Page 995 - Small Animal Internal Medicine, 6th Edition

CHAPTER 55 Clinical Conditions of the Bitch and Queen 967

metoclopramide at 0.1 to 0.2 mg/kg PO or SC bid. Alterna- thrombosis, as evidenced by an elevated D-dimer level, with
tive antiemetic drugs may not be safe or recommended for variable clinical appearances. Ultrasound can be used to
VetBooks.ir pregnancy; clinicians must evaluate risk versus benefit. In document thrombosis, which occurs commonly in the
caudal vena cava, resulting in venous congestion in the pelvic
uncommon cases, force-feeding must be undertaken. Hyper-
emesis gravidarum in women is believed to occur secondary
lar weight heparin is well documented in women but undoc-
to an acute elevation of human chorionic gonadotropin; no limbs (Fig. 55.12). Antithrombotic therapy with low molecu-
pregnancy gonadotropin has been identified in the bitch. umented in the bitch and can easily result in congenital
defects (aspirin-induced cleft palates) or loss of pregnancy
GESTATIONAL DIABETES due to placental or fetal hemorrhage. Warfarin is contrain-
Gestational diabetes occurs infrequently in the bitch and is dicated in pregnancy because it crosses the placenta. The
attributed to the antiinsulin effect of progesterone (mediated condition is believed to be inherited in women; affected
by increased levels of growth hormone) during the luteal bitches should be removed from the breeding pool.
phase. Polydipsia, polyuria, and polyphagia with weight loss
occur. High-fiber diets promote euglycemia in the bitch, but Pregnancy Edema
the diet must remain balanced for pregnancy and lactation. Marked edema of the distal pelvic limbs, caudal mammary
Insulin may be indicated. Oversized fetuses can result from glands, and perineum has been observed, usually in large-
their increased production of insulin in response to maternal breed bitches with large litter size (Figs. 55.13, 55.14). These
hyperglycemia and may cause dystocia due to fetal-maternal bitches are not hypoalbuminemic. Venous thrombosis
mismatch (Fig. 55.11). Gestational diabetes can resolve post- should be ruled out with Doppler ultrasonography. Vaginal
partum when progesterone levels decline; if not, it is reclas- hyperplasia can occur at term and be mistaken for pregnancy
sified as type I diabetes. Ovariohysterectomy is indicated edema. Mild elevation of estradiol at the end of gestation in
postweaning as recurrence with diestrus is likely. the bitch can induce reformation of vaginal hyperplasia, seen
more commonly during estrus, and can cause compromise
PREGNANCY TOXEMIA of the birth canal. Elective cesarean section is then indicated.
Pregnancy toxemia in the bitch is due to altered carbohy- Vaginal hyperplasia can be confirmed by digital examination
drate metabolism in late gestation, resulting in ketonuria of the vagina, finding a mass originating cranial to the ure-
without glycosuria or hyperglycemia. The most common thral papilla. If pregnancy edema is confirmed, mild exercise
cause is poor nutrition or anorexia during the last half of (walking or swimming) can be helpful. Diuretics are contra-
gestation. Hepatic lipidosis can occur. An improved plan of indicated; furosemide can cause a decrease in placental
nutrition can resolve the condition in most cases, but termi- intervillous blood flow and spironolactone is a pregnancy
nation of the pregnancy may be indicated in severe cases. category D (positive evidence of fetal risk) drug in humans.
Mild sodium restriction can help. Severe edema of the
perineum can cause dystocia (Fig. 55.15).
VASCULITIDES
Pregnancy Thrombosis
Pregnancy is a recognized hypercoagulable state that
becomes problematic in women with genetic prothrombosis.
Hypercoagulability has also been recognized in pregnant
dogs. Affected bitches have an increased tendency for

FIG 55.12
FIG 55.11 Venous distention noted in a Labrador Retriever bitch during
Oversized singleton fetus in a Chihuahua bitch with the eighth week of gestation. A caudal vena caval thrombus
gestational diabetes. Dystocia and fetal death occurred. was diagnosed ultrasonographically.