Introduction
One of the most rewarding
surgeries we perform is a Cesarean Section. Usually it is performed
on small breed dogs because their pelvic canals are just too small to
handle the size of the pups for a natural birth. This is the story of
Margarita, a Chihuahua that had 4 large pups in her tank.
Diagnosis
The gestation length in most
domestic dogs is 63-65 days. When Margarita first came to us one week
before she was due we knew a C-Section would be needed from her size
and her radiograph.
How
many pups do you see in Margarita's abdomen? The answer to this
question will become apparent later on.
Surgery
On the appointed day Margarita was brought to our
hospital for a C-Section by Dr.
Palazzolo. On a dog that is this small,
and has this many large puppies in its uterus, preanesthetic
preparation is important. This consisted of a preanesthetic
blood panel and intravenous
fluids prior to and during surgery.
Here she is on the surgery table. You can see the green tape
covering her IV catheter
and if you look closely you might be able to tell that her abdomen has already
been shaved. She has also been given a local anesthetic where her incision
will be. All of these things are done prior to any anesthesia. They will allow
us to use less anesthesia
for the actual procedure which is important to minimize any anesthesia the
pups will get.
At this point things
start moving fast. Margarita has been given an IV sedative to relax her,
the final surgical prep has been applied, and a breathing
tube is in her windpipe giving
her 100% oxygen. Within the next 5 minutes all of the pups will be out of
her uterus. While her anesthesia is being monitored the rest of the team
is preparing to receive the pups.
She is draped and a rapid
incision is made in her skin. By giving her the local anesthetic
earlier she does not feel the skin incision and we can keep the
anesthetic level to a minimum.
The uterus is rapidly located and gently
squeezed out of her incision. We make the incision in her
abdomen just big enough to gently exteriorize the uterus
because she will heal faster and nurse her pups better with a
smaller incision.
This is one horn of the uterus and contains
2 of the pups. The other horn of the uterus can be visualized
running horizontally at the bottom of the
picture.
A scissors is used to cut into the uterus. Special care is taken not to cut the pups,which could be moving in the uterus.
The first pup is gently removed with his
umbilical cord still attached.
You can get a better idea of the amniotic
sac that completely covers the pups.
The first things our
nurses
do upon receiving the pups is to rub them vigorously in a
towel. This stimulates them to breathe. They also gently shake
them to remove fluid from their lungs.
The nurses use a special bulb syringe to
suction fluids from pups that aren't eliminating fluid from
shaking and rubbing.
Any pup that is still not breathing well at this point is giving a drop of respiratory stimulant on the top of its tongue.
Once our nurses feel the pup
is breathing on its own they tie its umbilical
cord.
After all 4 pups are stable they are put under a heat
lamp since at this early stage in their lives they do not have a very
strong ability to regulate their body temperature.
Meanwhile back in surgery Dr. P is checking
the abdomen to make sure there is no bleeding prior to suturing
the abdomen. In Margarita's case she was also spayed.
Her muscle layer is carefully sewn back
together. These sutures are critical to prevent a hernia from
occurring, especially when pups vigorously
nurse.
With her skin sutures complete Margarita is now taken off the anesthetic machine and a pain injection is given
to her.
Our nurses take care of the
feeding while Margarita rests and recuperates. We won't let 4
hungry pups nurse until she is strong
enough.
Here are our 4 little
piggies all in a row sleeping after their ordeal and their
first meal. Their tummies are full and they are keeping each
other warm.
In a surgery like this there
needs to be close coordination between the surgeon,
anesthetist, and nursing
staff. You can see
how much time and attention our nurses put into doting over
these puppies.
Time for a little shut eye, we had a big
day!
This is one of those pups several months later
with her proud mom! Can you guess which of the above 4 puppies this
one is? (Hint-look at the white spot on the forehead).
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