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.
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.
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.
We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.
Once our surgeon has scrubbed up and is in sterile gown, gloves, and mask, the surgery begins
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 that depresses the pups.
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 (called an endotracheal tube) is in her windpipe giving her 100% oxygen. Once she is intubated we move fast, and in 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 where the experience of our surgeon, Dr. Palazzolo, comes into play.
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 gently yet 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).