Page 1002 - Small Animal Internal Medicine, 6th Edition

974 PART VIII Reproductive System Disorders

anesthetic time for the dam, delayed nursing for the neo- show aggression to housemate animals or even people with
nates, and increased loss of blood in the dam, and should be whom they are normally tolerant; such behavior tends to
VetBooks.ir postponed unless indicated (devitalized uterus, uncontrol- dissipate after 1 or 2 weeks of lactation. Lactation typically
presents the greatest nutritional and caloric demand of the
lable hemorrhage). Postoperative hemorrhage due to surgi-
cal error is more common if ovariohysterectomy has been
impact lactation if food and water are not made readily avail-
performed. There is evidence that estrogen acts in a permis- female’s life. Weight loss and dehydration may occur and
sive fashion for prolactin receptors in the mammary glands, able. Sometimes this entails leaving both in the nest box with
making ovary removal at cesarean section undesirable. If a nervous dam. Partial anorexia can be exhibited during the
uterine viability is questionable, however, an ovariohysterec- last weeks of gestation and in the immediate postpartum
tomy should be performed. In the normal dam the uterus period, but the appetite should return and increase as lacta-
will begin to involute shortly after removal of the fetuses, but tion progresses. Poor appetite during the last weeks of gesta-
if this is not the case oxytocin may be administered (0.25-1 tion can be due to displacement of the gastrointestinal tract
unit per dam) to facilitate involution and arrest any hemor- by the gravid uterus. Partial anorexia early in the postpartum
rhage; this also promotes milk letdown. period can occur secondary to digestive upset after the con-
Postsurgical discomfort should be addressed in the dam. sumption of numerous placentae. Diarrhea can occur sec-
Once the fetuses are removed, narcotic analgesia can be ondary to increased rations and rich food (bacterial
administered parenterally to the dam. Postoperatively, overgrowth secondary to carbohydrate malassimilation).
nonsteroidal antiinflammatory drugs (NSAIDs) are not Marked postpartum effluvium is normal in the bitch,
advisable because of their uncertain metabolism by the usually occurring at 4 to 6 weeks after whelping and sparing
nursing neonates with immature renal and hepatic metabo- only the head. This is usually more marked than that which
lism. Narcotic analgesia is preferable. Oral narcotics such as occurs in conjunction with the typical estrous cycle, and can
tramadol (Ultram [Janssen Pharmaceuticals]) at 10 mg/kg/ cause owner concern, especially in conjunction with the
day in divided doses provide fair to good postoperative anal- weight loss typically associated with peak lactation.
gesia for nursing bitches, with minimal effect in the neo- The body temperature of the dam may be mildly elevated
nates. In all cases, clients should be advised to closely monitor (<39.44° C, 103° F) in the immediate postpartum period,
bitches postoperatively until normal maternal behavior reflecting normal inflammation associated with parturition,
emerges. After cesarean section, bitches can be clumsy and but should return to normal levels within 24 to 48 hours. If
inattentive to the neonates and can even become aggressive, a cesarean section took place, differentiating normal post-
because the normal mechanisms of maternal bonding have surgical inflammation from fever associated with pathology
been bypassed. The neonates should be allowed to nurse may be difficult. The physical examination and a complete
colostrum as soon as possible under close supervision (Fig. hemogram help the clinician differentiate between the two.
55.24, see Chapter 57). Normal postpartum lochia is brick red in color and non-
odorous, and diminishes over several days to weeks (Fig.
55.25, A). The mammary glands should not be painful;
POSTPARTUM DISORDERS rather they are symmetric and moderately firm without heat,
erythema, or palpable firm masses. If expressed, normal
Normally, dams stay very close to their offspring during the colostrum is yellow to white; milk is gray to white in color
first 2 weeks postpartum, leaving the whelping/queening box and of more watery consistency.
briefly if at all to eat and eliminate. They are alert and content
to remain with their offspring. Some protective dams may INAPPROPRIATE MATERNAL BEHAVIOR
Appropriate maternal behavior is critical to neonatal survival
and includes attentiveness, facilitation of nursing, retrieving
neonates, grooming, and protecting neonates. Although
maternal behavior is instinctual, it can be negatively influ-
enced by anesthetic drugs, pain, stress, and excessive human
interference. Maternal bonding is a pheromone-mediated
event initiated at parturition. Whelping and queening should
take place in quiet familial surroundings, with minimal
human interference yet adequate supervision. Dams with
good maternal instincts exhibit caution when entering or
moving about the nest box so as not to traumatize neonates
by stepping or lying on them. A guardrail along the inside
of the whelping box prevents inadvertent smothering of
canine neonates (Fig. 55.25, B). The neuroendocrine reflex
FIG 55.24
Golden Retriever neonates nursing during the postoperative regulating mammary gland myoepithelial cell contraction
period after cesarean section. Close monitoring is indicated and subsequent milk ejection is mediated by oxytocin and
during this period. Nursing enables acquisition of colostrum. activated by neonatal suckling. During stress, epinephrine