VSR 421: Regional Veterinary Surgery (2+1)

CEASAREAN SECTION- DOG

Indications

•  Actual or potential dystocia 
•  Fetal putrifaction
•  Elective c- section indicated in brachycephalic breeds and other animals with history of dystocia or those with pelvic fracture malunion.

Pre-operative management

• Correct fluid and electrolyte imbalance
• Prophylactic antibiotics if fetal death or uterine infection is suspected
• If prepartum eclampsia , lead to hypocalcemia, it should be corrected.

Anaesthesia

• Glycopyrrolate - 0.005-0.011 mg/kg s/c or im for premedication
• Induction propofol - (4-6 mg/kg) i/v
• Maintenance - isoflurane or sevoflurane

Procedure

• Position the animal in dorsal recumbency, after aseptic preparation of the ventral abdomen
• Apply a  scrub
• Make a ventral midline incision from just cranial to umbilicus to near the pubis
• Elevate the external rectus sheath before making a stab incision through the linea alba to prevent inadvertent laceration of the uterus.
• Exteriorize the gravid uterine horns by gently lifting rather than pulling out of the abdomen 
• Isolate the uterus from the remainder of the abdomen with sterile towels
• Extend the incision with metzenbaum scissors
• Empty each horn by gently squeezing cranial to each fetus to move it toward the incision
• Then grasp and pull  it from the uterus
• Rupture the amniotic sac and clamp umbilical cord
• Avoid contaminating the abdomen and surgical field with amniotic fluids
• If the placenta has not separated gently pull it from the endometrium
• Do not forcibly separate the placenta from the uterine wall
• Palpate the pelvic canal and remove any fetus from this location
• Close the uterine incision with 3-0 or 4-0 absorbable sutures using an appositional pattern in a single or double layer appositional closure
• Lavage the surgical site
• Inspect for uterine vessel avulsion and control haemorrhage
• Cover the uterine incision with omentum. Appose the abdominal wall in three layers and suture the skin.