Indications

Dystocia (maternal or fetal causes)

Maternal indications are:
 Physical immaturity
 Uterine torsion
 Pelvic bone malformation
 Pre-parturient hypoglycemia
 Swelling of vulva and cervix
Fetal indications are:
 Abnormal posture, presentation and position
 Monster fetus
 Mummified fetus
 Emphysematous fetus

Pre-Op assessment:
 Level of progesterone (less than 1ng/dL of blood progesterone level & 100°F or
subnormal temperature near parturition, go for elective surgery, near parturition PCV =
30-35% which is more than normal = 25-30%. Normal gestation period is 60-72 days so
always wait up to 72 days.)
 Ultrasound
 Radiography to know the quantity of fetus

Procedure:
 Dorsal recumbence. For large animals of more than 30Kg weight, turn the animal to 10°-
15° to remove the weight of gravid uterus from caudal vena cava, preventing supine
hypotension syndrome.
 Anesthesia: Opioids along with anesthesia i.e Xylazine, Medazolam, Diazepam etc.
(Benzodiazepam or alpha-2 adrenoreceptors agonists). Avoid those that can cross BBB
(blood brain barrier) i.e Pentathyl sodium (barbiturate), ketamine or acepromazine etc.
Regional anesthesia via epidural injection of lignocaine 2% or bupivacaine 0.25% can be
used.
 Administer prophylactic antibiotics I/V after emptying the urinary bladder
 Incise the Ventral midline from Umbilicus to pubis
 Incise the linea alba that will be stretched while abdomen will be distended
 Carefully isolate the uterus from abdomen
  Exteriorize (bring outside the body) uterine horns
 Incise the gravid horn. If both horns are gravid horns then incise the body of uterus near
the bifurcation (stab incision)
 Bring each fetus to the incisional site by gentle peristaltic motion with hand
 Grasp the fetus & exert gentle traction
 Once the exteriorize, amniotic sac is broken & fetal fluids are wiped or suctioned from
neonate & surgical site
 If the placenta readily separates from the neonate, it is removed with the neonate, and
both are placed in a sterilize towel & handed to an attendant. After a few minutes is
clamped 2-3cm from the body wall & placenta is severed free. If placenta is difficult to
separate or bleeds excessively, it is left in place & umbilicus is clamped 2-3cm from the
body wall, and fetus is removed alone.
 After removal or all apparent fetuses, thoroughly palpate the uterus from ovaries to cervix
to ensure that no fetus remains.
 Uterine serosa & incision are wiped clean for the preparation of closure
 Hysterectomy is closed with fine (3/0 or 4/0 absorbable suture on a tapering point needle
with two inverted layer closure (Cushing over lambert)
 Muscles are closed with simple interrupted & skin with cruciate or horizontal

In cats:
Two approaches;

 Caudal ventral midline

 Flank approach
o Because teats are very close to each other & teat connections will be broken in
case of caudal ventral midline so this approach is adapted. But more chances of
other complications.

Post-Operative Care:
 Apply bandage at the incisional site
 Clean the incision site where antiseptics were used
 Feed the pup as early as possible
Complications:
 Vaginal hemorrhages (internal bleeding)
 Peritonitis
 Metritis
 Pup mortality rate = 8-20% while bitch mortality rate = 1%