration of the heart rates. Normal Beagles at term
have heart rates at least twice the maternal rate,17 Decelerations associ-
"ted with uterine contractions suggest mismatch of the fetus and dam
or fetal malposition, malpresentation, or malposture. Transient accelera-
lions occur with normal fetal movement.
16
19
THERAPEUTICS
The use of uterine and fetal monitors allows the veterinary clinician
10 detect and monitor labor and to manage labor medically with insight.
, I'h administration of calcium gluconate and oxytocin can be directed
Ind tailored based on the results of monitoring. Generally, the adminis-
11'r. tion of calcium gluconate increases the strength of myometrial activity,
li nd oxy to in .increases the frequency of myometrial contractions. Cal-
,' illl11 glu onate, 10%" is given when ineffective, weak uterine contrac-
11(1)1'1 <l re d ,t I' d. xyt 'in is administered when uterine contractions
, II'l ' I('HS fre' q li en I' 1'11 <111 'xp t 'd for th sta of labor and when fetal
111'11 1'1 l'nll'S Ilrv I 1() l'Ill , li , Suh Innli nli y low r than traditional doses of
ox IOI 'i" l i n ' l'ff(l \'l iv(' ill in'l )f'()vi nl'. II I(' qll ll lil of 111 Ol11ctri al ontrac-
I ( li lt \. Il i/', llt' l' dill " I1 (I I II 'I y l (H'1 1i , " ' 1I11' I\V" llI lll holll \' ,' 1\ 11 cn ll ,'l Ina ni ,
111' 111 '( ' 1 (. liI (' I'I III ' 1'11,111' 11 l ililil l 11 11 11 1'111111 11 '1111 1 111 ' 11' 1 II II Y/'," " I il ljll Iy hy
101 111 '1' 111 11 1 , 11 1111 "1 '1/ 111 11 " II 11' 1111 I" , II 1' \,1 11 1' 11 1 11 11 11 " 'I I'i1I1/( ' 111 111 1'1 11 1" 1
1111 1 1"1111 , 1( 11)'. I ,iI 1111 ' 1 1' 11111111 I Iitil 11 1' .1 111 1' 1 III ' 11' 1" ' 1 111111 11 111111
312 DAVIDSON
with elevated baseline levels of contractility compromIsmg placental
blood supply, or a uterine obstructive pattern negate further use of
calcium gluconate or oxytocin.
SUMMARY
The use of uterine and fetal monitoring improves the outcome of
canine obstetrics. Much of the guesswork of managing whelping can be
eliminated. At normal term, absolute indications for cesarean section are
detected with monitoring, before multiple fetal deaths or any serious
maternal compromise occurs. Bitches with previous history of cesarean
section may be able to whelp vaginally successfully, having medical
intervention based on monitoring. The anxiety level of owners during
whelping is diminished, and the level of participation of the veterinarian
improves.
References
1. Bennett D: Canine dystocia: A review of the literature. J Small Anim Pract 15:101-
117,1974
2. Concannon PW, McCann JP, Temple M: Biology and endocrinology of ovulation,
pregnancy, and parturition in the dog. J Reprod Fertil Suppl 39:3-25, 1989
3. Darvelid AW, Linde-Forsberg C: Dystocia in the bitch: A retrospective study of 182
cases. J Small Anim Pract 35:402-407, 1994
4. Eneroth A, Linde-Forsberg C, Uhlhorn M, et al: Radiographic pelvimetry for assess-
ment of dystocia in bitches: A clinical study in two terrier breeds. J Small Anim Pract
40:257-264, 1999
5. Feldman EC, Nelson RW: Canine reproduction. In Veterinary Reproduction and Endo-
crinology. Philadelphia, WB Saunders, 1996, pp 567-570
6. Freak MJ: Practitioners- breeders' approach to canine parturition. Vet Rec 96:303-308,
1975 .
7. Friedman EA: Use of labor pattern as a management guide. J Reprod Med 8:57-60, 1968
8. Gaudet DA: Retrospective study of 128 cases of canine dystocia. J Am Anim Hosp
Assoc 21:813- 818, 1985
9. Gaudet DA, Kitchell BE: Canine dystocia. Compend Contin Educ Small Anim Pract
7:1406-1418,1985
10. Lopez-Zeno JA, Peaceman AM, Adashek JA, et al: A controlled trial of a program for
the active management of labor. N Engl J Med 326:450-454,1992
11. Neutra RR, Fienberg SE, Greenland S, et al: Effect of fetal monitoring on neonata l
death rates. N Engl J Med 299:324-326, 1978
12. Sharpe WS, Hauptman, JG, Dennis JS: Detrusor atony of the urinary bladder fo ll owing
prolonged dystocia in a dog. J Am Anim Hosp Assoc 29:299-302, 1993
13. Shenker L, Post RC, Seiler JS: Routine electronic monitoring of f tal h art ra t' and
uterine activity during labour. Obstet Gynecol 46: '185- 18 , '1975
14. Snyder KC, Yoches CC: A retrospective SU111111 Ar of!'iO ,'n llin,' prvgl,n IWilIK. III WI
Watch, Handout for Veterinari ans, '19 7
15. Taverne MA, Naaktgebor 11 II, (Ii ,II : M)' IlIlli 'II'1. 11 1' 1('(' 11'11 '1 ,1 II, ' llvlly "'1.1
plasma of I1I'OI\I'lilI ' I'I1I1" , "11 11'111'0" ' 11 1, ","1 I 1\ \, Inl'l II dlll 'lli )', lil li ' I "'''1', 1 I, ll lI ' y
and par turiliol1 ill I'hl' 11,1'1111 1111'" " I,., 11 1,,1 ' I II ' '', 11 11/ 1'1'/' /
'lfi. '1',,1'(" '11 C: , NI'W' II II1I 1, 1,: tI,' I,d 1IIIIIilI III " I'. 11 ", " ", 11111 1"" 1I1I11I 11", ,,I ,il ll y iI "oI "" "11 ' ''' 111
lil', ' III) " 1'11 11 '11 " 1111 1111 11"''1 ,11 ,"111 11 111. Iii I I lI 'h ll ,1 1'1 ,,' It " I I " ''' 'll " ,I 1'1"' ,
17. van der Weyden Gc, Taverne MA, Dieleman SJ, et al: Physiological aspects of preg-
nancy and parturition in dogs. J Reprod Fertil Suppl 211-224, 1989
18. van der Weyden, GC, Taverne, MA, Okkens AC, et al: The intrauterine position of
canine fetuses and their sequence of expulsion at birth. J Small Anim Pract 22:503-
510, 1981
19. Verstegen JP, Silva LD, Onclin K, et al: Echocardiographic study of heart rate in dog
and cat fetuses in utero. J Reprod Fertil Suppl 47:175-189, 1993
20. Wallace MS: Management of parturition and problems of the periparturient period of
dogs and cats. Seminars in Veterinary Medicine and Surgery (Small Animal) 9:28-37,
1994
Small Animal Clinic
Veterinary Medical Teaching Hospital
1 Shields Avenue
Davis, CA 95616
e-mail: apdavidson@ucdavis.edu
PERIPARTURIENT AND
NEONATAL ANESTHESIA
Peter J. Pascoe, BVSc, and Paula F. Moon, DVM
Patients presented in the periparturient period may need surgery
for nonobstetric reasons, they may be undergoing hysterectomy, they
may be undergoing an elective cesarean section, or they may need an
emergency cesarean section. In all these circumstances, it is important to
recognize that the dam has undergone some physiologic changes during
pregnancy that alter the response to anesthesia. In addition, the clinician
must consider the fate of the neonates and be able to optimize the
,1I1esthetic technique for their welfare. Extensive human data have been
published on the action of and outcome from anesthesia; however,
h 'cause of species and technical differences, veterinarians may not be
dble to directly apply the knowledge gained from human obstetric
('xperiences. For the veterinarian, many review articles have been pub-
I i:-; hed,6, 12, 24, 32, 35, 39, 49, 57, 69 but there are few data that support the use of
one technique over another,31,56 This has resulted in tremendous varia-
t ion in the perioperative management of such cases and a continued
He" rch for the "best technique."
PHYSIOLOGIC CHANGES AND THEIR IMPACT ON
ANESTHESIA
Th altered physiologic state of the pregnant patient results in
1 111' 'inl pcrioperative problems concerning the choice of anesthetic tech-
1' 11 1111 11 11 ' 1)\'1) 111' 1111 \' 111 (If , ' 1II'V,ie, Ii 1111(1 I{n li ologi al Sciences, School of Veterinary Medicine,
\ ,,,I VI" 'fil l y PI' ( '1\ 111'11 , "111, I )" VIH, C,1 \i(urni ll (PJP); and S ti on of Anesthesiology, Col-
I'T," \\ 1 VI' II " 'I,",, ,\, M" rll l'i lll '. ( ' 111111, 11 \ Jll lVl' l'Kil , It'hn A, New YOl' k (PFM)
11111' 111 A 'IMA I ,I. ANIMAI , I ' I 'A( "I'H 'I (
I II 1\. II I' II '111 11
316 PASCOE & MOON
nique.
15
The most important changes that affect anesthetic management
are summarized in Table 1 and are provided in more detail here.
Respiratory Changes
Oxygen desaturation occurs more easily during pregnancy?4 Ventila-
tory changes include a decrease in functional residual capacity (FRC)
and total lung volume and an increase in minute ventilation. The de-
creased FRC relative to alveolar closing capacity suggests that atelectasis
may occur more readily than in the nonpregnant animal; in fact, in 50%
of awake healthy pregnant women, airway closure developed during
normal ventilation? Combined with higher oxygen requirements, preg-
nant animals are extremely vulnerable to hypoxemia under anesthesia.
An especially critical time is during induction, when the patient is still
breathing room air and variable periods of apnea are likely to occur
from the anesthetic induction drugs. Hypoventilation on room air may
cause not only fetal hypoxia but fetal acidosis. In people, it has been
shown that anesthetized apneic pregnant women desaturate to an arte-
rial hemoglobin saturation of 95% in less than half the time taken by
nonpregnant women when seated at a 45 angle (156 vs 331 seconds).4
Preoxygenation via a face mask for 3 to 5 minutes at a rate of 4 to 6 L/
min decreases the likelihood of hypoxia. Intermittent sighs during sur-
gery to re-expand the lungs may decrease the severity of atelectasis.
Pregnant women have an increased minute ventilation with a conse-
quent reduction in the normal Paco
2
(26- 32 mm Hg) and an increased
sensitivity to changes in Paco
z
.
47
If further hyperventilation (Paco
2
< 22
mm Hg) occurs as a result of maternal stress or excessive positive-
pressure ventilation, there may be negative effects on the fetus.
37
, 63
Hyperventilation, with alkalosis, shifts the oxygen- hemoglobin dissocia-
tion curve to the left, causing less oxygen to be released to ' the fetus
(Bohr effect).16 This effect cannot explain the whole decrease in fetal
oxygenation; thus, hyperventilation must also cause a decrease in uterine
blood flow. It is not certain if this is caused by a direct effect on uterine
vessels or by a general effect on cardiac output.
50
, 63 Although it is
important to preoxygenate, provide supplemental oxygen throughout
the procedure, and assist or control ventilation, care must be taken not
to hyperventilate the patient. The addition of positive end-expiratory
pressure or continuous positive airway pressure to positive-pre sure
ventilation may further decrease the risk of atelectasis, but the circula-
tory depression associated with this approach mu t b balan 'd agai nst
the potential benefit in gas exchange. Pul oximct rs nd "pnom'I' rs
are useful noninvasive monitor to val LI m t 0 ' yg n s< lLi ration DI1 I oli t'-
quacy of ventilation..
Neurol ogic Chang s
Il n ' I', lldlll ' }' \'1111 11' 11 111 111 ' 1' 1111'111 111' 111 Il lvl l y II , ,1111'1 1111 ' 111 ' (hll ' 1111 '11,1\
1\1 1 111 IIII V III ' 111i ' 1111 1' 111 '1 / 1'l llll h ' I' , ' 111 '1 11 I ii 111111',1'111" 111111 '" I I l d II
W
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tl:
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318 PASCOE & MOON
endorphins,34, 85 which are elevated during pregnancy. The potency of
inhalants is increased for halothane (25%) and isoflurane (28%-40%).33,70
In addition, uptake of inhalant anesthetics is more rapidly achieved
because of the decreased FRC and increased minute ventilation. The
combination of a more rapid uptake of inhalant anesthetics and a de-
creased anesthetic requirement may lead to anesthetic overdose. Drugs
must be titrated slowly, and depth of anesthesia needs to be carefully
and frequently assessed. A further indicator that there are significant
changes in the nervous system during pregnancy is that there is a change
in the sensitivity to local anesthetics.
14
, 22, 30 The onset of a local anesthetic
is faster in the pregnant animal, and the block lasts longer with lower
concentrations of local anesthetic?5
Cardiovascular Changes
Changes in cardiovascular parameters recorded during pregnancy
in Beagles are given in Table 2.13 Systemic blood pressure and right
and left atrial pressures decrease, although heart rate increases slightly.
Cardiac output and blood volume are increased to provide adequate
blood flow to the fetus (but note that in the data from Beagles, the blood
volume per kilogram does not alter up to 46 days of gestation) . This
increased cardiac output mitigates (to some extent) the respiratory
changes by reducing the rate of induction with an inhalant anesthetic.
Plasma volume increases more than red blood cell volume, leading to a
relative "anemia of pregnancy". This anemia is correlated with the
number of puppies the dam is carrying, with greater changes seen as the
number increases.
45
Furthermore, uteroplacental perfusion is pressure
dependent, and autoregulation of blood flow to the fetus does not occur.
The consequence is that uterine blood flow is directly proportional
to the arterial- venous uterine blood pressure difference and inversely
proportional to uterine vascular resistance. Either hypotension (e.g.,
anesthetic depression, patient condition, intraoperative fluid losses) or
increased vascular resistance (e.g., pain, fear, excitement, shock) can
Table 2. CHANGES IN CARDIOVASCULAR VALUES DURING PREGNANCY IN
BEAGLES
Blood Left Atrial Right Atrial
Gestational Heart Rate Pressure Pressure Pressure Blood Volume
Age (days) (bpm) (mm Hg) (mm Hg) (mm Hg) (mL)
Nonpregnant 74 112 lO.9 5.5 1772 (76 IId ,/ kg)
<39 97 11 3 7.8 2, 1
40-46 97 10< 7.4
.:'
17 ('Ill 1111. / 1-1)
47-53 ' ()7 lOll, '/.II
r,
54-60 II G IIl I 'I ,ll
( I I,I,' X,) 10%) 'Ht'{I) ' d",,)
11111111 V!" \ , 111 11 111" IIHldIHH' 1I I 'I II II1111 Hl !l 11 , , 111I 1'11 ''''' 1111 .II II1I\PI 1II Itl PHll ll lil IHtIl I H\1I 111
wil l i III " II ""p, II ,1I11 I " I, "11,, ,,'11' II , "1 11'1 1\ d,oI '1'11 11 "III Irol 'l 1'1111 , 111, 1"'"11111 '""
PERLPARTURIENT AND NEONATAL ANESTHESIA 319
decrease uterine blood flow and adversely affect the fetus . In women,
hypotension can also occur from aortocaval compression by the fetus.
As a result, women are often positioned in lateral recumbency or with a
lateral tilt. In dogs, however, dorsoventral positioning did not cause any
more hypotension than lateral positioning or positioning at a 10 or 15
oblique angle.
2
, 76, 77 Two of these studies measured systemic blood pres-
sures as their main indicators of cardiovascular change, and it is recog-
nized that regional flows could be altered without a change in pressure.
The third study looked at blood flow and found normal venous return
even when the posterior vena cava was ligated.
2
Given these data sug-
gesting a much greater available collateral circulation and the anatomic
differences between human beings and small animals, positioning the
animal in dorsal recumbency is less likely to have a negative effect.
Finally, a delay in compensatory cardiovascular reflexes in response to
blood loss and hypovolemia may be present during pregnancy,B and
pregnant patients may be less responsive to therapy with vasopressors
or chronotropic drugs. 15 With epidural anesthesia, it has also been shown
that uterine blood flow can remain decreased in women despite therapy
that treats maternal hypotension.
46
Collectively, these data justify having aggressive cardiovascular sup-
port as an integral part of the anesthetic protocol. Intravenous (IV) fluids
should be administered to all pregnant animals during surgery as well
as before and after surgery in some critical cases. Whether or not the
Lype of fluid is important remains unclear, although there is some
evidence in women that colloids result in a lower incidence of maternal
hypotension than isotonic crystalloids.
46
Mild hypotension (systolic
bl.ood pressure> 90 mm Hg and < 100 mm Hg) should be treated
i rnmediately by increasing the rate of fluid administration. Changing the
maintenance anesthetic protocol to include analgesic agents such as
r ntanyl (3-5 j.Lg/kg IV) permits a decrease in inhalant concentrations
nnd may improve cardiovascular function. Refractory hypotension
should be treated with ephedrine (0.03- 0.1 mg/kg IV) as the first choice
or with dopamine (1-5 j.Lg/kg/min IV) or dobutamine (1- 5 j.Lg/kg/min
I V). Ephedrine is unusual in that it preserves uterine blood flow better
I han other IX] agonists, and it has recently been suggested that this drug
, Ii mulates release of nitric oxide in uterine vessels, hence reducing the
v lHO onstrictor effect of alpha-agonism.
52
Dopamine must be titrated
( '.II' ,fu ll y as it can either increase or decrease organ blood flow de-
I'vl1tl ing on the dose. At rates greater than or equal to 10 j.Lg/kg/min,
dll pu rn inc au es systemic vasoconstriction with potentially decreased
( iI 'r, 1n I "fusion. Dobutamine has not been extensively studied in obstet-
I' (' 1111(' HlhcHi8 but ShOll ld incr ase uterine blood flow by increasing
I y k ill iv p rt' HH(II VH wifholl t vaso on triction. Dopamine and dobutamine
dl'I ' I" .l t li ld 11 11'I' ill(' I dlH1l 1 nnw al dOH'S of 4 to 40 j.Lg/kg/rn in in pregnant
I'WI 'II '" fll l\ l :il llJl rltI (li dy 1)(' 110 I' d 10 11'(' d' pt'I'HiHt('nl' nOI1 I'I'HpOnHi ve hy-
l' II II ' l ll riOIl 1': 1"1 11' 1,111 1111 ' \l1 'dl l loilil'l dl dl'( ' I'I 'HH(' tl 111 (If ' i ll( ' 1,1 ()()d fl llw 111, d
dll'l tid Il lrl y III' IlI lI' d III ii I" 11 11' II I pi II II' 111 1111 ",, ' II I 1' 111 11/ 11'll pl l " lil l -
II l iI ,II I I
320 PAS E & MOON
Pregnancy also induces a number of gastrointestinal changes, the
most important of which increase the likelihood of regurgitation. Lower
esophageal sphincter tone is decreased, and intragastric pressure rises.
An increased amount of gastrin is produced by the fetus and the pla-
centa, leading to increased production of gastric acid.
47
Labor is thought
to prolong gastric emptying. These factors combined put the parturient
at greater risk for regurgitation, and if this occurs, there may be more
pulmonary damage from aspiration (greater volume, low pH).
Premedication of a painful (i.e., in labor), anxious, aggressive, or
fractious patient may be beneficial in decreasing the maternal stress
response (elevated cortisol and catecholamine release) and aid in uterine
perfusion. These stress hormones cause constriction of uterine vessels
and increase uterine vascular resistance. Premedication also allows clip-
ping before anesthetic induction and better tolerance of the oxygen
mask. With few exceptions, the type of drug used for premedication
does not seem to affect fetal outcome provided that appropriate doses
and effects on the dam's condition are considered. 59
ANESTHESIA FOR THE PERIPARTURIENT PATIENT
REQUIRING URGENT NONOBSTETRIC CARE
The main factors to consider in this type of patient would be to
minimize the amount of stress experienced by the animal (promotes
early onset of parturition) and to try to avoid hypoxia, hyperventilation,
uterine hypotension, and anemia. These may be difficult things to ac-
complish, because it is likely that the patient may already be stressed; if
it has suffered from a traumatic episode, it may also have lost blood
and thus be hypotensive and anemic. Given these issues, it is extremely
important to resuscitate the patient and provide analgesics so as to
minimize stress before proceeding with any anesthetic. Blood transfu-
sions should be considered at a higher hematocrit (e.g., 25%) than in
the nonpregnant patient, and the blood should ideally be typed and
crossmatched before transfusion. Once the animal is stable, the anesthetic
technique should aim to avoid further hypotension (e.g., no acepromaz-
ine) and provide excellent analgesia (e.g., opioids). The clinician should
consider the use of local anesthetic techniques and epidural opioids or
local anesthetics to further minimize the stress response to the surgical
intervention.71, 79 The use of drugs that cross the placental barrier i not
of great concern, because they are returned to the dam as she recovers
from the anesthetic. At the late stage of pregnancy, iti un likel y that
<;tny of the anesthetics have teratogenic eft ts.
ANESTHESIA FOR THE PREGNANT PATIENT
UNDERGOING HYSTERCTOMY
In Ihi il, illlllllllll , 1111 ' 11 ' 11 1'11 '11111 ' )',1 il l I/" l il l I! ' 11'IlIilll llll ,lI , 1111111111 ' .1 III
I hOld" \II ' III lilli ' 11 1,'1 1 11,, ' 111 II I 11 11' 11' 11 Il ld l 11 11 ' \ 11111 1'1 ' 1' 11111.1 110" I,d
PERlPARTURlENT AND NEONATAL ANESTHESIA 321
without further distress. All the physiologic changes mentioned pre-
viously need to be accounted for in providing the best anesthetic for the
dam, but the drugs used should be given in sufficient doses to anesthe-
tize the fetuses. This happens with normal induction doses of most
anesthetics, but it might be appropriate to use drugs with a longer
duration of action. For this procedure, it would be better to use thiopen-
tal or ketamine rather than propofol, because thiopental and ketamine
remain in the fetus for a longer period. Once an inhalant has been
started, it is more likely to anesthetize the fetuses if it has had more
time to diffuse into the uterus; thus, there need be no effort made to
preclip the dam or to rush into the surgical procedure. Immediately after
the uterus has been removed from the dam, the fetuses should be
euthanatized by an overdose of pentobarbital intraperitoneally (IP) or
IV via the umbilical vein.
CESAREAN SECTION
Preparation of the Patient
For an elective or emergency cesarean section, the delivery of live
vigorous puppies or kittens and the rapid recovery of the dam are the
ultimate goals. Once a decision has been made to carry out the cesarean
I-)cction, it is important to proceed with these factors in mind. At a
minimum, the dam should be given a careful physical examination with
f articular attention to cardiopulmonary function. She has had to adapt
lo the growth of her fetuses in the ways indicated previously, and these
'hanges may put significant stress on the cardiopulmonary system.
I}ecause vomiting and aspiration may occur during labor, the lungs
should be auscultated carefully so that treatment can be initiated if this
h<ls occurred. A careful evaluation of hydration status should be made
I'lO that any deficits can be addressed before surgery. As part of the
I'xmnination, it is ideal to use ultrasound to check on the viability of the
fduses. This may also allow the measurement of fetal heart rate, which
i, . an indicator of fetal well-being. In the periparturient period, the
I'ilrd iac output of the fetus/neonate is mainly dependent on heart rate,
Ill'cau e the right ventricle is relatively stiff (low compliance) and the
1IIItonomi nervous system is immature (minimal inotropic response to
1',1 1(\ holall1ine ). If the fetuses have heart rates above 200 beats per
lili nut ', th 'yare probably doing well, but lower heart rates may indicate
111 1 inndqllnt \ ardi a output with resultant stress and the need to
1"'(I"I' I'd 1\101" 1"1) idl y. A blood SO'ltnil c +lOuld be drawn from the dam;
,11 . 1 lltillillllllll , il . 11(111111 Iw \'lll'cl vti fUI" Ill'mntn ri t, total protein, glucose,
I n Ivil 1111 / d lld hl(1(1d 111'( '11 IIIII'Il)',' II . I "1'1'1 ' 11 , ,'d 1'.111 (' 1).' 1' or (' ::I I illm on en-
11 111 11 111/ 1 lilllidd I,, ' 1I'I 'I 1II ,d 1ll'i 11 1'I' III ')',I ' I'Y, II"I" lIl fh' 1111 ' hl'1l1.l l o(, f'il i8
I' 1" ' 1 1, ," III 1,1, 111\ 1' 1 1111111 I",' 11 11111 11 " 11' 11' 11' 11 1'1' 1'1111 /',1' /1 1(\ 1' IlIllljll'( ' /', II , lIiI
,lI ti lll l dr, \'11 1111 ' I 11 1111 ' 11 11 1111 11 1 11111 /'," 111 01\ 111111 Iii, ' .11 ' '' \' <11 ,, 111 111 1'1 1.1 111
),, 111 101 1' 111 11\' I", I il l " I ii 11 11 . il l, III III I' 11 [ilil Ili l' ," d\ 111 h ' i ll I II' 1I / 1' 11t! I
322 PASCOE & MOON
the fetuses have been dead long enough to produce gas. A radiograph
does not enable one to differentiate live from freshly dead fetuses. If a
radiograph is taken, it is a good idea to try to include the stomach in
the picture so as to assess the amount of food present. In human obstetric
practice, it has been recognized for a long time that labor alters gastric
motility and that patients undergoing cesarean section are at increased
risk of developing aspiration pneumonia.
54
There was no indication that
this was the case in veterinary medicine until new data revealed this as
a distinct possibility. 56 In this study, five of nine (56%) maternal deaths
after canine cesarean section were attributed to pneumonia. The study
was done prospectively, but it was not designed to determine at what
stage this pneumonia developed. Nevertheless, this is a much higher
incidence than in the general population of anesthetized patients and
suggests that there might be a concern with regard to aspiration pneu-
monia during cesarean section. The owner should be questioned about
recent food intake and for a possible history of vomiting before presenta-
tion. Any radiographic evidence of a full stomach would be an indication
to use a technique that would allow rapid control '6f the airway to
prevent aspiration during induction. Vomiting and regurgitation during
recovery are also possible; thus, the endotracheal tube should remain in
place until adequate control of the airway is regained by the patient. If
there is any stained mucus in the endotracheal tube at extubation, the
animal should be treated with antibiotics for 4 to 5 days and monitored
carefully for signs of pneumonia.
As indicated previously, it is necessary to provide aggressive cardio-
vascular support during cesarean section. Therefore an IV catheter
should be placed as soon as possible, and appropriate fluid therapy
should be started.
Part of the success in achieving lively active neonates is to give
them as little anesthetic as possible and to be prepared to resuscitate and
support them should this be necessary. The first goal can be promoted by
shortening the time from induction to removal of the puppies or kittens,
and this means getting the animal clipped and prepared as much as
possible before induction. All the surgical equipment should be out and
ready, and if the surgeon has already scrubbed and is ready, this can
also speed delivery. Finally, it is necessary to set up equipment (see
article on neonatal critical care) and have personnel available to receive,
care for, and resuscitate the neonates as needed. Ideally, there should b
one person per newborn animal so that immediate care can b given a '
soon as the puppy or kitten is delivered. Although this may not always
be feasible, the clinician should be creative in achieving thi s nd.
Anesthesia
0111' ('111'1'( ' 111 1,lit ' pi IIIOw l"d )',1' w i lli 11 ' )',III'd III 11)1' 111 ' 111 ' 1 II IlIld
"ill'n ll , IIi' l il l y 1' 111111' 11 IIj II 11 '111 11 II III 11111 1\11 11 1111111 11 111 ,11 wlilt 1111 ' 111111111 11 1
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PERIPARTURIENT AND NEONATAL ANESTHESIA 323
some canine data, but there is a paucity of information on feline cesarean
section, In one study of feline dystocia, 123 cesarean sections were
performed, but no outcome data were given on maternal or fetal sur-
vival,27 and in another study detailing en bloc resection of the uterus
and ovaries, 26 cats underwent cesarean section.
82
From this group of
cats, there was a 58% incidence of stillbirths and, during the first week,
a 10% mortality of the kittens born alive. One dam died 9 days after
surgery as the result of an ongoing coagulopathy. Given this lack of
scientific information, the technique that is chosen for cesarean section
depends on the and facilities available and the knowledge and
skIlls of the prachhoner. For an emergency cesarean section, it may be
better to use a familiar technique rather than one that you have not used
before even if the familiar technique is less than ideal for this purpose.
The comprehensive study of cesarean section in dogs to date was
prospechve and analyzed data from 809 operations.
56
The only two
drugs associated with a lower puppy mortality rate were isoflurane and
prop'ofol, and the o.nly two drugs with a negative effect on puppy
survlVal were xylazme and methoxyflurane. The measure of success
(puppy mortality) in this study is an important one but may miss some
of the more subtle effects associated with different anesthetic techniques.
What follows is an attempt to point out the concerns with different
approaches, recognizing that the information provided is biased by the
.1 uthors' experience (Table 3).
The first general statement to be made with regard to placental
I ransfer of drugs is that if the drug crosses the blood-brain barrier, it
crosses the placental barrier. This means that all drugs used as sedatives,
I centrally acting analgesics, and anesthetics cross the pla-
cental barner and have an effect on the neonate. The approaches that
1'. n be used to minimize the effects on the neonate include the following:
1. Use local anesthetics and minimize systemic absorption.
2. Use the smallest dose possible to get the desired effect on the
dam. As indicated previously, the periparturient animal has a
lower requirement for anesthetics, and labor and fatigue may
further decrease the doses needed. These things suggest that
thetic dose should be titrated carefully for each patient (one
eIghth- one fourth of the calculated dose).
3. Us d rugs that have a short duration of action and are rapidly
m' tabolized by the dam. The neonate has a limited ability to
lTl ' tnboliz drugs; thus, any drug remaining in the fetus at the
lim' of d li v ry may per ist for longer than expected in the
"dull. If I"Iw I. m ITl ctaboli z d th d rug rapidly, her blood concen-
I ro1 l iOI)H (k uvns(' qllicll favor I' abs rpti on of the drug from
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light P lane of anesthesia; use a local anesthetic technique in
conjunction with the inhalant).
Pr medication
Premedication mayor may not be necessary depending on the state
III I h ' dam. An animal that has been in labor for 24 hours may be
11I'.ll'ing exhaustion and may be getting toxic, in which case it needs no
IlIt'l ll l'dication. On the other hand, a vicious dog or ferocious cat pre-
"llll'd for an elective cesarean section may need a high dose of drug so
[11,11 the veterinarian is able to proceed. Apart from the need to minimize
IIloIlt'rna l distress and provide analgesia, premedication often reduces
IIII' dose of induction and maintenance drugs required for general anes-
1ll"rd,l, thus helping to decrease exposure of the fetuses to more de-
1"I'HHi ng drugs.
!\ccpromazine was not associated with an increase in maternal or
II' tlll.l lnl mortality,56 but it is a potent aI-antagonist and a long-acting
011111', lhat requires hepatic metabolism. This is not an ideal drug to give
11\1' .loI ll1 b cause of hypotension or to give the puppies, because the
dlli)" Illsts longer (immature hepatic metabolism) in the puppies than in
III' dol l\) .
Mosl I r gnant dogs and cats respond well to opioids, and routine
,1,1' 1'/ of th se drugs provide analgesia and sedation. The f-L-opioid
1)',llI li NIH ( .g., morphine, meperidine, methadone, oxymorphone, fen-
I I) , 11'( ' mOI-e effective at reducing the doses of induction and mainte-
1101111 '1' dnl gs than the opioid agonist/antagonists (e.g., butorphanol).
\yl.l y- in and other a2-agonists are not recommended for cesarean
, , 111111. I.v;ine is associated with a higher mortality in small animals
1I11I111I 1'l'd with other anesthetics
17
and, more specifically, with a higher
1""loi l. II Ill ()rtality after cesarean section in the dog.
59
In awake healthy
1'1' )', 1 lo ll iI ,'wes, a clinical dose of xylazine produced adverse fetal re-
11111111 'ti, i ii I' '' Lding bradycardia, hypertension, and hypoxemia, which
," I III11 't I I (I I' It.p to 20 minutes after administration?3 It is likely that the
1,"1"11 1 IV , Ill\nn ist effects of medetomidine and romifidine have equally
III '"ill t' t'lk\'ts on uterine blood flow. Even at doses of 1 f-Lg/kg (admin-
I 1,It ,d IV), II 'ledetomidine induced a 60% to 70% decrease in cardiac
II 11'1 II III HI ,I 00% increase in systemic vascular resistance?8 A study in
" ,ll 11 /1 II )', 110 )-Lg/kg of medetomidine administered intramuscularly
I 11111 1,1 1 111 11 11' r ommended dose of 1000 f-Lg/m2 in dogs) demonstrated
I ,II" " II'd II' Ii 0 1 in uterine blood flow, with resultant fetal hypoxemia
111 ,1,"1.1,1/111, /1 '
II11 111'i1 111 "dl'l lgs (kt'l:nl11inC', til tcl'rnine) are also not recommended
I. I 1111 111"tll lll litlil 11111, ,1'1 ' 1111' 11' 11 :11' i. di ctntcd by the need to chemically
II I II 11 11 , ti l 11111 ,11 IH,elll 'l ' 11'1111 h.' I\,lIldl. ," ,
326 PASCOE & MOON
Local Anesthetic Techniques
In people, the maternal mortality rate is 17 times lower when
local anesthetic techniques are used compared with general anesthesia.
38
These techniques are also chosen to minimize fetal depression because
they decrease the amount of drug that is absorbed by the fetus. In
women, it seems that epidural techniques produce less neonatal depres-
sion compared with general anesthesia,so, 83 but potential adverse effects
such as severe hypotension continue to remind us that no technique is
perfectly safe.
9
It is possible to perform the cesarean section with a local
infiltrative line block (up to 2 mg/kg of lidocaine diluted to the volume
necessary to infiltrate the incision site) until the puppies or kittens have
been delivered. Inhalant anesthesia can then be provided if needed
during closure of the uterus and abdominal wall.
Epidural lidocaine (2-3 mg/kg, not to exceed a maximum volume
of 6 mL) may be used, and the uptake of the drug can be reduced by
the addition of epinephrine (5 J-Lg/mL). The epinephrine also intensifies
and prolongs the block achieved with the lidocaine. In cats, and occa-
sionally in dogs, the needle penetrates the dura mater, and cerebrospinal
fluid is obtained. At this point, the clinician can try to replace the needle
in the epidural space or can inject 25% of the calculated epidural dose
into the subarachnoid space. Lidocaine is preferable to bupivacaine,
because bupivacaine has too long a duration of action (3-4 hours) and
is 20 times more potent as a negative inotrope should the local anesthetic
be absorbed systemically. Less local anesthetic is required with epidurals
performed during pregnancy because of the distention of the epidural
veins from increased collateral blood flow. This venous distention de-
creases the epidural and cerebrospinal fluid spaces and facilitates trans-
fer of drugs into the cerebrospinal fluid. Care must be taken to remain
on midline and to keep the tip of the needle as close to the ligamentum
flavum as possible (i.e., do not push the needle to the floor of the spinal
canal) when performing these blocks, because inadvertent entry into the
epidural veins is more likely. Hypotension secondary to sympathetic
blockade may occur, and higher blocks may depress respiration or
induce respiratory arrest. The hypotension has been shown to occur
despite preoperative fluid loading in women, and uterine blood flow
may be decreased even with normal systemic maternal blood pressures.'16
Hypotension did not occur in healthy bitches given 3 mg/kg of lidocaine
epidurally,64 although it certainly can occur clinically; thus, it is st ill
important to monitor blood pressure in these patients. The benefits of
,local anesthetic techniques must be weighed against the increas d tin ('
required to perform them and the quantity of d pr 'ss iv ' d rugs I'hal Il Hl
need to be given to the dam 0 as to po ition hel' tl il el do the HlII')\t'I" .
Alternatively, any local blocl r nn bt' l '() Il I 'III' I'{' nti y wi lh 1',(' IH' I' 11 1
anesthesia such thLlt Ll Ii ' hi pi n I1\' Ilf' )',vlI!'!'ill 1I1 1I 'H I IH'tl l.l i l IUll lll lli ril" I'I1I
o tha t 1"11(' I nti en l iH t ll ) " lI l )/ w inll l 11\ 11 .r ll , II )',I' ,III I I I lI'llvldl,d I ,y 11 11 ' 11\(',d
i:('l' hlliql i1 '.
General Anesthesia
As indicated previously, a rapid induction technique is desirable
after preoxygenation because of the increased potential for regurgitation
and aspiration during induction of the pregnant patient. As previously
discussed, any delay in intubation or protection of the airway should be
avoided; thus, anesthetic protocols with long induction times such as
those administered by mask or IV opioid induction may not be appro-
priate. Even when concern for aspiration is low, one author (PFM)
avoids mask induction techniques because of inhalant gas exposure to
personnel and prefers a rapid IV technique for all cesarean sections. The
other author (PJP) advocates the use of mask induction with an inhalant,
because it is likely to have the least effect on the puppies or kittens (the
inhalant is breathed off rapidly and does not need to be metabolized)
and is a simple technique that is familiar to most clinicians. It is accepted
that there may be a risk of aspiration pneumonia, but the data collected
so far do not pinpoint the time of aspiration in the bitch. For an
injectable technique, the authors' preference is propofol-isoflurane in
uncompromised cesarean sections, with or without opioid premedica-
tion. In critically depressed dams, a small IV dose of fentanyl is used
before induction with etomidate, followed by isoflurane.
For cesarean section, puppies may do better if propofol or isoflurane
is used in the anesthetic protocol,31 Propofol and thiobarbiturates (thio-
pentallthiamylal) have been used in human obstetric medicine, and
both have the advantage of rapid onset and short duration with minimal
residual fetal depression. 60, 88, 89 Neither drug should be used without
consideration of the dam's clinical condition. Both have significant car-
diopulmonary effects and need to be titrated carefully to effect. Bradyar-
rhythmias (with propofol) and ventricular and supraventricular arrhyth-
mias (with barbiturates)48 may occur as well as decreases in myocardial
contractility and preload. These effects decrease cardiac output, blood
pressure, and, most importantly, uterine blood flow. Propofol and the
barbiturates cause a transient apnea and may cause severe fetal hypoxia
n nd acidemia if the mother is not preoxygenated, rapidly intubated, and
provided with enriched oxygen with assisted ventilation. These transient
l' ff cts may not be problematic in healthy patients but enhance fetal
,) ' idosis and hypoxia if these conditions are preexistent. Although propo-
rol 'i generally safe as an induction agent, maintenance of anesthesia
with propofol is not yet recommended, as initial investigations in infants
Indi ate lower neurologic and adaptive capacity scores compared with
Ilm, (' ottai n d Lls.ing thi pental.
96
Safety with the barbiturates can be
IIH'i'l'f1 HCd if the nfl' lIdlllini t:J t 'r d with either lidocaine (0.25-1.0 mg/kg
IV) ()\' dl :Ii',cpnl1l (0, I () " mg/ I g 'IV), both of which reduce the induction
dlll I' l'(' qu in" 1, I ) ) 't ,( ' p ,llI ) !"IVI 'I I 10 the moth r has b n shown to alter
11 11' 1'1I11l1" ')\ lil lI l (l ll 1III II IIII I'lll ,II !J I,. /1, 1,,,,1
1
1 bliino lata on thi fj ar' avaHabl
III dl'I',r III' , ' fl i M" ll llI ll ,' l i d II l ll y dHIJ h( , tl Ht' d ill IIbHh'II'I I' IlIll'HlhcHin,
il IIIIIII )'," 1111' dll I" 11I', dl,rllli rill) ', I 01111 11 ' II I Iii III (1 III 1I ',l d I" r"t rI
.1 "1
11
'" I 1'"1 II
328 PASCOE & MOON
Ketamine (4-6 mg/kg N) combined with diazepam (0.2-0.4 mg/kg
N) or midazolam (0.1-0.3 mg/kg N) is an alternative rapid induction
technique with positive cardiovascular effects and may be considered in
critically ill dams. In women, ketamine provided better cardiovascular
effects than thiopental, although neither choice affected the general
condition of the neonate.
48
Thiopental inductions caused a transient
decrease in uterine blood flow, although ketamine did not.
48
In addition,
ketamine administered IV at 5 mg/kg was shown to maintain or increase
blood pressure and to increase uterine blood flow by 15% in near-
term ewes.
S1
Ketamine combinations did not affect puppy survival. 59 A
residual depressant effect has been observed in puppies,s9 human ba-
bies,2s and primates
28
after cesarean section, necessitating intensive neo-
natal resuscitation. Thus, it seems that ketamine causes fewer cardiovas-
cular disturbances in the dam and fetus than propofol or thiopental but
may have more prolonged depressant effects on the fetus. Diazepam and
midazolam can be reversed with flumazenil (0.1 mg/kg) if necessary, but
these drugs rarely alter cardiovascular function if less than 0.5 mg/kg
administered IV is used. Some puppies may seem to have poor muscle
tone after administration of benzodiazepines, and this may be a good
indication for flumazenil reversal.
In severely ill dams, etomidate (1-2 mg/kg IV) is a safe but expen-
sive induction agent. Advantages of etomidate include excellent cardio-
vascular support, rapid onset, and short duration of action. There was
no difference in Apgar scores (scores that measure baby vigor after
delivery) when etomidate was compared with methohexitaVO and etomi-
date had more favorable fetal acid- base measurements compared with
thiopentaF6,43 for human cesarean section. As is the case in the adult,
transient cortisol suppression occurs in the fetus when there is maternal
administration of etomidate.
20
Without premedication, etomidate may
cause some gagging or retching, but induction is rapid and aspiration is
unlikely if the airway can be secured quickly. .
Opioid induction can be used in dogs but not in cats. Ideally, drugs
with rapid onset and short duration should be used. In this context
fentanyl, alfentanil, and remifentanil would be superior to oxymorphone
or methadone. Advantages with opioid use are their excellent maternal
analgesia and minimal cardiovascular effects. Disadvantages are mater-
nal respiratory depression (necessitating assisted ventilation), the con-
current use of benzodiazepines, and bradycardia, which can be treated
with anticholinergics. If bradycardia occurs, atropine (0.02-0.04 l11 g/kg)
is the anticholinergic of choice, because glycopyrrolate doe not r OSi:J
the placental barrier and the bradycardia may be occurring .in the f lus
as well. Oxymorphone has great r depr s an t a tivi ty in hllml1n
nates than the other opioids. Fentanyl, on \'\" o\'l ll'f' h:IIHI , CillI HCd no
change in neonatal Apg, f' S orcs, I lood gd, p" ()I' lIl ('I' ilH' hl ood flo w,
suggesting it sa fe l (01' il1ll'<I0lwl'f1 li vl' .111.1I)',I' II i. 1 III p,)',/ I /,. I V) , I\i
sLIming, Plli c: tli oll (I1 1111111olll d.llil 1(1 1IIl ' dll )'" 1I ' IILill ylll iol Y 111l11I1 'I' Il'rn
PIlPI <I (' p\'( ', r i(l/l IIt,," II VlI lt lll"IlIl Il ' ( ',111\" 1 ,1,1\,, 111 1111 .1 " 11C' 111 )',1 111 1'
Ijlilil ' 11' 1\1 livi' III II" , 1' 11 1',1, III " I Jillitl 111111 11111"" \\'11 11 1,1 11"1
and it is unclear if veterinarians should be equally concerned over opioid
depression in the dog. In general, opioids were not a risk factor during
cesarean section in the dog,59 and depression may be reversed with
naloxone (1-10 J.Lg/kg IV or intramuscularly).
Although all inhalant anesthetics have been used successfully for
canine cesarean section, methoxyflurane was associated with decreased
puppy survival,59 Halothane did not have any positive or negative effect
on cesarean section- derived puppies, and isoflurane was associated with
improved neonatal survival,5, 98 In healthy women, neonates were also
unaffected by halothane as long as the induction-delivery interval was
short, but when fetal distress was present, halothane aggravated the
fetal condition.72 Halothane is thus not recommended for emergency
surgery. Nitrous oxide, a less potent inhalant anesthetic, is sometimes
used to supplement anesthesia. Because nitrous oxide decreases the
oxygen delivery of the mother, it is not recommended in any situation
where maternal hypoventilation or hypoxia may occur. Nitrous oxide
reaches equilibrium with the fetus within 20 minutes, and if the anesthe-
sia is prolonged, nitrous oxide has been associated with infant depres-
sion.
62
Furthermore, diffusion hypoxia in the neonate may occur after
delivery. Nitrous oxide is used extensively for cesarean sections in
women, but times from induction to delivery are often shorter in people;
thus, care should be taken with its use in dogs and cats. Although there
() re currently no data on cesarean section using sevoflurane or desflurane
in cats and dogs, it is expected that the use of these drugs would be
rlssociated with even faster recoveries than with isoflurane.
Competitive neuromuscular blocking drugs such as atracurium are
large polar molecules that do not cross the placental barrier to any
l'xtent. The addition of a neuromuscular blocking drug may allow one
louse less anesthetic and hence decrease the degree of cardiovascular
depression. The addition of atracurium during cesarean section necessi-
l(ltes the use of intermittent positive-pressure ventilation, and care
should be taken not to hyperventilate the animal.
In dogs, if the dam is "lethargic" after surgery, litter survival de-
1'1' ases,59 and this may be an area on which to focus future studies.
I. ,thargy may be influenced not only by the condition of the dam before
SlIf'g ry but by other factors such as duration of surgery and type of
,111 " thetic teclu1ique. Although it is rarely reported, ketotic hyperglyce-
Illin ha occurred in canine pregnancies and may contribute to poor
lil[lt'rna l status. Dam depression probably also results in poor care of
lilt' I III pi 's by the mother during the critical postoperative period.
Nlllrili ol1 al "Ind supportive needs of the puppies (e.g., being dried,
lilll lil ull' d, WDf'm(.' I) shoul d be carefully attended to by the care pro-
viii, '!' ill illl :ILiol1s where "he dam do - n t em to be recovering
1IIII' Ill ,III y 11'(1111 lilt' Hil f')\ic:ll procedure. Immed iate ass ssm nt of the dam
11111 I i "dil ',il t' 11\1' 1)('I'1i (01' ,'nnlil1l1t' d cnl'( liovnl'{('I rI <l f' Stlpj1of'I , o X W' n
111'\111 '1111 '111 11 111 11 , II WII I'IlI"I ' (' ll vim" III ('"I , dlHI ,ll ld ili()I1,tI l'I'i lk. lI ( '1 11' ('
III 111 /1)'," 1111 ' ,,1
I"" lil lli " ' 11111\ it! II I 1111 ' 111/' 111/1 1I11t! 11,11111' 11 111 11 '1'1' 111" 1" "'11 til '
330 PASCOE & MOON
scribed with the stated advantage that this is a safe and effective alterna-
tive to cesarean section (assuming the need for ovariohysterectomy).82 In
the article describing the technique, the maximum time from clamping
the vessels to removal of the uterus was 60 seconds, but in less experi-
enced hands, it may take a lot longer than this. In an elective cesarean
section, a clamp time of several minutes may not affect neonatal survival,
but in an emergency, where the fetuses may already be severely stressed,
the use of this technique may adversely affect neonatal survival.
ANESTHESIA OF THE NEONATE
Neonatal Pharmacology
The distribution and metabolism of drugs are different in the neo-
nate than in the adult. Some of the factors involved are as follows:
1. Decreased protein binding. This is a result o' , generally lower
albumin levels, and the albumin present also has a lower affinity
for drugs. Neonates also have decreased a 1-acid glycoprotein
concentrations, which are important for some drugs (e.g., lido-
caine, alfentanil, sufentanil). In people, alfentanil varied between
being 81% and 92% protein bound in the mother versus between
58% and 74% in newborn children. The differences were directly
correlated with the acacid glycoprotein concentrations.
55
2. Increased permeability of the blood- brain barrier. The blood-
brain barrier is five to six times more permeable to pentobarbital
and morphine in neonates than it is in adults.
3. Neonates have higher body water content and lower fat content
than adults. This results in a greater initial volume of distribution
for some drugs. More lipid-soluble drugs should have a smaller
average volume of distribution, and this seems to be the case with
fentanyl, sufentanil, and alfentanil. Lidocaine and mepivacaine,
which are also highly lipid soluble, show increased volumes of
distribution, and it has been speculated that a greater proportion
of the blood flow goes to the vessel-rich group of tissues, hence
increasing the volume of distribution. Other factors such as pul-
monary uptake of local anesthetics and protein binding may al 0
playa role in this finding.
4. In most neonatal animals, there is a decreased ability to metabo-
lize drugs. Phase 1 reactions are those that oxidiz , hyd rolyz , or
reduce a drug. The cytochrome P450 and NAI I II :,;ysl: ' 111 :4 nl'l'
not well developed in th n onat -; thll S, drugs rVlJlliril1g Ihvsv
phase 1 reactions ar nwl'at 1)li Z,t' d mOrt' /'.dl) wl , ( )I)(' 11 H'Il HlIl'l' Il l'
cytochrome P450 ndi vil ill PIIPI i('. ilHI WI,d d Id>dold
over the fil'sl tl WI I,'I (11 iii ", wilir II IIIIII'II IIt! 11 1' 11'1 1 I' II IIVi ll )I,
o CllITVd h IJ wl'I,I, I Iii 11)',1 ' ( h ,,1.1I 11I1 I, II I! ' 11 111/ I ,' lI i,I" 111
prOI'I'1I II I Irl lllIl 1IIId II, ,' """'i' Iy ,11 ' 111 1 111 111 '111 1' I 'I lil il y Irll"1
birth. Phase 2 reactions are the conjugation reactions, and these
are poorly developed at birth (one third- one fourth of adult
activity in dogs). These immature processes affect the duration
of effect of some anesthetic agents (e.g., pentobarbital in 1-day-
old rabbits administered intraperitoneally (IP) at a rate of 18 mg/
kg produces a sleep time of 173-265 minutes versus 12- 27 min-
utes in the adult,93 and ketamine administered IP at a rate of 75
mg/kg causes a sleep time of 95 minutes in rats less than 1 week
old versus =30 minutes in 16-week-old rats
91
). Although there
are few data available on the neonates of our domestic animals,
the clinical response to some drugs requiring hepatic metabolism
indicates that these neonates are likely to have a decreased ability
to detoxify drugs. Glycogen stores in the newborn animal are
relatively low, and although glucose levels are well maintained in
normal and normal fasted neonates, these neonates may become
hypoglycemic if stressed and fasted. Renal clearance rates are
slower in the neonatal animal than they are in the adult. Nephro-
genesis in puppies is not complete until the third week of life,
and the outer cortical nephrons are the last ones to become
fully functional. The ability of the neonatal kidney to produce
concentrated urine is less than that of the adult; thus, fluid
balance is more labile in neonates.
5. The differences in neonatal respiratory function mean that in-
haled agents have a more rapid onset and recovery (higher ratio
of alveolar ventilation to FRC, increased permeability of the
blood-brain barrier, increased flow to the vessel-rich group of
organs, decreased body fat stores).l1 In contrast, the upper airway
of puppies seems to be more reactive to the presence of inhalants,
and this may decrease their minute ventilation and rate of uptake
of the drug.
86
6. Altered minimum alveolar concentration of inhalants at which
50% of the subjects do not respond to a noxious stimulus (MAC).
In neonates, MAC is decreased but initially increases with age.
36
The only data in small animals showed that the MAC of halo-
thane in cats at 4 and 9 weeks and 2 years was 1.3% 0.01%,
1.39% 0.02, and 1.21%, respectively.65,66
7. Immature nervous system. Neonatal nerves require less local
anesthetic to produce a block than adult nerves. Nerve conduc-
tion velocities are slower; thus, responses to some stimuli show
Ion er latencies.
4Q
,87
8. Ill1rnatur neuromuscular junction, increasing muscle mass, and
ch<lnging I11US I fj b r types. These all have an impact on the
dfl'CI of IWtll'() Il1US Lil aI' jun tion bl ocking drugs. Succinylcholine
:li'" Wf lill ll' Vl ll'i nl, ion ill dose reqlli rcm nt in th neonate com-
p,lI 'I' d W lit IIi( ' "dtrll Il H 11l1I )' (I , ' 11)(' do,' (' is h, sed on l11illi grc I11 S
111 ' 1 ' 111111 1' 11 11' 11' 1' I ,I'll 1III'.r!'\lrillill i !'I ' I II Ii I'l l" 111 1111' IWIl I1;! I I '
111 1111 '" ,'d \ 11 1 11 11' ,111l1ll 111 1 l Id (III III 111 /" , 01 '"1 1' 1, ,'/ 11 1"111 '1' 1111 ' 11'1'
332 PASCOE & MOON
Preoperative Preparati on
Animal
This must include a thorough physical examination, paying special
attention to the cardiopulmonary system. Evaluation of the hematocrit
and total protein are essential, and measurement of blood glucose is
advisable. In the case of abdominal emergencies, the plasma/serum
electrolytes are also essential guides to therapy. In neonates with a
distended abdomen (e.g., intestinal accident, ruptured bladder), ventila-
tion can be greatly improved if the abdomen is deflated. Deficits in
circulating blood volume should be corrected using an appropriate solu-
tion (e.g., lactated Ringer's solution, Plasmalyte 148 (Travenol Labora-
tories, Deerfield, IL), Normosol R (CEVA Laboratories, Overland Park,
KS), saline, blood [all with or without 2.5% to 5% dextrose]). Because
neonates have less tolerance to the stress of surgery and anesthesia, it is
important that the preoperative preparation be optimal. Suckling ani-
mals do not need to be fasted preoperatively.
Equipment
The two biggest concerns with the anesthetic circuit are the resis-
tance to breathing and the risk of increasing dead space. The largest
source of resistance in these small creatures is usually the endotracheal
tube because it is likely to have a much smaller diameter than the circuit
to which it is attached. Standard endotracheal tubes can be obtained
with a 2-mm internal diameter, but animals with smaller airways can be
intubated using IV catheters. The relatively sharp and stiff ends of these
catheters can be softened by the use of a small piece of silicone tubing
glued to the end of the catheter.23 The use of these small endotracheal
tubes is an indication for assisted or controlled ventilation. Sources of
increased dead space would include endotracheal tubes that are too long
and the space in the end of the circuit that is attached to the tube.
Nonrebreathing circuits should normally be used because they have less
resistance. A neonate's ability to breathe tends to fatigue more easily
when an increased work of breathing is required; thus, intermittent
positive-pressure ventilation is generally needed in neonatal puppies
and kittens. This makes the choice of circuit less critical, because the
work of breathing is being taken over by the anesthetist. Another argu-
ment against using a circle system is that the capacity of the yst In is
large compared with the flows required with such small pati nts; c s a
result, the rate of change of anesthetic con -ntration it> slow 'I'. Thi tl '; 111
bereducedtosomeextentby ui nga Innll rel r'<1l' hingbi1g: 1I 11 pldi: driL'
rebreathing hoses or a p 'diat ri ircie H 1-' 1(' 111 .,
In human bcirl)"K/ l'I ll'r!' iI-I )'/!' 1I ! 'OIl('I 'I ' 11 (IVI' I' II Il' ('rrl ' I' IM (I I Id) ',11
con cnl nll' iOI1 H !)r () )';1' 11 i ll lil l' II 1'Pll oI I I' 11( ' 1' 111 1111' I I I II I!' plrl ' III I III I' I )l lI ) Ill'
r/' {innl d iI(II ' 111 1111' 1 11i '(II 'I.d"I I" , til , ,, / 11 ' 11111111"11 111 Wi ll " " 11'1' 11 1
1(1 II I V(' 1111 1' l ' lil\ ( 'I t! 11I1I 111i '1 II I lIljl l ril ' 1111111 1 111 1' 11
When dealing with any small patient, it is possible to overload the
animal with fluids just because of the capacity of the fluid lines used for
larger patients. In a 300-g patient with a flUid. of 10 (a
total of 3 mL/h), it would be easy to exceed thIS Just by flushmg the IV
line. For this reason, it is wise to use tubing with a much smaller internal
diameter to avoid this problem. Care must also be taken to ensure that
the lines do not contain any air, because these patients are quite small
and may still have communication between the left and right
making it possible for IV air to produce coronary or cerebral embolI.
Premedication
In neonatal puppies and kittens, we usually do not use any premedi-
cation except for an anticholinergic (e.g., atropine or glycopyrrol.ate). As
the animals get older, it is feasible to use almost any drug used m adult
animals that is appropriate for the presenting clinical condition.
Induction Maintenance
For most neonates, a simple mask induction with an inhalant has
given satisfactory results. Halothane, isoflurane, and can. be
used for this purpose. The addition of nitrous may
slightly, and even in the patient in which its contmued use IS contramdI-
cated (e.g., severe intestinal distention), this brief use seems to be safe.
Because the uptake of .ir:halants is sli.ghtly faster in
neonates are more senSItive to the tOXIC effects of the Inhalants,' It IS
usually unnecessary to turn the vaporizer beyond 3%. The larynx of
neonatal kittens and puppies seems to be fragile, and great care
be taken to intubate atraumatically. In the extremely small young patient,
careful consideration should be given to maintaining the animal with a
mask so as to avoid the possibility of postoperative laryngeal edema.
[nhalants also seem to cause a greater degree of cardiovascular depres-
sion in the neonate compared with the adult animal, which is probably
the result of a negative inotropic effect and a blunting of the baroreceptor
responses to hypotension.
s
.
92

Injectable drugs need to be metabolIzed, and because some of the
I' quired enzyme systems are this age, the use of mo.st
injectable drugs is not ideal. The thlObarbiturates can be. safely m
I itt 'ns and puppies over about 4 weeks of age. In pUppI:S, It has
HI own that the potency of the thiobarbiturates changes WIth Usmg
" Iwnd I 1'01''' as an nd pOint, the median effective dose of IV thiopental
W, \H Hhown ('O in r ' as f ro m 1 lng/kg at J week of age to 4 mg/kg at 8
W('vkH or olgl' ," I CHpi l'!' 1'1)(' r<lel' that ancsth sia with a
WI '. H f ot'f h r( ldif'\ II' illllli ll ll , li lt' dl' \I )" h i l K IO() b(' metnboli 7.'d, and thIS
p l'IH'I'HH / p l'o l llll)',I'" ill 1\1 '(1 11011 rI ." dlll. rl ll, 'I' l l(', \' ,1 \1 l h o l'H wOlild
11),"1 11 11 1 1111' II /It' II I III 1II I. I rillll ll l il , I 111111 IIl ldll I" II II Jl III 1"1.1 \ y l 1, 1.1 ,
, '1' 111 ' 111 11' ttl I IIi HII ,II ' " dill)', ( 1)1' 1111 11 Iii ' ,11111 li ll' l dl lll l ll') 11 11"(lIli li l il
illlillJl d l 11 III ,1111' ' III 111 ,d l ll ' l 11, '1" Ii 11,, /1 111 '1' 11 Jilil lV ll 11 1111 1111 1
334 PASCOE & MOON
elimination of ketamine is prolonged in the neonate. In neonatal rats
2 weeks old), IP ketamine was associated with a more rapid onset
time 15 minutes versus 20-35 minutes for 10- to 6-week-old rats) and
markedly prolonged sleeping times.
91
In this study, it was also shown
that the neonatal rats were able to metabolize ketamine to its first
metabolite (norketamine) but that metabolite II was undetected until the
rats were 3 weeks old. The production of metabolite II, which has a
minimal anesthetic effect, requires oxidation, and it is known that this
activity is deficient in neonates (even as adults, cats do not seem to
metabolize ketamine beyond norketamine). Similar results concerning
the pharmacokinetics of ketamine have been reported in human neo-
nates. Ketamine may even be harmful in the first few days of life,
because several NMDA antagonists have been associated with an in-
crease in neuronal cell death in rat pUpS.44 These results suggest that the
dissociative drugs should be avoided in the first 2 to 3 weeks of life.
Propofol can be used as an induction drug in young animals. It is a
highly lipid-soluble drug, which initially redistributes to muscle and fat
but is also rapidly metabolized by the liver. It induces cardiopulmonary
depression similar to that induced by the thiobarbiturates. To date, there
are no specific studies that have examined the effects or pharmacokinet-
ics of propofol in puppies or kittens.
Etomidate could also be used, although the dose required is likely
to be reduced.
93
This drug preserves cardiovascular function better than
most other anesthetics; thus, it may be useful for animals with significant
cardiovascular compromise (including shock). As mentioned previously,
it may suppress cortisol production, but this can be covered by the use
of exogenous corticosteroids. The drug is hyperosmolar and may cause
significant vascular reactions in neonates because of the small size of the
vascular access and the fragile nature of the vessels.
Monitoring and Support
Because of the immaturity of the animal, it is especially important
to support and monitor cardiopulmonary function. Unfortunately, we
do not have the capability of obtaining the information necessary to
understand the physiologic changes occurring under anesthesia; thus,
we have to use our clinical skills and the imperfect monitoring tecb-
niques that we can apply to these small patients. As indicated pr viou Jy,
cardiac output in these patients is dependent on rate; thus, pr venting
. bradycardia in a neonate is more important than in an adul t. Monitors
such as the esophageal stethoscope and the electrocardi ogram (II ,) are
more useful in the neonate than in th adult, wh 'rc hearl rate proviLi t'l-l
little understanding of ardi ova. ul ar fU ll tiOIl . An Jo: ~ C nl. () (I ll oWH Oil( '
to detect arrhythmi nH should lill 'Y 1l( 'I' UI' IIIHII ' r 11I lI' Hll w i.1. Wi th 111,1I1 y
of these smoll rJ'(' ,1\I IJ"(' H, il 1'+1 11 [II ' dlrnl 'ldl III )',1'1 ,I )"pod H( '( : 11' 11 '1'
hl'(, IIII ,'I' or IIII' Hlll ,dl / 1'/1 ' II I Ill" 1':( '( : "111 1'1"" I ' 11111 1 1111 ' 11111 1" 1111 II I
),,1'1 11111', )',llIld 1'1111'111 '111111, I VI/,' 1111,1 111 ,11 1111 ' II " ,iI 1,1" , 111 11 '1\1 1'1'\1,11 1.
graphic electrodes with fine needles or pediatric ECG pads taped to the
foot pads provides the best solution for overcoming this problem.
Because circulation is so labile in neonatal animals and resting blood
pressures are normally low (see the article on neonatal critical care), it is
helpful to be able to monitor blood pressure and support cardiovascular
function. Doppler ultrasonography is a good monitor for indirect mea-
surement of systolic blood pressure, although it can be difficult to get
cuff sizes that are small enough for some newborn puppies and kittens.
This technique is usually only reliable for the measurement of systolic
pressure, but the clinician can make some judgment about the mean
pressure by palpating the pulse and using pulse pressure as an indicator
of the difference between systolic and diastolic pressure. Pulse pressures
are often wide in the extremely young animal because of a patent
ductus arteriosus (provides a low-resistance component to the systemic
circulation). In many neonates, it is difficult to palpate the pulse because
of their small size and increased coverage of subcutaneous fat. Direct
pressure monitoring should be used whenever possible in the sick neo-
nate, but catheterization of the superficial arteries is not easy in these
patients because of their small body size and the seeming fragility of
their vessels.
Catheterization of superficial veins can also be difficult, although it
is usually feasible. In the extremely young or small kitten or puppy, it
may be easier to place a needle into the medullary cavity of a bone and
give fluids through this access. The bones of these young patients are
usually soft; thus, it is feasible to use a spinal needle or even a regular
hypodermic needle. Fluids to be administered during the procedure
should be warmed, and glucose (2.5%) can be added to the standard
replacement solutions.
If hypotension is detected or it is judged that tissue perfusion is
inadequate, treatment should be instituted. Initial therapy should in-
lude a reduction in the amount of anesthetic if possible and an increase
in the rate of fluid administration. If these treatments are ineffective, it
is probably better to use a positive inotrope or chronotrope than a
peripheral vasoconstrictor to try to increase blood pressure (unless it is
'xtremely low and a vasoconstrictor is needed to raise the pressure long
' nough to allow other therapies to work). Dopamine has been shown to
iJ r ase blood pressure in puppies less than 10 days old at a rate of 5
Lo '10 f.Lg/kg/min but has little effect on heart rate or cardiac output.
I )obutamin se m.s to have little effect at clinical doses. These experi-
Il .ents W ' I; arri d out in normal puppies, and the clinical response
1l1(i ~ ' d i f r r nt in th hYI ot niv patient, but it certainly seems to be
II" " I'hun in Ihl nd lill:. Adl'l'Ill',"!'i VdiO onstl'ictors may also be less
" rrl'I 'li vI' lw(" lll. (. Ill' Ihl' iI1) 11I,1 11 1I' il or Ih ' ndren rgi r ptor in neona-
lid Ili ll'pil 'l il iid I II Ii ' 11 11, 111 H I,) 1,1 I" IY (l Id 11\) 1'111;11 foa l,' , a omparison
III dllll1l1 ll1l1llll ' Wllh 111 111 ', ' 111' 11111 1111' nlll lWI,t! Ilt lll Ih' ilh(' I' dl'lI )', (' ,III Hed f\
/ 1) ', lId 1'11111 I,ll' lil lllI l II 1111111 1 I'll ' 1111 ' 1'liI 111 ,11 "llblil"ll! 1)1' 111111111.11(1(\
1111 IIIII "H I' III 1111111 ,). 1111 11" \ ' III 11 111 ', 11 ,. III 111 '1111 I ii, ' III 1111 ' I d),,1 11'1'
.I' ll " (I. 11111 1 III 11 )',1 1 )', 111 II) lilt ' 1)1111 I' :11 '1.111 III ' "li l/ h,d II 111 ',111 , I"
336 PASCOE & MOON
crease in heart rate and cardiac index (c. Craig, DVM, personal commu-
nication, 2000).
Core body temperature should be monitored, and hypothermia
should be treated as soon as possible. A supplemental source of heat
should be available (circulating water blanket or warm air blanket) to
prevent hypothermia, because many of the anesthetic drugs eliminate
the ability of the patient to thermoregulate, and neonatal animals are
more prone to hypothermia than adults. It is particularly important to
do everything possible to maintain normothermia in puppies and kittens
because they cool down so easily. Hypothermia generally delays recov-
ery because the decreased circulation and metabolism prolong the elimi-
nation of anesthetic drugs. The energy used to restore body temperature
to normal may consume critical stores of glucose and predispose the
puppy or kitten to hypoglycemia.
As indicated previously, neonatal animals are prone to hypoglyce-
mia; thus, it is important to monitor blood glucose before, during, and
after anesthesia. This can be difficult, because it is not always easy to
obtain a blood sample from these young animals; thus, pretreatment
with some dextrose and the inclusion of dextrose in the intraoperative
fluids may help to prevent this.
Peri operative Analgesia
Although the nervous system of the neonate is immature, there is
no doubt that nociceptive pathways are present and that pain is per-
ceived by the neonate subjected to noxious stimuli. In some tests, the
nociceptive threshold is much lower than it is in adults. This may be the
result of a lack of some of the descending inhibitory mechanisms found
in older animals. The coordination of motor responses to noxious stimuli
is not well developed, and the animal may have much wider receptive
fields to noxious events.
42
Neurotransmitters may not have reached full
function as evidenced by the lack of effect of NMDA antagonists in
some nociceptive tests in neonates.l,S The W and K-opioid receptors are
active but 8-receptor activation may be tied to weaning of the animal.9
These differences suggest that drugs effective in adults may not be as
effective in neonates. Procedures carried out on neonates with insuffi-
cient pain control produce greater stress responses than those for whi 11
analgesia has been provided.
94
,95 It is important to recognize potenti all y
painful procedures and to treat accordingly. The pharmacokifl ti s o.f th
opioid analgesics are different in the neonate and the adult. 1n hurnon
babies, the elimination half-life of most opioid analg si s is hi vhl' r 1'11:111
in adults.
67
Recent studi s exarnining the (f(' ets o( f 'I1I 01 I1 I .1IIt! 111!)1'
phine in puppi es have shown Ihol IOWN ' ti(I,' l'iol () ( Ilw t' dl ' II j\ H ,In'
requir d for anll lgl'sin nl I tid of d l\ ( ' ( '(llllPd)"( ,d wl lh ,II d ,l yl (I 111'(1('
fourfol I di(f<'I'(' l l<' (' H) .' " II ildl ,d /I (I hl '<' li IHIW/I 11,,11 ,,1I1
'
J1i< '11 ,11 '1' 111111 1'
H,' m il iv)' 1(1 IIii' l'I' t l dl 'l d Il I V 1\ "1 111' 11 1111 ,' 11, " I II I 111111,,1111 11' . 111101 Ilt l/
w I II 'h 11 11 )',1 ',1 " 11 ' 111 111 111 " 1" IVll lild I .. , 01 )', 11 . 111 '1 ,iI ,'I 1' 111 ' 11) ', 111 \ ,111 1 1111' 1111 '
of fentanyl as an analgesic in canine neonates.
1O
,53 Local anesthetics can
be used and are quite effective. When using these drugs, the dose
requirements are lower because of the immaturity of the nerves,4 but
the neonate does not seem to be at any greater risk of toxic side effects
with single doses of local anesthetics.
61
There is little clinical information
available on local anesthetic techniques for young cats and dogs.
Analgesia and anesthesia for tail docking and dewclaw removal in
neonatal puppies have been subjects of debate for a long time. Given
the current understanding of neonatal neuronal development, it is con-
trary to the oath that veterinarians take with regard to the prevention of
suffering to carry out the procedure in the absence of any analgesic
method. Application of local anesthetic techniques is difficult in small
wiggling animals, however, and great care must be taken not to overdose
the animal. The injection of a local anesthetic is invasive, carries some
risk, and requires further handling of the animals with a time delay
while the anesthetic takes effect. These factors make it hard to recom-
mend the use of injectable local anesthetics. A topical application of
eutectic mixture of local anesthetics (EMLA) cream has been shown to
provide analgesia for circumcision in baby boys, but for this to work,
adequate time is required for penetration into the skin (= 30 minutes),
and the hair coat of the puppy would tend to resist the uptake of the
drug. Systemic analgesics may be useful, but the doses of opioids and
nonsteroidal anti-inflammatory drugs to use in these young patients
have not been defined, and, as noted previously, ketamine may not be
effective, because the NMDA receptors have not yet reached their adult
pattern of distribution. More work needs to be done with respect to
analgesia in neonatal puppies and kittens before sound recommenda-
tions can be made.
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37. !iaruta M, Funato T NII I II Y, ,'I ,Ii : 1.:1 111<'1 11 ii i IIl lill \1I111I !i YI"" 1'11111,,11111 1111./ 'I
mhalatlon IlIl'in/\ lil(,o,' '"I 1,' lliI 1"1'"" H"II 11 1,,11111 II " I'IIII P'H' I N 1' 1"111 ' 11 111'1 1 11111,,1' 11
.nkkni ZI II lHlrl /l,I): I,ITI IIHI, 1'1/1/1
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hy l'I'lli l" ', I'1 111'1 '111111 I" IiII' I llti l"d ::111 11 '/' II lld ( ',II I' IIi" , I 1\ 111 1\ 111111 II 1Ifl P :1(0, ::159-
\(,11, "111111
1111 MI" Ii " I, 11111 I tvl 111\ 'iii 1,1 1 " I .iI I 'I' I'Ij "lil ll lI l' 11i ' II'\I "11i 1 111 1' 1,"/111 11 1111 1"ll lllI' lil lI llI ' 111 1
1' 11 111 , 11,,11 ill ', 1111 1111 <1 11 I, Iii, ,lilli ' II I' Id \ 11 11 ' II I1 11 II , jlll1"
340 PASCOE & MOON
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1
1,/
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'
, '1111, I'IHII
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23,1991
Peter J. Pascoe, BVSc
Department of Surgical and Radiological Sciences
School of Veterinary Medicine
University of California
Davis, CA 95616-8745
NEONATAL CRITICAL CARE
Paula F. Moon, DVM, Bruno J. Massat, DVM,
and Peter J. Pascoe, BVSc
Between birth and the age of 2 to 3 weeks, puppies and kittens are
defined as neonates. During this critical period of rapid growth, a delicate
balance between oxygen consumption and delivery exists. Care of the
diseased newborn must focus not only on treatment of the underlying
disease but on aggressive supportive care.
NEONATAL PHYSIOLOGY
Vital Signs and Normal Blood Values
One important sign of health is adequate gain in body weight. For
puppies, weight gain should be at a rate of 1 to 1.25 g/ d for each pound
of anticipated adult weight. Puppies should double their weight by 10
to 12 days, and kittens should do the same by 14 days.z4
Blood pressure and body temperature are lower than those of adults,
although heart rate and respiratory rate are higher (Table 1). As puppies
and kittens mature, changes occur in the hemogram (Tables 2 and 3).
Serum chemistry profiles show minimal variations from adult values
(Tables 4 and 5).
Five minutes after birth, infant pH and blood gas values show a
relative hypoxemia and acidemia (pH: 7.21 0.05, Paco
z
: 46 7 mm
Hg, base excess: - 8 2 mmol/L, Paoz: 50 10 mm Hg). At 1 hour
after birth (pH: 7.33 0.03, Paco
z
: 36 4 mm Hg, base excess: - 6 1
Prom the S tion of Anesthesiology, College of Veterinary Medicine, Cornell University
(PFM), And P I ' i v ~ t Practice (B1M), Ithaca, New York; and Department of Surgical and
'Radi ollll\kll i .' d" I1\'('H, hool of Veterinary Medicine, University of California, Davis,
01 if(l l' ll llI (I 'll ')
VI(TI(I{ INi\ I ' I I Ir 11 1 '1 111 hll li III i\ MI\I\l CA: SMALL ANIMAL PRA T[ E
VI II Il tvlJ
i
I I I I I I ~ 1111 I I I I I , II '11111
344 MOON et al
Table 1. VITAL SIGNS IN NEONATAL AND PEDIATRIC DOGS'
Heart Rate Respiratory Systolic/Diastolic
Mean Rate Mean Temperature (Mean)
Age (beats/min) (breaths/min) Range c (OF) Blood Pressure (mm Hg)
0-24 hours 200-250t 15-35 34.4-36.0 (94-96.8) 54/ 30 (40):1:
1 week 220 36.1-37.2 (97-99)
2 weeks 212 36.4-37.1 (97.6- 98.8)
3 weeks 192 37.2-38.1 (99-100.5)
4 weeks 156--137 20-36 37.7 (100) 70/ 45 (60)
5 weeks 208
Adult 100-130 20- 24 38.5-39.5 (101- 102.5) 130/80 ( 1 0 0 ) ~
' Unless otherwise indicated, data f rom Fox MW: Neonatal mortality in the dog. JAVMA 143:1219-
1223,1963.
tData from Poffenbarger EM, Ralston SL, Chandler ML, et al: Canine neonatology. Part 1. Physio,
logic differences between puppies and adults. Compend Contin Educ Pract Vet 12:1601- 1609, 1990.
:j:Data estimated from unpublished values from 30 near-term fetal lambs. Moon, PF: College of
Veterinary Medicine, Cornell University, Ithaca, NY, 2000.
Data from Magrini F: Haemodynamic determinants of the arterial blood pressure rise during
growth in conscious puppies. Cardiovasc Res 12:422-428, 1978.
llData from Bodey AR, Michell AR: Epidemiological study of blood pressure in domestic dogs. J
Small Anim Pract 37:116-125, 1996.
mmol/L, Pa02: 63 11 mm Hg) and 1 day after birth (pH: 7.37 0.03,
Paco2: 33 3 mm Hg, base excess: - 5 1 mmol/L, Pao2: 73 10
mm Hg), these values begin to normalize toward adult values.
30
Cardiovascular
Initially, the systemic arterial pressure in the newborn is not much
higher than in the mature fetus (see Table 1). Systemic vascular resis-
tance, stroke volume, and arterial blood pressure all increase toward
adult values over the first few weeks of life. Simultaneously, heart rate,
cardiac output, plasma volume, and venous pressure all decrease. For a
4-week-old puppy, normal cardiac index is 0.22 0.025 L/ kg/min
(mean SEM), central venous pressure is 8 2 mm Hg, and plasma
volume is 0.068 0.006 L/kg.
36
An immature baroreceptor reflex and autonomic nervous system
(particularly the sympathetic nervous system) prevent normal respon e
to acute changes in blood pressure or to exogenous vasopressors or
inotropes. Also, because of a high resting level of cardiac perform an c,
the newborn has a limited capacity to respond to additional tr 58 ' S.
Although an adult can increase its cardiac output by in r \cSing hea rt
rate or stroke volume (via preload), th mc h< ni sms [I re , Ir(\(1 d 01-
erating at peak perfonnan in I'h \ newhorn. Olll'ili g i'lw fin-II wI' (' 1 H of
life, the newborn r s'l onti s In i11 ('r('fl si11 )', oXYI',(' 11 l'l' qldn'111l' 11i H h il 1('I'\ ' 1I 11
ing oxygen (' Irndioll I' llll l'l' 11 11 111 ('ill ,d illl ' 1II IIpl ii '1' 111' III' wIHII 11' 011 11 '1'
pril'l Hll' ( '( 'll liI- 1/1 II l'pil l/ II'i I" II I'111 II I "l ld lli ' 11 11 11 '" 1 III 11 'I Ij 'III II. (' III
Il il lti 111' 111 1' II VI'II " ll dll, 11 11 ' 11 ' , II I,d 111 11 1111111 I t! 1"l llI d II II IY 1\1 1111 '
(f)
(9
o
o
....J
i:5
<I:
Z
o
llJ
Z
>-
I
~

llJ
I
Z
(f)
llJ
:::>
....J
~
()
(3
o
....J
o
~
:2
llJ
I
LL
o
[jJ
(9
z

a:
o
z

11,1
346 MOON et al
Table 3. HEMATOLOGIC VALUES OF HEALTHY NEONATAL CATS
Hematologic
Parameters
RBC ( x 10
6
JJ-L)*
Hemoglobin (g/ dL)
PCV (%)*
MCV (fL)*
MCH (pg)*
MCHC (%)'
Total WBC ( x 10'
JJ-L)
Band neutrophils
Segmented
neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
0-21"
5.29 0.24
12.1 0.6
35.3 1.7
67.4 1.9
23.0 0.6
34.5 0.8
9.67 0.57
0.06 0.D2
5.96 0.68
3.73 0.52
0.01 0.01
0.96 0.43
0.02 0.01
Age (in weeks)
2-4t
4.67 0.10
8.7 0.2
26.5 0.8
53.9 1.2
18.8 0.8
33.0 0.5
15.31 1.21
0.11 0.04
6.92 0.77
6.56 0.59
0.02 0.02
1.40 0.16
o
5.89 0.23
9.6 0.3
27.1 0.8
45.6 1.3
14.8 0.6
31.9 0.6
17.45 1.37
0.20 0.06
9.57 1.65
6.41 0.77
o
1.47 0.25
o
6.57 0.26
9.1 0.3
29.8 1.3
45.6 1.0
13.9 0.3
30.9 0.5
18.07 1.94
0.22 0.08
6.75 1.03
9.59 1.57
0.01 0.01
1.08 0.20
0.p2 0.02
Adult
Range:j:
5.6-8.5
13.7-19.6
39-57
64-73
20- 27
31-37
7.5-19.9
o
3.9-14.7
1.5-5.2
0.3-2.2
0.1-1.6
0-0.1
Adapted from Bounous Dr, Hoskins JO, Boudreaux MK: The hematopoietic system. In Hoskins JO
(ed): Veterinary Pediatrics. Philadelphia, WB Saunders, 1990, pp 294-295; with permission.
*MCHC = mean corpuscular hemoglobin concentration expressed as percentage; MCH = mean
corpuscular hemoglobin expressed in picograms; MCV = mean corpuscular volume expressed in
femoliters; NRBC/ lOO WBC = number of nucleated red blood cells per 100 white blood cells; PCV =
packed cell volume expressed as percentage; RBC = red blood cells; total WBC = total number of
white blood cells.
tOa/a from Meyers-Wallen VN, Haskins ME, Patterson OF: Hematologic values in healthy neonatal,
weanling and juvenile kittens. Am J Vet Res 45:1322-1327, 1984.
iOata from Veterinary Medical Teaching Hospital, Clinical Pathology Laboratory, College of Veteri-
nary Medicine, Cornell University, Ithaca, NY, 2000.
heart, brain, diaphragm, and adrenal glands and away from the spleen,
gastrointestinal tract, skin, and kidneys. 31
Pulmonary
Initial respiratory rates are higher than adult levels, and tidal vol-
ume and minute ventilation are lower. The first inspiratory effort is
singularly forceful to overcome resistance to lung expansion. In normal
infants, this first breath can generate a mean negative pleural pr ssure
of - 50 cm of water up to a maximum of - 100 cm of water:
19
At birth, the newborn has only limited protection against hypoxia.
One reason is that the fetal response to byp xia i th r vrsc r the
adult one. Hypoxia causes a r du tion in f,tal r<'srirfltor I1'lOV('IlWI L
and a lack of arousal. During the rirsl 4 10 tl,H hl)III'H () iI);C, 11I ('r(' il-! Ii
transiti.on. from ('hi s r<'SPOIlS(' 1'0 (11(' 11111111 l'(' II PlllHI ' : ' 1\1 birlh, h 1'\.;1"
an tr'iggt!" 11'1(' (1'1'111 l'I' HPIlili I' IIHI lil li tll liI)' IIH ' IlIlI 1' 1 til I I Hi lll.lIl1 ' ClIl II
I n'nlhill)l,. Thi: 11111,111 1' 11\ 1'( ' 11 1' 1'1111111'11" 1111'11/1 " "111 1111'1111" Ilillllll"
li(lIl ( IlI'l 11111 1111 IliI q' .1 II I', Ii"1 \ lid ill I,", 1II1 II f'" .1"11" ' 1' 11'.1
(f)
C)
o
o
C)
z
=>
o
>-

(f)
ill
=>
....J

....J
<l:
()

ill
I
()
o
m
....J
<l:
2
a:
o
z
u..
o
W
C)
z
<l:
a:
o
z
::s
II)
V
II)
V
II)
V
II)
V
...... 00
...... 00
......
......
NOO
91
...... ry,

...... \0
0"';

o--!1
90)

0 ......
.,,;

91
...... \0
SC
C0 ry,

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rir..r)

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348 MOON et al
Table 5. MEDIAN (AND RANGE) OF NORMAL BIOCHEMICAL VALUES IN YOUNG
CATS
Age (in weeks)
Test 2 4-6 7-12 Adult Range
Albumin (g/dL)t 2.1 (2.0-2.4) 2.3 (2.2-2.4) 2.5- 3.0
ALP (IV/L)*t 123 (68- 269) 111 (90- 135) 10- 77
ALT (IV/L)*t 18 (11-24) 16 (14-26)
AST (IV /L)*t 18 (8-48) 17 (12-24) 9-42
Bile acids* ND* <10 0-10
BSP % 30 min*t ND* ND* 0-3
Calcium (mg/dL) 9.7 (8.4-11.0) 9.9 (8.8-11.2):1: 7.8-11.3
Chloride (mEq/L) 122 (118-127) 122 (113-128):1: 112-129
Cholesterol (mg/ dL)t 229 (164-443) 361 (222-434) 150-270
Creatinine (mg/dL) 0.6 (0.5-0.7) 0.6 (0.4--1.0):1: 0.8-2.4
GGTP (IV /L)*t 1 (0- 3) 2 (0-3) 0-4
Glucose (mg/ dL)t 117 (76-129) 110 (99- 112) 63-144
Phosphorus (mg/dL) 7.4 (5.0-9.9) 8.2 (6.0-10.5):1: 3.1- 7.5
Potassium (mEq/L) 4.7 (3.7-5.6) 4.9 (3.6-7.1):1: 3.5-5.8
Sodium (mEq/L) 152 (147-158) 152 (144-160):1: 150-165
Total bilirubin (mg/dL)t 0.3 0.2
Total protein (g/dL)t 4.4 (4.0- 5.2) 4.8 (4.6- 5.2) 5.2 (4.2-6.7):1: 5.7-8.9
Adapted from Center SA, Hornbuckle WE, Hoskins JD: The liver and pancreas, p 206 and Crawford
MA: The Urinary System, In Hoskins JD (ed): Veterinary Pediatrics: Dogs and Cats from Birth to Sex
Months. Philadelphia, WB Saunders, 1990; p 274, with permission.
*ALP = alkaline phosphatase; ALT = alanine aminotransferase; AST = aspartate aminotransfer-
ase; BSP = bromosulfophthalein; GGTP = gamma-glutamyl transpeptidase; ND = not determined.
tData from Center SA, and Hornbuckle WE, College of Veterinary Medicine, Cornell University,
Ithaca, NY, 1987.
:f:Data from Veterinary Medical Teaching Hospital, Clinical Pathology Laboratory, College of Veteri-
nary Medicine, Cornell University, Ithaca, NY, 2000.
functional reserve capacity, higher closing volume, and less resistance to
muscle fatigue compared with adults. Increases in minute ventilation in
response to hypoxia cannot be sustained in neonates. Instead, there is
an initial brief increase in ventilation followed by a progressive decline;
hence, treatment of neonatal hypoxia must be initiated before fatigue
occurs. Finally, increases in environmental temperature reduce the venti-
latory response to carbon dioxide, suggesting that too warm an environ-
ment may predispose newborns to respiratory failure.
53
By the time they
are 2 days of age, however, kittens respond to carbon dioxide nonnally. 54
Renal
Micturition occurs within the first 24 h ()I II' s of Ijf(,. l):lil mil)('
output for 4- to 6-w d -old ki I t('ns is [j 11) 1,1 I 1\, wi I II .1 milll' Ii I I ,
of 1424 mOsl11/ 1 g. /\1 7 10 I WI'I,I II pi' Ii)', "' , Ilwtll' 1:1111 '(1 )1( '1'111111 ' 'I' 1111 ./
1 )'1 I1 IHI ,II. . Illnll lli / l )'" l'I 'I I" 'I' l l vl 1y 'I' l li' 11.lldl 1'1 11 11 11 1 II 11.1 Iy 11 1'111\ '
(llil)lId I ii 10 III ' 1() 1111 ./ 11)', I II 11i \ 111111"11 11 1111 )', ," dill y .1 , 11 '1 IIIlI "11 111
NEONATAL CRITICAL CARE 349
pletely mature until kittens and puppies are 8 weeks old, and glucosuria
is frequently detected in neonatal puppies.
13
Thermoregulation
Newborn puppies and kittens do not have the hypothalamic control
necessary to maintain body temperature. Rectal temperatures fall rapidly
during the first 30 minutes after birth.5 Newborns lose heat easily be-
cause of their high ratio of surface area to body mass, reduced subcuta-
neous fat stores, and poorly developed ability to shiver. In fact, until 6
days of age, they cannot shiver. In infants, nonshivering thermogenesis
accounts for 40% of their total heat production. This occurs through
catecholamine release and the breakdown of brown fat that is distributed
over the neck, back, viscera, and great vessels.
25
This mechanism has
high energy requirements, and responding to hypothermia can cause an
ill newborn to decompensate. The environmental temperature for which
metabolism is minimal while normal body temperature is maintained is
called the "neutral thermal temperature." Maintaining a neutral thermal
environment minimizes oxygen demands and conserves energy.
POSTDELIVERY NEONATAL RESUSCITATION
Comparison with Infants
Of all newborn infants, about 5% require some supportive interven-
tion. Most respond to simple resuscitative measures (Fig. I), and only
0.03% of deliveries require chest compressions.
34
Assessment of infants
at birth is done using an "Apgar" score to indicate "vigor." This score
is based on five characteristics: heart rate, respiratory effort, muscle tone,
reflex irritability, and color. A low score (1.7% of all live births) indicates
an abnormality and is associated with infiJ.nt mortality. The risk of a low
score is higher with low birth weight and severe malformations.
46
Such
a scoring system is not yet described for veterinary patients but, by
analogy, the "runt" of the litter is the most likely to have postdelivery
problems.
A veterinary study has shown that cesarean-derived puppies have
a mortality of 8% at birth and 13% by 2 hours
41
and that naturally
delivered puppies have a mortality of 2.2% at birth and 8% by day 1.
48
For the cesarean-derived puppies, the three most common methods of
postdelivcry are were administration of a heat source (41%), doxapram
(- 4%), ,nd () ),;('n (1.5%).41 Other therapy included administration of
nolo Ill1\' ,\ldi ci1o li n rgi.cs (2%), epinephrine (2%), glucose (1%),
1IIId "11.1'''"1111' ' 1\ 1 IlIlIhll li nn (,1/., ). As Figure 1 indicates, these methods
of ,'(1(1 11 11 1' 1111 1111 II I " <1 111"1'1' 1111'1' 0 111 I'he ones IS d in infant r suscitation.
( " 11111 ' 111 II 1111 \ II1 I 11 111 1111111 11 11 ( 'lI tlll IVl'pll 1" 1. ' ,' U)mcHI H I' ho l' vct:cr innritlns
Ili ll' ldd I I, 111 11 1, IIII 1 , I 11 11111 ' 111 111111)'. III 11I "'VI'lll hypoll]l'l'IlIill II ld
350 MOON et al
Assess and Support:
Always Needed
Infrequently Needed
Temperature (warm and dry)
Airway (position and suction)
Breathing (stimulate to cry)
Circulation (heart rate and color)
Dry, Warm, Position,
Suction, Stimul ate
Oxygen
Establish Effective Ventilation
.Bag-valve mask
.Endotracheal intubation
Chest Compressions
Figure 1. Inverted pyramid reflecting relative frequencies of neonatal resuscitation efforts
for the newborn who does not have meconium-stained amniotic fluid, Note that a majority
of newborns respond to simple measures. (From Shattuck KE: Neonatal resuscitation.
In: Pediatric Advanced Life Support, The American Heart Association, 1997-99; with
permission.)
hypoxia first and should reconsider the usefulness of some medications
(see Fig. 1).
RECOMMENDATIONS FOR NEWBORN
RESUSCITATION
The minimal equipment needed for neonatal resu itati on is li sted
in Table 6,
Warming and Drying
Tht' 1'1 1'11 ('(1 111 '(' 111 II I'll ' , ' II! 1111 1.1 II VI,"II\"II1\ 111 II VI' IlIII"II II " II
1' 1'1'1111\' 1111 ' /11' '1"1 ' " 1 111I ' lld
'
l1 l l .1 1' 11 11 1111 11 11 1\11 II h l \ aI "1 11 ' 1 II' 11 \1' II ' I III IHII'
352 MOON et ai
to other resuscitative measures. The newborn can suffer rapid cooling
and enormous heat loss initially via evaporation and then by radiation.
Wet infants exposed to room air lost nearly five times more heat than
those who were dried and warmed.
16
Newborns should be dried immediately with prewarmed towels
and placed under a radiant heater. Alternatively, a hair dryer set on
"warm" and gently moved over the newborns provides a radiant heat
source and still permits visualization and handling of the newborns.
After resuscitation, newborns should remain in a warm environment if
they cannot be returned to the dam immediately (i.e., cesarean section).
An environmental temperature of 28.4C to 32.2C (85F- 90F) is recom-
mended?' 47
Stimulation of Ventilation
The toweling and rubbing also provide tactile stimulation for spon-
taneous breathing. Clearing of nasal and oral passages should be done
on all newborns. Puppies and kittens are often "swung" at this stage,
with their heads down, to clear their mouth and nose of secretions. The
head and neck of the animal must be fully supported in the hands to
avoid injuries. A safer method for removing secretions is gentle applica-
tion of controlled suction. An infant suction bulb (obtained in most drug
stores) works well to aspirate fluid from the mouth and upper airway.
In kittens and smaller puppies, a cotton-tipped swab may be all that is
needed to clear fluid from the upper airway.
"Meconium aspiration syndrome" in the newborn is diagnosed by
respiratory distress, thick meconium staining of oral and nasal secre-
tions, and a chest radiograph with typical signs of aspiration. In infants,
meconium staining alone is seen in approximately 14% of term pregnan-
cies, and aspiration develops in only 0.2% of births. I S If there is evidence
of thick meconium staining around the mouth but the newborn is
spontaneously breathing, supplemental oxygen should be provided by
face mask and the trachea should be suctioned with a soft catheter. IS If
there is evidence of thick meconium staining during a cesarean section,
tracheal suctioning can be attempted before the cord has been clamped
and before the initiation of respiration. Great care is necessary to prevent
trauma to the tracheal mucosa. Indeed, prolonged or overzealous suc-
tioning can also cause a fall in arterial oxygen saturation. Deep suc-
tioning may cause a vagally induced bradycardia or apnea. Suctioning
should continue for no longer than 10 seconds, 100% oxygen should be
supplied between suctioning, and heart rate should be con tinuo'usly
monitored (a Doppler ultrasound probe placed on th ch.c t is a onv -
nient method).
Within the first 30 second of delivt' ry (HS Il l(' inil ill l II I' ill g ll nd
suctioning are being carri d oul ), II v IwwlJl J1'11 Ill' dH,' I'Hn'd fill'
the presence of sponl'll lw(JII H 11I"', lllJill /', ,11 11 1 .I "1'1 11'1111 '1 11 , !\ 11I 'I' III"il lF,
n wborn wii"l [I 1'( ')', 111.11' 1 11I '1I 1111 /" 1\1 '.1 11 ill II 11111 ' 11 1'1 I' I() III 1
1
,1) ", 'III.
pvr IlIintll ,' .lIlt! !lI lli, 11I 1\I 'tll 1I\I ' lld,I,IIi" 111 ,11 .1" 11 11 \1' l\I' wl lllll 1111/ II
normal heart rate but is apneic, tactile stimulation and oxygen adminis-
tration by means of a face mask are usually effective to elicit respiration
within 1 minute. If effective respiratory efforts do not begin or the heart
rate begins to decrease, positive pressure should be applied by means
of a face mask to expand the lungs. The head should be held in an
extended position to minimize the amount of gas being forced into the
stomach (in infants, gas does not enter the stomach when ventilating by
face mask unless the inflation pressure exceeds 35 cm of water),49 The
application of sufficient pressure to expand the lungs is difficult to
achieve unless the face mask fits tightly. Although ventilation by means
of a face mask may be useful in mildly depressed newborns, it is often
unsuccessful in severely distressed newborns. If this approach does not
give adequate chest expansion within two attempts, the newborn should
be intubated and ventilated until it begins to breathe on its own.
Endotracheal intubation provides the greatest airway control and
prevents gastric distention. It requires considerable skill when performed
in newborns, because the tongue is large and not mobile, the airway is
small, the tissues are fragile, and laryngospasm is possible. Ideally, the
larynx should be visualized using a laryngoscope, and a tube should be
gently passed into the trachea. In newborns with an airway too small to
accommodate a 2-mm endotracheal tube, it is possible to use 12-, 14-,
and 16-gauge intravenous catheters. To expand the lungs, start with an
inflation pressure of approximately 20 cm of water and hold this initial
breath for 2 to 3 seconds. Incremental increases in pressures up to 30 to
60 cm of water can be applied if initial attempts do not expand the
lungs. Once lung expansion has been achieved, lower inspiratory pres-
sures (10- 15 cm of water) and shorter inspiratory times (0.5- 1.0 second)
are usually sufficient. Once the newborn begins to breathe spontane-
ously, the tube should be removed and oxygen supplied by face mask
or chamber if needed.
Finally, some anecdotal success has been reported by stimulating
the Jen Chung acupuncture point to initiate breathing when face mask
ventilation and intubation attempts are unsuccessful. A 25-gauge needle
is inserted into the nasal philtrum at the base of the nares. The needle
is twisted when bone is contacted.
Cardiac Function
The 11 ed for prior ventilation must be emphasized, because cardiac
ll1:Jssng i ' not likely to be effective in a hypoxic animal. Furthermore,
Illl' most Ii i ' Iy atl s ' of newborn bradycardia or asystole is myocardial
h po in. ( 11(\' v' nlil ll ii on hns be n tabli shed, cardiac compressions
IImllld lwgin if Illl' I)('WhOI"lI slill tI We'll I , or nbs nt heartbeat.
III 11\l 111 l li n'vll ll, 1'11('11 1 ('OIl'l ll'I'H ill ll H : luJlild Ill' ;Ippli l'd .1CrtlHS Iht, Interal
I'll" I wl dl , 11", '1 111111 ' Il l! ' 1'1 1,'/1 1 IH 1'111 ' '111,11 11 1' ll llI ll', 1! 11 1. 11 II I\' Vl'\I 'l' illol rili ll
I lilt 11'1,1 Il l, ' hl'l lll ' 11 11 1 "1111 1111 ' 111 ,11 ' ,li d ill 1111111 ' 11' 1/1 111 11 1'1 III 'IIII I'ill )'. 11 1
11 11 11 " 1111111 ,1. 111 ,, 1"1 1 111"1 ,, 11 (") ', 1'11 1'.' hl 'lIlll 11111111(1)',1 ) 1"111,11 111111
354 MOON eta!
pression is more effective. A Doppler ultrasound flow probe held di-
rectly over the heart is often helpful in monitoring heart rates during
this period. Epinephrine is used if no apex beat is auscultated or no
pulse is felt. Naloxone should be administered only if the dam received
intraoperative opioids before delivery (see section on resuscitation drugs
for details on medications).
Route of Drug Administration
Gaining intravenous access in a newborn is difficult because of the
small size and fragility of the vessels. The umbilical vein is the preferred
site for vascular access during infant resuscitation. During a cesarean
section, it is important to leave the umbilical cord long enough to allow
venous access. The umbilical vein is the thin-walled, single, vascular
structure, and the arteries are paired and thicker walled. The catheter
should not be threaded more than 1 to 2 cm into the vein to avoid
cannulation of a hepatic vessel. Failure to freely aspirate blood suggests
that the catheter has been threaded too far into the vein. An umbilical
artery may also be catheterized for fluid and drug administration, but
intense vasoconstriction makes this vessel more difficult to cannulate.
After catheterization, it is important to dilute the drug to a sufficient
volume to reach the systemic circulation (because blood is no longer
flowing in the vessel). Once resuscitation has been completed, the cathe-
ter should be removed to minimize the danger of infection or portal
vein thrombosis.
Because the bones of newborns are soft, an intraosseous technique
is easy to perform.
45
A small needle (22-25 gauge) can be inserted into
the proximal humerus (base of the greater tubercle), proximal femur
(base of the greater trochanter), or proximomedial tibia. Studies in imma-
ture rabbits and piglets have evaluated the effects of different intraos-
seous solutions on the physes and growth rates of the infused bones.
Changes observed in the physeal bone had completely resolved after 3
weeks, and no growth disturbances occurred, suggesting no long-term
detrimental effects.
4
,55 Adverse results of intraosseous infusions include
fractures, pulmonary emboli, and prolonged drug effects.
56
Lipid-soluble drugs (atropine, epinephrine, lidocaine, and naloxone)
may be given by the endotracheal route. The drugs should be dilut d
first to increase the area of mucosal contact and improve uptake. Im-
portantly, drug pharmacokinetics after endotracheal administration may
be different between neonates and adults. For in t an e, on study
ating the usefulness of endotracheal atropin ' in hildr 'n on 'luLled thnl
the onset of action was so d lay c1 t:h nl ii' prtcltldt .d Li Ning II lroplll (' v i ll
this route for emerg ncy t lw rnp of IIf(1 lil n'lI l l l ollI !" il l'l l! I'nnli ll ,'" Spl'
cific infol"lTl ati on on 1I'w (l fW(ldIH'll1 (l l lid I'(l ili l ' of III' II ! ', ,1 dll) l l ti rll l'l tl loll
in p UI plt'1'I 111111 1.,1 111 ' 111 111 111' 1 Il l ',
RESUSCITATION DRUGS
The drugs used in neonatal resuscitation are outlined in Table 7.
Atropi ne
In the newborn, bradycardia is synonymous with decreased cardiac
output. of bradycardia during hypoxia is from direct
dep-:esslOn rather than from a vagally mediated event; thus,
atropme IS unhkely to be effective during hypoxia. Furthermore, if
atropine does increase the heart rate, the resulting increase in myocardial
?xygen demand may be detrimental. Because of this concern, atropine
IS no longer recommended for resuscitation of newborn infants.
20
,34 If
the clinician is suspicious that the bradycardia is drug induced, attempts
should be made to specific drug whenever feasible (e.g.,
for an OpIOld ar:d ahpamezole or yohimbine for an alpha-2
agonIst) before symptomatIc treatment with an anticholinergic.
Doxapram
The use of this respiratory stimulant in canine neonatal resuscitation
can be traced back to a brief article in which doxapram was administered
22 ? eliver.ed by cesarean section.
26
Doxapram was injected
mto .the umbIhcal vem at a rate of 1 to 2.5 mg, and all the puppies
No contr?l group and no description of the degree of puppy
hypOXIa were prOVIded; hence, the data are inconclusive. Doxapram is
to act as a and its effectiveness is profoundly
chmmIshed when the bram IS already hypoxic.
3
Given this information
doxapram is to be of much benefit in the apneic
newborn. Its routme use does not seem warranted, and it is not even
mentioned in the literature concerning infant resuscitation. 20, 21, 34 Doxa-
pram may be of to increase ventilatory efforts once they have started,
dlthough duratI.on of action of the drug is relatively short (minutes).
It can be gIVen by mtramuscular injection if venous access is not avail-
,1bJc, and this route may provide a longer duration of action.
Epinephrine
')'hi s Hti ll ,l'Iw dnl g of hoi for n onataJ cardiac arrest, although
1'l lilirOV(' I'SIl'H (' XI. ' I :lhol ll dOH(' , I'OUl l' ()( adlllini strati on, and side effects.
' )'IIt , i l il l l.lI dOH(' I'm il) 111I1 1[1 IN In fI'!', / 1 g i ll llll iIJi HI(' r(\ I intrav nously;
1111 '1'1'11 11111', dll/II,t! 1'1 11 1 III' )',1" "11 II 1'!' j1! '1 11 1,d "dll l i IJi , Iml iol l i:-; 1){I(' ('HHill" ,
(lI l li' l' 11 11111111 '11 ' 11 )',/',1'1 1 1IIId 111 1' ,\I) tlll II I Iri l , (I I () '
111 1
'./ 1, 1', I llil y , II' hi , lv!' II ii'
1" '11 II '/ Iil i l ' 11/1
1
11 '1/ 11 11 1,, 1 ,11111 11 11 \ I1I1 III,' 11i!',II!11 d lllll' Ii 111 '1111111, '11
II ,l.d, " III IIII' I'" 11" /11 "11 1 11 ' 1" II I II IJIII ' 1"II Ii , 1 '" III 1,, 1" 11111 11111 11 111 '
z
o
~
I-'
(3
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w
a:
-l
;:;

z
o
w
z
z
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Cl
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a:
o
r-:
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S
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I I I I
Nil) ('1) t.n
OQrlNOOrlN
oood6000
l1) l1) l1) l1) l1)
Nl1)OO Nl1)OONl1)OONl1)OONl1)OO
O O ~ N OOrlNOOrlNOOrlNOOrlN
L;
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~
.S
z
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. ~ \ ~
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h
and the risk of inducing brain hemorrhage if such high blood pressures
are maintained.
9
Endotracheal administration of epinephrine can be done
but may lead to intense vasoconstriction of the tracheal mucosa, re-
sulting in poor drug uptake. If available, intravenous or intraosseous
routes are preferred.
Glucose
Causes of hypoglycemia in the newborn are malnutrition during
fetal development or an extremely stressful birth. Neonates with a low
birth weight or those exposed to perinatal hypoxemia, sepsis, or toxemia
of pregnancy are especially prone to hypoglycemia. Although many
practitioners routinely give glucose to a newborn/
8
this practice does
not seem to be indicated
2o
.
3
4; the need for glucose administration is best
assessed by measuring glucose concentrations. Tile empiric recom-
mended dose of dextrose for hypoglycemic infants is a slow initial
intravenous bolus of 2 to 4 mL/kg of a 10% solution (250-500 mg/kg),51
and this is an adequate dose in veterinary medicine as well. Oral glucose
supplementation (2-3 mL/kg of a 10% dextrose solution) also may be
necessary when the dam is recovering from cesarean surgery or when
she is unwilling to nurse her offspring.
Naloxone
Research has now shown that naloxone is not particularly effective
and may even be detrimental when used routinely in apneic new-
bornsY 33 Its use was previously advocated based on the theory that
an increase in fetal endorphin release during parturition was partially
responsible for postdelivery respiratory depression. A recent study eval-
uated the effects of naloxone (administered directly to fetal sheep) on
the fetal cardiovascular response to hypoxemia.
33
The conclusion was
that endorphins are necessary for the regulation of fetal circulation
d uring hypoxemia but play no role in unstressed fetuses. Naloxone is
thus useless in the normal fetus and undesirable in the stressed hypox-
' l11 lc fetus. Clinically, however, because placental drug passage may
ontribute to the neonatal depression, naloxone may still be beneficial
in re piratory-compromised neonates when the dam has received an
l' ogenou, opioi d as part of the anesthetic regimen. The current recom-
Ilwndcd cl ost' in in fa nts i 0.1 rn. /k intramuscularly.21 This dose is 2.5
1I III l'S Ihe dmw l1()rrnnll y ITt'Ol11n end 'd for opioid reversal in adult dogs
11I 11 i. , Iill 1()w(' l' Ihil ll Ihl' () , 111 )', / 1 g l',ivvn to 98 infant with no adverse
.,11" ,''' 1,' ' 11\l 1', IV" 111l 111 "II II Ii II 1111'11 111,11 111 11 11(' IWe (' SHIH in s om puppi es
\'II Iii III w h,'l1 l1 1'11 1. ' Il l' 1'11.11 ' 1'i 1l 'liI ,II I( III . II IIH' Ill' w il o l'll IlI'C0i11l ' R mo r
1II III I V(' Il lti , " " ' 1[ ,,11 1111' III II II' II , il l l 1111 " , 1111 /1 lil ll 'llIlI hi ' 11"'11\ ,,1\ willi
11 111' 1./ 111 ' II
358 MOON eta!
Oxygen
Since the reports of oxygen free radical production during reperfu-
sion injury, there has been concern that providing oxygen during resusci-
tation is not indicated. Because few newborns are ever supplemented
with oxygen for more than the first few minutes of life, the concern over
this or other oxygen toxicity (e.g., retrolental fibroplasia and blindness)
is minimal. Oxygen administration is beneficial during resuscitation to
rapidly reverse the hypoxemia associated with birth.
Sodium Bicarbonate
No studies exist to demonstrate a beneficial effect of this drug in
neonatal resuscitation. Acid- base therapy is still considered important
in the treatment of severe neonatal acidosis or prolonged cardiac arrest
provided that ventilation is supported. Sodium bicarbonate might be
useful in the depressed acidemic puppy that is not responding to other
supportive care. The recommended dose for presumptive acidosis is 1
to 2 mmol/kg intravenously.20, 34 Because the standard 8.4% preparation
of sodium bicarbonate has an osmolality of 2000 mOsm/L, it should be
diluted by adding 1 mL of bicarbonate to 5.7 mL of sterile water
to provide an osmolality of 300 mOsm/ L. This decreases the risk of
hypernatremia but increases the volume administered, with concern for
possible volume overload. The drug should be given slowly, over at
least 2 to 3 minutes in an arrest and over 30 to 60 minutes for treatment
of nonarrest acidosis.
Tromethamine
Tromethamine (THAM; Abbott Laboratories, North Chicago, IL)
does not produce the hyperosmolarity, hypernatremia, and hypercapnia
of sodium bicarbonate
43
and has been advocated as a safer buffer in the
treatment of acidemic asphyxiated newborns.
56
To restore the base deficit
back to zero, the dose (in milliliters) for 0.3 M of tromethamine is the
body weight in kilograms times the base deficit. Similar to bicarbonate,
it should be administered slowly over 30 to 60 minutes.
ACUTELY ILL NEONATE AND SUPPORTIVE CARE
Canine neonatal mortality is 12% to 6%. 19, <1 0, 'IK Thl' n of (k ;lI h
is undetermined in most a s (28%). Thi s n' in (Ol'q's I'l l(' Iwli d Ih" l (lil t'
of the primary th rs pi es sholl I I nggrl'.HivI' 1111'1 Il l' livl' ]'"n' , Til] ' nll lti l
commonl y d iogno/ol (ld Cil i i. I' or pllppy 11H l1'l ii i! In II I(' f 1'11 1 :'d I)l HII'1 iii
Ir" Ulll il (111 %) 111'(' III / I<' II I tl ll']'(' 1 1111111' (, Ily II I] ' tlil ill ] lI ' 1l llf lfll '(J I' 1 .Ii ( I ,]' ,
I]H'III I])II, (11' 111'111 '1111 1' " I III\' wlll ,ll' 1\1', 1111 '11 \] , / h'l ]1111 1 11I 11/ I 11I 111I1I111d "
diagnosed cause is prematurity or immaturity (10%).19,48 Immature pup-
pies die because they are too weak to suckle, neglected by the dam, or
simply too underdeveloped to survive. These puppies must be identified
immediately because they are more likely to survive if treated as or-
phaned.
Newborns are also likely to die if they rapidly lose weight, become
hypothermic 34.4C [94FD, become bradycardic, or have periods of
apnea after birth. Respiratory arrest generally precedes cardiac arrest in
the newborn. Other signs of distress include muscle rigidity or flaccidity;
gagging; fluid in the nostrils; or decreases in vocalization, locomotion,
or righting reflex. Dehydration, hypothermia, and hypoglycemia, regard-
less of the causes, further compromise the fragile newborn, and correc-
tion of these abnormalities is a priority in patient care. For example,
hypothermia can lead to decreased intestinal and absorption of
essential nutrients and can result in hypoglycemia. Monitoring is similar
in the newborn and adult, although some equipment needs to be
adapted for use in newborns.
Hypoglycemia
Neonates have normal serum glucose levels below the adult range.
Blood glucose levels less than 35 to 40 mg/ dL in newborns or 40 to 50
mg/ dL between 2 weeks and 6 months of age are abnormal. Because of
their limited glycogen stores and immature liver, newborns can become
hypoglycemic within 2 to 3 hours of no food intakeY Even normal older
puppies become hypoglycemic after 23 hours without feeding.
40
A sick
neonate that is unable to nurse is not only dehydrated but hypoglycemic.
Predisposing factors for hypoglycemia include a debilitated or diabetic
dam, low birth weight, prematurity, hypothermia, respiratory disease,
bacteremia, or systemic inflammatory response syndrome. Clinical signs
of hypoglycemia include incoordination, seizure, flaccidity, weakness, or
coma. The severity of the signs does not always correlate with the degree
of the hypoglycemia. Puppies with clinical hypoglycemia should be
treated with a rapid intravenous infusion (2-4 mL/ kg over 1 minute) of
10% to 20% dextrose followed by a 2.5% to 10% dextrose infusion at 6
to 8 mg/ kg/ min.51 If there is no venous access, the solution can be given
orally by gavage tube. If the hypoglycemia is recurrent or prolonged
wi th no un derlying disease identified, problems with carbohydrate me-
tubolism should be considered.
Hypovolomlfl flnd Dehydration
'1'1](' J! I'\' II' I'],(,tI 1'1111 1]' II I Il ldd Iid lll illi Nfl':1 li on :1 1\' inlrevcnous or
1111 '1 111 1/11'(1 1\ /1 1111 111 1 111 '1111 1'11111 1 ."" ' I'll ld ll 'lIl dll l'] lIl l1 l1 dlll illl Hlr, il io!l iH slow.
1\ 1/11 1, "I, ]l lI dlllll ,,/ 1"111 11 111 11111 1 I Iy 1111 1111 1 IIl il d 11'l l' i1 ll'l " 1 10 II,H
11 1111 111 \ 111 '11 ",II I' ll 1I 11.qll ' l 1""Pl dl" 11 1(1 II ' 111111 .. / dll' IlId v 11 1I' lld I!I I
360 MOON etal
maintenance fluid administration and not for acute volume replacement.
Because of the absence of cardiac reserve capacity in the newborn, it is
critical to maintain heart rates at age-determined normal levels and an
adequate vascular volume (see Table 1) while avoiding fluid overload.
The rate of fluid administration is dependent on the severity of the
fluid deficit. Hypovolemia or shock may require rates up to 40 to 45
mL/kg/h, but neonates must be monitored continuously during such a
rapid rate of fluid administration. If the patient is normovolemic but
dehydrated, fluid replacement should be administered over a 6- to 8-
hour period, and maintenance fluids (40-50 mL/kg/ d) can be given over
24 hours. Circulatory overload can cause a number of life-threatening
problems in the newborn (bronchopulmonary dysplasia, persistent pa-
tent ductus arteriosus, intracranial hemorrhage, and necrotizing colitis).24
Signs of overhydration include serous nasal discharge, tachypnea, dys-
pnea, polyuria, chemosis, restlessness, vomiting, diarrhea, ascites, and
pulmonary edema. Cardiac slowing in response to increases in blood
pressure is not as marked, making monitoring of fluid administration
based on heart rate response less reliable.
52
Monitoring should include
not only heart rate but respiratory rate and character, blood pressure,
fluid balance (ins and outs), and general attitude.
Fluid type (crystalloid, colloid, or blood product) should be deter-
mined by replacing the fluid lost with a solution of similar composition.
44
Specifically, newborns may be better able to metabolize buffers such as
gluconate or acetate (Ringer's solution, Isolyte [McGraw, Irvine, CAl
or Plasmalyte [Travenol Laboratories, Deerfield, ILl) instead of lactate
(lactated Ringer's solution). Caution should be taken in administering
crystalloid fluids with preservatives to kittens, as one report indicated
severe adverse reactions (ataxia, seizures, coma) and death.1
4
Hypothermia
Normal neonatal body temperature is lower than that of adults, and
attempting to maintain the adult value is not justified. Term babies have
a neutral thermal range between 32C and 34C (89.6F-93.2F)? Thi
value has not been established for animals. Maintaining an environmen-
tal temperature of 29.4C to 32.2C (85F-90F) and an air humidity
between 55% and 65% until the neonate is 1 week of age and a temp ra-
ture of 26.7C (80F) from 1 to 2 weeks of age has been recommended.'17
A warmed container should be used whenever tran por tin n wborns.
Radiant heat and warmed air maintain body t mp ratul" ' b tt 'r thtl il
circulating water mattresses.
32
Flui d shou ld be wa 1"111(' I to J)o (9 ).811),
and any inspired gas s (-.g., oxyg n) shou ld tl lso Iw Iwntc'<I 111<1 hun1it! i
fied.
Electrolyte Abnormllllti c
1':I(II' II '(l ly ll ' h lll d " III' 111 11I!i IIIlI tI 111 1111 III 11I ' I Hl lI ll" II I 111I 1I1 'l tl ll l',
II \1( 11 ' 11 11'1' 111 111 1111 1'1111 Iv 1111 111 II 11 1' 11 1' 1 , 1' 111 111 111 ' 111I111I'l d 1' 1111 1 1111 11 11111
transport across the placenta and an inadequate amount of parathyroid
hormone. Contributing factors for hypocalcemia include septicemia, low
birth weight, administration of sodium bicarbonate or citra ted blood
products, and maternal diabetes.
RESPIRATORY EMERGENCIES
Differential diagnoses for respiratory difficulty in the neonate or
pediatric patient include hydrothorax, congenital diaphragmatic or peri-
toneopericardial hernia, meconium aspiration syndrome, hyaline mem-
brane disease, bacterial septicemia, pneumonia, iatrogenic pulmonary
injury, or right-to-left congenital vascular shunts. Airway and respiratory
problems are the leading cause of pediatric cardiac arrest, and this
is probably true in veterinary pediatric medicine as well. Newborn
brachiocephalic puppies have a higher risk of r;leath after delivery than
other puppies.
42
This also suggests that upper airway obstruction may
be a silent killer in these animals.
Oxygen Therapy
Depending on the severity of the disease, oxygen therapy may
range from 40% oxygen administered by face mask to 100% oxygen
administered by intubation. Standard techniques of nasal insufflation
are more difficult to implement in neonates because of their small nares.
If appropriately sized tubing can be found, an oxygen flow rate of 50
mL/kg/min maintains a 97% hemoglobin saturation.
37
Alternatively, the
nasal cannula can be placed as close to the nares as possible without
occluding the nasal passage, and the neonate can breathe the enriched
air as it flows past the nostrils. Another method of oxygen supplementa-
tion can be provided by running the insufflation tube under a makeshift
Elizabethan collar, with the collar's opening partially occluded with a
I iece of plastic wrap. Part of the collar should be open to room air to
prevent a buildup of carbon dioxide, heat, and humidity. Although
fac tual information on the delivered oxygen percentage is unknown
using thi method, the minimum useful flow rate is ~ 1 5 0 mL/kg/
min. Nasal insufflation and oxygen collars have the disadvantage of
h. mp r in.g the neonate' s mobility and ability to nurse; thus, their use
l"i houl d b ' r 'Q rv ' d for pati nts that are already immobile. They also
hny ' th ' potenti,, 1 1:0 aus hYI ot]p 'I'mi a, because the delivered gases
11 1\' enid, I'/; I\' ill g Ihe IWOIl !iI !' i ll lin i nfa nt in ubator or oxygen cage is
Illi ll 11I Il' 1) 1' 11)(1 h l 'H I 11 11' 1\) o d tl Ill' pl'l) YiLi i ll i', on ' n!'i h d oxyg n environ-
111\' 111 , 11 1I 11'I,d , Il lI" 1111111 ' 111 1'. 111 11\1 1\1 . ' I',ll lly, II HI )', 114t ' ' 1111 b' wa rm d
11111 11111111 Ii I.'" 1\ 111 1d'l' d d ll (I V)', I' II (' II)', " , II l lh(III )',11 II'HI (, t'l kli' 1l 1 I hil n n
I'(JIII II I/ ' i l Iii 1III I' , I IIIII II'I 'lI l liil l lll ll' tll ,v 111.11 11 )', 1" " 1111' WI I'I I Il YI' I' !' lll ' lll/"
11 1111\ 11 1 I II)'," iI lll lI 1I 111 1 11 1111111)"II II Il 'If'," III I1II I' 11111 1 1111'1 '111 ', 1' 1' 1111 11 )', 11
II
I
362 MOON et al
container of hot water in the cage (but out of reach) provides some
humidity.
CARDIOVASCULAR EMERGENCIES
Hypovolemic Shock
Severe neonatal hypovolemia can occur at delivery as the result of
a number of causes such as sequestration of blood in the placenta
(during a cesarean section, when the newborn is held high above the
uterus at the time of umbilical clamping), placental diseases, or rupture
of the umbilical cord. The recommended treatment is administration of
10 to 25 mL/kg of fresh whole blood obtained aseptically from the
placenta. Alternately, adult fresh whole blood, diluted packed red cells,
or Oxyglobin (Biopure, Cambridge, MA) may be useful. If blood prod-
ucts are unavailable, colloids such as dextrans or hetastarch are also
acceptable for rapid volume expansion.
In the neonate, sepsis develops primarily as a result of poor hus-
bandry or newborn care. During the first 4 days of life, the umbilical
cord is a likely source of infection. Maternal sepsis, metritis, or mastitis
can also produce neonatal septic shock. Insufficient colostrum intake
also favors infections.
Hemorrhagic Syndrome
In case of death of more than one neonate, spontaneous hemorrhag
should be suspected. Indeed, newborns can easily become hypopro-
thrombinemic or deficient in vitamin K. Administration of vitamin K,
(0.01-0.1 mg intramuscularly) in remaining littermates may prevent fur-
ther deaths. Providing the dam with 5 mg of vitamin Kl daily during
gestation may prevent this syndrome.
40
Neonatal Isoerythrolysis
This syndrome is rare in puppies but can occur if th. dam rc civet!
an incompatible blood transfusion befor Iv r prc rnan . i<ittC'nH wilh
group A blood type can also d velop h rnolyl'i(" I 1l'111 i:1 i( I'll ' qll l'l' 1l
naturally occurriDg group A aIl OZl nti bodi('s. '1'lw, I' Ill' wl \)I'n fll 'V I ll l ' l l
healthy but d v '101 (l IWll10 l li e ni Ki, wl illin I /'(,W I H111 I'H In 1i :1 II
after nlofl lrllnl ill)',I 'Hlloil , 11\ HI 'V('I '\ ' I'I IHI 'I f dl llll!' lldll l ill ' d 1,!lI' I VI II II ' lri fl l'
congl il ili joll 01' \'1 ' Ipll' IIIIlI' Y tl l: III'I'/ / "III d, 1,1111 ' N , 'wl'illlHI illl)l d d III'
n ' III( I V 11i r 1'1 )III 1111 ' Ii 11111 I 1)1 '11 II I ,iI lilli ' I " I', 1' 1 111 ' , 11 ' Ii 1 II .iI 11111 ' 1')1 I) I II/ III ' II
III II 1'1', ,, 11 '1'1
MALNUTRITION
Malnutrition, although almost entirely treatable, is still a common
cause of neonatal death in animals.
19
, 40, 48 Either maternal malnutrition
or a small area of placental attachment can result in poor intrauterine
growth, subsequent growth retardation, and postnatal weakness. Postna-
tal malnutrition can be caused by agalactia, mastitis, or lack of appro-
priate maternal behavior. Inappropriate nutrition can result in ineffective
nursing, hypothermia, hypoglycemia, and death within 36 hours.
40
Signs
of malnourishment are lack of weight gain, poor or no attempt to nurse,
constant high-pitched crying, inactivity, or a weak sucking reflex.
The caloric intake most often recommended for the healthy or-
phaned neonate is 60 calories per pound per day for the first 70
calories per pound per day for the second week, 80 to 90 calones per
pound per day for the third week and 100 calories per pound per day
for the fourth week, assuming an environmental temperature of 29.4C
to 32.2C (85F-90F).40
If the newborn is stressed or diseased, metabolic requirements are
higher and proportional to the severity of the stress or illness. Monitor-
ing for hypoglycemia and maintaining body temperature above 35C
(95F) are necessary. If the patient is too weak to suckle or is hypother-
mic, a warmed 1:1 mixture of balanced crystalloid and 5% dextrose at
1 mL per 30 g of body weight may be injected subcutaneously, or a
warmed (37.8C [lOOF]) nutrient-electrolyte solution may be adminis-
tered orally every 15 to 30 minutes until the newborn responds.
27
Oral
feeding should not be done until the rectal temperature is above 35C
(95F).
DIARRHEA
Overfeeding by well-meaning caregivers is a common cause of
diarrhea in young orphaned neonates. Treatment consists of diluting the
existing feeding formula in half with water or a balanced crystalloid
'olution. As the condition improves, the amount of milk replacer can
t; lowly be increased back to the normal levels. Other dietary causes of
diarrhea in the newborn include a sudden change in the diet and food
or lactose intolerance. There are numerous other causes of diarrhea
(d rug- induced, parasitic, infectious, obstructive, or metabolic diseases)
fur whi h mana gem. nt is discussed in greater detail in other reviews.
28
COMPLICATIONS WITH THERAPY
Compllo "l'tlon
1 11111 ', / 111 11\' III ' 1111 ' 1 ,f l l.l l'cI 11 111 1111' 111 ' " " !1"II '"II V I II Ih, ' III 'wlll)f 'il;
1111 11, dlil l', .J ll lt' III 111111 11 /', lill ' l 'l il l ll l ' liI 111 111' , llillllil l'l l ' 11 11
'
11' / 111 1
,I
364 MOON et al
rule of thumb, however, on how to adjust all drug doses. For example,
in infants, acetaminophen's elimination may be twice the adult rate, but
the elimination of bupivacaine may be prolonged up to 19 times the
adult rate.
24
Consultation with a veterinary pharmacologist is necessary
for drugs in which response to therapy is not easily evaluated.
A drug's osmolarity needs to be determined before administration
to a neonate. Intracranial hemorrhage and necrotic enterocolitis can be
caused by intravenous hypertonic fluid or drug administration. Intra-
cranial hemorrhage can also be caused by acute hypervolemia, and
necrotic enterocolitis can also occur after alimentary infusion of hyper-
tonic solutions. Nutritional solutions, fluids, and drugs should not ex-
ceed an osmolarity of 460 mOsm/kg in the neonate. 24
Hypovolemia from Blood Sampling
No more than 10% of the blood volume should be removed within
a 24-hour period (a puppy's blood volume is 68 mL/kg'6). This volume
should be replaced with fluids at a ratio of 3:1 if crystalloids are adminis-
tered or at a ratio of 1:1 if colloids or blood products are being adminis-
tered.
46
Nosocomial Infections
The incidence of nosocomial infections in human pediatric units is
between 6% and 14%. Babies who were more prone to develop infections
were the ones who were immunocompromised, had received antibiotics
that altered normal gut flora, or had received invasive procedures. The
most common sites of infection were respiratory, urinary, gastrointesti-
nal, blood stream, and surgical wounds. Not surprisingly, the single
most significant method of prevention was simple hand washing be-
tween handling of patients.
Thermal Injury
Burns or overheating from heating pads, heat lamp , or hot water
bottles can occur in the neonate that is depr ss d and unabl to mov '.
Immediate therapy consists of appl ying old Or ic('d wat 1' '_ 17 .
[37P-63PD to the burned site, aSf)('HHinl', () g<'nnti () I1, .1I1d In' ilting (Ot'
possible shock. Additional thl' l' rq ('() II I If{ 1111 l'I' pl (' Il IHilill l; ollgolll )', llilid
losses, treating th burn Hil t' , 11I 'I'v\'111 II)', lil l,'IIIIII II, jll'l 'V(' IIIII1)" II YI' ()Ii1I ' I'
mia, and provicl i Il l', I' ,liq 1'1,11'1 11 1111 , .. 1 111, 11 11 ',11 11111/ ,II ',' ,.1 111 ' 1'1',1,
silv I' Hli I (,,<I ill'/,II 1( ', 1\lld , ld' lI hi ' lli l i li' I
SUMMARY
The first few minutes after a neonate's birth may determine the
quality of its entire life. Immediate care includes prevention of hypother-
mia, clearing of nasal and oral passages, stimulation of ventilation and
oxygenation, and, in a few cases, advanced life support. Any
stress during the first weeks of life can also result ill neonatal morbIdIty
and mortality. Care of the diseased newborn must focus not only on
treatment of the underlying disease but on aggressive supportive care.
A safe, warm, clean, proper environment and adequate nutrition are
essential.
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IOt' lnled Ring ' I" H Hollil ioi1 . JAVMA '182:61, 198
I;;, (' IIIlIl I,1Ii hol lli AS, I " ' WI'I Il '1 HI ': , Mnr li" R), ' I' al: Tl'a h al su.ction and meconium: A
1"'01' (1111''' HIII I" IIII'" II I t'I H"'. I 1'" lI IIII, ' 11 6: lii:1 111
1
1., I . .
1, 1, 1),111111 1,:,/ 1111111 '/1 I,H: N,'wllIl lIl 1"IIIP"" /l IIII'" " ," 1 "l1 tvll lnll' d Iwnl IIlKS 111 1'1, ' d 'livery
11111111 , 1',., 11 ,, 111 <1' d' l:' ,1 11 1>1 I, I 'I'/, I
1'/ 1
1
,, 11 I/] !'v11'1 1' 1" ',''' 1\1 , WI I," III hU ' I'h,' 1" ' 11 1111111 11 1' . lI l d 111 11 1" II III II I'W 1," ill, ,, 11111 1'1 \)11 1
111 '111,, 11 ,11 1111.1 I '1" 'l dllll \ 1" '1 11'. 11 .1111 I " I, \" III '" I ' \ 111111 1,11
1
" II}'/ \
III, iI, "" "III, 1' 1 1 Mil 11111 11 01 11111" III I Ii 1111,11 ,11 1-'" 11111 1111111111 '\ 1'''" 111'1 11 I ,lIl d,' NI ' I 1111"
-\, ,I,h 'lIll. 1'10 " 1'111 1 I'" II I 111'1
366 MOON et al
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Ki,' " I{W, 1\(\ 11 111',1 11 '1 1 II I ("d 'l ) ( '111,,,"1 VI' II'rl ll lll y l'I" ' I' q'y \ 1 11 111 1i11 1IIIII ,iI 1' 1111 11".
1' lI lllI il l. ll'l lIlI , WII : '111111111 ' 1 I I'l'/" 1'1, 111'/ II '
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Paula F. Moon, DVM
C3109 VMC
College of Veterinary Medicine
Cornell University
Ithaca, NY 14853
e-mail: pfm4@cornell.edu
CLINICAL THERIOGENOLOGY 0195-5616/ 01 $15.00 + .00
NEW CONCEPTS IN PEDIATRIC
NUTRITION
Claudia A. Kirk, DVM, PhD
The goal of nutrition is to provide a diet optimal to meet an
individual's specific physiologic needs at each life stage and to optimize
performance. When feeding the puppy and kitten, we strive to supply
the building blocks for optimal growth, health, and disease resistance.
Qespite this understanding, the nutritional requirements of the growing
puppy and kitten have largely been established by determining the
nutrient level at which maximum growth occurs without much consider-
ation for other health factors such as immune function, future reproduc-
tive performance, physical capabilities, or disease resistance. As our
understanding of nutrition has expanded, it has become evident that the
nutritional influences of early life are the foundation for future health
and longevity. New research in pediatric nutrition seeks to define nutri-
ent requirements using indicators beyond that of achieving maximal
growth and also to understand the impact of early nutrition on lifelong
health. With this awareness, it should be no surprise that the nutritional
management of the canine and feline neonate begins before birth.
REPRODUCTION
Maternal malnutrition can have a significant impact on reproductive
outcome and is a major factor in intrauterine growth retardation and
mall-for-gestational-age human beings and animals.
14
Although the pre-
ise m chan ism is not well understood, maternal nutrition can alter
hor m n s, ytokines, and placental functions that control implantation,
ti ,'OIlI ill!" " d v, IIIl'I'd I{" " "M,'I, I )" 1,, "'1111(\111 , Scil' IWl' ond
1' 11 1111111 1
I 11 ' 1' 11'1 I ' I I II W ', III r 1111 ' II I A 1'1 I tvl I 1'1' I III I',
\I I L II '1111 1
370 KIRK
embryonic differentiation, fetal growth and development, and parturi-
tion.
14
Recently the concept of Ufetal programming
U
has been more
widely accepted. Several studies in animal models and human subjects
have described the programming of select fetal genes by the perinatal
nutritional environmenty, 44 Fetal programming can increase the risk of
developing chronic disease such as diabetes, heart disease, or allergies
later in life or result in a variety of permanent behavioral abnormalities.
17
, 44
Interestingly, severe nutritional deficiencies that exist during a dam's
development can result in immune impairment in her subsequent off-
spring.
6
, 15, 20 It is thus necessary to evaluate the dam to assess fetal
nutritional adequacy.
Nutritional Assessment in Reproduction
The steps involved in providing good nutritional management are
to systematically assess the animal; the food, and the feeding method.
Once a nutritional assessment is established, correction or optimization
of the feeding plan can be made. The initial evaluation starts with a
prebreeding evaluation. This should include an appropriate anamnesis,
physical examination, and any necessary laboratory evaluation. The sire
and dam should be genetically sound, in good health, and at optimum
body condition. Although small variations in body condition can be
corrected during pregnancy, breeding should be delayed in animals that
are significantly under- or overweight (body condition score [BCS] < 2
or > 4.5 on a 5-point scale). Obesity and undernourishment can be
detrimental to reproductive performance and neonatal health. Malnour-
ished dams may fail to conceive, abort, or bear small underweight
young.
8
, 22, 23 Lactation failure is particularly common in malnourished
queens. Overnutrition, or obesity (BCS = 5/5), has an equally negative
effect on pregnancy outcome. Stillbirths, dystocia, and cesarean sections
occur more frequently in obese queens compared with those at ideal
body condition.
24
Similar results have been described in dogs and peo-
ple.
8
The mechanism may, in part, be the result of altered nutrient
transport across the placenta to the fetus. Hormonal and nutrient concen-
tration in the dam alters transcription and translocation of specific nutri-
ent transporters in the placenta and regulates placental growth. 15
Unfortunately, suboptimal nutrition and mild deficiencies are often
difficult to determine in a clinical setting. Even in severe fasting or
chronic dietary restriction, fetal malformations are uncommon. Thi is
likely a result of maternal catabolism and release of tissue mi cronutri nts
that strive to balance the fetal diet at the expense of th d a l l ) . ' ~ d' OHi'>
fetal deformities are more typical of single nutrient d fi i 'n i ' S or n Ol1
nutritional causes. Nevertheless, early f t a I IOSH, prell) , lu rc dd i V(, I' , low
birth weight, failure to thriv , and in r(, fl. '(d O{'('III"I'(' IJ( '(\ (I f 1'"11 1111il lil
death have all been nltriblllc' d hI I'Iw Illon' \"'1111111111 ('111111 '/1 01 1\1 ill 'l'll llI
malnutriti on, I'l lori (' tI( (j eil , or (', d ill'il' 1' 1( 1', ' I I . "
In :Hldiliol1 iii I ' ll 111 111 /', IIPIII 'I' I' IIIII,' 111111 \, 1I' Ihili il ll dll d "'11'1) ',\
NEW CONCEPTS IN PEDIATRIC NUTRITION 371
balance, a nutritional assessment should include close scrutiny of the
food and feeding method. Nutrient levels during gestation should meet
established requirements for reproduction (Table 1). Marginal intake of
key nutrients is best corrected well in advance of breeding, as correction
during gestation may too late. Copper levels adequate for adult mainte-
nance but deficient for gestation resulted in reproductive failure, early
abortion (25 days), and fetal deformities in one group of queens despite
dietary supplementation at breeding (Fig. 1).10, 22 These observations
suggest that timing of nutrient availability is critical to normal embry-
onic growth and differentiation or that maternal tissue repletion or
placental nutrient transfer may be inadequate to compensate for defi-
ciencies during critical periods of need.
Key Nutritional Factors in the Dam during Gestation
and Lactation
There are few studies establishing the minimum nutritional require-
ments for the reproducing dog and cat. Many recommendations are
extrapolated from growth studies, data from other species, and clinical
experience. Although most foods appropriate for growth are adequate
for female reproduction, certain nutrients are required in higher
amounts. Nutritional claims for nutritional adequacy during reproduc-
tion should be supported by successful feeding trials during gestation
and lactation. Careful attention to pet food labels is important. Newer
foods designed to reduce the risk of developmental bone disease in
large-breed puppies or to maintain urinary tract health in the adult cat
are not ideal for gestation and lactation. A summary of key nutritional
factors for reproduction is found in Table 1. The following sections
describe in more detail key nutritional factors important to the growing
fetus and neonate.
Water
Water needs increase during normal reproduction. Expansion of
extracellular fluid compartments and maternal and fetal tissues during
pregnancy increases the need for water. Water is particularly important
for milk production during lactation. Water needs during lactation vary
D cording to the maintenance needs of the dam, type of food (canned
vs. d ry), and rate of milk production. Water requirements in milliliters
P ' I' day a 1" approxim.ately equal to the energy requirement in kilocalo-
I' i 'So I\)t, bl ' Wil t r should b available at all times. Feeding canned
foodH or l1 dd i ng more wn t I' d iI" tl y to food can improve water intake
i ll Ihol'll \ t1dl11l'l I' l' l IIl'1nn I 1\ ) drinl .
I /I( lOY
IIIHIII I', " Ill il il Y ,11111 '111 ,Ii 1)1111 "III II I' " 'II" I .. d II 111 '11'11111 '.1 II' "I I
"1 1, Ii II', 11'1' 11 1"111 Ihll l, " 11 ' 1,11 \ "111 '1) ', \' II 'l Ill i,' II IIIIII II IIII \' II ii' 11 111 I lilllll lil l',

o
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rl
Figure 1. The effect of dietary taurine deficiency in a queen at 45 days' gestation. The
placenta is underdeveloped with poor vascularization. A partially reabsorbed embryo re-
mains attached to embryonic membranes and is visible at the center of the opened pla-
centa.
"nutrient." The pattern of energy intake during reproduction differs
between dogs and cats (Fig. 2). In the queen, energy intake and weight
gain increase linearly from conception to parturition. The recommended
energy allowance for feline gestation is 25% to 50% above maintenance
levels or approximately 90 to 110 kcal/kg/ d. The energy increase can be
accomplished by providing 1.6 times the resting energy requirement
(RER; RER = 70[body weight in kg]o.7S) at breeding, with a gradual
increase to two times the RER at parturition. In the dog, energy require-
ments remain at adult maintenance (1.9 times the RER) during the first
two thirds of gestation and peak at 30% to 60% above maintenance
during the last third of gestation. Beginning at week 4 to 6 of gestation,
gradually increase energy intake to 30% above maintenance by
whelping. Because of individual variation and increased energy needs
in dams with larger litters, energy requirements may increase to 60% or
more above maintenance levels. Free-choice feeding allows the dam to
adj ust food intake as needed to meet her energy requirement for gesta-
li on. This is th preferred method of feeding the queen throughout
)' 'HITlli on an:t 18 tat ion. Dogs in arly gestation and obese-prone queens
li i10lJid Iw nwn l-fed to on ll"ol ex 'siv food intake and maintain opti-
111011 hod wvigill .lIHI nil'l' of gain. dig s tible energy-dense foods
1)('11' III lill 'I' 1 Ldl ' )',I 'H t. Ii II)l 1 ('l\ lpl'i{' ilil ,d ('Ii ('i' minimize stomach fill to
Idl ll\1\1 II\ IlII ' ,il ll lll lllll llI l IPI\I 'I' 1111' IIII' )', 1' \vitl \ll t'I'II H, 1\(1'('1' I art lll'iti on, th
111 1i h 1IlI liid WI' I)',II I,"" III III"" I!I III \' I' 11 1I 11I 111I '1'I .d lll )" w(' I),,111 III lYIoin!:.,il
11I11 'IJl I,III ' 1,"11111111 'IIII' '111"1'111\ I til ,111 \ ),,1 1111 1111\ ,,, Id 1111I1,til)()() )', ,!I l()VI'
374 KIRK
40 900
--Body weights
= Energy intakes
30
700 OJ
!
u
600

:;: 20
1/1
CI)
III ....
.S
500 S
CI)
.S
Cl 10
400 >-
c:
e'
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c:
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0
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0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6
III Gestation . +-Lactation--+
A Weeks
30
--Body weights
8
= Energy intakes

UJ
c::
20 6 ><

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B Weeks
Figure 2. Comparison of the pattern of energy intake and body weight (BW) gain during
gestation and lactation in the dog and the cat. A, The queen gains 'weight in a linear
fashion throughout gestation and then draws on body stores to maintain lactation. Weight
loss during lactation is substantial despite an energy intake 2-3 times above maintenance
levels. B, The b itch gains weight in the last trimester at which time food intake will increase
by 30- 60%. At parturition she should weigh 5-10% above the premating weight and
gradually return to this weight by weaning. RER = resting energy requirement. (Adapted
from Debraekeleer J, Gross KL, Zicker SC: Normal dogs. In Hand MS, Thatcher CD,
Remillard RL et al (eds): Small Animal Clinical Nutrition, ed 4. Marceline, MO, Wals-
worth Publishing Co, 2000, p 235; and Kirk CA, Debraekeleer J, Armstrong PJ: Normal
cats. In Hand MS, Thatcher CD, Remillard RL et al (eds) : Small Animal Clinical Nutrition,
ed 4. Marceline, MO, Walsworth Publishing Co, 2000, p 321.)
prebreeding weight. Queens failing to gain ad quat w ighl' durill );
gestation have suboptimal lactation perform, n (' .
Lactation is the most ener y-d mandinl'l f lll)',I ' or li rv. Pl' liI IIdll
production typically oc urs nt I;() II. w( I(II /4 ()I 1.1 1'l.llillll , '1'lli 'I)('l'I i!' di y,
peak energy d m, nd l'pill<'iti l' willi 11 11 11 11I' 111l ti , ' .(iI I dl 'I(l lllI y
OC UI'S ,I ) II) 7 WI' !, I I p OI I(1I1 I'111I11 11, '1 1 ' ''II'I)', \' 11 \' 11111'1111' 11 1" III II}
exceed two to six times the RER. The discrepancy in the timing of
peak lactation and peak energy demand is a result of combined food
consumption by the dam and offspring. Neonates begin eating the dam's
food in increasing amounts from 3 weeks of age until weaning. Even
though there are several useful guides to estimate the energy require-
ment of lactating dams, it is preferable to feed free choice. A wide
variation in energy needs makes accurate prediction difficult, and free
access to food encourages early food exploration and consumption by
the neonate. If controlled intake is required to avoid excessive weight
gain, two to three daily feedings are recommended.
Protein
During gestation, the protein requirement increases from 40% to
70% above maintenance. Minimum recommended protein intake is 6.3
g of protein per 100 kcal (25% dry matter [DM]) in the bitch and 7.5 g
of protein per 100 kcal (35% DM) in the queen.
S
22
Protein quality and
quantity are important to provide essential amino acids for growth and
development of the fetuses . Animal-based proteins are preferred as the
major contributor to dietary protein because they generally have greater
digestibility and more desirable amino acid profiles. Improved protein
quality enhances newborn vigor and reduces neonatal mortality.32 Pro-
tein deficiency during pregnancy may result in lower birth weight,
higher neonatal mortality, and lowered immunocompetency.6.32 Protein-
restricted foods fed to queens during late gestation and lactation resulted
in abnormal behavioral development such as delayed home orientation
(ability of kittens to orient to and return to the nest), aberrant locomotor
development, and decreased emotional responsiveness.
12
During lactation, the dam increases protein synthesis to supply milk
with protein concentrations suitable for growth (approximately 36% DM
milk protein) . In queens nursing large litters, daily milk protein output
may reach 19 g of crude protein per day by a 4-kg cat. It is not surprising
that protein needs during lactation exceed even gestational requirements.
Inadequate dietary protein concentration results in poor lactation,
slowed neonatal growth, and impaired immune function.
33
Taurine
Tal.lrin defi ciency in gestating queens may result in fetal death near
I'he 25th day of g ta tiol'l , abortions throughout gestation, fetal deformity,
low birl'll and d lay d rowth and development.
42
The taurine
l'l' tjllil'l' I1Wnl (01' rvprotiucl' ion in I'h, atis similar to that at other life
HI,,!;!, : .I Illinill1llll1 of 11.1 % I)M laLlI' ill t' in d r food and 0.25% DM in
(11111111 ' .1 II HH III, Idlll' il lI' 10 1% I)M hns res ul t d in li ghtly
111111'11 I,d l'I' I" lI lilll ' l VI' 1" ' 1' 111 1'111 .1 11"1 ' " ' 1'11
1
1'1 11 1 hili Ill wvl' kil'tcn )!; rowth
l 'l il l' I' () II I' I' 1I1 1' 111 Ill', 1'111 111111 ' 11 Ld 1(1111 1/1 111'1 )', II"1i 10 1' I'I ' p I'IH IIIt ' li o l) il J'l'
Iii 11 1 111 111 11 1 I I Iii 1.11111 111 ' " ,II! I' ll! \' ' 11 111 I' '111 1'1' 1111 1'1 11 111) ', l 'llnd y 1111 '11111
376 KIRK
lated homemade foods or dog foods are more likely candidates. Taurine
is not a required nutrient for canine reproduction.
Fat and Essential Fatty Acids
Because of the increased energy demand during gestation, high-
energy foods are beneficial. Fat delivers over twice the amount of calo-
ries as the same amount of protein or carbohydrates and represents an
important source of calories. In studies comparing the effect of two
different foods on reproductive performance, higher fat foods resulted
in improved birth weight, survival, and growth compared with a diet
containing lower fat.
31
Fat levels recommended for reproduction are
listed in Table l.
Linoleic and a-linolenic acid are essential in the diet of cats and
dogs. Arachidonic acid is essential in the cat, and deficiency results in
reproductive failure.
29
, 34 Essential fatty acid deficiency has been associ-
ated with small litter size, low birth weight, preterm delivery, and poor
placental development in a variety of animals,21 Current recommenda-
tions by the Association of American Feed Control Officials (AAFCO),
US regulatory standards, are appropriate for gestation and lactation
but do not provide recommendations for essential omega-3 fatty acids
(W-3).1 A dietary source of docosahexaenoic acid (DHA; 22:6w-3) is
required for normal development of retinal function in nursing kittens
and children and possibly in puppies.
35
In young female Beagles fed
w-3 supplemented foods, there was an earlier onset of first estrus, larger
litters, and fewer stillbirths compared with similar previous breeding
groups with low w-3 intake.
21
Milk concentrations of DHA parallel
dietary intake by the dam; thus, DHA should be included in foods fed
during lactation. Common ingredients such as fish, fish oil, and poultry
meal represent a source of DHA in commercial diets. .
"'"
Calcium and Phosphorus
Calcium and phosphorus are required at levels greater than mainte-
nance to support fetal skeletal development and lactation (see Table 1).
Calcium supplementation is rarely indicated except to balance a home-
made food or to treat animals with eclampsia. Concerns exist ov r
excessive calcium intake during gestation and its role in prOln oting
eclampsia or skeletal abnormalities in the offspring. To date, high d i.eta ry
calcium during gestation does not seem to increase the risk for ' lDl1Ips in
or developmental bone disease in dogs.
40
Nevertheless, ex essivc < Id lll11
intake during early growth is a significant ri kin lar -brc I I til Ii '. ' ,
Because puppies begin to eat the mat rnal di el' nl ::\ wt' vI H, Il IlrOI1l' I'
calcium and phosphorus 1 v !1 ( nd roti o in Hw 111 11 1\'t'llll I tii('1 i ' jlllporl.IllI ,
Moderate 81 ium nnd plHIHpilorll H inl.ll;;, ' "1.1 II ,' II" il llll !pll(l1 pll(ll II
ratio of 1.1 : 1 10 15: 1 fl l'l' 1'I ' III'OI'I'i III, ',
NEW CONCEPTS IN PEDIATRIC NUTRfTION 377
Carbohydrates
Low-carbohydrate foods have resulted in maternal hypoglycemia
and ketosis in late gestation, low birth weights and neonatal deaths in
puppies, and excessive weight loss and poor lactation in queens.
33
, 38
Dietary carbohydrates spare protein required to sustain blood glucose
concentration during gestation and provide substrate for lactose synthe-
sis during lactation. Increasing dietary protein levels reverse the effects
of carbohydrate-free foods in gestating dogs. Lactation performance is
improved by providing some dietary carbohydrate to queens even in
the face of abundant dietary protein.
33
Other Nutritional Factors
Digestibility
Foods with more than average DM digestibility (> 85%) are best
suited for reproduction. The benefits of highly digestible foods include
(1) improved nutrient availability to meet the increased nutrient needs,
(2) reduced required food volume and subsequent abdominal fullness,
and (3) avoidance of large amounts of undigested nutrients entering the
colon, which can lead to diarrhea.
Urinary pH
Highly acidified foods should be avoided during gestation, as they
may impair bone mineralization in the developing fetus. Anecdotal
reports have implicated certain highly acidified semi-moist foods in poor
reproductive performance in queens. Foods designed to produce average
urinary pH values at or above 6.2 seem to be safe during reproduction.
Monitoring
One of the early indicators of successful breeding and conception
in the queen is a steady gain in body weight (see Fig. 2). In the queen,
w ight gain increases linearly from conception to parturition. This pat-
t I'll is different from that of dogs, which experience small increases in
hody wight until the last third of gestation, when weight gain and
(' Iwrg in t. I ' gr otly in I' a ' . Wight gain in early pregnancy is not
dHHocinlt'd wilh Hignifi c< nt growth of I' productive tissues or the concep-
IUN bill '("' 111 1'1 10 lw slot', 'd in ,' nl' rgy d pots (PI' sum ably as fat) to
/1I IPIHli'l Illl'I ltlil lll , )(11
,
, ' 11/ 1 IIIld" t' WI,jl', ill ,II pnrlurili Ol1 of I: n xp ri nce
1' (l IH' IlI d ,tl i'"1 1)(' 1' 1111'111 11111 '" 111 11 1 ",, !>l llly III IIll1 illll ili hi lt! ,' (lllliilio)') ,
MI 'I III WI' )',111 )',1 1 II 11111 II )', ),,"11 1,11 11 11 II ' 1"" "1111 I I ,qll' I'Il \ IIII III " ly \o() % ll f
111" 1" "1 111 11111 )" \\I 1' 1)', It! (' Hili I ' (11 ) ),, 1111 ,1\" ' 101 )',1' 1111 ,' 1 I ' ) ' ' 1\' 111 1'1111 I Ill ,'
I , li ll ,llIlIilti 1111 11'1111, 111 ' 1 111111 \ \ " 1),, 111 I.\, .1,"" il l \\, 11, ,11 11 11)', \ 1 Iii 11111 1
378 KIRK
tion, the queen loses only 40% of the weight gained during gestation.
The remaining 60% of prepartum weight gain is used during lactation
to sustain milk production. Unlike the queen, the bitch enters lactation
at only 5% to 10% above prebreeding weight.s The mammary glands
should be closely evaluated to ensure health and ready access. Express-
ing milk from each gland does not ensure adequate milk production.
Continuous weight gain by the offspring is the best indicator of lactation
performance.
GROWING PUPPIES AND KITIENS: NEONATAL
PERIOD
The neonatal period encompasses the time from parturition to com-
pletion of weaning. During the nursing period, the neonate relies on
colostrum and milk to supply its nutritional needs. The nutrient profile
of maternal milk is thought to provide optimal nutrition for the neonate
even though larger growth rates have been observed in puppies and
kittens fed milk replacers.
36
Nutrient recommendations for neonates have
been derived from the composition of maternal milk (Table 2) and
growth studies in weaned puppies and kittens. Milk provides benefits
Table 2. NUTRIENT COMPARISON AMONG MILK OF VARIOUS SPECIES
Queen Bitch Cow Goat
Nutrients Milk' Milkt Milk:!: Milk:!:
Moisture (g/100 g) 79 77.3 87.7 87.0
Dry matter (g/lOO g) 21 22.7 12.3 13
Crude protein (g/100 g) 7.5 7.5 3.3 3.6
Arginine (mg/100 g) 347 420 119 119
Taurine (mg/ 100 g) ' 27 0.13
Methionine (mg/ 100 g) 188 82 80
Crude fat (g/ 100 g) 8.5 9.5 3.6 4.1
Lactose (g/ 100 g) 4.0 3.3 4.7 4.0
Minerals
Calcium (mg/100 g) 180 240 119 133
Phosphorus (mg/100 g) 162 180 93 111
Potassium (mg/ 100 g) 103 120 150 204
Magnesium (mg/ 100 g) 9 11 14 14
Copper (mg/lOO g) 0.11 0.33
Iron (mg/100 g) 0.35 0.70 0.05 0. 05
Metabolizable energy (kcal/100 g) 121 146 64 69
Metabolizable energy (kJ/100 g) 506 610 268 2H8
' Data from Adkins Y, Zi cker Sc, Lepine A, et al: Changes in nu[!'i (' nl fll1d I 1'01" ill (,(" " pn"i I iOl1 01
cat milk during lactation. Am J Vet Res 58:370-375, 1997; and Zollmnn il, I )"h" I1 I'l"kt 'I' il, l<il ' lwk II, 1'1
al: Investigations on milk composition and mil k yield in QUCl' I1" 1ItI'" I" 1t1 I) , I" l 'I'Ott,,' lI ll1f',1I 01 11 11 '
Waltham International Symposi l "'), Orl ancio, 1')97,
tDatafrom Meyer H, K i nzl(' 11, f),,,,,,, "" '11 I ': MlIl'IlI' H' I1 f',1" ''' lt l MI I, III IIIII "' I" """i1,I/' ''"f1 I'l'l "lid
Hiindin sowi e Futtcrau fnnhl11 \' !l 1l1! (;,Iw!t lli IHI II WI, ll li il g 11 111 1' Ih ll l 1'11 11 I II \I HIIII 1I111 111d lt II, ' III , 1111
Ti erphysiolof,\ il' "nd ' l'II'I'I' I1ll1 ll1 l1 lf; (Ad"""" ,. III A" I" " II l 'Ii VIl III IIIII\ 11 ".) \ ,11,,," 1 11,', 1 '"
19R5.
1" 1/111/1"111 l 'I'II"I"fl l ll l l I 1,,,,, 1 ,iiI< ,01 1'," 111111,, 1 ""1"1111111 I f " I Id I I lid 11 ' "1'''
II'II\\' l'Ittll
beyond a supply of nutrients. Enzymes, immune factors, hormones, and
digestive factors serve important functions in the developing neonate.
Although it sometimes becomes necessary to hand-feed puppies and
kittens less than 4 weeks of age, it is probably better to foster or
supplement feed than to completely deprive the neonate of maternal
milk.
Neonatal Assessment
Nutritional assessment of the neonate requires regular evaluations
beginning at birth. A nutritional assessment should include the dam's
history and a detailed physical examination, including body weight,
temperature, muscle tone and vigor, and behavior. At birth, kittens
should weigh approximately 100 g. The birth weight of pups varies by
breed (75-700 g) . Both species should nearly double their weight in the
first week of life. The neonatal kitten should gain between 10 and 15 g
daily. Gains below 7 g/ d are inadequate. Puppies should gain 2 to 4 g/
d/kg of their anticipated adult weight.s, 22
Caretakers should be encouraged to keep logbooks of all data that
may provide information about the health and nutritional status of the
neonate as well as about the reproductive performance of the dam.
Records should include food intake, body weight, body temperature and
stool characteristics, especially during the first 2 postpartum weeks.
Successful management depends on the quick recognition and correction
of health, nutrition, and management problems.
Key Nutritional Factors in the Neonate
Colostrum and Milk
Colostrum provides nutrients, water, growth factors, digestive en-
zymes, and maternal immunoglobulins, all of which are important for
the development and survival of the neonate. Colostrum differs from
mature milk in water and nutrient composition. In addition, non-nutri-
tional factors change concentration over the course of lactation. The
pa ttern of change is similar between dogs and cats, although not identi-
' I) I. In g n ra 1, tb DM concentration declines as water content increases
from day '1 to 3 of lactation. Lactose concentrations are low in colostrum
(- -30 I!;/ I, or 25 I11 g/ k al) and increa as milk matures. Protein and
l i pi I i('vvls t k cl int' mari e JI from d, y 'I to . Tbi decline likely reflects
III(' inili ,)1 (' 11,111)',1' ill w,lt v l' .I H cnloHlrlll11 transiti ons to mature
lid II , l 'l'nl l'i ll I'dHHIIHI 11 111 1 i l ll ' I'IW I' ii l ili htl (\vt' r til' ('ollrsc of
I ,wl l tl ill il , ( ' II , lIl l',I '/i i l) 11 \1 1)1'1 .. 11 1'11111 1' 111 il il ll V1 II ' y wil it 1111)\ ' . (" II ('i llll1 111111
l"II ' / lJdl l lll li I 'P III 'I ' ltll" ll P il i 11 1 11' d lll' III' I II I !'I Y 1.1, w lli ' I'I '11i l 'II II, I 'II JiJ!I II',
II I HI 111 11)', 111 1 1 11 11 \ 11111< '1'1 111 111 111111 dl ' l l l l lI ' hll ii' I lldl, ' I " ' I HIIII ' 1i 111\1' 11111
li lli l l 1111111 ' 1111 tl llI!' 1I II iI " ti , 11 11 11 I"II HI I"IIIIII>I 1111 111/ 11 1 11 11 1 II 'JlI"I ' III '
380 KIRK
milk. These values likely represent colostral milk (calcium:phosphorus
ratio of 0.4:1) in that recent studies of queens' milk report calcium:phos-
phorus ratios ranging from 0.8:1 to 1:1 on day 7 and ratios reaching 1.2:1
by late lactation. Surprisingly, the maternal diet has a limited effect on
the nutrient content of milk, with the exception of dietary fat and
carbohydrates.
The neonate acquires passive systemic and local immunity from
consuming colostrum or mature milk. Puppies and kittens should re-
ceive colostrum within the first 12 hours of life to obtain adequate
systemic immunity (primarily IgG); after 16 hours, passive immunoglob-
ulin transfer does not occur.
4
,7 Failure to ingest colostrum or milk during
this period leaves the neonate immunologically compromised. This win-
dow of absorption is far shorter than that reported for large animal
species, where adequate immunoglobulin absorption occurs for at least
24 hours.
Milk provides additional factors that help to regulate and enhance
immune function. Components include cytokines and memory cells,
which help to protect against antigens and pathogens and act as signal-
ing factors within the intestinal mucosa.
26
They also include proteins
and enzymes that can inhibit or kill key pathogens. Certain oligosaccha-
rides may serve as binding sites for pathogenic bacteria, thus preventing
attachment at the intestinal epithelium.
2o
,26 Lysozyme and lactoferrin
have antiviral activity. Maternal milk has thus been shown to inhibit
important pathogens responsible for neonatal disease such as Camphylo-
bacter, Escherichia coli, Staphylococcus, and Rotavirus.
26
The practical out-
come is a lower incidence of gastrointestinal disease in animals receiving
maternal milk versus milk replacer.
Other benefits of maternal milk include improved nutrient absorp-
tion, control of neQnatal growth and development, and promotion of ,
gut colonization with "host-friendly" bacteria. Milk-derived proteins
known to facilitate neonatal nutrient absorption include such factors as
lipase, lactoferrin, and vitamin-binding proteins, which aid in fat, iron,
and B-vitamin absorption, respectively.26 Leptin, insulin, epidermal
growth factor and insulin-like growth factor are all found in milk. The
role of these hormones has not been clearly defined; however, they are
thought to influence gut maturation as well as body composition and
growth. Nursing animals and human infants have less body fat and
weigh less than formula-fed neonates.
26
,36 In people, this slower growth
and lower body fat is associated with a lower incidence of diab et an 1
heart disease in later life,
. Milk from the bitch and queen varies marl<edly from thnt of ru mi-
nant species, Consequently, mill< from these alternotiv 81 t' ics is nol
suitable as the sole source of nutritiol1 f r nursing I ill'(' ns 11 11<1 pllpp i l 't .
Replacement formula wi th c i'l litri I t pl'Ofi l(, Sil l)i lll l' I'() Ihnl I ll' 111 ,)1111'1'
mill< shoul d b uS d fOt' ol'J hnnH nnd , (lppll' Il H' l1 l. d f(l(ld lll )', ll (11(11' '111 1111'
2).
Energy
Maternal milk typically meets the energy requirements of the neo-
nate. Estimated caloric intake is approximately 200 kcal/kg of body
weight up to 4 weeks of age. By 6 weeks of age, male puppies and
kittens are significantly heavier than female puppies and kittens and
consume a proportionately larger quantity of food. At this stage, energy
requirements are approximately three times the RER until the animals
reach 50% of their adult weight. As a rule, milk contains from 0.85
to 1.6 kcal/mL (average, =1.46 kcal/mL) and milk replacers contain
approximately 1 kcal/mL as fed.
Water
Total body water of the neonate is nearly 30% greater than that of
the adult animal. To maintain adequate hydration, the water intake of
the neonate is relatively high, A normal neonate needs about 130 to 220
mL of water per kilogram of body weight per day.
Protein
The minimum protein requirement of the nursing neonate has not
been established but is assumed to be comparable to that of weanlings.
The AAFCO crude protein recommendations are 22% and 30% DM for
puppies and kittens, respectively. The protein content of maternal milk
is greater than 30% DM in both species, however, and the digestibility
of milk protein is nearly 99%. As a result, the nursing neonate typically
ingests protein levels greater than those recommended by AAFCO.
Taurine
Taurine is important for normal growth and development of kittens.
Queens' milk supplies about 400 mg/L of taurine. Queens fed low-
taurine foods have significantly lower milk taurine levels, which can
impair normal growth and development. Cow's milk is a poor source of
taurine (i. e., only 1.3 mg/L). Homemade milk replacer based on cow's
milk should be supplemented with taurine.
Fat
Mi ll f:1 1 is , n impor tant source of energy and essential fatty acids
C(lj' Ill l' I)VI I II ' l ll' . Uillil c most ther nutrient, the fat composition of the
d l l l l ) ' ~ l Ii It ' I ('(I I ) 11i)" n i n ell nil ill n u(' n('(' m il k fat quantity and quality.
M,1I1 '1' 1\ tI III II I, 1" 'lIvl ti l' Il ll' ('I'll'll ' j II lit! filII lI eitl M I inol 'i (;), id, arachidonic
I I( ' d
f
II ll d 1111 ;\ 1111/\ /1 (' 1 11' 111 111 1 1(11 ' I )OI'l llI " 1'\'Ii ll,t! 1i ('vI lnl 11 1cnt and
1II I 1I 1 ( III II II Il fl li ll, ' l ld l 'l d l d ll 'll Ililti l " lll lollrl y 111 ti t))',I) . II'
382 KIRK
Calcium and Phosphorus
Calcium concentrations in dog and cat milk are approximately 1%
DM by middle to late lactation. The calcium:phosphorus ratio is approxi-
mately 1.2:1 at 1 week and remains so throughout lactation. The maternal
diet has little influence on milk calcium content. Nevertheless, it is
important to note that calcium supplementation to large-breed puppies
between 3 and 6 weeks of age resulted in significant enostosis and
developmental bone disease.
16
,40 Growing puppies have passive calcium
absorption until several weeks after birth. During this time, they cannot
regulate calcium absorption across the gastrointestinal tract below 40%
of the ingested amount.
16
, 40 Because this period often coincides with
initial food exploration and weaning, it becomes critical to provide foods
with proper levels of calcium and the correct calcium:phosphorus ratio
to large- and giant-breed puppies (Table 3). Calcium supplements should
be strictly avoided, except to balance a home-prepared diet or to treat a
specific disease.
Trace Minerals
Dog and cat milk contains iron, copper, and zinc concentrations
markedly higher than those in human and bovine milk. Copper and
iron levels tend to gradually decline throughout lactation, whereas zinc
concentrations remain constant. Mineral deficiencies are rarely reported
to occur in nursing kittens and puppies fed maternal milk. Occasionally,
iron deficiency and'\mild anemia may occur at 3 to 4 weeks of age if
insufficient stores are not accumulated during gestation and the first
week of life. Fast-growing large-breed puppies seem to be at greatest
risk and may be treated with iron-containing supplements or early
provision of good-quality food.
8
The occurrence of iron deficiency should ,
prompt an immediate review of the food and feeding practices of the
dam before and during gestation.
Feeding Plan
Foods should be liquid until puppies and kittens are 3 to 4 we ks
of age, when semisolid to solid foods may be introduced. Foods m,
consist of maternal milk or milk replacer. Maternal milk i con id " I' 'd
ideal because it provides all the essential nutrients, antibodies, ll ZY IJl l'S,
and hormones. Commercial and homemade milk r pi a ' f S may mimi c
the essential nutrient content of maternal mi ll but In litH Ol'l'WI" hl' lldi
cial properties. The quality of milk and mi ll 1'(' 1 1:ICl ' I'S i, ' diCnculi 10
assess without analysis. Measul' l11 ent or IWOI) ,ll.ll )',I'owli) L I m h,lld
the most practical m tllOc! of :1:-;:-; (':-; :-; 111<'111.
Nursing pUF I ie,' , lilt I I ill l ' l) S :4 hl\\lld III' ,dl ' )l VI '1! fl 'l 'l ' " I't '" Ii fll fi ll'
dam. NCOIl (1 f( '. si)llIdd III ' 1111:11 ' 1' I ,d fll 1'1 1' 111 1' fll ,iI 1111' II" VI ' 11 '1'1,1\1 1'"
colosll'lllll Il y f ' l 11 11111 Il illt ' l b l lfll MIII I 111 '11I1,il l " 1I ' '1il II ' II ", tl l ll )', I ' ~ I I ' "
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384 KIRK
2 to 4 hours during the first week of life and then every 4 to 6 hours until
weaning. Cold neonates do not suckle and have reduced gastrointestinal
function. It is thus imperative to adequately warm weak puppies and
kittens before they are fed. Hypoglycemia and hypothermia may occur
simultaneously in neonates and have similar clinical signs. If kittens or
puppies fail to respond to warming, a dilute glucose solution (2.5%
glucose) may be given orally. This should be repeated until kittens are
able to initiate a strong suckling reflex.
Monitoring
Nursing puppies and kittens should be reassessed daily by the
owner or breeder. If the neonate fails to thrive, is weak, demonstrates
restlessness, exhibits excessive vocalization, or has a bloated abdomen,
it should be evaluated together with the dam. These signs may indicate
insufficient milk production or quality or another disease process. Pup-
pies and kittens that are well fed should grow at the previously de-
scribed rate and remain content between nursings.
GROWING PUPPIES AND KITTENS: POSTWEANING
PERIOD TO ADULTHOOD
The postweaning growth period includes weaning until adulthood
(i.e., 10-12 months). The nutritional needs for growth include mainte-
nance needs similar to those of the adult and energy and substrates ,
necessary for rapid tissue accretion. The growth rate slows if nutritional
deficiencies exist. As is the case during other stages, a nutritional assess-
ment evaluating the animal, diet, and feeding method should be per-
formed. The general health and risk factors should be determined during
the growing phase. A thorough history and physical examination, in-
cluding determination of body weight and condition, are generally suf-
ficient.
The rapid growth rate continues until the animal reaches 5 month '
of age and then slows as the kitten or puppy approaches 80%, of ad u I t
size. Large- and giant-breed dogs mature somewhat later. Most at8 an
dogs achieve skeletal maturity by 1 year of age. Additiona l W 'i )" ht go in
may occur after 12 months and represents a p hase of mat urn [i of) <l lll!
muscle development. There is no evidence thnt th nl' IWliI"t' I"iI) )',
alters the rate of growth. Unfortunately, en ' rgy rC'(l'lirvlll (' nl. dOl" li lll'
with neutering, and Ih ri sk fo r 01 cHil inCI"('IIKl'S. ()I v ' il Hhuilid IH'
pr v nt d at ( n ('11 1" 1 :11',1' I WI' II 11 ,' (' or it. illljl l(' l 0 11 1lI '.lilh II l1d
101 gc'v il .
Key Nutritional Factors during Postweaning Growth
. Many of the key nutritional factors were discussed in the preceding
section, and recommended levels are outlined in Table 3. The following
sections highlight factors to consider once the neonate is weaned.
Energy
Growing puppies and kittens require substantial energy to meet the
needs of rapid growth, thermoregulation, and maintenance. Ensuring
optimal growth is desirable, but excessive energy intake may contribute
to obesity or developmental bone disorders in large- and giant-breed
dogs. Eight-week-old puppies and kittens have an energy requirement
of approximately three times the RER, which declines to adult levels
near 1 year of age. Neutering reduces energy requirementsY, 39 After
neutering, limiting food intake or decreasing dietary energy may be
required to prevent excessive weight gain or an excessive rate of growth.
Protein
The protein requirements during growth reflect essential amino acid
and nitrogen needs for tissue accretion. In kittens, protein also provides
sulfur-containing amino acids, which are required in greater amounts
than in other species. A source of animal protein is best for the cat.
Although the role of high-protein diets as a cause of developmental
bone disease in dogs has been refuted, excessive protein levels are
not generally advised.
30
Amino acid levels compatible with AAFCO
recommendations seem adequate.
1
Fat
Dietary fat serves three primary functions in growing animals: it
supplies essential fatty acids, it acts as a carrier for fat-soluble vitamins,
and it provides a concentrated source of energy in the food, Excessive
fat contributes to obesity and other health-related problems, however. In
the large- and giant-breed dog, excess energy intake is a key contributor
to the occurrence of developmental skeletal disease. The AAFCO mini-
mum recommendations for growth are 8.0%, 0.5% and 0.2% for total fat,
lino] i.c acid, and arachidonic acid, respectively. These levels sustain
<ld quate growth. Faster growth rates are achieved with higher fat intake
bll t may hav negat.ive health consequences in the large-breed dog,
C I Ilml I1d Pli O. pll ru
' l 'l ll' )',"IlW II I', ." dlll ill iI ,I I 1',I"I', II I' !" !'i n1 nf di (' 1 Ilw lii nl(' d sl ' Icta l
Ii / 1'1111 ' i 'i)lI'l " II 'l'rI w ill II II' 1I1 1r11 111' IlI dllll\ l III 1 111< ' 111 , ,II ' " ll l"\ll , rlili l'
1I ,1.1I " rI III I' '1 '1 11 111 tll ' l ,11 ' 111 , I 1' 1111 11 11111 1 I dli ll 1, Iltl lli i /11 1,, 1' 1' ,11 '1' IlI \i'i lill
1111, 11 " "" 1' 1 ", 1r "11 11'I,d I II', 11111111 ' 11\,,111 ' IIIiHI N I JII II 1I1111 1d 11'1111111,11 V II Y
386 KIRK
perparathyroidism as a result of dietary calcium deficiency is the most
common cause of nontraumatic orthopedic disease in cats in Utrecht.
16
The minimum requirement for dietary calcium in growing kittens is
approximately 5 g/kg of food (0.5% DM), although levels of 0.8% DM
are more than appropriate for nursing, weanling, and postweaning kit-
tens.
22
Unlike the situation with puppies, calcium excess in kittens is
not associated with developmental orthopedic disease. Nevertheless,
extremely high concentrations of calcium can significantly reduce mag-
nesium availability in the caUB
Both excess and deficient dietary calcium can promote skeletal ab-
normalities in puppies. Although nutritional secondary hyperparathy-
roidism and osteoporosis may result from calcium deficiency, a more
common concern is the risk of developmental skeletal disease as a result
of calcium excess in large and giant breeds. Several factors influence the
frequency and severity of skeletal disease resulting from improper cal-
cium intake (Table 4). Because calcium homeostasis mechanisms are
poorly developed in the young, increasing dietary calcium results in
increased calcium absorption and retention. Foods for large- and giant-
breed puppies should provide 0.7% to 1.2% DM calcium in a moderately
energy-dense food (3.2-3.8 kcal (of metabolizable energy (ME) per gram
of DM). Phosphorus levels influence the utilization and balance of cal-
cium. The calcium:phosphorus ratio in the dog should be maintained at
1.1:1 to 1.8:1. Small-breed dogs are more tolerant of a wider range of
dietary calcium and phosphorus (see Table 3).
Potassium
The potassium requirement of kittens is dependent on the protein
content of the food and the effect of the food on acid-base balance.,
Urinary potassium loss is markedly increased when kittens are fed
high-protein or acidified foods. To avoid syndromes associated with
hypokalemia, kittens should not be fed highly acidifying foods, and
potassium allowances should be at least 0.6% DM intake.
Other Nutritional Factors
Diet Acidity
The urinary pH of growing kittens is lower than that of ad ult ats
fed similar foods. Presumably, the lower pH is caused by hydrogell ions
released during bone formation, which are excret d in to the lIriIW."
Excessive dietary acidification may re 'LIlt in poor bOlw mincnlii l',fl li ol1
and growth. Thi incr ascd I' SF OI1fK' to di('i'o!' nei lifi cn li()1l VOld l""(' H
tmtil kitt ns arc nl pf'() ill\ ;rl l' 1 I monlh, of .1)',(' . I 11 1( '1114 ho(d" 11 1)1 il, '
rt' cI ,foodH 1 1 ~ ' 1 1 prodlll '" 111 'ill l ll ' Y /1I1 V.lill, ' 1 1, ' 1/ Ihl ill I,: ' Will ' ll Ii'd 11 '( ' 1'
('hOII'I' , I I(l o d / 1111 rI II) ',I I YI'I ,.ill II IVI' 1\ II If "" 11 1' llli ll l pi I
NEW CONCEPTS IN PEDIATRIC NUTRITION
387
Table 4. FACTORS THAT INFLUENCE THE RISK AND SEVERITY OF
DEVELOPMENTAL SKELETAL DISEASE IN LARGE-BREED PUPPIES
Factor
Dietary calcium
Age of onset
Duration of excess
Phosphorus level
Caclium availability
Growth rate
Dietary energy
Feeding method
Protein content
High Risk!
Increased
Severity
> 3.0% dry matter
3-17 weeks
Weeks
> 1.4% dry matter
High
Rapid
Calorie-dense
Free-choice
No effect
Rationale
Puppies are unable to regulate calcium
absorption until they are several weeks
old. High calcium intake results in
passive gastrointestinal uptake,
hypercalcitonism, decreased
osteoclastic activity, and decreased
bone modeling.
Excess calcium between 3 and 6 weeks
(partial weaning) results in the most
severe abnormalities in calcium
balance; however, calcium is poorly
controlled through at least 17 weeks of
age.
Chronic intake during a susceptible age
results in hypercalcitonism and
parathyrOid atrophy.
The effect of high daily calcium excess is
exacerbated by concomitant high
phosphorus intake.
Certain calcium salts (e.g., calcium
carbonate) are more absorbable than
other sources. They can exacerbate
dietary calcium excess through
increased uptake.
Rapid growth requires greater bone
remodeling and increased mechanical
loading on bone and cartilage.
Energy intake directly affects growth rate
and indirectly alters various hormones
that stimulate chondrocyte
proliferation and differentiation and
bone formation and resoprtion. Fat is
the major contributor to diet energy.
Ad libitum food intake or free-choice
feeding allows excessive caloric intake.
Free-choice feeding should be avoided,
except with low-energy diets or
underweight puppies.
Protein content of the diet enhances
palatability and can promote increased
food intake. Without excess food
intake, protein does not increase the
ri ' k of developmental skeletal disease.
388 KIRK
Digestibility
The food should be palatable and highly digestible (i.e., apparent
DM digestibility> 80% and protein digestibility> 85%). The small
stomach capacity and relatively high energy demands of young
limit food intake capacity. Providing highly digestible foods maXimizes
use of the nutrients consumed and helps to avoid diarrhea.
Functional Foods and Nutraceuticals
The provision of specific nutrients or ingredients with functional
properties beyond that of meeting basic nutrient needs is currently
generating much interest. Recent findings establish of
altering body composition, immune competence, gastromtestmal func-
tion, and joint health in the growing animal through nutritional manipu-
lation. Although few studies are specific to the growing dog or cat, the
potential benefits provide exciting opportunities for enhancing the over-
all health of dogs and cats. In livestock, ingredients such as carnitine,
chromium, and conjugated linoleic acid repartition energy stores and
promote accretion of lean tissue over fat during the growth period. In a
recent study, puppies supplemented with carnitine were larger with
more muscle and greater bone mass and density than unsupplemented
dogsY Chromium supplementation of Beagle dams d':lring
and lactation resulted in slight increases in the body weight of nursmg
puppies but no specific benefit to the reproductive efficiency of the
dam.
2s
Chondroprotectives
Chondroprotective ingredients such as glucosamine and' chondroitin
sulfate are popular dietary supplements and food additives for the
support of joint health. Studies in adult dogs have shown mild to
moderate benefits with chronic supplementation. In puppies, intramus-
cular administration of glycosaminoglycan polysulfate from 6 weeks to
8 months improved coxofemoral joint congruity and reduced the occur-
rence of coxofemoral subluxation in treated pUpS.28 Controversy remains
over the bioavailability efficacy and mechanism of action of the various
glycosaminoglycans. Nonetheless, glycosaminoglycan therapy has re-
sulted in positive outcomes in dogs with certain orthopedic disorder .
The long-term benefit to growing puppies and kittens is yet to b'
determined.
Probiotics
Probiotics are microorgani sm Sli h ,Ii-! IlIlIIPdll llll', I'I )i, ' IlI lI 'I"1 ,I Ill '
yeasts fed to animals for th I uq or l'q ',ldlll lll l'. II \! , 11\1, '/1 11111 11 11 111 ' I ,Ii
the host. Th y hel ve' ht'('1) II Hi'd Ilwl'I II li' III II ' 11 111 1 IIlll l ril \, IIII II"II II v II
human beings and livestock to correct or normalize the microbial popu-
lation within the gut. More recently, probiotics have been found to aid
nutrient digestion and stimulate the immune system. Common organ-
isms supplied as probiotics include Lactobacillus sp, Bifidobacter sp, Strep-
tococcus thermophilus, and certain yeasts. The health-promoting effect of
Lactobacillus includes improved food digestion as a result of microfloral
enzymes that breakdown fiber, stimulation of antibacterial activity of
Peyer's patches, enhanced IgA secretion, and a potential protective effect
against allergies via modulation of the Thl and Th2 lymphocyte ratio.
2
Lactobacillus can also stimulate macrophage function and increase the
rate of apoptosis, a possible benefit in cancer protection.
2
One study has
reported alteration of gut microflora in response to probiotic therapy in
puppies.
3
The changes were short-lived, and specific health benefits were
not determined in that study. Anecdotally, probiotics seem useful in
managing diarrhea in response to antibiotic use in puppies and kittens.
Probiotics may also prove to be beneficial in intensive breeding opera-
tions or large kennels, where stress, overcrowding, or unfavorable hus-
bandry practices increase the likelihood of transmission of intestinal
pathogens. For most puppies and kittens, however, good husbandry and
sound nutritional practices are better options.
Prebiotics
Prebiotics are indigestible substances that provide substrate for the
growth of healthful bacteria in the intestinal tract. Examples include a
variety of oligo saccharides (e.g., inulin, fructooligosaccharides, manni-
noligosaccharides), resistant starches, and fermentable fibers. In addition
to selectively supporting the growth of nonpathogenic bacteria, fermen-
tation of prebiotics can help to reduce proliferation of gut pathogens,
increase calcium bioavailability, and increase levels of short-chain fatty
acids that serve as a major energy source for the gut muscosa. Certain
prebiotics are thought to have a direct immunomodulatory effect as
well as the ability to reduce hypertriglyceridemia and hyperinsulinemia.
Negative side effects are rarely reported, with most involving mild
gastrointestinal distress (i.e., flatulence, bloating, laxation).2,37 Data are
limited on the benefit of prebiotics in companion animals. Although
some studies have reported increased levels of Bifidobacterium and Lacto-
baciLl. us in dogs and cats after the feeding of lactosucrose,19 two other
:> tudi reported negligible changes after the addition of fructooligosac-
'hari d s in either dogs or cats.
41
,43 Regardless of any alterations in gut
mi 'l"oflon1 or int stinal 111 rphol.ogy, studies demonstrating a functional
hen ' fil on il111THl nC 'ta tul:l, gnstroin t tina l health, or disease resistance
il) pllPpil \ 11I Id I illl ' Ii , 111'( ' I(\ cl ing.
II 114 111'1' 11111111'" Iii 11 11 11 ,' II jll ', 'lrI ,' 1"'I'Ollllll t' lld Cl l'ions fo r th use of
III'li ' l tll l, lI 1()(l tl lI ill 111 1'/11'111 l' I'IIII Ii II )I' II ll1d il'H II IIVI'
1 11 '1 IlI il lI ll I)', 1111111 1'111 '" 1111 1'1' 1\ ,1111 II\I Y 111\1 11',11 ' 1(II WIIIlIl / """ 111 1'. 1',I'(lWlhi
11 ,I W" Vil l, 11 11'1 11 1'11 111 11,\ ''1 111111 ' '1 11111 d l ll'IHII' 1111 '\"' 111 1111 , IIIIIII II II I', I'V Iy
' 111 '1"" 1,1 III ' .1 ,, 11'1111111""
390 KIRK
Feeding Plan
A food that is complete and balanced for growth as demonstrated
by AAFCO or similar animal feeding trials should be fed until puppies
and kittens reach adulthood (10-12 months). Unmoistened dry foods and
moist foods are appropriate. Semimoist foods that excessively acidify the
urine (i.e., <6.0 pH) should be avoided until skeletal growth is com-
pleted. Identification of health risks such as obesity or developmental
bone disease in large-breed dogs necessitates a scrupulous review of
foods provided for growth. Treats are unnecessary but may be fed in
small quantities (i.e., <10% of the daily intake). Milk is commonly
offered to kittens as a treat. Amounts offered should be limited, because
intestinal lactase levels decline shortly after weaning.
All feeding methods are appropriate for growing kittens. Free-choice
feeding is preferred in kittens younger than 5 months. Conversely,
regulation of excessive food intake by meal-feeding twice daily is pre-
ferred in dogs. Free-choice feeding and time-limited feeding are not
always satisfactory in controlling food intake. Fresh water should be
available at all times.
To determine the amount to feed, energy needs may be calculated
based on age-appropriate requirements or determined using various
feeding guides.
s
,22 After an initial food and amount is chosen, weight
gain and body condition should be monitored to tailor the feeding
amounts to individual pets. Poor weight gain, hair coat, and muscle
tone along with inactivity and excessive crying are some of the signs of
inadequate nutrition. A BCS above 3 (5-point scale), bloating, and diar-
rhea can be signs of overnutrition. All changes in appetite, body condi-
tion, attitude, or feces should prompt a review of the diet and feeding
methods so that early corrections can be made.
SUMMARY
The ultimate goal of feeding puppies and kittens is to ensure a
healthy adult. The specific objectives, however, are to optimize growth,
minimize risk factors for disease, and achieve optimal health and longev-
ity. Minimum nutrient requirements are easiest to determine in growing
animals using growth rates as the nutritional marker. These level en u r
a minimum level of good health in most animals. Never th I s, th '
optimal nutrient levels for growth may not represent the optima l. I 'v ,It;
for other physiologic functions (e.g., immune function, di as' prevt' n-
tion, behavior). Nutritional requirements for growing <1 1 imnls nrc lwin);
redefined using physiolo ic param ters oth ' I' tho n v; r()w I h 1'0 I (' .
The most common < L1S 5 of malnulrilion In Ill<' 1l(' () I) li l' (1(' 111 10 111'
protein-en rgy defi , it' llI ' or !)v('nJlllrilloll ill III(' 111'1"1 11 111. 11 pI I' II)!i.
mi rOn UITil' nl nhnol' ll wlilil' ll [II'(' l'I ' I:ll lvI' ly 1111< '("11111'"1 N,'vI' I'lh"I" 1 , dll '
11111rilinl)1I1 :1\ 11111 1 dill ' II)'. 111
'
1)1 11 11 11 1 11( ,,, .01(11'1111 '"1 II " ". IIY II II I 1111"1 '1 fIj I '
11l'111 ' i" llI'i'wlilll 1111" III III IVI\ ,1 1111 11(111) 1, 11I1j' 11I 1 II III 11111 1 111'111 11 111 111 III
tailor the nutritional plan to the individual at each life stage and to
remember that pediatric nutrition should start before conception.
References
1. Association of American Feed Control Officials: Official Publication, 2000
2. Bengmark S: Bacteria for optimal health. Nutrition 16:611-615,2000
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128(suppl):2730S-2732S, 1998
4. Bouchard G, Plata-Madrid H, Youngquist RS, et al: Absorption of an alternate source
of immunoglobulin in pups. Am J Vet Res 53:230-233, 1992
5. Buffington CA, Rogers QR, Morris JG: Effects of age and food deprivation on urine
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6. Burkholder WI, Swecker WS, Jr: Nutritional influences on immunity. Semin Vet Med
Surg (Small Anim) 5:154-166, 1990
7. Casal ML, Jezyk PF, Giger U: Transfer of colostral antibodies from queens to their
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Remillard RL, et al (eds): Small Animal Clinical Nutrition, ed 4. Marceline, MO,
Walsworth Publishing Company, 2000, pp 213-260
9. Dieter JA Steward DR, Haggarty MA, et al: Pregnancy failure in cats associated with
long-term dietary taurine insufficiency. J Reprod Fertil SuppI47:457-463, 1993
10. Fascetti AI, Morris JG, Rogers QR: Dietary copper influences reproductive efficiency
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1{" IIIIII II I'd 1, 1" 1,1 11 1 (. ,dil): Hl1 l1 dl 1\ /l III lI tI ( '11/1 1"11 1 Nldril l(ll1, vd 4. Mnr ' line, MO,
WltI ,IWllll li I'li id ' dllli', I'." 'II 'II II \I, ' 1111111, I'l ' WI
') I, I "" 1', 11 \1 111 I rvt A 11 1' 111 1 III It! (I I 1,1111 I IIi ', i', 11I 1 !lilt' ,11111 Iil l 1I11 ' III I'lI lI ll llI III 1,1I, 'I IIIII ,,. ill/
i\ III WIII 1( ' 1,".1,,11 111 '1 '11111 11 III I "II' I 1111 1 li lli'" 1'11111
' I 1111 1"1 1111 f\ 11I 1I1I I I r-, lll d dd I, " 'id 1111111 ,1111 1' III " I'IIIIII lliI 111 11'111> II I I V." H"II
1', I 1',1
,
11' ,11 1'11 11
392 KIRK
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Address reprint reques /:$ 1'0
Claudi.a A. Kirk, DVM, I hi )
Hill's Science and "[: hn logy Ill,' I'
Post I'n l30x I )fitl
Top '1<0, KS 6660 I- I WK
CONGENITAL AND INHERITED
RENAL DISEASE OF
SMALL ANIMALS
Deborah S, Greco, DVM, PhD
Normal pediatric patients have immature kidneys, impaired renal
function, and decreased renal blood flow and glomerular filtration rate
until approximately 10 weeks of age.
3
The immaturity of the kidneys
leads to clinical implications in the treatment of pediatric veterinary
patients, particularly when renal compromise is present. Pediatric pa-
tients are more susceptible to dehydration and overhydration. Similarly,
drugs eliminated by or toxic to the kidneys should be used cautiously
in pediatric patients.
Congenital renal diseases are present at birth and may be deter-
mined genetically; familial renal disorders occur in related animals with
a higher frequency than would be expected by chance, and frequently
are inherited. The most common familial disorders in cats and dogs
include renal amyloidosis, renal dysplasia, polycystic kidneys, basement
membrane disorders, and tubular dysfunction (Fanconi's syndrome),
This article alerts the veterinarian to commonly observed congenital and
hereditary conditions of the kidneys in small animals.
FUNCTIONAL ANOMALIES
Fanconi's Syndrome
Fanconi's syndrome, which results in impaired renal tubular reab-
sorpti on of amil10 acids, glucose, and electrolytes, has been described in
Ji l'( lIll Il lI' 1)(' pl1 l' ll1w l1l ,, 1' ClIll k: 1I ( '(l II ('ge (l r Veteri na ry Med ici ne and Biological
HI'i I" It '!')I, V" I, II'lI dll :-1 111 1, ' 11111 " "lil l \" P( lI ' l ( 'lI ll i ll H, ('\l II Il'lI d"
IIIIH III 1\ 111 ' 11 \ ' 11\ 1\ /1 I\) I tvl 1\ I l ' I I\( ' I'It '11
\ I II I I I I. "I I' II 111111 IliI
394 GRECO
Basenjis, Norwegian Elkhounds, Schnauzers, and Shetland Sheepdogs.
3
Clinical signs develop between 1 and 7 years of age, and are consistent
with chronic renal failure. Urinalyses reveal glucosuria, mild proteinuria,
and low urine specific gravity. Diagnosis is based on breed, clinical signs
of polydipsia, polyuria, and laboratory abnormalities of normoglycemic
glucosuria, aminoaciduria, nonanion gap metabolic acidosis, and hypo-
kalemia.
3
\
Cystinuria
Primarily a disorder of male dogs, including Irish and Scottish
Terriers, cystinuria has been reported in over 60 breeds.
3
There is a risk
factor for the development of cysteine stones; however, most dogs show
no clinical signs related to the disorder.
Hyperuricuria
Unlike cystinuria, hyperuricuria is associated with prediposition to
urolithiasis in adulthood. The disease is transmitted as an autosomal-
recessive disorder in Dalmations.
3
Nephrogenic Diabetes Insipidus
This disease is described in puppies with severe polydipsia and
polyuria, nocturia, and poor growth. Urine-specific gravity ranges from
1.002 to 1.005. Diagnosis is based on clinical signs and response to
cautious water deprivation and antidiuretic hormone administration. '
Therapy consists of strategies to reduce the severity of polydipsia and
polyuria, such as salt-restricted diets, and the diuretic chlorothiazide.
Primary Renal Glucosuria
Primary renal glucosuria has been reported in Scottish Terriers,
Norwegian Elkhounds, and mixed-breed dogs.
3
The dogs are asymptom-
atic. Diagnosis is based on persistent glucosuria in the face of eu ly-
cemia.
STRUCTURAL ANOMALIES
Renal Agenesis
If both kidn ys ;11'1 ' 11 ( ((' ('\ (' <1 , "" II ,tI 01 1',1'11 1' 1111 I,,"d: 11' 1'1' 1'111 ,111 11 , 11'11 111
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CONGENITAL AND INHERITED RENAL DISEASE OF SMALL ANIMALS 395
because of compensatory hypertrophy of the contralateral kidney. This
condition is familial in Beagles, Shetland Sheepdogs, and Doberman
Pinschers. Clinical findings include an inability to detect both kidneys
on palpation or radiography. This condition is often associated with
agenesis of the ureter and abnormal or absent vas deferens, epididymus,
or uterine horns. '
Renal Hypoplasia
Hypoplastic kidneys are composed of histologically normal neph-
rons; however, renal mass is reduced. Clinical findings and therapy
depend on the extent of involvement with bilateral disease, carrying a
much poorer prognosis.
Renal Dysplasia and Aplasia
Disorganized parenchyma and segmental or focal areas of immature
or anomalous structures in an otherwise normal kidney characterize
renal dysplasia. Renal aplasia refers to a more severe generalized form
of dysplasia that affects the entire kidney. These conditions are observed
in male and female puppies of many breeds (Table 1) and rarely in
kittens. 1, 3-5, 8, 15 Puppies and kittens with renal dysplasia are often clini-
cally normal for extended periods of time before signs of chronic renal
failure ensue. The age of onset of clinical signs range from 4 weeks to 5
years; however, most are seen before 2 years of age.
Early subtle signs of chronic renal failure include selective appetite,
poor growth and haircoat, weight loss, nocturia, and mild to moderate
polydipsia and polyuria. Abdominal palpation may reveal small irregu-
lar kidneys and occasionally signs of rubber jaw, which is characterized
by symmetric enlargement of the maxilla and mandible, bone pain, and
soft pliable mandibles. Pathologic fractures also may be observed.
Laboratory findings characteristic of chronic renal failure include
azotemia, hyperphosphatemia, metabolic acidosis, isosthenuria and nor-
mocytic, normochromic anemia. Renal secondary hyperparathyroidism
may result in hypercalcemia or more commonly hypocalcemia. Low
urine specific gravity, inactive sediment, and mild to moderate protein-
uri.a are observed on the urinalysis. Diagnosis is based on signalment,
lini.cal findingsl and laboratory findings; however, renal biopsy is re-
g II i I' 'd for d fjni. tiv diagnosis. Primary lesions of the kidneys include
fvl;d glol11 ' 1'1I1i or I'ubulc , persistent mesenchyme, persistent metaneph-
ric duelH, [I I I iell l lll blll Hr " pith ' Iiu m., and dysontogenetic metaplasia.
3
,5
'1'\1 (' rllj1I' lIli l' inl vl'VVllli OIl i,' IIll' S,IIIW as for adult dogs with chronic
1'\' 11 11 1 ,, " 111 1'\ '; IU IWI'VI'I ', ~ IlI" ' i" ,1I1 l' llli ll ll , ll(Ildd lw I <l id to th metabolic
I li' l II III II I 1 1\ '11 11 1 11'1 '1 II II I.II 'Y Il ypl' I'I'ol l'. illl mi d l:l lll , ,Inti H Htt' tni hypcrt'lI-
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)',III\VIIII', .I II)', IlIld, III ' d Ii 11111.1)'",d '11\1' 111111 1111 l'I'I 'll ll llllI ' IHIt lit i l l) ',
(f)
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CONGENITAL AND lNHERITED RENAL DISEASE OF SMALL ANlMALS 397
adult dog or cat food in these patients. Phosphorus should be restricted
by using a dietary phosphorus binder; the goal is to keep the serum
phosphorus in the normal range.
9
Calcitriol therapy (2-3 ng/kg per
day) may be helpful in this regard; alternatively, calcium carbonate
supplementation can be used. Finally, the use of angiotensin-converting
enzyme inhibitors (dogs) and calcium channel blockers (cats) is sug-
gested to ameliorate systemic hypertension.
9
Metabolic acidosis can be
addressed with oral bicarbonate therapy.9
Renal Ectopia and Fusion
Ectopia is the congenital malposition of one or both kidneys. Renal
fusion is the congenital union of normally lateralized kidneys; fused
kidneys may assume various shapes, such as horseshoe kidneys.
Duplex and Supernumerary Kidneys
Puppies may present with one or more accessory kidneys. If the
supernumerary kidneys are affected by pyelonephritis, surgical resection
is recommended.
Primary Renal Neoplasms
Several renal malignancies, including nephroblastoma, lymphosar-
coma, carcinoma, and undifferentiated sarcoma, have been described in
puppies and kittens, Surgery and chemotherapy may be recommended,
although prognosis often is guarded in the case of nephroblastoma
because of widespread metastasis. Hereditary multifocal renal cystade-
nocarcinomas have been reported in the German Shepherd dogP
Glomerulopathies
Proteinuric renal disease is the hallmark of glomerulopathies, in-
I.udin congenital and inherited glomerulopathies. Congenital glomer-
Ldopathi 'S h av b n describ d in the Samoyed, Bull Terrier, Doberman,
IIngli l) h 0 I 'I" GI,i I, Rollw 'iI and Newfoundland.
3
, 5, 10-12, 16 Most
I 1I1 I i(\ ' li nd I illl' nH w ilh t l i . tj I I" nt with signs of chronic
I" ' nnl f:lillll'l' t'i illl('1' Iholll wi lli {)V(' I'I IIl' l hl"o li s ndl"om (peripheral
(.\11' 1"01 , II 1>I' 1'I ' 11\ )1" I,II ' I I ,I"lI illl , l ,r"" ,I IIII I'i I' , .\IHI h pon l hutni l111ri ).
III !'" IIIII y,dl, 1\ldl ' 1" "" '1 , l llld 1':11) 1, 11111 ( ',,1'11'1 ' Il l(' illi1l'r
II,," (\ Iild' l'd d!l lil 11 11111 )',1' 11 ,1) dl ' l l'l l 11 "lI dl li III " " ,111 1' 11111(11) II I Ihl' I YI 'I'
I V l 'II I1 ' i)',I ' 11 111 11 1 111111 1' 1'1 ' II,, ' 1', I'IIIII ' l lti ,1I " 'Ioill II \, 1" I II' lIlt ' lIl 11\1 ' 111
1' 111111 ' I iii I "I,ti, . ,j"I'. ""l l tI" II l1 i ,til",II" 1111111 11I " IIII ' ldl , 111 11 11 1O' III ,tI"
398 GRECO
dogs (X-linked). Affected dogs develop persistent proteinuria as early as
2 months of age and as late as 2 years of age. The affected male dogs
may develop signs of chronic renal failure as puppies and may die at 8
to 16 months of age. Affected female dogs may have mild proteinuria
in middle age. Urinalysis may reveal moderate to severe proteinuria and
glucosuria or hematuria. Bull Terrier hereditary nephritis is a genetic
disorder of Bull Terriers that is characterized by abnormalities of the
glomerular basement membrane. It is similar histologically to the Sa-
moyed glomerulopathy and is inherited as an autosomal dominant.
Doberman Pinscher familial glomerulonephritis is observed in pup-
pies as young as 6 weeks, or may not become apparent until 8 years of
age.
16
Male dogs seem to be affected earlier than female dogs. Urinalyses
reveal persistent marked proteinuria and, variably, glucosuria. Affected
dogs also may have concurrent unilateral renal and ureteral aplasia.
Diagnosis of hereditary glomerulopathies is based on signalment, clinical
signs, and renal biopsy. Therapy for chronic renal failure, including
dietary phosphorus restriction, control of systemic hypertension, and
acidosis, may slow the rate of progression of disease.
Amyloidosis
Renal amyloidosis, the familial form, occurs in young related
Abyssinian cats and. Chinese Shar Pei dogs.
6
, 7 The condition is recog-
nized between 1 and 6 years of age. Clinical signs are those of chronic
renal failure. Surprisingly, proteinuria is an inconsistent finding in af-
fected animals. The medullary interstitium is the primary site of amyloid
deposition in this disease, as opposed to the glomerulus in acquired
renal amyloidosis. Diagnosis is based on breed, dinical signs, and renal
biopsy.
Polycystic Renal Disease
This disorder is characterized by formation of multiple cysts
throughout the renal medulla and cortex.
2
,14 Affected kidneys are en-
larged and lobulated. Puppies and kittens of various breeds may be
affected. A strong familial tendency occurs in Cairn Terriers, Persian
cats, Beagles, and domestic long-haired cats. In Cairns, Persians, and
domestic long-haired cats, hepatic biliary cysts also are observed. Cl ini
cal signs include progressive abdominal enlargement, renomega ly, 21 1 d
signs of chronic renal failure. Diagnosis is based on r nal ultrasound
and biopsy.
References
1. Aul"rnn (i(. MOI'1I 11l I I ~ ; , ) ,11111 11 ,,1,1 : d', 1,1 ,iI 11I 11' lil l,' 1I 'l lI iI .l 1I 1I'II/H' II I 1'o01d" 11 ,, 'I I Ii 'v l ' l ll
')'w,' '''' ' ,'11 111 '11 ( 1'i1{,1 1'111 I ) 11\ 1\ 1 '1111 " II I " 'I" 1'I' It ,
CONGENITAL AND INHERITED RENAL DISEASE OF SMALL ANIMALS 399
2. Biller DS, Chew DJ, DiBartola SP: Polycystic kidney disease in a family of Persian cats.
JAVMA 196:1288-1290, 1990
3. Bovee KC: Genetic and metabolic diseases of the kidney. In Bovee KC (ed): Canine
Nephrology. Philadelphia, Harwell Publishing, 1984, pp 339-354
4. Brown CA, Crowell WA, Brown SA, et al: Suspected familial renal disease in Chow
Chows. JAVMA 196:1279-1284, 1990
5. DiBartola SP: Familial renal disease in dogs and cats. In Ettinger SJ, Feldman EC (eds):
Textbook of Veterinary Internal Medicine, ed 5. Philadelphia, WB Saunders, 2000,
pp 1698- 1703
6. DiBartola SP, Benson MD, Dwulet FE, et al: Isolation and characterization of amyloid
protein AA in the Abyssinian cat. Lab Invest 52:485-489, 1985
7. DiBartola SP, Tarr MJ, Webb DM, et al: Familial renal amyloidosis in Chinese Shar Pei
dogs. JAVMA 197:483-487, 1990
8. Eriksen K, Grondalen J: Familial renal disease in soft-coated Wheaten Terriers. J Small
Anim Pract 25:489- 500, 1984
9. Finco DR, Brown SA, Barsanti JA, et al: Recent developments in the management of
progressive renal failure. In Bonagura JD (ed): Kirk's Current Veterinary Therapy.
Philadelphia, WB Saunders, 2000, pp 861-863
10. Hood Jc, Robinson WG, Huxtable CR, et al: Hereditary nephritis in the Bull Terrier:
Evidence for inheritance by an autosomal dominant gene. Vet Rec 126:456-459, 1990
11. Jansen B, Valli VE, Throner P, et al: Samoyed hereditary glomerulopathy: Serial clinical
and laboratory (urine, serum biochemistry, and hematology) studies. Can J Vet Res
51:387-391, 1987
12. Lees GE, Wilson PD, Helman RG, et al: Glomerular ultrastructural findings similar to
hereditary nephritis in five English Cocker Spaniels. J Vet Intern Med 11:80-85, 1997
13. Lium B, Moe L: Hereditary multifocal renal cystadenocarcinomas and nodular derma-
tofibrosis in the German Shepherd dog: Macroscopic and histopathologic changes. Vet
Pathol 22:447-455, 1985
14. McAloose D, Casal M, Patterson DF, et al: Polycystic kidney and liver disease in two
related West Highland White Terrier litters. Vet Pathol 35:77-81, 1998
15. Minkus G, Breuer W, Wanke R, et al: Familial nephropathy in Bernese Mountain dogs.
Vet Pathol 31:421-428, 1994
16. Picut CA, Lewis RM: Juvenile renal disease in the Doberman Pinscher: Ultrastructural
changes of the glomerular basement membrane. J Comp Pathol 97:587-596,1987
Deborah S. Greco, DVM, PhD
Department of Clinical Sciences
College of Veterinary Medicine and Biological Sciences
300 W. Drake
Colorado State University
Fort Collins, CO 80523-1601
e-mail: dgreco@Vth.colostate.edu
DIAGNOSIS AND TREATMENT OF
JUVENILE ENDOCRINE
DISORDERS IN PUPPIES AND
KITTENS
Endocrine and metabolic disorders affecting puppies and kittens
from birth until 6 months of age may manifest as clinical problems
related to growth, water metabolism (polydipsia or polyuria), or as
episodic weakness. Endocrine and metabolic disorders which affect stat-
ure, such as pituitary or hypothyroid dwarfism, present to the veterinar-
ian for the assessment of delayed or aberrant growth. On the other hand,
juvenile-onset diabetes mellitus and diabetes insipidus cause excessive
thirst, urination, and difficulty in house-breaking.
PITUITARY DISORDERS
Central Diabetes Insipidus
Diabetes insipidus is a disorder of water metabolism characterized
by polyuria, urine of low specific gravity or osmolality, and polydipsia.
1

17. 18 It is caused by defective secretion of antidiuretic hormone (i.e.,
central diabetes insipidus) or by the inability of the renal tubule to
respond to antidiuretic hormone (i.e., nephrogenic diabetes insipidus).1.
17. 18 Deficiency of antidiuretic hormone (vasopressin) can be partial or
om.pl teo Central diabetes insipidus is characterized by an absolute or
1I"UI1' 111<' I )" 1',1,'11111 ' ,,1 of ' 1111 i<'n l , ' d l' IW" H, ( 'ol l('ge of V t r inary Medicine and Biological
: vI, , lI'l 'I , ( 'plo,' ,ti o :11,11 " I l ,d 1" 'l il l y, Jlorl C(l IIlI1H, ' olOl'l1do
.\ I r-. I \ 11 ~ ~ I M I I ' l l ( 11 '1
1
402 GRECO
relative lack of circulating antidiuretic hormone, and is classified as
primary (idiopathic and congenital) or secondary. Secondary central
diabetes insipidus usually results from head trauma or neoplasia. Cen-
tral and nephrogenic diabetes insipidus are rare disorders.
Central diabetes insipidus may appear at any age, in any breed,
and in either gender; however, young adults (6 months of age) most
commonly are affected. The major clinical signs of diabetes insipidus are
profound polyuria and polydipsia (more than 100 mL/kg per day;
normal, 40 to 70 mL/kg per day), nocturia, and incontinence usually of
several months' duration. The severity of the clinical signs varies because
diabetes insipidus may result from a partial or complete defect in antidi-
uretic hormone secretion or action. Other less consistent signs are weight
loss, because these animals are constantly seeking water, and dehydra-
tion.1, 12, 17, 18
Routine complete blood count (CBC), serum biochemical, and elec-
trolyte profiles are usually normal in animals with diabetes insipidus.
Plasma osmolality often will be high (> 310 mOsm/L) in central or
nephrogenic diabetes insipidus because of dehydration. Puppies with
primary polydipsia often will exhibit low plasma osmolality 290
mOsm/L) because of overhydration. When abnormalities, such as slightly
increased hematocrit or hypernatremia, are present on initial evaluation,
they are usually secondary to dehydration from water restriction by the
pet owner. In diabetes insipidus, the urinalysis is unremarkable except
for the finding of a persistently dilute urine (urine specific gravity
1.004-1.012).1, 17,18
Diagnostic tests to confirm and differentiate central diabetes insip-
idus, nephrogenic diabetes insipidus, and psychogenic polydipsia in-
clude the modified water deprivation test or response to antidiuretic
hormone supplementation. The modified water deprivation test is de-
signed to determine whether endogenous antidiuretic hormone is re- \
leased in response to dehydration and whether the kidneys can respond
to antidiuretic hormone. The more common causes of polyuria and
polydipsia should be ruled out before this procedure. Failure to recog-
nize renal failure before water deprivation may lead to an incorrect or
inconclusive diagnosis or may cause significant patient morbidity.I, 12. 17, II!
Pituitary Dwarfism
Pituitary dwarfism results from destruction of the pituitary gle nd
by a neoplastic, degenerative, or anomalous process. It may basso int(( I
with decreased production of other pituitary hormon s, il III ling III
roid-stimulating hormone (TSH), adreno orti otrOI i hor11101')(' (/\(''1' 11 ),
luteinizing hormone, Folli 1 - timul ating hormone, nnd !'I'OWlh I l( ) 1'1l 10 1 ll' .
Pituitary dwarfjsm i::l m().'t common ill ;<'1' 111 1111 , '11I'plll'I'd .Il l!''; l},,"d :>
to 6 months. OI'lWI" 1I((('<' I,' d hJ'(l('dtl il l<' lllIl , ( 'IlI 'IWI II Il 1\" ,11 ' dO/ ',i1,
Toy l) in,'1ciwl" I IlIhl W,' 1I I1 II 'I) II"I '}, Tit" d 1' 1111' II lil ll' l II d 1/1 II I "'1 iii '
.I1i1o 01111111'('1'1'1 1, 11 '11 I II (:"1 11 11 111 : :lII ' III\; ' ld dll)" , lIlId 11, '111 1 1 111 '1 dll "
III ' I I' Y II 1' lI lld' I"I I"" I,11 ' 1111' II 1"1 '" 1\11 101 ,,, 111 1 'II I t',11I 1,111111111111\'
JUVENILE ENDOCRINE DISORDERS IN PUPPIES AND KITTENS
403
dwarfism are slow growth noticed in the first 2 to 3 months of life and
mental retardation that usually is manifested as difficulty in house-
training.
2
Physical examination findings
dwarfism, retained puppy haircoat, hypotOnIC skm, trunkal alopeCla,
cutaneous hyperpigmentation, infantile genitalia, and delayed dental
eruption. Clinicopathologic features include eosinophilia, lYI?phocytosis,
mild normocyctic normochromic anemia, hypophosphatemIa, and occa-
sionally hypoglycemia resulting from secondary adrenal insufficiency.2
Differential diagnoses include other causes of stunted growth, such as
hypothyroid dwarfism, portosystemic shunt, diabetes mellitus, hypera-
drenocorticism, malnutrition, and parasitism.
lO
Diagnosis is made by
measuring serum growth hormone concentrations (no longer commer-
cially available) or serum somatomedin C (insulin-like growth factor 1).2
The advantage of insulin-like growth factor 1 is that it is not species-
specific. There is a usually a subnormal response to exogenous TSH and
ACTH stimulation tests; furthermore, endogenous TSH and ACTH are
decreased in affected dogs because of panhypopituitarism.
PANCREATIC DISORDERS
Juvenile Diabetes Mellitus
Diabetes mellitus, a common endocrinopathy of adult dogs, rarely
is observed in puppies. All reported cases of diabetes mellitus in dogs
and cats have been type I or insulin-dependent diabetes mellitus.
6
Many
canine juvenile cases of diabetes mellitus, as in humans, are believed to
have a viral cause. Dogs suffering from juvenile diabetes mellitus usually
present between 3 and 6 months of age. A genetic basis for diabetes
mellitus is suspected in the Keeshonden, and predisposed breeds for
diabetes mellitus include Puliks, Cairn Terriers, miniature Pinschers,
standard poodles, miniature schnauzers, dachshunds, and beagles.
6
In young dogs and cats, stunted growth often is associated w.ith
diabetes mellitus because of calorie deprivation. In dogs, progressIve
polyuria, polydipsia, and weight loss develop rapidly usually over sev-
eral weeks. Another presenting complaint of diabetes mellitus in puppies
i acute onset of blindness caused by cataract formation. Diabetic cata-
racts can develop rapidly, and the owner may notice that the puppy
suddenly i bumping into furniture and other obstacles. The most com-
mon phy i a.l examinati on findings are dehydration and muscle wasting
or thin body onditi on. d di.abetic animals may have concurrent
IlI1dl'rI ing li sol'(kl':-l, !-l li ch (IS ' xo rin' pancreatic insufficiency, particu-
1,, 1'1 Ilms\' wilh jll Vt' llil l' 1l 1l 1'I \'l di nbel t' s.H /\ di agnos is of di abetes mellitus
/: h()lIld hi ' "il li l,d ,H I 1111 ' 111 \' 11' 1)(,1' nll ' li"iI'ill Higns coml , li bl ' with di be-
11'11 11 11' 111111, , 11111 I'V11l " II I'I' il l lil ld111)', II Yl lI' l')', IYi 'I' IlILI IIIH I ).J \'iI, lll'i n,
' 1'1'1, ,111111 ' 111 " I jll\" ' l tl ll ' 1Il , tl lI'li' / 11 11' 1111 1/ "II Y 11i' 1'111"11'11)"1 11) ', , I\\' I',)II H"
1111'11' 11 11111 11 11 1 il l l ' )', 11 11\ III)', lil l ' .II , 11 1111111 11 ' '11111 ' 11 11 ' 111 ' 1I111y 1'11.
11
1)',"
dill 111t, ill , 1111 II " ,lih 11 1 \ ' ill, ll \ 111 1 1 11 11 ' 1IIIIIil11 11 I1 1,,11 / II"" III
11i'1\ 11t1 t', I I 1 " '1, 1 ,.1.1 '''' '\ 11 11 1111.1 1"'1' 1'" I lilt II '1 I I/ I t', 1"111, IlIldlli
404 GRECO
subcutaneously (SQ) twice daily. The puppies must be fed 3 to 4 times
daily, and regular insulin must be administered at a dose of 0.1 to 0.2
U /kg SQ with meals. A growth formulation, rather than high-fiber
foods, should be fed to growing puppies and kittens. Caloric require-
ments should be calculated for a growing animal.
THYROID DISORDERS
Congenital Hypothyroidism
Congenital hypothyroidism is a common endocrine disorder in hu-
infa.ntsP In contrast, there are few reports of congenital hypothy-
rOIdIsm m dogs and cats.4, 10, 14, 15,20 Only 3,6% of the cases of canine
occur in dogs younger than 1 year of age,15 Congenital
hypothyrOIdIsm may be caused by aplasia or hypoplasia of the thyroid
/?iland, thyroid ectopia, dyshormonogenesis, maternal goitrogen inges-
tion, maternal radoactive iodine treahnent, iodine deficiency (endemic
autoimmune hypopituitarism, isolated thyrotropin
defICIency, hypothalamIc dIsease, or Isolated thyrotropin releasing hor-
mone (TRH) deficiency,
9
Because thyroid hormone secretion is essential for normal postnatal
of the .nervous skeletal systems, congenital hypothy-
IS charactenzed by dIsproportionate dwarfism, central and pe-
npheral nervous system abnormalities, and mental deficiency.13 Signs of
adult-onset hypothyroidism, such as lethargy, inappetence, constipation,
dermatopathy, and hypothermia, also may be observed.
Congenital hypothyroidism, regardless of cause, has characteristic
historical and physical examination features, Dogs and infants have a
of large birth weight (in babies, a result of prolonged gestation)
IS followed by aberrant and delayed growthP In puppies, the first \
SIgnS of abnormal growth occur as early as 3 weeks after birth, and
a!='n?rmal body are evident by 8 weeks of age- which is
to which are normal at birth but, if undiagnosed,
charactenstIc SIgnS by 6 to 8 weeks of ageP Historical finding
m puppies with hypothyroidism, such as lethargy, mental dullness, wea k
nursing, delayed dental eruption, and abdominal distention, a1 0 ar
observed in children with hypothyroidism.
13
. features. of dwarfism in children include hypo-
toma, umbIlical herma, skm mottlmg, large anterior and po t ri r fonta-
nels, macroglossia, hoarse cry, distended abdomen, dry skin, joun.li "
pallor, slow deep tendon reflex, delayed dental eruption, and hYI other-
mia?' 11, 13, 21 In dogs with congenital hypothyroidi sm, hypotoniCl ,
glossia, distended abdomen, dry skin, delay d d ntal ' 1"1'1 lion, .111(1
hypothermia have been d s rib d (Fi g, '1 on I 2).,1, (', II, 'I, II 1" , " II 1$ '1' :11 1111"
dogs develop mor r;:q idl y nn I be('OII; <' w{' ighl bl'n ril1)', '$(111( '1' Ih,lll
111.11nan infants, g; dl Ilhl101'Ill :liil i(" .lIlt! di :4 prOI 1( 1I 'll(llloll, ' dW.1 I'll: III 111 '1'
f(', lIIII 'I't III 1'111"111" 1'()II) ', I'IilI.Ji hYllillll Vl'll ld 11 111 MtdJ.II 'I, II VIIII
1'1,111 111 , II hl'llll1l 111 1111' , Iliitl II III }', I' 1'11 1111111111 )', 1(111 )', 111 ' 111 1' Plll l' " I 11' 1'
JUVENILE ENDOCRINE DISORDERS IN PUPPIES AND KITTENS 405
Figure 1. Standard Schnauzer littermates demonstrating differences in physique between
euthyroid (right) and congenitally hypothyroid (left) puppies.
sequelae of untreated hypothyroidism in humans.
13
Similar facial fea-
tures, such as broad maxillas and macroglossia, have been observed in
affected puppies. In humans, delayed eruption of permanent teeth is
observed in untreated individuals with congenital hypothyroidism; de-
layed dental eruption is characteristic of puppies with hypothyroidism
diagnosed after 4 months of age. In humans and in dogs, macroglossia
and effusions of the body cavities are the result of myxedematous fluid
406 GRECO
accumulation.
9
, 13 Puppies with hypothyroidism often exhibit haircoat
abnormalities, including retention of the puppy haircoat and thinning.
Thyroid hormone is crucial for proper postnatal development of the
nervous system. Infants with untreated hypothyroidism exhibit poor
coordination and speech impediments later in life.1
6
Delayed treatment
often results in low perceptual-motor, visual- spatial, and language
scores in children with congenital hypothyroidism. If treatment is de-
layed beyond 4 to 6 months in human babies, intelligence irreversibly is
affected, and mental retardation may ensue. Mental retardation is also
likely in puppies with hypothyroidism; however, no objective evidence
of delayed or aberrant intelligence is available to assess affected puppies.
Because the bulk of cerebellar development occurs postnatally, Purkinje
cell growth also is affected significantly by congenital hypothyroidism.
19
In humans and puppies, if treatment is delayed, signs of cerebellar
dysfunction, such as ataxia, are observed.
9
, 19
Skeletal abnormalities, such as delayed maturation and epiphyseal
dysgenesis, are the hallmark of congenital hypothyroidism.
23
Delayed
epiphyseal maturation is observed in the vertebral bodies and long
bones of affected puppies. Epiphyseal dysgenesis, which is characterized
by a ragged epiphysis with scattered foci of calcification, is observed in
humans and dogs with untreated congenital hypothyroidism (Fig. 3A
and B) . Normal epiphyseal development proceeds from a single center;
however, in hypothyroidism, thyroid deficiency leads the development
of multiple epiphyseal centers, each with its own calcification progres-
sion. Disorderly epiphyseal calcification leads to secondary arthropathies
in children suffering from untreated congenital hypothyroidism.
23
Clinicopathologic features of congenital hypothyroidism include hy-
percholesterolemia, hypercalcemia, and mild anemia. Hypercholesterol-
emia develops in congenital and adult-onset hypothyroidism because of
decreased hepatic metabolism and decreased fecal excretion of choles- '
terol. Hypercalcemia secondary to congenital hypothyroidism is the
result of decreased renal clearance and increased gastrointestinal absorp-
tion of calcium.
22
Decreased thyroid hormone stimulation of erythropoi-
etic precursors results in a mild normocytic, normochromic anemia in
some puppies suffering from hypothyroidism.
s
Thyroxine is essential for the proper transcription, translation, and
secretion of growth hormone by pituitary somatotrophs.
24
In humans
(and most likely the dog), circulating growth hormone
are high during the first few days after birth, but rapidly decrease during
the subsequent few weeks to levels just slightly above tho in ad I Ii ts.
In a previously reported case of congenital hypothyroid i 111 , th ' dog
exhibited a blunted growth hormone response to xyla7. in , but hnd n
normal growth hormone response to provoca tiv stil11ul , li ot, nfl'{'r Irl-I II
ment of the hypothyroid sta teYI
Diagnosi of ongl- nil . I h polh J'oidi ,' 111 L' hdNt-d (I ll 1' lilli e,1I /11) ;1\: "
upporting clini cnl I .Ilholo)" y ,lI ld II I I'lli d 11111t 'lioll It':IIIII )'" Ntll'lll .d Pili '
pi t'. ' '))',l' tl !) 10 (I WI'I,I :I I' ,! \' t' :1\' 11111 1 11l 1.t! 11 1\' " 1 II I" CII'I ) l'IIII I'I' IIII'dll llll '
IWII II I 1111'1'1' 1111 11'1 I tI ),, 1Ii ' l 111 11 11 111 111 11 11 1 ,1, llil l til l)', I. 1111 ' 11 '111 11 ', Ii .1' 11 1111
Figure 3. A and B, Differences in long bone growth plates between littermates in Figure 1.
Note the delayed progression of closure of growth plates and shortened radius and ulna in
the affected puppy.
TT4 of 2.0 fLg/ dL, which is normal for an adult dog, would be low in a
6-week-old puppy and indicative of thyroid dysfunction. Serum-free
thyroxine (FT4) also would be expected to be higher in neonatal dogs.
Indeed, . a recent report of TT4, FT4, total triiodothyronine (TT3), free
triiodothyronine (FT3), and reverse T3 (rT3) in puppies from birth to 12
weeks confirmed the suspicion that TT4 and FT4 are high in neonates.
3
At birth, TT4 was within the normal range; but by 1 week of age and
until 5 weeks of age, the serum TT4 was two to three times the normal
adult range, TT3 and FT3 were lower in these neonatal puppies, sug-
gesting an inability of neonatal animals to convert T4 to T3 peripherally.
The advent of the endogenous canine TSH assay should allow discrimi-
nation of prim.ary congenital hypothyroidism from secondary hypothy-
r i li sm (T H d fi d ncy). Puppies with primary hypothyroidism (e.g.,
('hyroid 1ysg 11 -sis, dys honrt onogen sis) would be expected to have
(' lvv;) I( 'd enti ogl-l1lHl ' '['SII on -nl r::tl ions, whet: a puppies with TSH
d '(ki "Il ' , hOlild buv(' , IlilIH)I 'IIl HI I'ndo)',t'l Oil S T. li on ntrations. Spe-
\'In" il llId j, 'n 11 11 ,'I\l lol',I'IH111 11 111 II (lOll dl" l'l1 nitw,' I nvC' nOl" h n
111 '1'111 1'1111 ' i I
'1''' '1 11'' 11" 111 II I 111 11 ),, "1\ l,tI 11 1' 1,,, 1111' 1111" '111 11 III 111 1[ ' 1' " /I ,1111 1 I, 111 " ll il ill
1111 hll 111111 '1 1111 1, '111 Iii 11 11 ' l"l til 1111 II lt tl ( I I II 111-.1 1, )', 'I IIII' tl lI )\ III'" II
408 GRECO
Figure 4. Normalization of physique after supplementation of L-thyroxine in the congenitally
hypothyroid puppy from Figure 1.
f.Lg/kg once daily in the cat). Early treatment results in normalization of
the physique (Fig. 4).
References
1. Bruyette DS: Polyuria and polydipsia. In August JR (ed): Consultations in Feline
Internal Medicine. Philadelphia, WB Saunders, 1991, p 227
2. Campbell KL: Growth hormone-related disorders in dogs. Compend Contin Educ
Pract Vet 10:477-482, 1998
3. Casal ML, Zerbe CA, Jezyk PF, et al: Thyroid profiles in healthy puppies from birth to
12 weeks of age. Proc Am Coli Vet Intern Med, San Francisco, CA, 1994, P 989
4. Chastain CB, McNeil SV, Graham CL, et al: Congenital hypothyroidism in a dog due
to an iodide organification defect. Am J Vet Res 44:1257- 1265, 1983
5. Cline MJ, Berlin NI: Erythropoesis and red cell survivial in the hypothyroid clog. 1\111
J Physiol 204:415-418, 1963
6. Feldman EC, Nelson RW: Canine and Feline Endocr in.ology and R>procl u li on, cd. I.
Philadelphia, WB Saunders, 1987, pp 55- 90
7. Fisher DA: Medical management of sll spect d aSCH of l'OI1)\I 'lIi I'll I Ii I (l lh roi d l 111 , 11/
Burrow GN (ed) : Neonat@l Thyro"icl S p 'ning. NI'w (11' 1, 1{.lVI' 1I l' I"'IiH, 19BO, pp 2:1'1
244
8. Greco DS, h i J ~ t n i n CH: I ':n(l 1)(' 1'1 1) 1' di HOI'd,'! 'H, II/ 11 ' 11 11, 111 11 II ) (, d): V,' I", 'I," " Y I'"dllll , I, tl,
d . 2, Phil acl \' lphi ll , WII :;, 11 11 11 1,' 1'11, 11)%, 1' 1' \'1'/ 111'/
9. Greco DS, Feldman EC, Peterson ME, et al: Congenital hypothyroid dwarfism in a
family of Giant Schnauzers. J Vet Intern Med 5:57-65, 1991
10. Greco DS, Peterson ME, Cho DY: Juvenile-onset hypothyroidism in a dog. J Am Vet
Med Assoc 187:948-950,1985
11. Kenny FM, Klein AH, Augustin AV, et al: Sporadic cretinism. In Fisher DA, Gurrow
GN (eds): Perinatal Thyroid Physiology and Disease. New York, Raven Press, 1975
pp 73- 78
12. Krause KH: The use of desmopressin in diagnosis and treatment of diabetes inSipidus
in cats. Compend Contin Educ Pract Vet 9:752, 1987
13. LaFranchi SH: Hypothyroidism. Pediatr Clin North Am 26:33- 51, 1979
14. Medleau L, Eigenmann JE, Saunders HM, et al: Congenital hypothyroidism in a dog.
J Am Anim Hosp Assoc 21:341- 343, 1985
15. Milne KL, Hayes HM: Epidemiologic features of canine hypothyroidism. Cornell Vet
71:3-14,1981
16. Moschini L, Costa P, Marinelli E, et al: Longitudinal assessment of children with
congenital hypothyroidism detected by neonatal screening. Helv Paediatr Acta 41:415-
424,1986
17. Nichols CE: Endocrine and metabolic causes of polyuria and polydipsia. In Kirk RW,
Bonagura JD (eds): Current Veterinary Therapy XI. Philadelphia, WB Saunders, 1992,
p 293
18. Nichols R: Diabetes insipidus. In Kirk RW (ed): Current Veterinary Therapy X. Philadel-
phia, WB Saunders, 1989, p 973
19. Noguchi T, Sugisaki T: Hypomyelination in the cerebrum of the congenitally hypothy-
roid mouse (hyt). J Neurochem 42:891-893, 1984
20. Robinson WF, Shaw SE, Stanley B, et al: Congenital hypothyroidism in Scottish Deer-
hound puppies. Aust Vet J 65:386-389, 1988
21. Sawin CT: Hypothyroidism. Med Clin North Am 69:989-1004,1985
22. Tau C, Garagedian M, Farriaux JP, et al: Hypercalcemia in infants with congenital
hypothyroidism and its relation to vitamin D and thyroid hormones. J Pediatr 109:808-
814, 1986
23. Wilkins L: Epiphyseal dysgenesis associated with hypothyroidism. Am J Dis Child
61:13- 34, 1941
24. Wood DF, Franklyn JA, Docherty K: The effect of thyroid hormones on a growth
hormone gene expression in vivo in rats. J Endocrinol 112:459-463, 1987
Department of Clinical Sciences
College of Veterinary Medicine and Biological Sciences
300 W. Drake
Colorado State University
Fort Collins, CO 80523-1601
e-mail: dgreco@vth.colostate.edu
FRUSTRATING CASE
PRESENTATIONS IN CANINE
THERIOGENOLOGY
Generally, small animal theriogenology is a rewarding subspecialty
in veterinary medicine. Although demanding of the clinician's time and
expertise, the breeder client tends to be loyal and compliant. A good
reproductive practice generates its own referrals, and usually is busy.
Obstetrics and pediatrics are undeniably rewarding parts of the specialty.
Theriogenology incorporates the interesting fields of reproductive physi-
ology, endocrinology, embryology, genetics, metabolism, nutrition, criti-
cal care, anesthesia, pharmacology, and anatomy. The theriogenologist's
practice is uniquely medical and surgical.
Frustrations do exist in the small animal theriogenologist's practice.
Technology in the small animal theriogenology practice has not kept
pace with that in the equine or bovine field and even less so with the
practice of human reproduction. The primary reason is a lack of funding
supporting the development of technical expertise in a field in which
anticipated financial returns are poor. The Westminster Kennel Club Best
of Breed stud dog will never match the financial expectations of the
Triple Crown winner. The value of such dogs (and cats) is more personal,
but even the most motivated dog or cat owner cannot afford to develop
a technique permitting intracytoplasmic insemination or embryo trans-
plant in his or her pet. Technology developed for equine and bovine
patients may not be applicable or effective in the canine or feline.
Reli able induction of fertile estrus in the bitch remains technically chal-
iI'( lm lIw I k pn,I I1ll'nIH or ML'cii in!; nnd Epi d 'll1i ology, School of Veterinary Medicine,
l!lll v,,sll y or '" l lromi.., I .I nti 1111' Vel ' rinary lini c, Guide Dogs for the Blind,
II 11' ., 1, " 1 .... 1, ( " rl lI,\I !i ,l
VII' II 'IWJ Il (11 tJ II ', III' I Jt il ' lll \[\ 11 1'1\ '1[\ 1 II N I1v\ 1\ 1 I ' I{I\ ( 1'1('1'
\ I II I I \I I I t 11 I I I II I I I ' I I 'I Ii I I III
412 DAVIDSON
lenging. Male subfertility in the stud dog has few options. Pediatric
critical care in canine and feline practice is exacerbated by small patient
size and financial constraints.
Fortunately, the development of advanced reproductive technology
in endangered canine and feline species may apply to dogs and cats.
The of dogs and and the consequent pet overpo-
pulation problem Inject further ethIcal concerns into the small animal
theriogenologist's practice. Clinicians should guide their clients through
the myriad genetic screenings advised for the particular breed, and
discuss proper puppy placement and neutering. Some dogs and
cats sImply should not be bred (aggressive or genetically defective
individuals), despite their inherent value to the client.
s
Unsolved and
controversial clinical problems are not uncommon to the reproductive
practitioner. Progress in understanding the cause, pathophysiology, and
proper therapeutics of such problems is hampered by anecdotal informa-
tion abounding among the breeder clientele and often among veterinari-
ans. University residencies and postdoctorate programs limited to OL
even emphasizing small animal theriogenology are uncommon. Collabo-
small animal theriogenologists is developing slowly. This
article dIscusses some of the clinical problems familiar to the small
animal reproduction specialist.
PUPPY VAGINITIS
Chief Complaint
An apparently healthy female puppy presents with mucoid vulvar
discharge, usually white to yellow and sometimes copious. The dis-
be accompanied by mild perivulvar dermatitis. The puppy '
IS not typIcally attentive to the discharge, and there is not. any associated
change in urinary behavior. The age of onset ranges from 6 weeks to
puberty, the duration is days to months, and the disorder is often
intermi ttent.
Diagnostics
Cytologic examination of the discharge finds suppurative inflam-
mation. cultures .(aerobic) generally fail to grow anything but
normal flora In small, mIxed numbers. A urinalysis (culture "if"), a -
quired by cystocentesis, is characteristically normal (a decrea durin
specific gravity is typical for pediatric dogs).
Cause
The p . ifi il lL ' (' iii 111l111!1 WI) , 1\ 11 illil lltl llllll ' Iii /lI VI'IIIII ' li d) ', ll ld
gland lll nr ( pIlIHlllIlll hli li 11I 11'Il llI ll llil lll Jl d 1III III ' IIII ' lIdllll ', III, ' "1111.11 11111
FRUSTRATING CASE PRESENTATIONS IN CANINE THERIOGENOLOGY 413
is reported to resolve with puberty or ovariohysterectomy (two different
events endocrinologic ally, neither likely to be truly therapeutic). Puppy
vaginitis diminishes with maturity in most cases. Important differentials
include urinary tract infection, urinary incontinence, the onset of the
initial estrous cycle, vaginal foreign bodies (i.e., foxtails), and vaginal
anatomic anomalies causing pooling of urine or secretions.
2
Therapeutics
Cleansing the perivulvar area with a gentle solution (nonalcoholic
otic preparations or baby wipes) and benign neglect are advised if other
maladies are not evident.
CHRONIC VAGINITIS
Chief Complaint
The dog presents with variable vulvar discharge that is mucoid to
hemorrhagic or purulent, which is accompanied by signs of discomfort
(e.g., licking, scooting, pollakiuria). Perivulvar dermatitis also may be
present.n The condition usually is noted in ovariectomized bitches, of
any age, and in variable times from the spay procedure. The history
usually includes multiple therapeutic efforts without resolution, al-
though transient improvement can occur. The duration is generally
chronic, from weeks to months and sometimes years.
Diagnostics
A minimum data base (complete blood count [CBC] and serum
chemistries), including a urinalysis (preferably acquired by cystocen-
tesis) and culture or culture "if," is advised. A careful perivulvar and
vaginal examination, preferably with the dog under sedation or anesthe-
sia, with endoscopic equipment allowing evaluation of the entire vaginal
vault, should be performed. Radiography (e.g., vaginogram, urethro-
gram, cystogram, intravenous pyelogram [IVPl) and ultrasound of the
lower genitourinary tract may be indicated. Vaginal cytology, aerobic
ondmy opla ma cranial guarded vaginal cultures, and pinch biopsy of
(Iff ted vaginal mucosa are helpful. Identification of any contributory
(1 \1 , torn ic nbnorrnaliti s iimportant (e.g., significant strictures, mass
ivli i()I1S, rvtiunliant lors'" I vLdvar fold, pelvic bladder, anomalous ure-
1III'il i 11 111i1 III1) y), II is h \11 (ul to v;) luntc I'll bitch in a normal standing
IHII 1IIll11 Itl II/ It'HI ,\\ 1, '1'11 ,11 Il l1 l1 tOIll fll ' (, lI I'll Ivl nnd to I' peat the exami-
11 ,11 1(111 11 111 ' 1' I I II' 11.11 11 1'i 11 .II I,d ,'Illi .I )'"ti ll ti'1t'1'1'1'('111111)('n . Th PI' n e
Iii 1111111 ' 1"lIdlll )'1 III 1111' V 1)',1 11 d vi lldl , 11I111 ,1i WIIl '11 IIII' hil t' h i. ' lInti l' 1'
dll ,11 1I 111'11I1 1 ' 111\ II" Ildfl l,'j\d II )'., 111111 11 \1 ' 1111 ' (\ 111 '1' II I 1'Idlll\1I 11111 vll lv,I I'
414 DAVIDSON
folds can be difficult to ascertain when the bitch is positioned for
vaginoscopy.
Cause
The cause of chronic vaginitis is usually multifactorial, and the
primary cause often is masked and exacerbated by previous therapies,
including long-term antimicrobial use, self-mutilation, and topical irriga-
tions. Vaginal mucosal biopsy frequently shows lymphoplasmacytic in-
flammation, but sometimes suppurative (neutrophilic) or eosinophilic
inflammation is predominant. Cranial vaginal cultures can show over-
growth of an atypical bacterial species (pure gram-negative cultures,
resistant organisms, Pseudomonas species) or pure culture of Mycoplasma
species if antibiotics have been used extensively. Occasionally, a yeast
(Malessezia) overgrowth is identified. Extensive perivulvar dermatitis can
perpetuate chronic vaginitis. Urinary tract infection with urethritis and
cystitis also can contribute to vaginitis. Vaginal foreign bodies and neo-
plasia can cause symptoms of chronic vaginitis.
2
Therapeutics
The discontinuation of topical irrigations, prevention of self-mutila-
tion with Elizabethan collars, and initiation of antimicrobial therapy
only when indicated by proper interpretation of culture and sensitivity
testing should be undertaken. Antimicrobial therapy should be limited ,
to those cases in which pathogens have been identified as displacing
normal flora. Topical estrogen therapy is helpful in establishing normal
mucosal integrity in postmenopausal women with idiopathic vaginitis;
oral diethylstilbesterol therapy can be evaluated in the ovariectomized
bitch. The dose is empiric and usually the same as used for urinary
incontinence caused by sphincter incompetence (0.5- 1.0 mg orally given
one to two times weekly). Several weeks of therapy with estrogen may
be required before improvement is recognized. A short anti-inflamma-
tory course of corticosteroids can be useful in diminishing vaginal pa-
thology, but the subsequent propensity for urinary tract in f cti on m Li st
be kept in mind. Nonsteroidal anti-inflammatories may be us f Lil. urgi-
, cal correction with careful postoperative control of If-Ill uti la tion iH
indicated if anatomic abnormalities have contributed to Or hilv ' Ca liI' ,d
the condition.
6
Redundant dorsal vulvar folds ar mol" omlll oni inlpli
cated than vaginal strictures. Obviotl ' Iy, 1"1 (' id<'nl i(i cnli (l /1 ,1I 1d l'< ' lll (lv: li
of foreign bodies bOll ld cll re v<"Igini tis. ;\ 1"' 1 roJl!' !' II I' 1111'1'1 '1 II/' idllll inld
vaginal neoplms i" (' <"In incll l( ie H11I' g 'I' Ill' l'I" 'II)(l lhl' I'I IP ,II
SHORTENED INTERESTROUS INTERVAL
Chief Complaint
A bitch exhibiting failure to conceive is found to have interestrous
intervals of less than 4 months.
DiagnostiCS
Evaluation of the bitch's entire estrous cycle finds it to be normal in
all aspects except a shortened interestrous interval. Ovulation is con-
firmed with measurement of serum progesterone levels, and is preceded
by a normal elevation of serum estrogen as documented by serial vaginal
cytologies. Estrous behavior is normal. No evidence of systemic disease
is present. The interval from onset of proestrus between cycles is less
than 4 months. This shortened interval is documented to be caused by
an abbreviated anestrus or diestrus as opposed to a failure of ovulation
and subsequent lack of diestrus. Diestrus may not last the expected
average 45-day interval. Ultrasonography of the reproductive tract fails
to demonstrate any abnormalities.
Cause
The cause is unknown, but it is suspected to have a familial ten-
dency, because the condition is seen more commonly in certain breeds
(Rottweiler, Bull Mastiff, Mastiff). Exogenous inhibition of prolactin se-
cretion by the administration of dopamine agonists can shorten the
interestrous interval in bitches. The status of prolactin secretion (or
presence of undefined dopamine agonism) in bitches with spontaneously
abbreviated interestrous intervals is unknown. Infertility results, presum-
ably caused by a failure of adequate involution of the uterus during the
abbreviated anestrus.
Therapeutics
Inhibiting cycling for a milllmum of 6 months is advocated as
effective management of this condition. To benefit from the rest period,
br 'd lll g shou ld take place on the subsequent estrous cycle. Inhibition
of ' ycl ing n lll be CI com li oh '0 by n ative feedback. Unfortunately, the
()Ill drll ); li l'VII , l'ti (or /i ud l 11 1'(' is A ~ rog 'st rone compound, and it is
('Old " 111111 1"0111 '.1 ill 11\1 ' 11I !. I,'1 hill' h ni\( l I. PIVl' 11 lK' cali S' of its orrelation
wll h 11)(' iI ,' 1, 101'1I1I' liI Iii IIYI)llIi' II'Ii . 'I'h.' I I/h' or Idlll'li{' Ll nd rog 'ni
1"III'I I()l lI l!ir (11 11111 1,' 1'11111 ', ( '1''''1111 ' III I II ) 1\ 111'1 1\11 1 v,' 1'1101"(0 i'or III 'n' Nli lll)
"YI 'III ' lI y, 1VI II\lI III 11)1 ' Ilrl hil i 11111 11 11' 1111 11 11 ' " 0',,., 111 111 11 1'11 1 I" I'YII II II ' II'I1 , '
/\ ' \1 '1 ""I ,iI " ' 1'"1 1'1 "I dl,'liI 111 ', iI \. 1 , 111111 iil l' l ll ld \, . 1111 11 1', 11 \1' III II
416 DAVIDSON
estrous cycle after cessation of the compound, presumably caused by
uterine atrophy, are common. Waiting for a more fertile estrous cycle to
occur may allow frequent cycling to become No con-
trolled studies have been performed that evaluate the efficacy of. such
an approach. The manufacturer specifically states that the drug is not
intended for use in bitches intended for breeding.
PREMATURE LABOR
Chief Complaint
Healthy bitches sometimes exhibit a failure to carry litters to term
with no infectious or septic cause of the premature delivery apparent.
Premature neonates have a poor prognosis for survival.
Cause
Commonly, measured progesterone levels at the time of premature
delivery are low 5 ng/mL), suggesting or
luteolysis. Hypoluteoidism has not been documented m the bitch as a
primary cause for late-term Progesteror:e levels probably de-
cline because of local prostaglandm release, which occurs because of
myometrial activity.4
Diagnostics
If intervention does not occur, late gestational hemorrhagic vulvar
discharge can occur, followed by the appearance of uteroverdin and
eventually the delivery of premature,
labor can be documented in the bitch by performmg utenne momtonng
during the last 2 to 3 weeks of gestation with a availabl e
uterine monitor. Monitoring can be performed by chents m the hom\.!
setting. No more than one or two contractions should occur during a 1-
hour monitoring session before stage I labor is appropriate (56- 1::8 dnys
from the diestral shift or 64-66 days from the luteinizing bormOIll' SlII');V
or initial rise in progesterone above baseline). Monitoring should Inll'
place twice daily during the last 10 to !4 day of g'stnliol . l' lt'vil)l!.
examination of the aborted fetu sand blt h should he vt' nli('d (J Ill 011\
infectious (e.g., brullosis) or sell'i (' .g., I Inc(,ll lili s, IlWII'ill l-l ) ('1 1\1 /11, 1\11
early d li v ry, nnt! Ihl' ,d)()rl('d (l' III ,' ('S , illlllid hol v!' \)( '('1\ 1\111'11\111 11 1\
posl'morl(,lIl (' IlIlliJl,d i(111 \11111'1' 111 1111 Ih,jl\)', illllll llllll'I' W Ih 111, ,11'1 lill i/
Therapeutics
The administration of exogenous progestational compounds can
prolong gestation in the normal bitch, but will not alleviate premature
myometrial activity adequately. Their administration can cause abnormal
differentiation of fetal gonads. The administration of tocolytic com-
pounds (e.g., terbutaline, Brethine) by subcutaneous or oral route, ti-
trated to effect, can inhibit premature uterine activity. Terbutaline is a
tocolytic agent, a l3-adrenergic receptor antagonist. The administration;
should be discontinued 48 hours before the calculated delivery date to
permit normal labor and delivery to occur.
ACQUIRED MALE SUBFERTILITY
Chief Complaint
An apparently healthy, young, formerly fertile stud dog with normal
libido begins to produce small litters or frequently fails to cover bitches.
Diagnostics
Ideally, the breeding behavior of the dog should be witnessed to
rule out problems with husbandry. Documentation of failure to cover a
known fertile bitch when bred appropriately is desirable. Failure to
achieve a normal copulatory lock because of poor breeding habits (most
commonly, a dog that attempts to turn before complete engorgement of
the bulbis has occurred) can cause poor breeding success. If breeding
behavior is normal, a complete physical examination, CBC, serum chem-
istries, Brucella screening, urinalysis with culture (sample acquired by
cystocentesis), semen evaluation with appropriate quantitative urethral
and ejaculate cultures, and ultrasound evaluation of the reproductive
organs should be performed to rule out infectious, septic, and metabolic
causes of acquired sub fertility. Assessment of the thyroid status alleviates
client concerns (total T4, free T4 by equilibrium dialysis, thyroglobulin
autoantibodies, and canine endogenous TSH [thyrotropin]), but is an
unlikely cause of infertility.s Semen cytology typically finds oligosper-
mia, a thenospermia, and sperm morphologic abnormalities. Epithelial
' Il ' and l1'l.onocytes are increased in the ejaculate. Sperm-to-sperm ag-
glulinati on may be evident. Multiple semen evaluations over a 90- to
120-dny I ' rind shoul d be performed to be valid. Azoospermia should
prompl evn lu<lliol1 of s 'm 'n nil nlin ' pho phatase levels to assess libido
.1 1111 1'I1i(' (11 11 hil .i\vnd nbsln l(' li Vl' di sOI'lkrs. 1: ticular biopsy can be
IH' l'llll 'lIH,d III 1'h.II ' 1. 'II' Ij/,,(, ,1( 11 'I\II ,1('Y 0111(\ 1'01111 I('\'en 'Sf> of pennatogene-
I il iid 1111 ' IIlIoIl '1 I 11 '1 ' t il 'I III ' 111 "I" ' IIII ,iln)', I'lli l' "JlP,lrnlll s. liltLir of the
1111j1/1 \' \1\ '1 1111 ' 11 11111 Il\' " .. ll dll l II 11'111;'11 1111t! 11I '1' IIIml (, lIiIIlI'VS hnv('
1"'1'11 dlll l; 1"1 111 1111; ' 11 ' 11' 1 til 11 0111 ' 11 11 11 11 '1' 11 1" ' illIllIlI'd , Ii IWIIII ' rill )', iH
418 DAVIDSON
elected, the complete testicles should be submitted for histopathologic
evaluation, permitting the breeder to document the cause for planning
future breedings with related individuals.?
Cause
Generally, no infectious, endocrinologic, or metabolic cause for the
acquired sub fertility can be identified. Testicular biopsy can identify
lymphoplasmacytic inflammation if performed early. in the co';lrse. of
disease. The measurement of or assessment for antisperm antibodIes
would be of interest. The cause of this inflammation is unknown; previ-
ous traumatic or infectious causes generally are not identified. BioRsy
late in the course of the disorder shows no evidence of inflammation;
instead diminished spermatogenesis and atrophy are evident. A familial
tendency is suspected in some breeds (Bull Mastiff, Bernese Mountain
dog).9
Therapeutics
The diagnosis of premature testicular degeneration warrants a poor
prognosis for return to normal fertility. Assisted reproductive techniques,
such as intrauterine insemination, optimal ovulation timing, and semen
banking, can improve pregnancy rates for a limited time. Clients should
be warned of the potential heritability of this problem. The use of
immunosuppressive agents is contraindicated because of their effect on
spermatogenesis.
IDIOPATHIC AGALACTIA
Chief Complaint
A postpartum otherwise healthy bitch presents with inadequate
lactation to meet neonatal demand. Normal gestational length and hus-
bandry are typical.
Diagnostics
Determination that adequate mammary development and la ta tion
have occurred should take place before an elective c ar an s(' ti on. If
an emergency section is required, regardles of th stat uH of In 'Inliol1,
intervention is indicated. Bitch with inadc'l'.-IAte Id cl ;llioll ,II 1('I' Il)
should be evaluat d thol'OlI )' hly for 111c1'nbolic ()I" ill(l:lllll1l.lIlIl' !iil ol'll l' I'r
(e.g., In triti s, ,(' 1<1 1\\\1, i,l , Ill il , lil i.) ; 111(\ Ilul l'i li' )II,l1 ,1 1)(1 II (\1'.1 11, 111 lil llIl lI l,
nnd ,' holdd Iw In',lkd .l1' IH'Il III 'I. II, '1 , (). 'I'11i1 1111 \1 '/ \ II \, IY 11 1'1111111 I'VII I\II
lillil (I I 111i ' hl' l\lll) ',I'11I1I 1" 111\ 11 l'hl '"11 1111 ' I, 11111 1 \1( 1) ',1 111" "111'hlll l'l' " lI ild
FRUSTRATIN ASE PRESENTATIONS IN CANINE THERIOGENOLOGY 419
ultrasound evaluation of the uterus. The normal presence of colostrum
(typically not copious) should not be confused with agalactia. The level
of neonatal contentment and weight gain indicate adequate lactation
and nursing.
Cause
Lactation results from proper integration of mammary parenchymal
and glandular development during gestation, and is under the control
of pituitary and ovarian hormones (i.e., proclatin, estrogen). Milk let-
down is promoted by oxytocin release, a reflex triggered by nursing;
therefore neonates must spend adequate time suckling. Disruption of the
pituitary-ovarian-mammary gland axis can cause idiopathic agalactia.
Agalactia can be associated with premature delivery of neonates, and is
suspected (by breeders) to be a potential complication of ovariohysterec-
tomy performed at the time of a cesarean section. Because estrogen
promotes lactogenesis, the adequacy of mammary development should
be assessed before removal of the ovaries during cesarean section.
Bitches with adequate lactogenesis at term should not be impacted
negatively by ovariohysterectomy. A genetic component may be present
with' this disorder.1
Therapeutics
Lactation can be promoted if treated promptly when adequate mam-
mary development has occurred. The administration of minidose oxyto-
cin, 0.5 to 2.0 U per dose, subcutaneously every 2 hours should be
initiated. The nurslings should be removed from the dam before each
injection, and should be replaced 30 minutes later. The neonates should
be supplemented adequately to ensure survival, but not excessively, so
that they suckle vigorously. Gentle hand stripping of the mammary
glands should take place if suckling is not vigorous, Concurrent adminis-
tration of metoclopramide subcutaneously, 0.1 to 0.2 mg/ kg, every 6 to
8 hours may promote prolactin release. The administration of acepro-
mazine at mild tranquilization dosages also may facilitate milk letdown.
Therapy should continue until lactation is adequate (usually 12-24
hours later).
SUMMARY
'1'1)(' pl',Il 'li('I' of :iIlII III I1 l1il1l nl Ih('r iogC' nology i rewarding, but frus-
II',di ll ll! " I: I \'II II1 '\' I'ltl ll )" 11 'I'ltll ll lo)"il ' ,l( l v, II1('(':{ M i ompa rcd wi.th other
111
11 11
' 11 '11 1'1 '1'"11 111 111"" ,'111 111 l d l ll \ 11'1 ,,1 11/\ I() jll 'ill 'li" I' ),,()o(\ qll alil m di-
1'1111 ' " ',," 1\ Ilil ' ll l l\ 111 11, ,,1 ' 1'"\\'\111\ 11111 1'1'111 I 11111'/-1 IIt,II ,I i'( ' \l ol'
11 11'111 Iii '" Itt 1111 '1 '1
11
'1111
1
I Illli l ,III ' Illd Ii' II II ,ddl ' III I'l ' I' ll! ' dd. , 1111I"'ll I,d
420 DAVIDSON
collaboration among theriogenologists specializing in small animal prac-
tice is evidenced by growing attendance at national and international
scientific meetings, increased scientific publications, and internet com-
munications.
References
1. Davidson AP, Stabenfeldt GH: Reproduction and lactation. In Cunningham JG (ed):
Textbook of Veterinary Physiology, ed 2. Philadelphia, WB Saunders, 1997, pp 482--498
2. Feldman EC, Nelson RW: Canine and Feline Endocrinology and Reproduction, ed 2.
Philadelphia, WB Saunders, 1996
3. Freshman JL, Amann RA, Soderberg SF: Clinical evaluation of infertility in dogs.
Compend Contin Educ Pract Vet 10:443, 1988 \
4. Goldenberg RL, Rouse DJ: Prevention of premature birth. N Engl J Med 339:313, 1998
5. Johnson C, Bari ON, Nachreiner R, et al: Effect of l3lI-induced hypothyroidism on
indices of reproductive function in adult male dogs. J Vet Intern Med 13:104, 1999
6. Kyles AE, Vaden S, Hardie EM, et al: Vestibulovaginal stenosis in dogs: Eighteen cases
(1987-1995). JAVMA 209:1889, 1996
7. Larsen R: Testicular degeneration and hypoplasia. In Tilley LP, Smith FW (eds): The 5-
Minute Veterinary Consult Canine and Feline. Baltimore, Williams & Wilkins, 1997,
p 1094
8. Mostoskey UV, Padgett GA, Stinson AW, et al: Canine molecular genetic diseases.
9. Olson PN, Schultheiss P, Seim HB: Clinical and laboratory findings associated with
actual or suspected azoospermia in dogs: Eighteen cases (1979-1990). JAVMA
201:478, 1992
10. Root MV, Johnston SD, Johnston GR: Vaginal septa in dogs: Fifteen cases (1983-1992).
J Small Anim Pract 206:56, 1995
11. Scott DW, Miller WH, Griffin CE (eds): Environmental skin diseases. In Muller and
Kirk's Small Animal Dermatology, ed 5. Philadelphia, WB Saunders, 1995, p 887
12. Sobel JD: Vaginitis. N Engl J Med 337:1896, 1997
13. Thacher C, Bradley RL: Vulvar and vaginal tumors in the dog: A retrospective study.
JAVMA 183:690, 1983
Small Animal Clinic
Veterinary Medical Teaching Hospita I
1 Shields Avenue
Davis, CA 95616
CANINE MOLECULAR
GENETIC TESTING
Danika L. Metallinos, DVM, PhD
Recent advances in molecular genetics provide the groundwork for
the development of genetic tests for the diagnosis and prevention of
inherited diseases. The basis for the testing and the types of tests offered
are explained in this article. Veterinarians should be prepared to under-
stand genetic testing and counseling because they are becoming im-
portant to the practice of veterinary medicine.
INHERITED DISEASES IN DOGS
Inherited diseases are common among domesticated dogs because
of the population structure of dog breeds. There have been over 370
inherited diseases described in dogs, with additional diseases recognized
each year. Because of the high level of inbreeding within dog breeds,
autosomal recessive disorders are more common, with approximately
70% of the canine disorders inherited as autosomal recessive traits.l The
establishment of a breed begins when dogs with similar physical and
behavioral characteristics are bred to each other to create more dogs
with those characteristics. Once the breed has been established, there are
a limited number of individuals available for breeding purposes; thus,
related dogs are bred together, which leads to decreased heterogeneity
(genetic differences). Using this breeding practice, traits with value to
the breeder can be fixed in the progeny, leading to a consistent type of
dog. Unfortunately this practice, called linebreeding, also uncovers reces-
ti on, chool of Veterinary Medicine,
VIl' I'!l. I ' IN I I ( 1I ' llil li lll '.1\ 1 II ANl tvl i\ I , I 'I 'i\ t ' I'\l ' I\
Vii i 1/ 11 11 I I 11 11 '1111/ 1" 1
422 METALLINOS
sive alleles, which explains why most genetic diseases are recessively
inherited.
The popular sire effect further reduces variability in dog breeds.
There are a limited number of breeding animals within a purebred dog
breed, and many are closely related because of the overuse of popular
sires. Many breeders choose to breed to the top winning male dog, and
there are no prescribed limits on the number of progeny that a male\ (or
female) dog may produce. A stud dog could easily sire over 1000
puppies in 1 year. In a breed where only 5000 puppies are registered
each year, this is a significant number. Advances in canine reproduction
have led to the use of fresh-chilled and frozen semen, which adds to the
breeding potential of sires. The overuse of popular sires leads to a
limited gene pool within a population that is already limited, which can
be deleterious for the breed if a sire carries the allele for a recessive dis-
ease.
Historical bottlenecks have occurred in some breeds and have had
detrimental effects on diversity within those breeds. These bottlenecks
occur during times of war and when people's priorities change. The
Chinese Shar Pei and Portuguese Water Dog are examples of breeds that
were near extinction in their respective countries before their introduc-
tion into the United States, where fanciers have increased their numbers
significantly in the past 20 years.
Evidence for the decreased variability or genetic differences in dog
breeds can be found by molecular analysis. To date, all dogs affected
with a particular disease within a breed have the same mutation. This
is not true in human populations, except in the case of populations
where there is significant inbreeding. An advantage exists to reduced
heterogeneity in dog breeds. It is much easier to perform a genetic
analysis of inherited diseases in dog breeds than in human populations.
The possibility exists to correct these problems through selective breed- '
ing once mutation tests are available.
HOW DOES OUR UNDERSTANDING OF INHERITED
DISEASE AFFECT VETERINARY MEDICINE?
The advances being made in canine genetics have a profound im-
pact on veterinary medicine, Many of the diseases seen in veterina ry
medicine have a heritable basis. Breeders and clients are demanding
information about genetic diseases, and the opportunity exists for v t 1"i-
narians to have a positive impact on the incidence of inh rited d it; '[IS ' H.
A poll taken of the 27 veterinary schools in the United tnt s showvd
that only 11 offer formal genetics courses in Ih ir I I'of ss ionnl (' lIl'l'i (' 1I
lum. To meet the demands of clients, v tcrin;;l l'i llll ,' hove In II Ht ' 1'(II)lillil
ing education or be If-taught g n'ti isl:4.
There is funding nvnilnblv for I'l'HI'I II't' h (Ill IltllI ' I' II 'd di HI'illl"/i II d(l)', I,
Tn th ('(1 1'1 19 l)()H, dl))" 1'1'1'1 ,.1"1'/1 11 ,111111111' 1 ,111 111' 1 II Y 1111 ' 11t) 1;1I1"1 l' I'jlll
for jll'I)(ItIt 'ill )', dU)',1 IV 111 IltllI 'I 'II I'" 1IIII Id"1I 1I '1'111' 1' '' 1111 1) /11' III 11\1' II '
CANINE MOLECULAR GENETIC TESTING 423
attacks has been for the American Kennel Club (AKC) to develop a
Canine Health FOlmdation, whose mission is to improve the health and
well-being of purebred dogs. In addition, individual breed clubs have
developed foundations for the improvement of the health of their partic-
ular breed. Breeders have been forced to become more open about health
problems, and consumers are becoming more educated about health
issues as well.
There are now over 20 genetic tests available for inherited diseases
in dogs (Table 1). These tests can be used for diagnostics in the case of
diseases where traditional diagnosis is invasive, and they can be used
to determine breeding strategies to eliminate the diseases in future
generations. DNA testing affects veterinarians working in the area of
reproduction, because DNA profiling for individual identification is
required for stud dogs when they are collected for either fresh-chilled
or frozen semen or if they are used for breeding frequently. The AKC
may also allow the use of DNA testing to register dogs from the same
litter with different sires and to determine the sire in unsupervised
breedings.
MOLECULAR GENETIC TESTS
Samples Needed for Genetic Testing
DNA can be isolated from any cell in the body, except red blood
cells. Most genetic testing can be run using DNA isolated from buccal
mucosal swabs of the dog's mouth. This is a noninvasive procedure and
can be done by the owner. Buccal swabs can be taken at any age;
however, puppies should be weaned to avoid the mother's white blood
cells from milk giving false data. The buccal swabs, which are 6-in sterile
cytology brushes, can be obtained from companies that perform DNA
testing. The swab is gently rubbed with a back and forth motion on the
buccal surface of the mouth and is then placed in a sealed envelope
before being mailed to the company (Fig. 1). Veterinarians can keep
these swabs on hand in the clinic to facilitate testing. Swabs are available
free of charge by companies performing the tests. Some genetic testing
companies require whole blood, which is collected into EDTA tubes and
hould be refrigerated. Others accept anticoagulant acid citrate dextrose
(A D) tubes, which do not require refrigeration. Samples can also be
obtain d fronl any ti u , in luding postmortem samples. Ideally, tissue
i:4 Hil il p- froz ' n in Ii 1(lid nilrog n, but DNA can be extracted from sam-
pk'. (r()V- VII ill II 1'1')" liI ,lI' (1'\ '("l. vr for n short p ri od of time. It is difficult
In ohLlill 11\11 /', 1,11'('1'1 1) 1 I )NA illll)<'1 1'1 '1)111 (Ill'nlalin-(' Inb ' dd d tissues;
h(l W<'VI' I', /l illi\! ' I'II IIIJ ' 11111 '/1 II) IIY ' "'1'(' 111 1111 '/11 ' 1 )1111'1 1'/1 ill Ill<' (111111'(' . Un-
1111 ' 11111/1 / III 1111 ' II ' I I II I I,d I,v VI' I" I 11 111 /111 11 , II II' ,'(. Iili l III I lNA II'slH
III 'VI'I <'it llll /', I' 11 \'1' 1 1111 11' \ d'l l', II I II \ 11/1".1 111 III' II'I ill '" 11111'., 1111 ' I
Ii /I' ll It' 1111\ 1\ " 1 1' 1 II II, \ 1',' ",' 11 11,. 11 1t " 1'1 II' Iii I I I' )',
424 METALLINOS
\
Table 1. MUTATION TESTS FOR INHERITED DISEASES IN DOGS
Disease Breed
Canine leukocyte Irish Setter
adhesion
deficiency
Congenital Briard
stationary night
blindness
Cystinuria Newfoundland
Fucosidosis English Springer Spaniel
Mucopolysacchar-
idosis
Myotonia
congenita
Phosphofructoki-
nase deficiency
ProgreSSive
retinal atrophy
Progressive
retinal atrophy
Progressive
retinal atrophy
Pyruvate kinase
deficiency
Pyruvate kinase
deficiency
Severe combined
immune
deficiency
Von Willebrand's
disease
Von Willebrand's
disease
German Shepherd
Miniature Schnauzer
American Cocker Spaniel,
English Springer Spaniel
Irish Setter
Irish Setter, Cardigan Welsh
Corgi
Cardigan Welsh Corgi
Basenji, Dachshund, West
Highland White Terrier
Basenji
Basset Hound, West
Highland White Terrier
Doberman Pinscher,
Manchester Terrier
Poodle, Shetland
Sheepdog
Doberman Pinscher,
Manchester Terrier,
Pembroke Welsh Corgi,
Poodle, Scottish Terrier,
Shetland Sheepdog
Test Laboratory
Optigen LLC (Ithaca, NY)
(607) 257-0301
Optigen LLC
GeneSearch LLC
(Rockville, MD)
(301) 770-6970
PennGen Laboratories
(Philadelphia, PA)
(215) 898-3375
"
VetGen LLC (Ann Arbor,
MI)
(800) 4 VETGEN
GeneSearch LLC
Optigen LLC
VetGen LLC
GeneSearch LLC
Michigan State University
VetGen LLC
GeneSearch LLC
GeneSearch LLC
VetGen LLC
Individual Identification nnd Pnrontn 10 All 'IV I
Type of
Test
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutation
Mutati on
Mut, l;lll1
I )NA 111 1,1 III)', III ti l')', I I 11 'IId 1111 111 1 , Itl i litl iI"ltl l ll , 01 1 1111 ,11111
1I, III 'I il ll)',I' "IIIII I ,til ,11 1111 11 ') ',1111 111 1111 1 1' 1111 '11" 1111' \ 1 I 111 111 11 1, 11 1"
Figure 1. Samples can easily be obtained for DNA extraction using a sterile cytology brush
and gently brushing with a back and forth motion on the buccal surface of the dog's mouth,
individual identification for stud dogs used for artificial insemination
when the bitch and dog are not in physical proximity. In the future,
DNA identification may be required for registration purposes. Presently,
it is a means to permanently identify a dog. Because DNA can be
recovered from hair or saliva, techniques can be used to identify animals
for forensic purposes. For example, dog hair left at the scene of a crime
or saliva in a bite wound might be used in criminal investigations.
This is done by employing a panel of microsatellite markers to detect
differences between individuals.
Microsatellites are simple sequence repeats of DNA that exist all
over the genome of mammals (Fig. 2). Generally, they are dinucleotide
repeats, but they can also be trinucleotide repeats or tetranucleotide
repeats. During replication of the DNA, mistakes can be made, which
results in the addition or deletion of base pairs within the repeated
sequence, leading to size differences between individuals. Polymerase
chain reaction (peR) analysis can be used to amplify the repeat from
gcnomi DNA, and the product is then sized on a gel. Individuals
differ in th' s'iz of the bands amplified. In Figure 3, an example of a
ll1i ros, t(' lli tc rnDrl er showing individual variation in the size of the
'1'( ;' 1'( ; /1' 1' ( II : /1' 1'/1'1'( " I' ( ;( '/I( 11\11' 1"1'( '( : ( 'I '( "1"1"1'( : '1'/1 r 'r 'r '( '/\(; ( "1' ("I' eTC/I'T' 7\ TC CA
'1'( :'1'1\( ' 1\1 ' f\/ '1\ ( ' 1\ 1 '1\( ' N ' 1\( ' 1\( '1\ ( 'I\ ( ' f\{ ' f\{ ' 1\( '1\ ( '1\ '1'( :( '/1' 1'('( ' /1' 1'( ;' 1'( ;' 1"1' ( ' /\' 1'/1'1 '
1'( '/I I '/\/\ '1'( "1' 1'( .r ;' 1" 1'1 ' /1 '1'/1 ( ' /1/1/1/11 "1"1"1'( :( ;1111 '1'/1' 1'1"1'/11 ' 1'('( '/II ' /I '1'1' /1'1'1 '/II ;1\1'
1I IIU
n
1111 I III " I i11 /\ III jill 1111 ' 11\ II 11 111111 11 1IIIIlti (1(1i I" 11 11 111 1111" 111111 1 111111 A 1"111 II I
I 111 1111111 1111 1 IIIIIIIIII I( Itl (11111 111 1 Vi llI! iii hili Jilt l lilllill I 1IIIIIvldii II
426 METALLINOS
1 2 3 4 5 6 7 8 9 IO 11 12 l3 14
Figure 3. PCR primers were used to ampl ify a microsatell ite repeat from different dogs
numbered 1- 13 and a water control numbered 14. The PCR products were electrophoresed
on an 8% polyacrylamide gel and then stained with ethidium bromide prior to being
photographed under UV light. PCR = polymerase chain reaction.
PCR products amplified is shown. Markers that show many differences
between individuals are used for individual identification and parentage
verification. Because there are so many different dog breeds with differ-
ent sets of alleles, it is necessary that the microsatellites used for this
type of analysis be evaluated in the breed before the analysis is used for
identification purposes. The DNA sample and the set of alleles identified
by this method provide permanent identification of the dog. Disputes
about parentage can be determined using these methods. An example
of three microsatellite markers that are part of a parentage verification
panel used at the Veterinary Genetics Laboratory (University of Califor-
nia, Davis) is shown in Figure 4. The size of the band is written in base
pairs under the marker. The alleles of the putative sires, dam, and
offspring are shown to the left. Exclusion of sire 40 is demonstrated by
asterisks next to the alleles that show the exclusion; however, sire 37
could not be excluded using these three markers.
Mutation Tests
Inherited diseases are caused by mutations or changes in the DNA '
of the affected individuaL DNA is the genetic material of the cell. It is
composed of four bases: adenine, thymine, guanine, and cytosine. The
DNA is double-stranded: adenine pairs with thymine, and guanine
pairs with cytosine. The base pairs are translated into proteins using a
three-base pair code for an amino acid. The dog's body is made up of
thousands of different proteins. Each tissue expresses different sets of
the proteins encoded by the DNA. Mutations can cause disease by
AHT121 VIASD10 CXX161
Dam 104/110 114/1 22 112
Offspring 9 6/ 110 106/114 106 /112
Sire 40 98*/104 11 0* 1 06
Sire 37 9 6/ 112 10 / 1 . 0 10
Figure 4. The microsatellite mark r re II tod nl )1'O 1I11 1111 p. 1111 dOli. 11 11 11 Illd 011 ill ii
left. All eles are shown a Iz 0 iii 11(1( 0 pnln . 11111111111111111 IIIIW wli lll il 1111 1111 ' WillI! II 1111
to exclude Sire /.1.0 fTOm "" Ili 111111 11 11 01 11 11 111 11 1 JlIIII 1111 11 111 ", " I) 11 11 :111" :1/1 1111 11111 Ittl
exolu I (J II 111[111111 111 :1 111 11 11 1111 (L I'IIIII Y III Mrt ll 111 I tllI l" 11111 , 1'111). I ) lviI, 1.1\)
altering a protein's function or expression in the appropriate tissue.
These mutations can be single-base pair changes, insertions of DNA,
deletions of DNA, or rearrangements of DNA. The goal behind the
molecular genetic analysis of inherited diseases in dogs is to define the
mutation that causes a particular disease and to design a test specific
for that mutation.
Some diseases are caused by changes in an enzyme involved in a
biochemical pathway. These types of mutations can be defined by first
understanding the biochemistry of the defect and then looking for a
mutation in the gene that codes for the particular enzyme. Based on the
type of disease, tissues involved, and other clinical data, it is sometimes
possible to hypothesize which gene might be responsible for a particular
disease. Because there is so much information available in mouse and
human genetics, the disease gene in dogs can sometimes be a candidate
from human beings or mice. The approach is to clone and sequence the
gene from dogs and look for mutations in normal and affected individu-
als. The actual mutation can be located in the region of the gene that
codes for protein, or it can be located at a site distant from the gene. It
is almost impossible to prove that a gene is not responsible for a disease
without using genetic analysis, because the causative mutation can be
far removed from the coding region.
The type of test designed is based on the actual mutation. Some
mutations change a restriction enzyme site, allowing distinction of the
mutant form from the normal form by digestion of the PCR product
with enzyme. Other mutations change the length of a PCR product, for
example, severe combined immunodeficiency in Arabian horses, which
is caused by a four- base pair deletion.
4
Still other mutations are single-
base pair changes that do not change a restriction enzyme site, for
example, myotonia congenita, which is a single-base pair change in
Miniature Schnauzers, or Von Willebrand's disease in Scottish Terriers,
which is a single- base pair deletion.
2
3
More advanced PCR techniques
are necessary to distinguish the mutant allele in these cases. Table 1 lists
the mutation tests available in dogs. Mutation tests are breed-specific;
thus, a test designed for one breed cannot be used in other breeds.
Linked Marker Tests
Determining the actual mutation responsible for a disease can be
d i fficul t if th r are no obvious candidate genes. An alternative approach
to idcntifying th mu ta ti on is to find the location on the chromosome
of Illl' gVIl t' involv(' d using linl t g analysis. Linkage analysis is the
d(,[ (, t'IIlill nli(l11 of' 1111 ' 1'('! .l li vl' loc,)li oll or 111 :1 r1 ' rs or ph notypes (traits
0 1' tl i f! I ' II!H'II) 11 II , I l 'hl'IIIIHHIII III\' , ' 1'111 ' I II1I' (l I'III1l'I' (If I'hi s for v tcrinari ans
IlI lit lil lltl ll )t ('11 11'1 " 1111 , \ 1,(1" 11 111' 1I11i' l ld 111 111 '11' 1' 11'11 111 ~ ( l l h i 1 1 hf'( I( l d( 'I'H huv\'
111 /1 11 11 .1 11 )', III Il r 1' 111 1 1, /"1 II, ' 1' 111 I'" H" ", Ili l, II,, l il i li ll l lll il 11/ (1111 )('1 11 )"
I d l ' lil II l1d 'III" " III ti l , 1111 ,'1 11 ,1111 III! ' 111111 111111 11 III 11 111
1
'"11111 ' 11 1, 'y II I VI '
428 METALLINOS
some intrinsic error rate that must be taken into account when interpre-
ting them. Table 2 lists the linked marker tests currently available.
Dogs have 38 pairs of autosomes and the sex chromosomes (X and
Y). During meiosis, four gametes (haploid genome) are formed from a
diploid cell. The haploid cell contains one of each of the chromosomes.
Two events occur during meiosis that are integral to an understanding
of linked markers. The first is segregation, and the second is crossing
over or recombination. The chromosomes are replicated during the initial
phase of meiosis, with homologous pairs lining up and crossing over
occurring. This means that the homologous chromosomes exchange
sections of DNA with each other. During the next phase of meiosis, the
homologous chromosomes are pulled apart and segregate to opposite
poles of the cell. If two markers are on different chromosomes, they
independently assort to the daughter cells. There is a 50% chance that
they assort to the same daughter cell if two markers are on different
chromosomes. If they are on the same chromosome, the chance that they
assort to the same daughter cell is greater than 50%, and the markers
are said to be linked. A crossover can occur between two markers, and
the frequency of crossover is related to the distance between the markers.
The further apart two markers are, the greater is the chance that a
crossover event occurs between them. Even though the mutation causing
the disease has not been identified, a linked marker may be useful in
certain pedigrees to help eliminate the disease. Linkage analysis estab-
lishes the genetic distance between markers on a chromosome and
between the disease gene and markers.
There are two ways that linked marker tests can be false. One way
is if there is a recombination (crossover) event between the linked marker
and the disease. The frequency of this happening is related to the
distance between the marker and the disease gene; as a result, markers
that are close to the disease gene are the most useful.
The second way that a linked marker gives false results is if a
marker allele is assumed to be carried on the same chromosome as a
disease allele. Although the marker is always located the same distance
from the disease gene, in some individuals, different alleles of the marker
can be associated with the disease allele. The results of the test are then
Table 2. MARKER TESTS FOR INHERITED DISEASES IN DOGS
Disease
Copper toxicosis
Prcd form of progressive
retinal atrophy
Renal dysplasia
Breed
Bedlington Terrier
Chesapeake Bay !\ Jl gliti h
Cocker Spaniel, Labrndur
Portugll('HI' Wllh'"
Dog
I ,h' lI llI " PHil, Shih ' (' y.l! , :\11 11
\ '1111 11'11 Wllt' ltl I' 1! 'n'II I" ,
Test
Laboratory
Type
of Test
IVI",I I' I
misinterpreted. It is not possible to assume that the same disease is
caused by the same gene in two different breeds. Similarly, it is not
possible to assume that a linked marker test is going to be informative
in a different family of dogs even within the same breed. For example,
if a marker, M, is linked to a disease gene allele D* and there are two
alleles at M, 121 and 124, the D* could be on the same chromosome as
marker allele 121 in some families. In other families, the D* could be
carried with marker allele 124, which would lead to a mistaken diagnosis
of carrier status of the disease if marker allele 121 was found in an
individual from the second family. Using the marker to infer the disease
status could give a false-positive or false-negative result depending on
the phase in that family.
COUNSELING AND THE FUTURE OF VETERINARY
GENETICS
Veterinarians are often asked whether a specific disease is inherited.
This is often a difficult question to answer, which can lead to frustration
on the part of the breeder or client. Just because a purebred dog has a
disease does not mean that the disease is inherited. Inherited diseases
can also occur in crossbred dogs. There are many examples of mixed-
breed dogs with hip dysplasia, hypothyroidism, atopy, and osteosar-
coma. Assumptions about the mode of inheritance of a disease cannot
be inferred from other breeds (because of heterogeneity between breeds)
or human studies. Proof that a disease is inherited comes from either a
statistical analysis of pedigrees or breeding trials. Recommendations to
clients based on anything less are conjectures.
There are inherited diseases that are fixed within a breed based on
breed type, which can further complicate counseling. For example, an
elongated soft palate in Bulldogs is associated with their severe craniofa-
cial defects. A second example is chondrodysplastic dogs, which have an
increased incidence of vertebral disk disease. Dogs with large amounts of
white in their coats have a higher incidence of congenital deafness than
solid-colored dogs. Although not all individuals within these breeds
have the medical disorders, it may prove difficult to eliminate them
without changing the breed type.
In the next 10 years, more genetic tests should be available for
di.agnos.ing inherited diseases in dogs, and many diseases should be
b tter und r t od and liminated. In Tables 1 and 2, there are lists of
th' 1IIL1I'ali nn iJ nd lin l cd 1II.<:l rk r test available as of June 2000. Because
only n (' w g\' lwli c I'I' HI:-; nr(' iJv<1 ilnbl right now, counseling for the
(' lil1\iI),"il )!) (I I illl l(' ril vd diHi'.\fIl" ill dOl' , e:1I1 (' diffi lil t. Genetic coun-
HI ' llll /', 101' do)" 111'< '1,<1 1'1'1 I III 1111II I'wll(' I'I' 1H' lw( II' 11 1111111 1111 and liv sto k
)',( '111 '111 ' 1(,111 11 11' 1111 1', 1I 1\ 'I,d"I I II.l VI' I lid 1'111 1IIl II' IItil y 1' 1'( ' 11 1' <1 tiog ' wilh
Iill i'l ll l.d d II' I/H'I 111 11111/ 1 I III ' 11 11 ' II ' Iii " II VI ' II l iI 111 1'11 II VII 11""1' 10
1,1111 111 11111
1
1111 til 1', 1 " (1111 11'11 111 )',1 11 \ "ii" II Ililllltl lf. 1r IlI lt l," 11\11 11111 1'.
430 METALLINOS
of the literature, research being conducted, genetics, and important place
that dogs have in our society.
SUMMARY
Inherited diseases are common among dogs. Recent advances in
molecular genetics provide the groundwork for the development of
genetic tests for the diagnosis and prevention of inherited diseases. As
a result of this progress, genetics should become an integral part of
veterinary medicine. DNA tests are safe, easy to perform, and reliable if
interpreted correctly. Genetic tests only need to be performed once in a
dog's lifetime, because the results of DNA testing never change. Veteri-
narians should be prepared to understand genetic testing and counseling
because they are becoming increasingly important to veterinary medi-
cine.
ACKNOWLEDGMENTS
The author thanks Michael Bannasch and Dr Marcia Eggleston for their assistance in
preparing this article.
References
1. Patterson DF: Companion animal medicine in the age of medical genetics. J Vet Intern
Med 14:1, 2000
2. Rhodes TH, Vite CH, Giger V, et al: A missense mutation in canine C1C-1 causes
recessive myotonia congenita in the dog. FEBS Lett 456:54, 1999
3. Venta PJ, Li J, Yuzbasiyan-Gurkan V, et al: Mutation causing von Willebrand's disease ,
in Scottish Terriers. J Vet Intern Med 14:10, 2000
4. Wiler R, Leber R, Moore BB, et al: Equine severe combined immunodeficiency: A defect
in V(D)J recombination and DNA-dependent protein kinase activity. Proc Natl Acad Sci
VSA 92:11485, 1995
Suggested Reading
Thurman TF: A Comprehensive Primer on Medical Genetics. New York, Parthenon Pub-
lishing Group, 1999
Address reprints requests /:0
Danika Metallinos, DVM, PhD
Department of Population Health and Reprod u bon
School of Veterinary Mcdi in
One Shield Avenue
VIliy rsily of ali fomin, I n v i ~
Do v is, ./\ t)!'i (, I ()
Glossary
Allele: Alternative form of a gene.
Autosome: Those chromosomes not involved with sex differentiation.
Candidate Gene: A gene implicated in pathogenesis based on protein function,
chromosomal location, or sequence homology.
Chromosome: Long, single, continuous molecule of DNA. DNA is divided into
a number of chromosomes in all organisms.
DNA Marker: DNA segment, often anonymous, that exhibits sufficient sequence
variation to be useful in genetic linkage analYSis and DNA diagnOSis.
Founder Effect: Higher then expected allele frequency in a population as a
result of inheritance of the allele from a common ancestor.
Genetic Map: Map of loci assembled by genetic linkage studies.
Genome: Complete set of genes (DNA) in an organism.
Haploid: Half the chromosome number of somatic cells.
Linkage: The tendency for neighboring genes to segregate together during meio-
sis.
Locus: Unique location of a gene on a chromosome.
Meiosis: The process of germ cell division that randomly allots one chromosome
from each pair to gametes and reduces the chromosome number from
diploid to haploid.
Microsatellite: Repetitive DNA consisting of small numbers of repeating nucleo-
tides.
Mutation: Spontaneous change in DNA sequence or chromosome structure.
PCR: Polymerase chain reaction by which individual pieces of DNA are ampli-
fied through sequential cycles of heat denaturation, annealing, and polymer-
ization.
Phase of Linkage: Combination of alleles on parental chromosomes deduced by
linkage studies.
Predisposition: Greater likelihood of disease.
Restriction Enzyme: An enzyme that cleaves DNA at specific sites based on the
sequence of the DNA.
CLINICAL THERI
INDEX
Note: Page numbers of article titles are in boldface type,
Abortion, spontaneous, diagnosis of cause
of,242-243
Agalactia, idiopathic, causes of, 419
diagnosis of, 418-419
treatment of, 419
cxz-Agonists, for periparturient
premedication, 325
Amyloidosis, 398
Anesthesia, for cesarean section, 321-330
premedication for, 325
for periparturient patient requiring ur-
gent nonobstetric care, 320
general, for cesarean section, 327-330
local, for cesarean section, techniques
for, 326
of neonate, 330-337
periparturient and neonatal, 315-341
cardiovascular changes during, 318-
320
neurologic changes during, 316-318
respiratory changes during, 316
physiologic changes and impact on, 315-
320
techniques for, for cesarean section, 323,
324
Anestrus, bitch in, prebreeding
examination for, 238-241
Anovulvar cleft, closure of, 277-279
Atropine, for cesarean section, 328
in neonatal resuscitation, 355
Balanoposthitis, jn dogs, 253- 255
Bit h, trans ervi al insemiJlation
I" hniq" in, 291- 304
"I l' rim' ilnd fpl 'nl l11()nitt)l'ill g in, 305- 3'13
Ill o()d Hil mi ling, I" nVOnnll'H, h l' ,lvoiL'll1i ll
(", "", :I(,d
1I" I'I'dl'l f'" 1111111 111',1' "1" '11 111 1, 111 1" " "1'. ' ),11 ' )d 'l
1"""" II f', II I 'III ' II
ti ll 111 11 1 1', 111 '1111 ,111 dill 1111 111,,1111 ilill
I, I Ii 111111111,,11 11) III II'
Calcium requirements, during gestation,
376
for neonates, 382
of growing dogs and cats, 385-386
Carbohydrates, requirements for, during
gestation, 376
Cardiovascular emergencies, in neonates,
362
Cats, familial and congenital diseases of,
396
growing, nutrition of, postweaning to
adulthood, 384-390
healthy neonatal, hematologic values in,
346
young, normal biochemical values in,
348
Cervix, canine, 293-294
Cesarean section, anesthesia for, 321-330
preparation of patient for, 321-322
Chondroprotectives, for growing dogs and
cats, 388
Colostrum, nutritional value of, for
neonate, 379-380
Critical care, neonatal, 343- 367
Cystinuria, 394
Dehydration, in acutely ill neonates,
359-360
Dewclaw removal, analgesia and
anesthesia for, 336-337
Diabetes insipidus, central, 401-402
nephrogenic, 394
Di abetes mellitus, juvenile, 403-404
I i, rrhea, in n , onate, 363
for 'sa l' an 5 cti on, 327
111""1"' 11,, hl!i ' ll in, t ' ,ltninnli on of, 242
111 ' 11 ''' '''' (11 ), 11111 ' 1111 '.1, 1', "I\\ 'Ii<' li 'Nlinf', (nr,
' lillJ, I"" II """ !''' I, ,, , 1)1
I I I ri"f ', I ' I 1"
111101" 1' "11 11111\ il l \1 11 rll lI lI \
11111 l it I I II 11101 I" I I I
I II
434 INDEX
Disease(s) (Continued)
linked marker tests for, 427--429
molecular genetic tests in, 423--429
mutation tests for, 424, 426--427
parentage analysis for, 424--426
Dobutamine, for neonatal anesthesia, 335
Dogs, familial and congenital diseases of,
396
growing, nutrition of, postweaning to
adulthood, 384-390
healthy neonatal, hematologic values in,
345
inherited diseases in, 421--422
neonatal and pediatric, vital signs in,
344
reproduction services for. See Reproduc-
tion services, canine.
reproductive tract of, anatomy of, 292-
294
stud. See Stud dog.
vagina and vulva of, surgery of, 271-290
young, normal biochemical values in,
347
Dopamine, for neonatal anesthesia, 335
Doxapram, in neonatal resuscitation, 355
Drugs, in neonatal therapy, complications
of,363-364
Dwarfism, pituitary, 402--403
Ejaculation failure, in dogs, 249-250
Electrolyte abnormalities, in acutely ill
neonates, 360-361
Endocrine disorders, juvenile, in puppies
and kittens, diagnosis and treatment
of, 401--409
Energy requirements, of growing dogs and
cats, 385
of neonates, 381
Epinephrine, for cesarean section, 326
in neonatal resuscitation, 355-357
Episioplasty, 277, 278
Episiotomy, for canine vaginal surgery,
272- 275
Erection, failure of, in dogs, 248-249
persistent, in dogs, 253
Estrous cycle(s), 222
abnormal, 220
major hormones in, 222-223
Etomidate, for cesarean section, 328
for neonatal anesthesia, 334
Fanconi's syndrome, 393-394
Fat requirements, during gesta ti on, 37(',
of growing dogs and Wi
of n on", ',(' H, :lR !
110" nl'l dll, " III II' I" I,d, d,tt I iii ', n" 'I III II,tt " 1'/ (,
Feeding plan, for growing dogs and cats,
390
for neonates, 382-384
Fentanyl, for cesarean section, 328
Fetal monitoring, and uterine monitoring,
in bitch, 305-313
Fetal resorption, diagnosis of cause of,
242-243
Food(s), digestibility of, benefits of, during
gestation, 377
for growing dogs and cats, 388
Genetic testing, for inherited diseases,
samples needed for, 423
molecular, canine, 421--430
Genetics, veterinary, future of, counseling
and, 429--430
Gestation, and lactation, nutritional factors
in dam during, 371- 377
Glomerulopathies, 397- 398
Glucose, in neonatal resuscitation, 357
Glucosuria, primary renal, 394
Hemorrhagic syndrome, in neonates, 362
Hyperuricuria, 394
Hypoglycemia, in acutely ill neonates, 359
Hypothermia, in acutely ill neonates, 360
Hypothyroidism, congenital, 404--408
clinicopathologic features of, 406
diagnosis of, 406--407
nervous system disorders in, 406
physical features of, 404--406
skeletal abnormalities in, 406
treatment of, 407--408
Hypovolemia, from blood' sampling in
neonates, 364
in acutely ill neonates, 359- 360
HypovolemiC shock, in neonates, 362
Hysterectomy, pregnant patient
undergoing, anesthesia for, 320-321
Infertility, evaluation for, 215
of bitch, identification of, 2] 9
logical approach to, 237- 245
testing for, 231-232
Insemination techniqu s, tranB '"vi ' nl,
application of, 299- 300
equipnl ent fo r, 2
valuati on of, 29H , 0,
in bild" 29'1-,104
1" ' 11'1"1' 1', of, 2' )H 2\1\)
" N. ,w /1,.,.111 1,,1 " I,,, dllllt 'lI l d, II II' IIt " d
II I, II )' , " 111
11< 11 11' ''11(,' 1' '' 11 1,'1111,, 1 " I " I I I'l l.
results of, 301
safety concerns associated with,
300-301
uses of tech.nique and equipment for,
302-303
Interestrous interval, shortened, diagnosis
of, 415
possible causes of, 415
treatment of, 415--416
Isoerythrolysis, neonatal, 362
Ketamine, for cesarean section, 328
Kidneys, agenesis of, 394- 395
duplex and supernumerary, 397
dysplasia and aplasia of, 395- 397
ectopia and fusion of, 397
hypoplasia of, 395
Labor, premature, causes of, 416
diagnosiS of, 416
treatment of, 417
Lactation, gestation and, nutritional factors
in dam during, 371- 377
Lidocaine, epidural, for cesarean section,
326, 327
Luteinizing hormone, in estrous cycle, 223
Malnutrition, in neonates, 363
maternal, reproduction and, 369- 378
Marker tests, linked, for inherited diseases,
427--429
Milk, nutritional value of, for neonate, 380
of various species, nutrient content of,
compared, 378- 379
Molecular genetic tests, in inherited
diseases, 423--429
Monitoring, of nursing puppies and
kittens, 384
of queens, during gestation, 377-378
perina tal, in bitcl1, 305-311
therapeutics during, 311-312
uterine and fetal, in bitch, 305-313
Mutati on tests, for inherited diseases, 424,
426- 427
1,\ "I '''I lI d,, 1 "I'/ li 'lil'i ll"I " II,
N"I III Il I,d ,, 1'1 11,' " I'I It " ' , :111:1 :11.7
N" " ," ,I " I II II ' li lt ' Y, d'II I',/' III , \/, 1 111,1
NI'I"I" " 'l) "' 111 1,1, III '1 "1'1 " ,, 111 ,' ,,, ,, ' 1,",
1' ,iI lt d
.111" "'11 11 1111 1' III 1111 , \ \ I I \ I
1"1 11 11 I \ 1,, 1 \ I , III
INDEX
anesthesia induction in, 333-334
anesthesia of, 330-337
435
calcium and phosphorus requirements
of,382
cardiovascular emergencies in, 362
cardiovascular values in, 344-346
diarrhea in, 363
drug distribution and metabolism in,
330-331
energy requirements of, 381
fat requirements of, 381
feeding plan for, 382-384
hemorrhagic syndrome in, 362
hypovolemic shock in, 362
isoerythrolysis in, 362
malnutrition in, 363
monitoring and support for, during anes-
thesia, 334-336
nosocomial infections in, 364
nutrition of, 378- 384
assessment of, 378- 384
feeding plan and, 382-384
oxygen therapy in, 361-362
perioperative analgesia for, 336-337
postdelivery resuscitation in, 349- 350
cardiac compression in, 353-354
drugs in, 355-358
route of administration in, 354
equipment for, 351
stimulation of ventilation in, 352-353
warming and drying in, 350-352
preoperative preparation of, 332
protein requirements of, 381
pulmonary values in, 346--348
renal values in, 348- 349
respiratory emergencies in, 361-362
taurine requirements of, 381
thermal injury in, 364
thermoregulation in, 349
trace mineral requirements of, 382
vital signs and normal blood values in,
343-344
water requirements of, 381
Neoplasia, renal primary, 397
"New Zealand" endoscopic method, of
transcervical insemination tech.niques,
295-298
Nonobstetric care, urgent, anesthesia for
periparturient patient requiring, 320
"Norwegian" method, of transcervical
insemination tech.niques, 294-295
Nosocomial infections, in neonates, 364
Null'''' Iti als, for growing dogs and cats,
, HH
NI" t'i ll l' II , 11 14/1" 11/411 H' I1 I of, for I' l' I)J'olili li on,
1'/11 ,171, 17"
, ,( 11 ", ", " 1" ". \, /11 l/l i
,I I II III ti l I'llt III I
111 d lll l'. 1Ii ' III 11 11+1 II i ' \/1 1
I" .1 111 11 10 " , II 11 111 I tI I" \,,1, I'"
436 INDEX
u-Opioid agonists, for periparturient
premedication, 325
Opioids, for cesarean section, 328-329
Os penis, fracture of, in dogs, 255
Ovulation, and fertile period, 223-224
Ovulation timing, behavior and observable
signs in, 224-225
breedings and, 229-233
concepts and controversies in, 219-235
diagnostic procedures and, 224-228
exfoliative vaginal cytology and, 225
for canine reproduction services, 212
hormonal assays and, 226-227
indications for, 219-221, 230
protocol for, 228-229
reproductive physiology and, 222-224
vaginoscopy and, 227
Oxygen, in neonatal resuscitation, 358
Oxygen therapy, in neonates, 361-362
Oxytocin, during uterine and fetal
monitoring, 311-312
Pancreatic disorders, 403-404
Paracervix, and dorsal median fold,
canine, 292-293
Paraphimosis, in dogs, 252
Parentage analysis, for inherited diseases,
424-426
Pediatric nutrition, new concepts in,
369- 392
Penis, canine, congenital abnormalities of,
250-252
disorders of, 247-258
functional abnormalities of, 248-250
neoplasms of, 256
normal anatomy and physiology of,
247-248
physical abnormalities of, 250-256
trauma to, 255-256
pH, urinary, of foods, during gestation,
377
of foods for growing dogs and cats,
386
Phimosis, in dogs, 252
Phosphorus requirements, during
gestation, 376
of growing dogs and cats, 385-386
of neonates, 382
Physical examination, prior to breeding,
237
Pituitary disorders, 401-403
Polycystic renal disease, 398
Potassium requirements, of growing dogs
and cats, 386
Prebiotics, for growing dogs and a ts, 89
Pregnancy, canine, cardi.ova, IdAI'
during, an sl'hcsi) lind, ' Iii :I ()
n Llrologir ci lllll f'PI dll1'I'1 f'" 1111, '1 111<,,, 111
111111 , :11( 1 III!
respiratory changes during, anesthesia
and,316
diagnosis of, ultrasonography for, 242
hysterectomy during, anesthesia for preg-
nant patient undergoing, 320-321
management of, and whelping assis-
tance, 243-244
Priapism, in dogs, 253
Probiotics, for growing dogs and cats,
388-389
Proestrus, bitch in, evaluation in, 241
Progesterone, in estrous cycle, 223
measurement of, during nonpregnant di-
estrus, 243
Propofol, for neonatal anesthesia, 334
Protein requirements, during gestation and
lactation, 375
of growing dogs and cats, 385
of neonates, 381
Renal disease, congenital and inherited, of
small animals, 393-399
Reproduction, maternal malnutrition and,
369-378
nutritional assessment and, 370-371, 372
nutritional factors for, 383
Reproduction services, canine, artificial
insemination for, 213
chilled-extended semen breedings in,
213- 214
considerations for starting, 209-210
equipment needed for, 210
evaluation for infertility in, 215
insemination with frozen semen in,
214-215
mismating in, alternatives to
management of,216-217
overview of, 209-218
ovulation timing for, 212
prebreeding examination for, 211-212
pregnancy diagnosis, peripartutient
care, and cesarean section in, 215
pyometra and metritis treatment in,
215- 216
reproduction services to offer in,
210-217
semen collection and evaluation
212-213
Reproductive tract, canine, anatomy of,
292-294
Respiratory emergencies, in n onntCH,
361- 362
f;I' 1I11"I , 1I1111111" IWI , l1l l1 ll ll f',I ' I\i l 'IIII II dllf \l'
1'V Ih, " It', ') 1111
111 ' 11 """ 11 11 11,'11 " I, III IlI dl l " ,I III' II I li d dUll ,
'( Ii ',,/I
chilled or frozen, br eding with, 220, 233
frozen, insemination with, in canine re-
production services, 214-215
of stud dog, collection of, 261- 262
evaluation, 261- 262
quality of, testing of, 232
Skeletal disease, developmental, risk
factors influencing, in large-breed
puppies, 386, 387
Sodium bicarbonate, in neonatal
resuscitation, 358
Stud dog, sub fertile, clinical management
of,259-269
inability to breed but normal ejaculate
in,260-261
lack of libido but normal ejaculate in,
259- 260
semen abnormalities in, 261-268
Subfertility, acquired male, causes of, 418
treatment of, 418
Tail docking, analgesia and anesthesia for,
336-337
Taurine, deficiency of, in gestating queens,
375-376
requirements for, in neonates, 381
Theriogenology, canine, frustrating case
presentations in, 411-420
clinical, 209-430
Thermal injury, in neonates, 364
Thyroid disorders, 404-408
Trace minerals, requirements of, for
neonates, 382
Tromethamine, in neonatal resuscitation,
358
Ultrasonography, for pregnancy diagnosis,
242
in ovulation timing, 228
Urethral prolapse, in dogs, 255
INDEX 437
Urethrostomy, perineal, vulvovaginectomy
with, 287-289
Uterine monitoring, and fetal monitoring,
in bitch, 305-313
Vagina, canine, and canine vulva, surgery
of,271-290
caudal approach to, 272-275
length of, 292
surgical approaches to, 271-272
ventral approach to, 275-277
prolapse of, partial vaginectomy for, 283
Vaginal bands, correction of, 283-286
Vaginal masses, pedunculated, resection
of, 279-283
Vaginal mucosa, edematous, resection of,
279-283
Vaginal septa, correction of, 283-286
Vaginal stenoses, correction of, 283-286
Vaginal strictures, correction of, 283-286
Vaginectomy, complete, 286-287
partial, for vaginal prolapse, 283
Vaginitis, chronic, in dogs, causes of, 414
treatment of, 414
puppy, 412-413
Vulva, canine, and canine vagina, surgery
of,271- 290
Vulvoplasty, 277, 278
Vulvovaginectomy, with perineal
urethrostomy, 287-289
Water, requirements for, in neonates, 381
Whelping assistance, pregnancy
managementand, 243-244
Whelping date, prediction of, 221
Xylazine, for periparturient premedication,
325

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