Page 1006 - Small Animal Internal Medicine, 6th Edition

978 PART VIII Reproductive System Disorders

permits and she is poorly responsive to medical manage-
ment; however, this is uncommon. Therapy of postpartum
VetBooks.ir metritis is best monitored by serial evaluations of uterine
luminal contents with ultrasound along with hematol-
ogy, biochemistry, and clinical parameters (appetite, fever,
vulvar discharge). Metritis can become chronic and cause
infertility. Mild cases, when the bitch is eating, able to take
oral antibiotics (Clavamox [14 mg/kg q12h] or cephalexin
[10-20 mg/kg q8-12h]), and is still providing good maternal
care, can be successfully managed on an outpatient basis,
preserving home care of the litter. Bitches with metritis
should be evaluated clinically for mastitis as well, owing to
the potential for bacteremic contamination of the lactating
mammary glands.

MAMMARY DISORDERS FIG 55.31
Agalactia Inverted nipple with associated pyoderma, Old English
Agalactia is defined as a failure to provide milk to neonates. Sheepdog bitch.
Primary agalactia, a lack of mammary development during
gestation, results from a failure of milk production and is
uncommon. A defect in the pituitary-ovarian-mammary failure to rotate nurslings, litter loss, an unusually small litter,
gland axis is suspected. Administering progesterone com- ineffective nursing, and rarely with pseudocyesis (Fig. 55.31).
pounds late in gestation can interfere with normal develop- Warm compresses, cleansing/lubricating the nipple, gentle
ment of the mammary glands, precluding lactation. expression of the affected gland, and rotating neonates is
Secondary agalactia, a lack of milk availability due to a failure advised. With the loss of a litter, antiprolactin therapy with
of letdown and ejection, is more common. Mammary devel- cabergoline (1.5-5 µg/kg/day, divided bid) can be helpful.
opment is marked, but milk cannot be readily expressed Galactostasis likely increases the potential for mastitis to
through the teat sphincter. The normally scant production develop.
of colostrum in the immediate postpartum period should
not be confused with agalactia. Agalactia can occur second- Mastitis
ary to premature parturition, severe stress, malnutrition, Mastitis, septic inflammation of the mammary gland, can be
debility, metritis, or mastitis. Treatment includes providing acute and fulminate or chronic and low grade, involving a
supplementation to the neonates while encouraging suckling single or multiple mammary glands. Coliforms, staphylo-
to promote milk letdown, providing optimal levels of nutri- cocci, and streptococci are most commonly isolated in both
tion and adequate hydration to the dam and resolution of bitches and queens. The source of bacteria is cutaneous,
any underlying disease. Pain management after cesarean exogenous, or hematogenous. Mastitis can be comorbid with
section is indicated. If detected early, milk letdown can often metritis. Mild mammary discomfort and heat, galactostasis,
be induced pharmacologically. Minidose oxytocin, 0.25-1 cutaneous inflammation, and the presence of an intramam-
unit per injection, is given subcutaneously every 2 hours. mary mass effect are the earliest signs. Milk is commonly
Neonates are removed for 30 minutes preinjection and then discolored red or brown due to the presence of red and white
encouraged to suckle, or gentle stripping of the glands is blood cells. The dam exhibits pain, reluctance to nurse or lie
performed postinjection. Metoclopramide, 0.1-0.2 mg/kg down, anorexia, and lethargy. Fever can be marked and may
SC, is given q12h to promote prolactin release and mild precede other clinical signs. Advanced cases can present in
production. Therapy is usually rewarding within 24 hours. septic shock, with abscessed or necrotic glands. The diagno-
Some authors advise a much higher dose of metoclopramide, sis is based upon physical examination. Milk cell counts in
risking neurologic side effects; the author has not found this bitches are not predictive of mastitis.
necessary. The use of domperidone (Motilium [Janssen Culture and sensitivity of milk collected aseptically from
Pharmaceuticals]) at 2.2 mg/kg PO q12h PO from 6 days affected glands allows retrospective evaluation of empirical
prepartum to 7 days postpartum resulted in normal lactation antibiotic selection. Therapy should begin immediately and
in a queen previously agalactic. consists of broad-spectrum bactericidal antimicrobials and
gentle physical therapy. Analgesics may be indicated; neo-
Galactostasis nates tolerate opioid analgesia in the dam. First-generation
Galactostasis causes engorgement and edema of the cephalosporins (cephalexin, 10-20 mg/kg q8-12h) and
mammary gland, with associated discomfort making further β-lactamase-resistant penicillins (Clavamox 14 mg/kg q12h)
nursing unlikely, and can become self-perpetuating. Galac- are advised and safe for neonates. Antibiotic therapy may be
tostasis occurs secondary to inverted or imperforate teats, warranted until weaning and can preclude further nursing if