Caesarian Section

Caesarian section is the operation to turn foetuses into neonates when the mother is unable to perform the task herself.

This may be due to:
Foetal problems
- Single pup syndrome, the pup is unable to signal the mother to begin labour.
- Foetal malpresentation, malformation
- Dead foetuses
Maternal problems
- Uterine inertia
- maternal structural problems, eg pelvic conformation

When to perform
Although there is normal variation in gestation, usually owners should be advised to seek advice at normal gestation plus 2 days, particularly where an accurate mating date is available, and if there is a known dystocia history.

What anaesthetic
The anaesthetic given to the mother will also affect the foetuses, therefore it is wise to use one which is not stored in or strongly bound to body tissues, particularly since foetal detoxifying enzymes are not as effective as in the adult.
Current favourite anaesthetics are propofol and Isoflurane or Sevflurane. Propofol is rapidly and easily metabolised by mother and foetus, and isoflurane and sevflurane do not dissolve in the blood very easily so are lost quickly when the vaporiser is turned off.
General protocol for caesarian anaesthesia is :
-Rapid induction to an appropriate level, not too deep.
-As light as possible for removal of the pups.
-Anaesthesia can be deepened if necessary for closure of the wound.

What to do with the pups
Pups are recovered by caesarian section still enclosed in the foetal membranes and possibly attached to the placenta. If the umbilical cord is not bleeding, then the first task is to strip away the membranes and clear the airway. Then clamp and remove the remnant of the cord. If the cord is snapped already, ensure it is not bleeding, and if it is, clamp this quicklybefore removing foetal membranes.
When the pup is clear it should be rubbed VIGOROUSLY in a dry warm towel with the head held downwards to clear mucus. If necessary the pup can be swung to expel mucus. Check for spontaneous breathing every few seconds. When the pups are squeaking, they are usually safe.
Oxygen can be supplied by mask to poor breathers. Doxopram (Dopram) can also be used as a respiratory stimulant, usually given as a drop on the tongue.

Neonate Care
The main immediate post op problem is warmth. The ambient temperature for pups is around 25 degrees centigrade. This is warm. Clients should be advised that if they would be comfortable in a bathing costume at pup temperature, then it’s probably about right. It might be a good iea to advise clients to equip themselves with a “pig lamp” or other form of radiant heater, so that the pups can have localised heat, and the bitch can escape to one side if necessary.
The second demand is for nutrition. Pups should be suckling within 30 minutes of birth. They are unable to fully regulate glucose for at least 10 days, and require frequent feeding. Initially, if the mother is just too drowsy, then glucose solution can be given as a stop-gap. The pups should be offered up to the teats regularly.
If feeding is an ongoing problem, then milk replacer such as lactol should be fed, at least every two hours for the first week, including throughout the night. It is also the case that pups are unable to spontaneously defaecate and urinate for the first couple of weeks, so if there are problems with the bitch, the owner will have to stimulate the perineum with a damp cotton bud. This simulates the bitch licking the area and causes the pup to empty bladder and bowels.

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