i

TUGAS MATAKULIAH
ILMU BEDAH KHUSUS VETERINER
“Tehnik Operasi Bedah Caesar ”

OLEH:
Ni Luh Risna Cahyani 1609511111
Derisna Sawitri Ungsyani 1609511112
Elizabeth Kezi Damayanti 1609511124
Makrina Weni Misa 1609511125
2016D

Laboratorium Bedah Veteriner

Fakultas Kedokteran Hewan
Univerasitas Udayana
2019
 ii

RINGKASAN
Bedah Caesar merupakan tindakan operasi untuk mengeluarkan fetus dari induknya,
melalui pembedahan pada perut dan uterus. Tujuan dilakukan operasi Caesar adalah
untuk mengeluarkan fetus dari uterus secepat mungkin. Penyebab harus dilakukannya
tindakan operasi Caesar adalah adanya factor ras, anatomi dan genetic dan kesehatan.
Hal- hal yang perlu disiapkan sebelum operasi diantaranya adalah persiapan alat dan
bahan, persiapan hewa, persiapan tempat operasi dan persiapan operator. Prosedur
operasi dilakukan jika hewan tidak dapat melahirkan secara normal. Prosedur dalam
melaksanakan operasi dilakukan dengan enam tahapan. Setelah dilaksanakannya
operasi selanjutnya dilakukan perawatan pasca operasi diantara perawatan kepada
induk dan anaknya.

Kata kunci: Operasi, Caesar

 iii

SUMMARY
Caesarean section is an operation to remove the fetus from its mother, through surgery
on the stomach and uterus. The goal of a Caesarean section is to remove the fetus from
the uterus as quickly as possible. The cause of having to perform a Caesarean section
is racial, anatomical and genetic and health factors. The things that need to be prepared
before the operation include preparation of tools and materials, preparation of hewa,
preparation of the operation site and preparation of the operator. The surgical procedure
is carried out if the animal cannot give birth normally. The procedure for carrying out
operations is carried out in six stages. After the next operation, post-operative care is
performed between care for the mother and child.

Keywords : Surgery, Caesar

 iv

KATA PENGANTAR

Puji dan syukur Penulis panjatkan kepada Tuhan Yang Maha Esa karena atas
berkat dan bimbingan-Nya Penulis dapat menyelesaikan Tugas Ilmu Bedah Khusus
Veteriner dengan judul “Tehnik Operasi Bedah Caesar”

Tugas ini dibuat untuk memenuhi tugas mata kuliah ilmu bedah Khusus
veteriner. Pada kesempatan ini Penulis mengucapkan terima kasih kepada pihak yang
telah membantu penulis dalam menyelesaikan tugas ini baik berupa pikiran, tenaga,
bahkan dana.

Penulis menyadari bahwa paper ini belum sempurna. Oleh karena itu, Penulis
menerima dengan senang hati apabila ada kritik dan saran yang membangun dari
pembaca. Akhir kata semoga paper ini dapat bermanfaat bagi kita.

Denpasar, 22 September 2019

Hormat kami,

Penulis
 v

DAFTAR ISI

Halaman Judul............................................................................................. i
Ringkasan .................................................................................................... ii
Summary ..................................................................................................... iii
Kata Pengantar ............................................................................................ iv
Daftar Isi...................................................................................................... v
Daftar Gambar............................................................................................. vi
Bab I PENDAHULUAN
1.1. Latar Belakang ............................................................................... 1
1.2. Rumusan Masalah .......................................................................... 2
Bab II TUJUAN DAN MANFAAT
2.1. Tujuan ........................................................................................... 3
2.2. Manfaat ......................................................................................... 3
Bab III TINJAUAN PUSTAKA
3.1. Pengertian Bedah Sectio Caesaria ................................................ 4
3.2. Indikasi Bedah Sectio Caesaria .................................................... 5
Bab IV PEMBAHASAN
4.1 Persiapan Operasi .......................................................................... 7
4.2 Prosedur Operasi .......................................................................... 9
4.3 Pasca Operasi ............................................................................... 12
BAB V SIMPULAN DAN SARAN
5.1 Kesimpulan ................................................................................... 14
5.2 Saran ............................................................................................. 14
DAFTAR PUSTAKA ................................................................................. 15
 vi

DAFTAR GAMBAR

Gambar 1.Radiografi Andomen Anjing yang Mengalami Distokia .......... 7

Gambar 2. Proses Anestes ........................................................................... 8
Gambar 3. Persiapan Operasi Sectio Caesaria ........................................... 9
Gambar 4.Posisi Insisi di Daerah Abdomen .............................................. 9
Gambar 5.Penarikan Keluar Uterus ........................................................... 10
Gambar 6.Pengeluaran Fetus dari Uterus ................................................... 10
Gambar 7.Proses Pengeluaran Fetus dan Pembersihan Anak Anjing ....... 11
Gambar 8.Proses Pengambilan dan Pembersihan Anak Anjing ................. 11
Gambar 9.Hecting linea alba dan peritoneum ........................................... 12
Gambar 10.Pola Jahitan Interrupted Pada Kulit Bagian Abdomen ............ 12
 1

BAB I
PENDAHULUAN
1.1 Latar Belakang
Sectio caesaria berasal kata latin “Caesaria” yaitu “caeso matris utera”
yang berarti memotong uterus induk. Sectio caesaria atau pemdedahan Caesar
adalah pengeluaran fetus, pada umumnya pada waktu partus, melalui
laparohisterotomi atau pembedahan perut dan uterus (Toelihere, 1985). Bedah ini
dilakukan apabila mutasi, tarik paksa dan foetotomi tidak dapat atau sangat sulit
dilakukan untuk mengeluarkan foetus atau peternak menginginkan supaya fetus
dikeluarkan dalam kedaan hidup. Ada beberapa organ pada tubuh fetus yang
berbeda dengan induk atau hewan dewasa, organ-organ tersebut belum siap untuk
menerima pengaruh dari obat anestesi umum ketamin dan xylazin pada operasi
sectio caesaria. Perbedaan tersebut meliputi sistem pernafasan, sistem
kardiovaskuler, kebutuhan cairan elektrolit-metabolisme dan pengaturan suhu
tubuh (Raharjo et al., 2008).
Sebelum operasi caesar dilakukan yang terlebih dahulu diperhatikan
adalah pemilihal obat anestesi. Pada operasi caesar dapat digunakan anestesi
umum dan anestesi local. Ada beberapa hal lain yang berkaitan dengan komplikasi
yang akan terjadi pada induk pasca operasi. Komplikasi-komplikasi yang mungkin
akan terjadi terhadap induk pasca operasi caesar antara lain: gangguan pada luka
operasi, peritonitis, emfisema sub kutaneus, retensi membran fetus, metritis,
mastitis, infertilitas, bahkan adanya kemungkinan kematian mendadak pada induk.
Faktor-faktor yang mempengaruhi kesuksesan selama operasi berlangsung atau
pasca operasi selain dipengaruhi oleh komplikasi induk juga dipengaruhi oleh
tindakan-tindakan dokter hewan selama pelaksanaan operasi caesar dan perawatan
pasca operasi. Pemeriksaan terhadap kondisi kesehatan dan fisik induk sebelum
dan sesudah operasi caesar akan dapat mengurangi resiko terjadinya komplikasi-
komplikasi induk pasca operasi (Jackson, 2004).
1.2 Rumusan Masalah
1. Apa yang dimaksud dengan operasi caesar ?
2. Bagaimana persiapan sebelum melaksanakan operasi Caesar?
3. Bagaimana tehnik operasi Caesar?
4. Bagaimana cara perawatan pasca operasi Caesar?

2
 3

BAB II
TUJUAN DAN MANFAAT

2.1 Tujuan Penulisan

Tujuan penulisan paper ini adalah agar dapat memberikan informasi tentang
apa definisi dari operasi caesar, teknik operasi caesar, preanastesi serta anastesi
yang digunakan dalam operasi dan penanganan pasca operasi caesar.

2.2 Manfaat Penulisan

Setelah melaksanakan penulisan makalah diharapkan mahasiswa mengerti
dan mengetahui manfaat dan kegunaan dari dilaksanakannya operasi. Selain itu
mahasiswa diharapkan mampu mengerti bagaimana tata cara pelaksanaan operasi
caesar.
 4

BAB III
TINJAUAN PUSTAKA

3.1 Pengertian Bedah Sectio Caesaria

Sectio caesaria merupakan tindakan operasi untuk mengeluarkan fetus dari
induknya, melalui pembedahan pada perut dan uterus. Tujuan dilakukannya sectio
caesaria adalah untuk mengeluarkan fetus dari uterus secepat mungkin (Sudisma,
2006). Utamanya bedah sectio caesaria yang dilakukan adalah untuk penanganan
kesulitan dalam proses kelahiran, ini terjadi jika pada proses kelahiran induk
mengalami hambatan. Kata “Caesaria” berasal dari Bahasa Latin yaitu “caeso
matris utera” yang artinya memotong uterus induk. Operasi sectio caesaria juga
merupakan tindakan untuk menghentikan masa kebuntingan akibat distokia yang
dapat disebabkan oleh inersia uterus, rupture, dan perforasi uterus.
Bedah sectio caesaria dipilih karena keadaan darurat yang berhubungan
dengan tingkat keselamatan induk dan anak jika tindakan ditunda lebih dari 24 jam
(Onclin dan Vestegen, 2008). Banyak hal yang menyebabkan anjing harus
dilakukan tindakan bedah sectio caesaria, diantaranya:
1. Faktor ras
Ada beberapa anjing yang sering melaui tindakan pembedahan pada saat
melahirkan misalnya Scottish terrier, Chihuahua, Pomeranian, Pug, dan
Staffordshire bull terrier (Onclin dan Verstegen, 2008). Selain itu anjing yang
mudah kelelahan sehingga sudah kelelahan sebelum melahirkan juga kerap kali
melalui bedah sectio caesaria.
2. Faktor anatomi dan genetik
Anjing dengan brachycephalic (kepala pendek dan lebar) cenderung lebih
membutuhkan bedah sectio caesaria kemungkinan karena ketidaksesuaian
antara ukuran panggul induk dan kepala anak anjing (Evan dan Adams, 2010).
3. Faktor kesehatan
Penyakit yang kerap kali menyebabkan anjing harus bedah sectio caesaria yaitu
infeksi saluran rahim dan vagina ataupun anoreksia sehingga mengganggu
 kualitas kesehatan dan mempengaruhi kesehatan fetus. Selain itu kejadian
distokia, menggambarkan kelahiran yang sulit atau kegagalan persalinan
normal. Pada anjing, distokia adalah komplikasi yang sering dijumpai selama
proses kelahiran dan untuk sekitar 60% dari kasus distokia diputuskan untuk
melakukan bedah sectio caesaria (Dolf et al, 2018). Kejadian distokia
merupakan indikasi bedah sectio caesaria pada anjing contohnya Scottish
terrier, Chihuahua, Pomeranian, Pug, dan Staffordshire bull terrier (Evan dan
Adams, 2010).
3.2 Indikasi Bedah Sectio Caesaria
Indikasi utama melakukan sectio caesaria adalah distokia atau kesalahan
posisi fetus, fetus terlalu besar, pertumbuhan fetus yang tidak normal, pelvis yang
kecil, atau karena kelemahan uterus. Bedah sectio caesaria sering direncanakan
pada ras brachyocephalic dan hewan dengan sejarah distokia atau kejadian fraktur
tulang pelvis. Bedah sectio caesaria sering terjadi pada anjing kecil dan jenis
brachyocephalic (Sudisma, 2006). Adapun menurut Schultz et al (2008), beberapa
indikasi yang perlu dipertimbangkan sebelum melakukan bedah sectio caesaria,
yaitu:
1. Indikasi medis
- Kelelahan
Induk yang kelelahan sebelum melahirkan sehingga tidak memiliki daya
untuk mengejan atau induk yang memiliki penyakit jantun atau penyakit
kronis yang mempengaruhi tenaga.
- Kesehatan anak
Ukuran anak yang terlalu besar, posisi anak yang abnormal, serta anak yang
menderita stress fetus.
- Saluran keluar pada induk
Ukuran panggul induk yang sempit dapat memungkin adanya infeksi pada
saluran keluarnya anak yang jika dipaksakan lahiran normal dapat menular
ke anak.

5
2. Indikasi pada induk
- Usia
- Tulang panggul
Ukuran tulang panggul yang tidak sesuai dengan lingkar kepala fetus dapat
menyebabkan kesulitan melahirkan.
- Hambatan pada jalan keluar fetus
Hambatan dapat terjadi karena adanya tumor ataupun karena kelainan
bawaan.
- Kelainan kontraksi Rahim
Kontraksi rahim lemah dan tidak terkoordinasi atau tidak elastisnya leher
rahim sehingga tidak dapat melebar pada proses persalinan sehingga kepala
fetus tidak terdorong.
- Ketuban yang pecah dini
3. Indikasi pada fetus
- Keadaan darurat pada fetus seperti detak jantung melambat
- Ukuran fetus yang terlalu besar
- Posisi fetus dalam Rahim
- Faktor plasenta
- Kelainan pada tali pusar

6
 7

BAB IV
PEMBAHASAN
4.1 Persiapan Operasi
Beberapa hal yang perlu dipersiapkan sebelum operasi, diantaranya
adalah persiapan alat dan bahan obat, persiapan hewan, persiapan tempat
operasi, dan persiapan operator (Sudisma, 2016). Alat dan bahan instrumen
bedah yang diperlukan dalam operasi harus disterilisasi dengan tujuan
menghindari kontaminasi pada luka operasi yang dapat menghambat
kesembuhan luka. Obat-obat yang diperlukan seperti premedikasi, anestesi,
antibiotika, hemostatika, antiinflamasi, dan infus RL. Persiapan ruang bedah
atau tempat operasi dibersihkan dan sterilisasi dan penerangan yang cukup.
Sedangkan pada pasien persiapan yang dilakukan yaitu radiografi abdomen, tes
laboratorium, pasien dipuasakan selama 8-12 jam dengan tujuan untuk
menghindari dampak pemberian anesteso dan membersihkan saluran cerna.

Gambar 1 Radiografi Abdomen Anjing yang mengalami Distokia

Sumber: Cavanagh, 2017
Persiapan hewan lainnya yakni pengosangan colon dan vesica urinaria.
Pembersihan dan pencucian daerah abdomen caudal. Sebelum dilakukan
keduanya, hewan diberi premedikasi, secepatnya hewan tersebut diletakkan di
meja operasi dengan posisi dorsal recumbency. Infus dengan larutan elektrolit
sehingga efek obat lebih cepat terdistribusi. Persiapan terakhir adalah anasthesi,
hewan dapat diberikan anestesi secara epidural, regional, atau umum (Tobias,
2010).
 Pemberian premedikasi berupa atropin sulfat secara subkutan untuk
memberikan efek depresan pada fetus dilanjutkan 30 menit kemudian dengan
eter secara inhalasi pada anesatesi umum. Premedikasi dapat juga
menggunakan analgesia regional seperti acepromazin 0,01-0,02 mg/kg BB dan
oxymorphne 0,03-0,06 mg/kg BB diikuti infiltrasi lokal line blok 2 mg/kg BB
lidokain (Slatter and Douglas, 2002). Menurut Pereira et al. (2006), situs yang
umum digunakan epidrual pada sapi adalah ruang intervertebralis
sacrococcygeal (S5-Co1) dan ruang intervertebral interkoksigeal pertama
(Co1-Co2). Tujuan utama anestesi pada operasi caesar untuk meminimalkan
efek obat terhadap janin (Kraus, 2016).

Gambar 2. Proses Anestesi

Sumber: Oncline dan Vestergen, 2008

8
 4.2 Prosedur Operasi
Sectio caesaria atau bedah cesar adalah prosedur operasi untuk pengeluaran
foetus dari induknya, melalui laparohisterectomi atau pembedahan pada abdomen
dan uterus. Pembedahan ini dilakukan apabila hewan tidak dapat melahirkan
secara normal atau mengalami distokia dan upaya tarik paksa dan foetotomi tidak
dapat atau sulit dilakukan untuk mengeluarkan foetus (Musabine, 2012).
Hewan yang akan dioperasi dibaringkan dengan posisi dorsal recumbency,
rambut site operasi dicukur dan diberi antiseptik kemudian diberikan iodine
povidine. Setelahnya hewan ditutupi kain drape, site operasi dibuka.

Gambar 3. Persiapan operasi sectio caesaria pada Anjing

Sumber: Cavanagh, 2017
Dibuat irisan melalui kulit dan linea alba didaerah ventral midline dari daerah
xiphoid (sedikit dikranial umbilicus) sampai ke tepi pubis (Onclin dan Verstegen,
2008; Sudisma, 2016).

Gambar 4. Posisi Insisi di daerah abdomen

Sumber: Oncline dan Vestergen, 2008

9
 Tempatkan laparotomy pad atau handuk ditepi irisan untuk mengisolasi uterus dari
abdominal. Kedua cornua dan corpus uteri ditarik keluar dengan hati-hati karena
cornua uteri dan pembuluh darahnya sangat mudah robek. Dibuat irisan longitudinal
pada baigian dorsal corpus uteri dengan hati-hati agar tidak melukai fetus.

Gambar 5. Penarikan keluar uterus dan isolasi pada kain drip

Sumber: Oncline dan Vestergen, 2008

Fetus yang terdekat dengan insisi ditarik keluar atau didorong keluar dengan
mondorong uterus. Selaput amnion dibuka dengan jari atau gunting dan anak anjing
dikeluarkan. Umbilical cord dijepit dengan dua hemostat pada jarak 3 cm dari perut
anak anjing dan dipotong.

Gambar 6. Pengeluaran Fetus dari Uterus

Sumber:Oncline dan Vestergen,2008

10
 Gambar 7. Proses pengeluaran fetus dan pembersihan anak anjing
Sumber: Oncline dan Vestergen, 2008

Anak anjing diserahkan untuk perawatan selanjutnya dan placenta dilepas dari
uterus dengan jalan ditarik perlahan-lahan. Anak-anak lain didorong ke tempat insisi
dan dikeluarkan satu demi satu dengan cara yang sama.

Gambar 8. Proses pengambilan dan pembersihan anak anjing

Sumber: Oncline dan Vestergen, 2008
Insisi pada uterus ditutup dengan chomic catgut 2-0 atau 3-0 dengan jahitan
lambert atau cushing. Peritoneum dan linea alba dijahit dengan chomic catgut 2-0 atau
3-0 dengan jahitan simple interrupted, subkutan dan fascia menerus dan kulit dengan
pola jahitan terputus. Kontrasi uterus akan segera terjadi setelah fetus dikeluarkan,
diberikan oksitosin atau ergonovin apabila tidak terjadi kontraksi uterus (Sudisma,
2006).

11
 Gambar 9. Hecting linea alba dan peritoneum
Sumber: Oncline dan Vestergen, 2008

Gambar 10. Pola jahitan Interrupted pada kulit bagian abdomen

Sumber: Jyothi dan Rajesh, 2018

4.3 Pasca Operasi

Setelah dilakukannya operasi, tindakan selanjutnya adalah melakukan
perawatan pasca operasi pada anjing. Perawatan pasca operasi terdiri dari
penanganan induk dan anak anjing (Rosalina, 2015)
Penanganan Induk:
1. Pemeriksaan bagian yang diinsisi
2. Pembatasan pemberian latihan atau pengurangan aktivitas
3. Pemberian antibiotik
4. Pemeberian obat antipsikotik dalam beberapa kasus dibutuhkan

12
Penanganan anak anjing:
1. Membersihkan anak anjing dari lendir setelah dikeluarkan dari uterus
2. Diletakkan pada lingkungan yang hangat
3. Pemberian makanan tambahan jika induk belum dapat menyusui
4. Swab peritoneum untuk merangsang buang air kecil dan buang air besar.

13
 14

BAB V
PENUTUP
5.1 Kesimpulan
Bedah Caesar merupakan tindakan operasi untuk mengeluarkan fetus
dari induknya melalui pembedahan pada perut dan uterus. Tujuan dilakukannya
bedah Caesar adalah untuk mengeluarkan fetus dari uterus secepat mungkin.
Penyebab hewan harus dilakukan tindakan bedah Caesar adalah factor ras, factor
anatomi dan genetik dan factor kesehatan. Indikasi utama dilakukan bedah Caesar
adalah terjadinya distokia, fetus terlalu besar, pertumbuhan fetus tidak normal,
pelvis kecil dan kelelahan uterus. dalam proses operasi Caesar tahap-tahap yang
harus dilakukan adalah pre operasi, operasi dan pasca operasi. Hal-hal yang harus
dilakukan sebelum operasi adalah persiapan alat dan bahan, persiapan hewan,
persiapan tempat operasi dan persiapan operator. Saat melaksanakan operasi
dilakukan enam tahapan. Setelah dilaksanakan operasi dilakukan perawatan pasca
operasi. perawatan tidak hanya dilakukan pada induk tetapi anak anjing juga
dilakukan perawatan.
5.2 Saran
Penulis menyadari bahwa penulisan masih jauh dari kata sempurna oleh
karena itu penulis membutuhkan kritik dan saran agar kedepannya penulis akan
lebih fokus dan detail dalam menjelaskan tentang operasi bedah caesar dengan
sumber sumber yang lebih banyak yang tentunya dapat di pertanggung jawabkan.
 15

DAFTAR PUSTAKA

Cavanagh, A. 2017. Canine Dystocia. Dapat diakses:

https://www.cliniciansbrief.com/article/canine-dystocia. [23 September 2019].

Dolf, G., Gaillard, C., Russenberger, J., Moseley, L., Schelling, C. 2018. Factor
Contributing to the Decision to Perform a Cesarean Section in Labrador
Retrievers. BMC Veterinary Research 14: 57-66.
Evans, KM., dan Adam VJ. 2010. Proportion of Litters of Purebred Dogs Born by
Caesarean Section. Journal of Small Animal Practice, 51: 113-118.
Jyothi JS dan Rajesh K. 2018. Cesarean section in canine: Case report. The Pharma
Innovation Journal Vol 7(4): 561-562.
Kraus, BH. 2016. Anesthesia for Cesarean Section In The Dog. IOWA State
University.
Onclin, KJ., dan Verstegen, JP. 2008. Caesarean Section in the Dog. NAVC Clinician’s
Brief: 72-28.
Pereira, F.L.G., Greene, S.A., McEwen, M.M. and Keegan, R. 2006. Analgesia and
anesthesia in camelids. Small Rumin. Res Vol 61: 227-233.
Schultz, LG., Tyler, JW., Moll., HD., Constantinescu, GM. 2008. Surgical Approaches
for Cesarean Section in Cattle. Can Vet J 49(6): 565-568.
Rosalina, I. 2015. Bedah Caesar pada Anjing. Dapat diakses: http://lin-
myvetdays.blogspot.co .id/2015/01/bedah-caesar-pada-anjing.html. [23
September 2019].

Sudisma, IGN. 2006. Ilmu Bedah Veteriner dan Teknik Operasi Ed 1. Denpasar:
Pelawa Sari
Slatter, D. 2002. Text Book of Small Animal Surgery 2nd edition. United States of
America: WB saunders.

Sudisma, I. G. N. 2016. Ilmu Bedah Veteriner dan Teknik Operasi. Denpasar: Fakultas
Kedokteran Hewan Universitas Udayana. ISBN: 979- 25-5196-6.
Tobias, M.K. 2010. Manual of Small Animal Soft Tissue Surgery. A John Wiley &
Sons, Ltd. Publication: Tennese, United State of America.

16
Veterinary Clinical Sciences Publications Veterinary Clinical Sciences

2016

Anesthesia for cesarean section in the dog

Bonnie Hay Kraus
Iowa State University, bhkraus@iastate.edu

Follow this and additional works at: http://lib.dr.iastate.edu/vcs_pubs

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Anesthesia for cesarean section in the dog
Abstract
The major goal in anesthesia for cesarean section (CS) is to minimize fetal effects of anesthetic drugs in order
to minimize fetal respiratory, central nervous system and cardiovascular depression and deliver live, vigorous
puppies. Of equal importance is to provide adequate analgesia to the dam and prevent anesthesia-related
complications such as hypotension, hypoventilation, hypoxemia, hemorrhage and hypothermia, which will
increase morbidity and mortality in both mother and puppies. The physiochemical properties which allow
drugs to cross the blood-brain barrier also facilitate crossing of the placenta, therefore the assumption should
be made (with very few exceptions) that anes- thetics, analgesics and sedatives/tranquilizers all cross the
placenta. Prolonged labor prior to delivery causes maternal physiologic compromise, resulting in fetal
depression due to decreased placental perfusion, hypoxemia and acidosis. Maternal and puppy mortality is
significantly increased during emergent versus planned CS (1,2). Timing and preparation are extremely
impor- tant for puppy survival for both elective and emergency CS, and a thorough understanding of the
maternal phy- siologic changes and the potential impact of anesthetic drugs is essential to optimize outcomes
for both mother and fetus (Figure 1).

Disciplines
Small or Companion Animal Medicine | Veterinary Physiology | Veterinary Toxicology and Pharmacology

Comments
This article is published as Hay Kraus BL. Anesthesia For Cesarean Section in the Dog.Veterinary Focus, vol.
26(1) 2016, pp. 24-31. Posted with permission.

This article is available at Iowa State University Digital Repository: http://lib.dr.iastate.edu/vcs_pubs/14

 Anesthesia for cesarean
section in the dog
■ Bonnie Hay Kraus, DVM, Dipl. ACVS, Dipl. ACVAA
Iowa State University, College of Veterinary Medicine, Iowa, USA
Dr. Hay Kraus received her DVM degree from the University of Missouri – Columbia in 1989. She
completed an internship at the New Jersey Equine Clinic in Clarksburg before undertaking residencies in
both Equine Surgery and Comparative Anesthesia at Tufts University School of Veterinary Medicine,
completing them in 1993 and 1998 respectively. She is board certified by both the American College of
Veterinary Surgeons and the American College of Veterinary Anesthesiology and Analgesia. In 2007, she
joined the veterinary faculty at the Department of Veterinary Clinical Sciences, Iowa State University –
College of Veterinary Medicine, where she is currently an Anesthesiologist.

■ Introduction increase morbidity and mortality in both mother and

The major goal in anesthesia for cesarean section (CS) is puppies. The physiochemical properties which allow
to minimize fetal effects of anesthetic drugs in order to drugs to cross the blood-brain barrier also facilitate
minimize fetal respiratory, central nervous system and crossing of the placenta, therefore the assumption
cardiovascular depression and deliver live, vigorous should be made (with very few exceptions) that anes-
puppies. Of equal importance is to provide adequate thetics, analgesics and sedatives/tranquilizers all cross
analgesia to the dam and prevent anesthesia-related the placenta. Prolonged labor prior to delivery causes
complications such as hypotension, hypoventilation, maternal physiologic compromise, resulting in fetal
hypoxemia, hemorrhage and hypothermia, which will depression due to decreased placental perfusion,
hypoxemia and acidosis. Maternal and puppy mortality
is significantly increased during emergent versus planned
CS (1,2). Timing and preparation are extremely impor-
tant for puppy survival for both elective and emergency
KEY POINTS CS, and a thorough understanding of the maternal phy-
siologic changes and the potential impact of anesthetic
• The major goals for cesarean section are to drugs is essential to optimize outcomes for both mother
deliver live, vigorous puppies while providing and fetus (Figure 1).
adequate analgesia to the dam.
• There is a higher anesthetic risk with ■ Maternal physiologic changes
cesarean section due to pregnancy- Increased metabolic demands imposed by the fetus
associated physiologic changes.
result in major physiologic changes during pregnancy
• Planning and preparation are important and impact the anesthetic management of these patients
for both elective and emergent surgical
(Figure 2). Much of the data describing these alterations
scenarios.
have been obtained in humans and sheep, but should
• Optimized ventilation, oxygenation and
be comparable – if not greater in magnitude – in the dog,
perfusion in the dam should permit a “happy
dam, happy baby” scenario. since birth weight as a percentage of maternal weight is
significantly greater (3). Pregnancy-associated physio-
• Neonatal resuscitation centers on stimulating
respiration and supporting oxygenation and logic changes to the cardiac, pulmonary and gastroin-
body temperature. testinal (GI) systems are summarized in Table 1. These
• Most commonly used analgesic drugs may result in greater anesthetic risk (due to decreased car-
be safely administered to lactating dams diac and respiratory reserve and a higher chance of
without adversely affecting the neonates. vomiting/regurgitation with aspiration) as well as de-
creased anesthetic requirements (which may put them
at risk for anesthetic overdose) (3,4).

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Cardiovascular

© Photo courtesy of Stephanie Kelley and Rhonda Snitker of Snitker Goldens, Waukon, IA USA
The growing fetuses increase metabolic demand and
maternal oxygen consumption. Increases in heart rate
and stroke volume augment cardiac output by 30-40%
to meet the demand (3-5), but result in decreased
cardiac reserve.

Unlike other major organs, uterine blood flow is not

auto-regulated (4). Uterine blood flow and placental per-
fusion are directly related to systemic blood pressure
and inversely proportional to myometrial vascular resis-
tance (3). Decreases in uterine blood flow will result in
decreased fetal oxygen delivery. Pain, stress, hyperven-
tilation and some drugs (e.g., alpha-2 agonists) can all
decrease cardiac output during labor and contribute to Figure 1. Maintaining adequate ventilation, oxygenation
decreased uterine blood flow. Control of pain and anxi- and perfusion in the dam will optimize fetal outcome =>
ety are key components of successful patient manage- “Happy dam, Happy baby”.
ment. Care must be taken to avoid cardiac depression
from excessive doses of sedatives or anesthetics. In
humans, the posterior vena cava and aorta can be
compressed during dorsal recumbency which decreases
venous return, cardiac output and uterine blood flow.
Although less significant in dogs, the amount of time in
dorsal recumbency should minimized (3,4).

Maternal blood volume during pregnancy increases by

up to ~23% in dogs, along with red blood cells (RBCs) (6),
with plasma volume increasing more than RBCs, lead-
ing to decreased packed cell volume. This pregnancy-
© Bonnie Hay Kraus

associated anemia increases in magnitude in relation to

the number of fetuses (7). Increased blood volume buffers
against losses during parturition but can confound the
use of packed cell volume as a measure of dehydration Figure 2. Pregnancy-associated physiologic changes
preoperatively; other clinical signs may need to be uti- to the cardiac, pulmonary and gastrointestinal systems
result in greater anesthetic risk due to decreased cardiac
lized. There is a greater risk of intra-operative hemorrhage and respiratory reserve and higher risk of vomiting/
due to the increased blood flow to the gravid uterus (20- regurgitation and aspiration.
40 times normal) and mammary glands (5). Intra-opera-
tive hemorrhage should be quantified and replaced with
3-4 times the amount in crystalloid solution (up to 10%
loss of the total blood volume) to avoid the associated
hypotension and decreased uterine blood flow. Colloid
therapy should be added if hemorrhage reaches 20%. decreases due to craniodorsal displacement of the ab-
Hypotension may be treated with ephedrine (administered dominal organs and diaphragm by the gravid uterus
as a bolus, 0.03-0.1 mg/kg IV); this is the drug of choice (3-5). Decreased FRC leads to small airway closure and
in pregnant women since it increases blood pressure atelectasis. The combination of decreased FRC and in-
while maintaining uterine blood flow, whereas both dopa- creased oxygen consumption raises the risk of hypox-
mine and dobutamine decrease uterine blood flow (3,4). emia during periods of hypoventilation or apnea (e.g.,
during anesthetic induction (3,4)). Pre-oxygenation prior
Pulmonary to anesthetic induction is recommended to delay the
Tidal volume, respiratory rate and minute ventilation onset of hypoxemia from approximately 60 seconds to
all increase, but functional residual capacity (FRC) up to five minutes if the patient is tolerant (8).

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Gastrointestinal Table 1. Pregnancy-associated physiologic

Increased serum progesterone decreases lower esopha- changes.
geal sphincter tone, GI motility and gastric emptying,
whilst cranial displacement of the stomach increases Heart rate, stroke volume,
ñ
cardiac output
intra-gastric pressure; together these contribute to a
Vascular tone, arterial blood
ò
greater risk of regurgitation and aspiration (3,4). In- pressure
creased gastrin and gastric acid production lowers Cardiovascular Oxygen consumption
ñ
stomach pH and puts parturient patients at greater risk Red blood cells, blood/plasma
ñ
for aspiration pneumonitis and esophagitis (4). Prophy- volume
Packed cell volume/hemoglobin/
ò
lactic administration of metoclopramide or anti-emetics
plasma proteins
such as maropitant or ondansetron and/or H2 receptor
antagonists may help ameliorate these effects. Emergent Respiratory rate, tidal volume,
ñ
patients are also likely to be inadequately fasted, and Respiratory minute ventilation
rapid IV induction followed by intubation (ensuring the cuff Functional residual capacity
ò
is properly inflated) is recommended.
Lower esophageal sphincter
ò
Passive regurgitation may occur due to increased intra- tone
Intra-gastric pressure/gastric
ñ
gastric pressure, exacerbated by positive-pressure ven- Gastrointestinal emptying time
tilation or manipulation of the viscera; if this occurs, GI motility, pH of gastric
ò
esophageal suction and lavage should be performed secretions
and 4% sodium bicarbonate infused to increase the pH Gastrin production
ñ
in the lower esophagus (9).
Central Nervous
Endorphins
ñ
System
CNS
The minimum alveolar concentration of inhalant anes-
thetics decreases up to 40% in parturients (3,4). How-
ever, it may be offset by the omission of sedatives/tran-
quilizer premedication. Inhalant-sparing techniques such • Molecular weight < 600 Da
as incision blocks, epidural and parenteral analgesia will • High lipid solubility
help avoid high inhalant concentration and reduce fetal • Low degree of protein binding
cardiopulmonary and CNS depression. • Non-ionization at maternal blood pH (3,4)

■ General pharmacology and
pregnancy
Placental transfer of drugs has been primarily studied in
sheep and laboratory animals, and direct extrapolation
to dogs may be misleading due to species differences in
placentation, extent of placental metabolism and trans-
port of drug across the placenta (4). However, in gen-
eral, the same physiochemical properties that allow
drugs to cross the blood brain barrier also facilitate their
placental transfer. The safest assumption is that most, if
not all, drugs cross the placenta and affect the fetus.
Elective procedures requiring anesthesia are best
avoided during the first trimester (20 days of gestation
in dogs), when the fetuses are most vulnerable to tera-
togenic effects of drugs.
Simple diffusion is the most important mechanism of
placental transfer of drugs. Properties favoring transfer
include:
Most anesthetic drugs, with the exception of glycopyr-
rolate and neuromuscular blocking agents, have MW
< 300 Da and are relatively lipid soluble, and thus readily
cross the placenta.
Drug protein binding and degree of ionization is deter-
mined by its pKa and blood pH, which in turn can affect
the distribution between the dam and fetus. As blood pH
decreases, acidic drugs such as thiobarbiturates will be
less ionized and the fraction of drug bound to protein is
decreased, leading to greater clinical effect (3,4). Weakly
basic drugs (opioids, local anesthetics) become more
highly ionized, resulting in less effect on the dam and
fetus (3,4). Redistribution of drugs out of the fetus back
into the dam’s circulation as maternal plasma levels
decrease makes clinical estimation of fetal plasma con-
centrations difficult. Although ~50% of umbilical vein
blood passes through the fetal liver, microsomal enzyme
activity and metabolism are minimal (4).

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Inhalant agents readily cross the placenta and should
be titrated to the lowest level needed to achieve ade-
quate anesthesia. Unlike halothane and methoxyflu-
rane, which rely heavily on metabolism (~20-50% and
50-75% respectively) for elimination, isoflurane and
sevoflurane are almost entirely eliminated through the
respiratory system. Additionally, the low blood solubility
results in rapid clearance from the newborn as long as
they are breathing at delivery. It is important to avoid
high inhalant concentrations to prevent neonatal respi-
ratory depression and apnea. Isoflurane is associated
with improved puppy survival at 7 days compared to
methoxyflurane and there is no difference when com-
pared to epidural anesthesia (1).
Anesthetic drugs
• Anticholinergic agents such as atropine and glyco-
pyrrolate are primarily used to decrease vagal tone due
to opioids or traction on the uterus, or to support fetal
heart rate. Choice depends on the desire for placental
transfer, since atropine crosses the placental barrier
but glycopyrrolate does not. Glycopyrrolate will miti-
gate the increased vagal tone caused by mu agonist
opioids and prevent maternal bradycardia and possi-
ble hypotension. It also increases gastric pH and may
decrease the severity of chemical pneumonitis should
regurgitation and aspiration occur in the dam (3). Fetal
bradycardia (< 150 beats/min) indicates fetal distress
and is one of the prime indicators for emergency CS
(10). Fetal cardiac output is more dependent on heart
rate than blood pressure. Atropine may be adminis-
tered to the dam if the objective is to increase fetal
heart rate, which may be low due to hypoxemia, fetal
distress or mu agonist opioids. Increasing the fetal
heart rate will increase myocardial oxygen consump-
tion in the face of hypoxemia, which may lead to myo-
cardial ischemia, so atropine use is controversial.
However, it may support the heart rate long enough to
allow delivery and proper resuscitation. It is important
to optimize maternal oxygenation, cardiac output and
blood pressure, and ensure good ventilation for the
puppies after delivery.
• Tranquilizers/sedatives are typically avoided due to
cardiorespiratory and CNS depression. Xylazine alone or
in combination with ketamine is associated with higher
fetal death (1). Medetomidine at low doses (< 20 µg/kg)
does not increase uterine muscle activity or cause abor-
tion (3), but both medetomidine and dexmedetomidine
cause significant decreased cardiac output in the dam
due to vasoconstriction and baroreceptor-mediated
bradycardia, and drug label recommendations advise
against their use in pregnant dogs. Benzodiazepines
(diazepam and midazolam) can cause neonatal depres-
sion, lethargy, apnea and hypothermia, especially at
higher doses. Low dose acepromazine may be an
option for very stressed or anxious dogs to avoid de-
creased uterine blood flow. The drug crosses the pla-
centa slowly due to its higher molecular weight and
protein binding, and is not associated with increased
maternal or neonatal mortality (2,4), but its αa-adrenergic
antagonism can cause vasodilation and therefore it should
be avoided in dehydrated or compromised patients.
• Opioids include mu-receptor agonists such as mor-
phine, hydromorphone, oxymorphone, fentanyl, meth-
adone and meperidine. Buprenorphine is a partial mu
agonist and butorphanol is a mu-receptor antagonist
and a kappa agonist. These latter two drugs typically
produce less sedation and respiratory depression than
full mu agonists, but offer less potent analgesia.
Administering opioids to the dam will result in placental
transfer, the extent of transfer differing depending on
the drug. Less than 10% of buprenorphine is transferred
to the fetus, whereas fentanyl (which is highly lipid solu-
ble) crosses the placenta in high amounts, persisting
long after maternal clearance (4). Of the commonly
used mu agonists, morphine is the least lipid soluble
and only 20-30% is non-ionized at normal plasma pH
(4). It crosses the placenta less rapidly than more lipid
soluble agonists such as fentanyl. The lipid solubility of
hydromorphone lies between these two drugs.
Neonates are significantly more sensitive to CNS and
respiratory depression of opioids due to the immaturity
of their CNS, increased permeability of the blood-brain
barrier and end-organ sensitivity, and even small
changes in ventilation may lead to hypoxemia and
increased mortality. Respiratory and CNS depression
in newly delivered neonates can be reversed with
naloxone.
■ Anesthetic induction
The use of thiopental, ketamine, xylazine and methoxy-
flurane have been associated with increased puppy mor-
tality and/or decreased puppy vigor at birth, and are best
avoided (1,11,12). Epidural anesthesia/analgesia used
alone for CS has minimal fetal effects but has various
drawbacks; it is technically difficult, airway protection
via intubation is impossible, and there is the risk of hind-
limb paralysis, hypotension or urinary retention (if epidural
opioids are used).
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© Bonnie Hay Kraus
a b
Figure 3 (a and b). Resuscitation equipment and drugs should be organized before induction of anesthesia.
Propofol has a short half-life and rapid metabolism,
including extra-hepatic metabolism, but it can cause
cardiopulmonary depression depending on the dose
and rate of administration. Propofol followed by isoflu-
rane has puppy survival rates equivalent to epidural
anesthesia and is associated with a positive effect on
neonatal survival at 7 days (1). Propofol has similar fetal
mortality rates to mask induction with isoflurane, but it
allows IV induction and rapid control and protection of
the airway (1,13).
Alphaxalone is available in many countries and has
been shown to have a shorter terminal half-life com-
pared to propofol (14,15). Two recent studies compar-
ing propofol to alphaxalone for induction at CS found no
significant difference in puppy mortality at 24 hours or
up to 3 months after delivery, but both studies identified
differences in “puppy vigor”. Apgar scores and all four
health vigor assessments (withdrawal, sucking, ano-
genital and flexion reflexes) were greater for puppies for
up to 60 minutes post-delivery where the dams received
alphaxalone (16,17).
■ Anesthetic technique
If labor has begun, the puppies are likely to be in some
degree of distress and the dam may be exhausted and
dehydrated; crystalloid fluids can be given and may be
started pre-operatively and continued during surgery to
save time. An IV catheter can be placed with the aid of a
local block using an insulin syringe with 18 units of
28 / Veterinary Focus / Vol 26 n°1 / 2016
S E C T I O N I N T H E D O G lIIIIIII
lidocaine and 2 units of sodium bicarbonate. Clipping
and initial surgical preparation of the abdomen can be
done prior to anesthetic induction.
As noted above, the increased risk for regurgitation and
aspiration can be decreased using maropitant (1.0 mg/
kg SC administered at least 30 minutes prior to opioid
administration (18)). For more emergent situations, ma-
ropitant may be given (1.0 mg/kg IV over 5 minutes while
monitoring blood pressure) and discomfort on injection
can be decreased by diluting 50:50 with crystalloid solu-
tion. Alternatively, an opioid premedication which does
not induce vomiting may be administered (e.g., butor-
phanol at 0.2-0.3 mg/kg IM or IV). Sedatives, e.g., ace-
promazine at 2.0-5.0 µg/kg IM or IV, should be reserved
for highly stressed dams; however, remember that this
drug has a long duration of action and cannot be reversed
in either the dam or puppies.
Premedication with an opioid, either butorphanol or a full
mu agonist should be administered even to quiet or
debilitated dams as it decreases pain, stress and the
induction and inhalant dose requirements. Using a low
dose may lessen the respiratory and CNS depressant
effects on the fetuses/neonates. Anti-cholinergics may
be administered depending on the objective(s) as indi-
cated above.
Lumbosacral epidural with either local anesthetic or
opioid (alone or in combination) can be administered
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Table 2. Neonatal resuscitation equipment list.
• Oxygen source
• Small tight-fitting mask
• Heat source (e.g., circulating water blanket,
hot air or electric blankets)
• Clean towels
• Neonatal bulb syringes
• 1mL or insulin syringes
• Small (25G) needles
• Dextrose
• Crystalloid fluids
• Monitoring equipment
• Intubation equipment:
➢- Laryngoscope with small blade (size 0-1)
➢- Endotracheal tubes (size 2.0-3.0 mm OD,
14G or 18G IV catheter)
• Resuscitation drugs:
➢- Naloxone
➢- Doxapram
➢- Epinephrine
either before or directly after induction to provide anesthesia
and analgesia. Lidocaine (2.0-3.0 mg/kg, 0.1-0.15 mL/
kg of 20 mg/mL concentration)) will last for ~90 minutes,
whilst bupivacaine (0.75-1.5 mg/kg, 0.1-0.2 mL/kg of
7.5 mg/mL concentration) lasts up to 4-6 hours. Both
drugs will affect hindlimb motor function and may con-
tribute to intra-operative hypotension through sympa-
thetic blockade. Alternatively, preservative-free morphine
may be used alone to provide analgesia (0.1-0.2 mg/kg);
the onset of action may take up to 60 minutes, but motor
function is not affected. Epidural opioids may cause urinary
retention and – since early hospital discharge is advanta-
geous for healthy dam and puppies – owners must moni-
tor urine output for 24 hours after discharge. The combi-
nation of lidocaine (2.0 mg/kg) and morphine (0.1 mg/kg)
provides rapid onset of anesthesia along with synergistic
and long-lasting analgesia. Epidural drug administration
requires much lower doses than the same drugs given
parenterally and therefore decreases systemic effects in
the dam and puppies. Alternatively, the epidural can be
performed after the pups are delivered and the incision
is closed to provide post-operative analgesia.
Pre-oxygenation of the dam (100 mL/kg/min by face mask
for 3 minutes prior to induction) will prevent hypoxemia
associated with hypoventilation and apnea at induction.
Propofol or alphaxalone can be used for anesthesia
induction, followed by maintenance with isoflurane or
sevoflurane. Close monitoring of anesthetic depth is rec-
ommended to titrate inhalant to the lowest level that will
provide adequate anesthesia in the dam. Monitoring of
ECG, blood pressure, pulse oximetry and end-tidal car-
bon dioxide is recommended to ensure adequate oxy-
genation, ventilation and perfusion in the dam.
If local anesthetic epidural is not performed, a lidocaine
block along the line of incision (at 2 mg/kg, diluted with
sterile water if necessary to increase the volume) will pro-
vide intra-operative analgesia. Bupivacaine may be used
(1.5-2.0 mg/kg) for an incisional block at the time of clo-
sure of the linea alba for longer post-operative analgesia.
Lidocaine and bupivacaine mixtures have a decreased
duration of action and are not recommended (19).
If butorphanol is used as a premedication, stronger opi-
oid analgesics such as hydromorphone (0.05-0.1 mg/
kg IV) or morphine (0.5-1.0 mg/kg slowly IV) can be
administered once the puppies are delivered. Alterna-
tively buprenorphine (0.01-0.02 mg/kg IV) will result in
less sedation, bradycardia and respiratory depression
than the full mu agonist, and also offers a much longer
duration of action (4-10 hours in dogs), but the cost
may be significantly higher. Milk transfer has not been
analyzed for opioids, NSAIDs or local anesthetics in lac-
tating dogs. However, breast milk transfer of opioids
has been well studied in humans and although most
opioids are excreted in low concentrations in human
milk they do not pose a significant neonate risk unless
large or repeated doses are administered (20). NSAID
safety profiles have not been evaluated in puppies less
than 4-6 weeks of age, but carprofen is poorly excreted
and undetectable (< 25 ng/mL) in the milk of lactating
dairy cattle (21).
Excretion of lidocaine and bupivacaine and/or their
metabolites does occur but there is minimal effect on
human neonates (22) and milk concentrations of ropi-
vacaine are lower than for other local anesthetics (23).
Although species differences may occur, based on cur-
rent evidence it seems that most commonly used anal-
gesics may be safely administered to lactating dams
without adversely affecting the neonates.
■ Neonate resuscitation
Resuscitation equipment and drugs should be organ-
ized before induction of anesthesia (Table 2, Figure 3)
with (ideally) one assistant per neonate delivered.
Resuscitation should center on tactile stimulation of
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© Bonnie Hay Kraus
Figure 4. Rub the newborn pup vigorously with clean,
warm towels to stimulate respiration.
© Bonnie Hay Kraus
Figure 5. Suction of fluid from mouth and pharynx can be
accomplished with a neonatal bulb syringe.
© Bonnie Hay Kraus
Figure 6. The JenChung GV26 acupuncture point used
to stimulate respiration; a 25G needle is inserted into the
nasal philtrum until it contacts bone and then twisted.
30 / Veterinary Focus / Vol 26 n°1 / 2016
S E C T I O N I N T H E D O G lIIIIIII
respiration and maintaining or improving ventilation,
oxygenation and body temperature. During the normal
birth process through the pelvic canal, the neonate’s
chest is compressed, expelling fluid from the respiratory
tract and stimulating the first breath through recoil of the
chest wall. This does not occur during cesarean deliv-
ery, therefore immediately after delivery the fetal mem-
branes should be removed, the umbilical cord clamped
and severed, and the neonate rubbed vigorously with
clean towels to encourage respiration (Figure 4). Stim-
ulation of the perineal and umbilical areas, and rubbing
of the hair in a backward direction, may also benefit res-
piration. At the same time, a suction bulb should be
used to clear the mucous and fluid from the nose, mouth
and pharynx (Figure 5). A proprietary aspiration/resus-
citation device is available in some countries which clears
the respiratory tract and stimulates the respiratory reflex.
Acupuncture can be useful; a 25G needle inserted into
the nasal philtrum until it contacts bone (the JenChung
GV26 point) and then twisted can help stimulate respira-
tion (Figure 6). The practice of “swinging” newborns to
facilitate resuscitation or clearing of fluid from the respi-
ratory tract is not recommended and increases the likeli-
hood of injury (24).
Spontaneous breathing should be identified by observ-
ing the chest wall, listening for vocalization, or ausculta-
tion with a stethoscope. The two major causes of fetal
depression are hypoxemia and drugs administered to
the dam. Vigorous rubbing should continue along with
oxygen supplementation and gentle chest compres-
sions. Opioids administered to the dam should be
reversed in the neonate with naloxone (0.002-0.02 mg/
kg IV or 1-2 drops sublingually) after delivery if the pups
are slow to begin breathing, moving and vocalizing.
Neonatal heart rates should be ~220 bpm and can be
counted by palpating a precordial pulse. Bradycardia
usually indicates hypoxemia and should be treated by
stimulating ventilation, supplemental oxygen, patient
warming and mechanical stimulation as described
above. Doxapram (1-2 drops sublingually) can be used
as a respiratory stimulant, but it also increases cerebral
oxygen consumption and should only be used with oxy-
gen supplementation. There is no evidence against
employing the drug in dogs, but its use has been dis-
continued in humans. If spontaneous breathing is still
not observed, the pup should be intubated using a
short-bladed laryngoscope and (depending on the size/
breed) a flexible 14 or 18G IV catheter or 2.0-3.0 OD
endotracheal tube; careful handling is necessary to
avoid traumatizing the delicate neonatal tissues. Severe
IIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIIIIIIIIIIIlIIIIII
bradycardia or asystole may be treated with epinephrine
(0.1 µg/kg) diluted with 0.5 mL of crystalloid fluid, and
administered though the umbilical vein (identified as the
thin-walled vessel within the umbilical stump; umbilical
References
1. Moon PF, Erb HN, Ludders JW, et al. Peri-operative risk factors for puppies
delivered by cesarean section in the United States and Canada. J Am Anim
Hosp Assoc 2000;36:359-368.
2. Moon PF, Erb HN, Ludders JW, et al. Peri-operative management and
mortality rates of dogs undergoing cesarean section in the United States and
Canada. J Am Vet Med Assoc 1998;213:365-369.
3. Raffe MR. Anesthetic considerations during pregnancy and for the newborn.
In: Grimm KA, Lamont LA, Tranquilli WJ, et al (eds). Veterinary Anesthesia and
Analgesia: The Fifth Edition of Lumb and Jones. Ames, IA: Wiley Blackwell,
2015;708-719.
4. Aarnes TK, Bednarski RM. Cesarean section and pregnancy. In: Snyder LBC
and Johnson RA (eds.) Canine and Feline Anesthesia and Co-Existing Disease.
1st ed. Ames, IA: Wiley Blackwell, 2015;299-309.
5. Camann W, Ostheimer G. Physiological adaptations during pregnancy. Intern
Anesthesiol Clin 1990;28:2-10.
6. Brooks V, Keil L. Hemorrhage decreases arterial pressure sooner in pregnant
compared with non-pregnant dogs: role of baroreflex. Am J Physiol
1994;266:1610-1619.
7. Kaneko M, Nakayama H, Igarashi N, et al. Relationship between the number of
fetuses and the blood constituents of Beagles in late pregnancy. J Vet Med Sci
1993;55:681-682.
8. McNally EM, Robertson SA, Pablo LS. Comparison of time to desaturation
between pre-oxygenated and non pre-oxygenated dogs following sedation
with acepromazine maleate and morphine and induction of anesthesia with
propofol. Am J Vet Res 2009;70(11):1333-1338.
9. Wilson DV, Evans AT. The effect of topical treatment on esophageal pH during
acid reflux in dogs. Vet Anaesth Analg 2007;34(5):339-343.
10. Smith FO. Guide to emergency interception during parturition in the dog and
cat. Vet Clin Small Anim 2012;42:489-499.
11. Luna SPL, Cassu RD, Castro GB, et al. Effects of four anaesthetic protocols on
the neurological and cardiorespiratory variable of puppies born by caesarean
section. Vet Rec 2004;154:387-389.
12. Funkquist PME, Nyman GC, Lofgren AJ, et al. Use of propofol-isoflurane as an
anesthetic regimen for cesarean section in dogs. J Am Vet Med Assoc
1997:211:313-317.
arteries have thicker walls). Thermoregulation reflexes
are underdeveloped in neonates, therefore as soon as
the neonate is breathing, moving and vocalizing, they
should be placed in a warmed incubator.
13. Moon-Massat PF, Erb HN. Perioperative factors associated with puppy vigor
after delivery by cesarean section. J Am Anim Hosp Assoc 2002;38:90-96.
14. Ferre PJ, Pasloske K, Whittem T, et al. Plasma pharmacokinetics of alfaxalone
in dogs after an intravenous bolus of Alfaxan-CD RTU. Vet Anaesth Analg
2006;33:229-236.
15. Zoran DL, Riedesel DH, Dyer DC. Pharmacokinetics of propofol in mixed-breed
dogs and greyhounds. Am J Vet Res 1993;54:755-760.
16. Doebeli A, Michel E, Bettschart R, et al. Apgar score after induction of
anesthesia for canine cesarean section with alfaxalone versus propofol.
Theriogenology 2013:80:850-854.
17. Metcalfe S, Hulands-Nave A, Bell M, et al. Multicentre, randomised clinical trial
evaluating the efficacy and safety of alfaxalone administered to bitches for
induction of anaesthesia prior to caesarean section. Aust Vet J 2014:92:333-
338.
18. Hay Kraus BL. Effect of dosing interval on efficacy of maropitant for prevention
of hydromorphone-induced vomiting and signs of nausea in dogs. J Am Vet
Med Assoc 2014;245(9):1015-1020.
19. Lizarraga I, Janovyak E, Beths T. Comparing lidocaine, bupivacaine and a
lidocaine-bupivacaine mixture as a metacarpal block in sheep. Vet J
2013;197(2):515-518.
20. Seaton S, Reeves M and Mclean S. Oxycodone as a component of
multimodal analgesia for lactating mothers after caesarean section:
Relationships between maternal plasma, breast milk and neonatal plasma
levels. Aust N Z J Obstet Gynaecol 2007;47:181-185.
21. Ludwig B, Jordan JC, Rehm WF, et al. Carprofen in veterinary medicine. I.
Plasma disposition, milk excretion and tolerance in milk-producing cows.
Schweiz Arch Tierheilk 1989;131(2):99-106.
22. Ortega D, Viviand X, Loree AM, et al. Excretion of lidocaine and bupivacaine
in breast milk following epidural anesthesia for cesarean delivery. Acta
Anaesthesiol Scand 1999;43:394-397.
23. Matsota PK, Markantonis SL, Fousteri MZ, et al. Excretion of ropivacaine in
breast milk during patient-controlled epidural analgesia after cesarean
delivery. Reg Anesth Pain Med 2009;34(2):126-129.
24. Grundy S, Liu S, Davidson A. Intracranial trauma in a dog due to being
“swung” at birth. Top Comp Anim Med 2009;24:100-103.
31 / Veterinary Focus / Vol 26 n°1 / 2016
Dolf et al. BMC Veterinary Research (2018) 14:57
https://doi.org/10.1186/s12917-018-1381-8

RESEARCH ARTICLE Open Access

Factors contributing to the decision to

perform a cesarean section in Labrador
retrievers
Gaudenz Dolf1* , Claude Gaillard1, Jane Russenberger2, Lou Moseley2 and Claude Schelling3

Abstract
Background: In the past 10 years, the frequency of unplanned cesarean sections in the Labrador Retriever breeding
colony at Guiding Eyes for the Blind stayed around 10% (range 5% to 28%). To reduce the number of cesarean
sections, factors influencing the occurrence of a cesarean section need to be known. The goal of this study
was to identify factors that contribute to the decision to perform a cesarean section.
Results: Of the 688 Labrador Retriever litters whelped between 2003 and 2016, 667 litters had sufficient data
and remained in the analysis. The target trait was ordinal with the three levels “normal whelping”, “assisted
whelping” and “cesarean section”. A general ordinal logistic regression approach was used to analyze the data. Model
selection with possible predictors resulted in a final model including weight of the dam, the weight of the heaviest
puppy of a litter, the number of fetuses malpositioned and the quality of uterine contractions. Weight and size of a
litter, parity, maternal inbreeding coefficient, whelping season, dam and sire were dropped from the model because
they were not significant. The risk of a cesarean section was influenced by the combination of the weight of the dam
and the weight of the heaviest puppy in the litter, as well as by the number of malpositioned fetuses and the quality
of the contractions. Larger puppies increased the risk of cesarean section especially when the dam had a lighter
weight. For dams weighing 23.6 kg and 32.8 kg the predicted probability of a cesarean section was low, with
0.06 and 0.02, respectively, when the heaviest puppy in a litter was light (0.42 kg), contractions were normal
and no fetus was malpositioned. However, the probability of a cesarean section was much higher, ranging from 0.24 to
0.08, when the heaviest puppy in a litter was heavy (0.66 kg).
Conclusions: Means to reduce the cesarean section frequency in this Labrador Retriever breeding colony should
include genetic selection for ideal puppy weight. In addition, dams with an adult body weight substantially below
average should not be selected as breeders in this colony.
Keywords: Cesarean section, Assisted delivery, Labrador retriever, Risk factors

Background surveillance is an important epidemiological tool to im-

A cesarean section (c-section) is the surgical interven-
tion applied when a dam with dystocia fails to respond
to the medical treatment or fetal distress is evident [1].
The term dystocia is used to describe a difficult birth or
the failure of a normal vaginal delivery. In dogs, dystocia
is a frequently encountered complication during partur-
ition and for roughly 60% of these cases the decision to
perform a c-section is taken [2]. Although health
* Correspondence: gaudenz.dolf@vetsuisse.unibe.ch
1
Institute of Genetics, Vetsuisse Faculty, University of Berne, Bremgartenstrasse
109a, 3001 Berne, Switzerland
Full list of author information is available at the end of the article
prove canine health and welfare, the collection of disease
information for dogs is still problematic [3]. Incident
rates for dystocia and c-sections have been reported for
the general dog population as well as for specific breeds
[2, 4], but as they are based on insurance data or ques-
tionnaires they may not be representative. Based on the
observation in humans that dystocia runs in families a
genetic background has been suggested [5, 6].
Knock-out mice implicated several genes to be involved
in dystocia [7], but the relevance of these models for
dystocia in humans could not be shown [8, 9].

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Dolf et al. BMC Veterinary Research (2018) 14:57
Maternal and fetal factors are known to cause dystocia
often resulting in a c-section. The most common cause
of maternal dystocia is uterine inertia whereas malposi-
tioned fetuses are the most common cause of fetal dys-
tocia [10]. In some dog breeds, particularities of the
pelvic anatomy of the dam or the facial skeleton of a
puppy may result in a predisposition for obstructive dys-
tocia [4, 11]. Bergström and coworkers [2] identified the
breed, age of the dam, and the geographical region as
possible risk factors for a dam to be in need of a c-
section. In addition, the veterinarian and the owner
seem to have a rather high influence on the decision of a
surgical intervention.
In the past ten years, the frequency of c-sections in a
breeding colony of Labrador Retrievers at Guiding Eyes
for the Blind never dropped markedly under 10% and
even reached a high of 28% in 2012.
The aim of the present study was to identify factors,
other than uterine inertia and malpositioned fetuses that
have an influence on the occurrence of a c-section in the
Labrador Retriever breeding colony at Guiding Eyes for
the Blind and could be improved by breeding and/or
adapting management.
Methods
Guiding Eyes for the Blind is a non-for profit
organization that breeds and trains mostly Labrador
Retrievers (LR) and a few German Shepherd guide dogs
to serve people who are blind or have visual impairment.
Dams receive a complete physical examination at the
start of each estrus cycle and the decision to mate is
made based on receiving medical clearance and the need
for puppies. The dam is tested for Brucella canis using a
rapid slide agglutination test at the beginning of each
heat where a mating is planned. Males are tested for
antibodies against Brucella canis every 6 months. On
average 65 LR matings are realized per year resulting
in 61 whelpings with an average litter size of 7.9 and
a litter size at weaning of 7.2. Stillborn puppies and
neonatal losses account for 65% and 35% of the
puppy losses, respectively.
The timing of matings is based on determining the
peak fertile window of the dam through progesterone
level testing. The “initial rise” (IR) generally occurs when
the serum progesterone level rises to between 1.5 and
2.0 ng/ml (Antech Diagnostics – Fountain Valley, CA
92708 and in-house Tosoh 360 – Tosoh Bioscience –
King of Prussia, PA 19406 progesterone assays) and typ-
ically coincides with the release of luteinizing hormone.
Matings occur most often on days 3 or 4 and 5 or 6 post
IR. Estrus is also monitored through vaginoscopy, vagi-
nal cytology and receptivity.
After mating, dams are returned to their foster homes
from the start of diestrus until 3 to 5 days prior to their
Page 2 of 9
due date which is based on 65 days post IR. An ultra-
sound to verify pregnancy and approximate the litter
size is performed at approximately 33 days post IR.
Dams are admitted to the Guiding Eyes whelping ken-
nel approximately 3 days prior to their due date, which
allows sufficient time to acclimate to the kennel environ-
ment, and housed in a private, specially equipped whelp-
ing suite. Experienced staff monitor for prepartum
changes such as nesting, changes in food intake and
most notably the drop in rectal temperature below 37.2
degrees Celsius. Individual dam progesterone levels are
monitored daily during the 2 to 3 days prior to the antic-
ipated whelp date. If progesterone levels are 2 ng/ml,
whelps are typically within 24–36 h; if progesterone
levels are 1 ng/ml, whelps are typically within 18–24 h;
if progesterone levels are below 1 ng/ml, early stages of
whelp have either begun or will begin within 18 h.
Normal parturition is monitored via video monitors by
staff in a nearby room with occasional visits to the whelp-
ing suite to provide needed elimination walks, food, water
or support for the puppies. The decision points for
assisted whelping are guided by an established protocol. A
c-section will be performed if labor fails to initiate by day
66 from the progesterone IR date measured during estrus
or within 24 to 36 h after the progesterone level drops
below 2 ng/ml. If the dam has exhibited visible contrac-
tions without delivering a puppy the protocols depend on
the presence of a fetus in the vaginal canal, strength of
contractions and fetal heart rates.
In cases of obstructive dystocia where a fetus is pal-
pated in the vaginal canal and the dam is exhibiting tail
arching contractions for 30 min without delivering a
puppy a vaginal examination is performed to check for
malposition and/or structural maternal abnormalities.
Attempts are made to reposition the malpositioned fetus
through digital manipulation and/or manually deliver
the puppy. The staff veterinarian is called in for a c-sec-
tion if a puppy is not delivered within 20 min.
If a fetus is palpated upon vaginal examination, how-
ever tail arching contractions are very weak or absent,
fetal heart rates are measured by ultrasound twice,
10 min apart. If fetal heart rates are 150 beats per mi-
nute or slower, the staff veterinarian is called in to pro-
vide support which often results in a c-section. If fetal
heart rates are above 160 beats per minute, staff will fea-
ther the dorsal vagina, often resulting in stronger and/or
more consistent contractions which move the fetus
within reach to manually deliver the puppy. If a puppy is
not delivered, fetal heart rates are monitored and if they
are above 160 beats per minute, intermittent periods of
allowing the dam to deliver the puppy, feathering the
dorsal vagina and monitoring heart rates continue, and
the veterinarian is consulted. If heart rates drop below
150 beats per minute, a c-section is performed.
Dolf et al. BMC Veterinary Research (2018) 14:57
In cases where no tail arching contractions have oc-
curred for a period of two hours since a puppy was de-
livered and the dam is sleeping or resting the dam is
taken for a short exercise walk and fed a small meal. A
vaginal examination is performed to check for a fetus in
the vaginal canal and fetal heart rates are measured. If
fetal heart rates drop below 150 beats per minute, the
staff veterinarian is called in and a c-section is per-
formed. If fetal heart rates are at least 170 beats per mi-
nute, the vaginal examination is repeated 30 min later
along with feathering. If no contractions result, the staff
person handling the whelp obtains approval to administer
2 units of oxytocin (Henry Schein Animal Health –
Dublin, OH 43017) frequently administered subcutane-
ously and occasionally by intramuscular injection along
with 23% calcium solution (Vedco – Saint Joseph, MO
64507) administered subcutaneously at the dosage of
0.5 ml per 4.5 kg body weight. If within 30 min a
puppy is not delivered and/or no contractions re-
sulted from feathering, oxytocin and calcium are re-
peated provided fetal heart rates are at least 170
beats per minute. If within an additional 30 min a
puppy is still not delivered and/or fetal heart rates
drop below 150 beats per minute, the staff veterinar-
ian is called in and a c-section is performed.
Statistical analyses were carried out using Stata/SE
14.1 (StataCorp, 4905 Lakeway Drive, College Station,
Texas 77,845, USA). The initial data set comprised 688
litters of LR from 2003 to 2016 by 256 different dams
and 150 sires. The target trait, ease of whelping (EOW),
was ordinal with the three levels “normal whelping”,
“assisted whelping without c-section” and “c-section
with or without prior assistance”. Correlation coeffi-
cients between possible predictors were calculated to
avoid the inclusion of highly correlated predictors.
Possible predictors were the parity ranging from 1 to 6,
the number of malpositioned fetuses (defined as birth
position not either head first and front legs forward or
rear first and rear legs extended at time of delivery), ran-
ging from 0 to 3 or more, as well as that number
squared, the quality of contractions coded 0 if normal
and 1 if poor (poor was coded when medical treatment
fails to improve contraction strength sufficiently to de-
liver the puppy), as an indicator for uterine inertia, the
whelping season with 4 levels (January to March, April
to June, July to September and October to December),
and the inbreeding coefficient of the dam. Dam age was
not included as a variable because dams are bred on a
regular basis so that the age at a given parity would not
differ greatly among dams. Most parities and c-sections
are in dams 4 years of age and younger. The identity of
the dam and the identity of the sire were evaluated as
random effects. In addition, two groups of variables were
considered as predictors. The first group comprised
Page 3 of 9
variables that describe the body condition of the dam,
including the adult weight in kg, the height at withers in
cm, the body mass index in kg/m2, and the weight (kg)
to height (cm) ratio. The second group comprised vari-
ables describing the litter, including the litter size ran-
ging from 2 to 13, the litter weight in kg, the average
puppy weight in kg, the standard deviation of the puppy
weights in kg, and the variance of the puppy weights in
kg2, and the weight of the heaviest puppy in kg.
The ordinal target trait EOW was analyzed with or-
dered logistic regression. The different steps of the
model development are described in Additional file 1.
Results
Dropping 13 observations because c-sections were
planned, 7 observations because of missing data and a
single observation with parity 7 left 667 litters in the
analyses. With the body mass index, height at withers or
weight to height ratio in the model an additional 203 ob-
servations were lost due to missing values for the height
of the dams, leaving 464 observations in the analyses.
Details of the descriptive statistics of all variables are
presented in Additional file 2.
P-values, df, Akaike’s information criterion and the
Bayesian information criterion for the full and the final
model are given in Table 1.
Figures 1, 2, 3, 4, 5 and 6 visualize the probabilities of
the three different outcomes of EOW for different repre-
sentative combinations of the four predictors adult
weight of the dam, weight of the heaviest puppy in a lit-
ter, number of malpositioned fetuses and quality of con-
tractions. All predictions and their probabilities depicted
in Figs. 1, 2, 3, 4, 5 and 6 are listed in Additional file 3.
Table 1 Comparison of the full model and the final model for EOW
Variable Full model Final model
Adult weight of the dam 0.001 0.003
Weight of the heaviest puppy in a litter 0.000 0.000
std of the puppy weights in a litter 0.333
Litter size 0.128
Parity 0.881
Season of whelping 0.667
Number of malpositioned fetuses, linear 0.000 0.000
Number of malpositioned fetuses, quadratic 0.000 0.042
Quality of the contractions 0.000 0.000
Inbreeding coefficient of the dam 0.973
df 12 8
Akaike’s information criterion 896.69 858.23
Bayesian information criterion 950.73 894.25
The full model was calculated with an ordered logit regression. The final model
was calculated with a generalized ordered logit regression. P-values are given for
each independent variable in the model
Dolf et al. BMC Veterinary Research (2018) 14:57 Page 4 of 9

Fig. 1 Predicted probabilities of EOW outcomes if contractions are normal and no malpositioned fetus is present. On the y-axis are the predicted
probabilities of the nine outcomes of the target trait EOW for the weight of the dam ranging from the mean – 2sd (23.6 kg) to the mean + 2sd
(32.8 kg) on the x-axis. HPW is the weight of the heaviest puppy in a litter in kg. All predicted probabilities are significantly different from zero

Figure 1 shows the implications of an increasing adult
weight of the dam for 3 different weights of the heaviest
puppy in a litter in the case where the dams have normal
contractions and no fetus is malpositioned. Actually, this
constellation was observed in 507 litters, which is 76%
of the total number of litters. Predicted probabilities for
an assisted delivery and a c-section are very similar and
low if the weight of the heaviest puppy in a litter is average
or below average. If the weight of the heaviest puppy in a
litter is high, these probabilities increase for both, but
more steeply for a c-section, if the adult weight of the dam
is low. The predicted probabilities of c-sections and
assisted deliveries decrease slightly with an increasing
adult weight of the dam. The differences between the ex-
treme weights range from 0.04 probability points in the
case of a c-section with a lightest weight of the heavi-
est puppy in a litter to 0.16 probability points in the
case of a c-section with a heaviest weight of the
heaviest puppy in a litter.
Figure 2 shows the huge impact of poor contractions
on the probabilities of the c-section outcome in com-
parison to the situation in Fig. 1. The delivery condi-
tions, poor contraction and no malpositioned fetus in a
litter, are not very frequent in our data set (n = 14 or
2%). The risk for a c-section is highest (0.84) when the
dam is light (23.6 kg) and the heaviest puppy of a litter

Fig. 2 Predicted probabilities of EOW outcomes if contractions are poor and no malpositioned fetus is present. On the y-axis are the predicted
probabilities of the nine outcomes of the target trait EOW for the weight of the dam ranging from the mean – 2sd (23.6 kg) to the mean + 2sd
(32.8 kg) on the x-axis. HPW is the weight of the heaviest puppy in a litter in kg. All predicted probabilities are significantly different from zero with the
exception of the estimate for a c-section at 32.8 kg in the case of a light heaviest puppy and the estimates at 23.6 kg in the case of a heavy heaviest puppy
Dolf et al. BMC Veterinary Research (2018) 14:57 Page 5 of 9

Fig. 3 Predicted probabilities of EOW outcomes if contractions are normal and one fetus is malpositioned. On the y-axis are the predicted probabilities
of the nine outcomes of the target trait EOW for the weight of the dam ranging from the mean – 2sd (23.6 kg) to the mean + 2sd (32.8 kg) on
the x-axis. HPW is the weight of the heaviest puppy in a litter in kg. All predicted probabilities are significantly different from zero

is heavy (0.66 kg) that is 0.60 probability points higher
than in Fig. 1. The decline of the risk of a c-section from
light (23.6 kg) to heavy dams (32.8 kg) seems very simi-
lar for all 3 levels of the heaviest puppy in a litter (0.29,
0.31, and 0.25 probability points). Differences of prob-
abilities of a c-section between light and heavy weights
of the heaviest puppy in a litter are similar and vary over
the whole range of the adult weight of the dam from
0.32 to 0.37 probability points. In contrast, the probabil-
ities for an assisted whelping are only slightly higher as
in Fig. 1 (0.12 probability points at an adult weight of
the dam of 28.2 kg and a weight of the heaviest puppy in
a litter of 0.54 kg). As a consequence of the high
probabilities of a c-section, the probabilities of a normal
whelping are much lower than in Fig. 1. The differences
in the probabilities between light and heavy dams are
more pronounced in Fig. 2.
Figure 3 shows that the impact of one malpositioned
fetus is not as severe as poor contractions considering
the predicted probability of a c-section. In our data, the
combination of normal contractions and one malposi-
tioned fetus occurred in 93 litters or 14% of the deliver-
ies. Compared to Figs. 1 and 2 the probabilities for an
assisted whelping are much higher (0.36 and 0.25 prob-
ability points, respectively) when the adult weight of the
dam and the weight of the heaviest puppy in a litter are

Fig. 4 Predicted probabilities of EOW outcomes if contractions are poor and one fetus is malpositioned. On the y-axis are the predicted probabilities
of the nine outcomes of the target trait EOW for the weight of the dam ranging from the mean – 2sd (23.6 kg) to the mean + 2sd (32.8 kg) on
the x-axis. HPW is the weight of the heaviest puppy in a litter in kg. All predicted probabilities for a normal delivery, as well as for an assisted delivery
of a heavy heaviest puppy, are not significantly different from zero whereas all others are
Dolf et al. BMC Veterinary Research (2018) 14:57 Page 6 of 9

Fig. 5 Predicted probabilities of EOW outcomes if contractions are normal and the weight of the heaviest puppy in a litter is 0.54 kg. On the y-axis
are the predicted probabilities of the nine outcomes of the target trait EOW for the number of malpositioned fetuses ranging from 0 to 3 or more on
the x-axis. DWT is the adult weight of the dam in kg. All predicted probabilities are significantly different from zero with the exception of a normal
delivery in the case of 3 or more malpositioned fetuses, regardless of the weight of the dam

average. The risks for a c-section are higher than the
ones in Fig. 1 but clearly lower than in Fig. 2 (0.13 and
− 0.35 probability points, respectively) when the adult
weight of the dam and the weight of the heaviest puppy
in a litter are average. The probabilities of c-sections de-
crease with an increasing adult weight of the dam about
twice as much for a heavy than for a light weight of the
heaviest puppy in a litter (0.29 and 0.12 probability
points, respectively).
Figure 4 shows an extremely unfavorable scenario
where the dam has poor contractions and one fetus is
malpositioned. Fortunately there were only 3 cases in our
data set which makes about 0.4%. Comparing the curve
patterns with those of Fig. 2 and Fig. 3, Fig. 4 is much
more similar to Fig. 2 than to Fig. 3. This seems to con-
firm the impression from the comparison of Fig. 3 with
Fig. 2, that poor contractions do affect whelping more
than malpositioned fetuses. The probabilities for a
normal delivery are all not significantly different
from zero that is the weight of the heaviest puppy in
a litter has no influence. If the weight of the heaviest
puppy in a litter is heavy and the adult weight of

Fig. 6 Predicted probabilities of EOW outcomes if contractions are poor and the weight of the heaviest puppy in a litter is 0.54 kg. On the y-axis
are the predicted probabilities of the nine outcomes of the target trait EOW for the number of malpositioned fetuses ranging from 0 to 3 or more
on the x-axis. DWT is the adult weight of the dam in kg. If the number of malpositioned fetuses is one or more, predicted probabilities for a normal
delivery are not significantly different from zero, regardless of the weight of the dam. If the number of malpositioned fetuses is two or more, predicted
probabilities for an assisted delivery are not significantly different from zero, regardless of the weight of the dam. All other predicted probabilities are
significantly different from zero
Dolf et al. BMC Veterinary Research (2018) 14:57
the dam below average a c-section is practically
unavoidable.
Figures 5 and 6 show the influence of the number
of malpositioned fetuses for 3 different adult weights
of the dam on the outcome of EOW in the case
where the weight of the heaviest puppy in a litter is
average (0.54 kg).
Figure 5 shows the situation for dams with normal
contractions which was observed in 97% of our data.
Probabilities for a normal delivery drop to or close to
zero if there is more than one malpositioned fetus. In
the case of 3 or more malpositioned fetuses the pre-
dicted probabilities for a normal delivery for all three
levels of the adult weight of the dam are not significantly
different from zero. In the case of one malpositioned
fetus, the probability for a normal delivery is much
higher in the case of a heavy adult weight of the dam
(0.51) in comparison to a light adult weight of the dam
(0.22). The increase of the risk for a c-section from 0 to
2 malpositioned fetuses is linear but much greater for a
light than for a heavy adult weight of the dam (0.35 and
0.16 probability points, respectively). The increase of
that risk between 2 and 3 malpositioned fetuses is much
smaller (0.02 and 0.01 probability points, respectively).
The increase of the risk of assisted deliveries from 0 to 2
malpositioned fetuses is similar for a heavy and average
adult weight of the dam (0.60 and 0.51 probability
points, respectively), whereas the increase from 2 to 3 is
clearly smaller (0.09 and 0.04 probability points, respect-
ively). For a light adult weight of the dam the risk of
assisted delivery increased by 0.32 probability points
when the number of malpositioned fetuses increased
from zero to one, with no real increase thereafter (0.03
probability points), when the number of malpositioned
fetuses increased from one to three or more.
Figure 6 shows the situation where the dam has poor
contractions. This situation was observed only 22 times in
our data set or in 3% of all cases. It is apparent that the 3
c-section curves are positioned at much higher predicted
probabilities in comparison to Fig. 5, e.g. the increase at 0
malpositioned fetuses for an average adult weight of the
dam (28.2 kg) amount to 0.48 probability points and at 1
malpositioned fetus to 0.60 probability points. A c-section
practically is unavoidable in the case of a light dam and 2
or more malpositioned fetuses. The probabilities of
assisted deliveries decrease marginally from 0 to 3 or more
malpositioned fetuses but the range between a light and
heavy adult weight of the dam are smallest at 0 with 0.07
probability points and about double at the other malposi-
tion levels with 0.13 to 0.17 probability points.
Discussion
Dystocia is a common emergency in dogs and criteria
for the decision to perform a timely c-section have been
Page 7 of 9
proposed [10]. Most of the dystocia cases in dogs are of
maternal origin [1]. In a multicenter study in the USA
and Canada the LR was among the top five breeds for
emergency and elective c-sections during 1994 to 1997
[12]. In a multi-breed study c-sections were performed
in 20% of the parturitions in LR [4]. c-sections bring a
health risk for both the dam and the puppies. Therefore,
the reduction of emergency c-sections is desirable in dog
breeding to enhance animal welfare.
The comprehensive and large data set for parturitions
recorded by the Guiding Eyes for the Blind (Additional
file 4) allows for the analysis of possible predictors for c-
sections. In the present data set there was one heaviest
puppy weight, 0.11 kg (weight of the dam 25.40 kg) that
could be considered an extreme value. Plotting the lever-
age against the normalized residual squared clearly
showed that it did have a large residual but no leverage
meaning that it had no great impact on the estimates of
the regression coefficients (Additional file 1). The weight
of the dams showed no extreme values. Neither the dam
nor the sire could significantly explain part of the total
variance in our data. It is not surprising that the body
mass index of the dams did not affect the probability of
the occurrence of a c-section as the body mass index in
dogs probably does not reflect the condition of the body
as it does it in humans. The Guiding Eyes breeding stock
are also closely monitored and managed to maintain
their established target weight within ±1.5 kg. We hy-
pothesized that the weight to height ratio characterizes
the body condition of a dog much better than the body
mass index. Also we considered the weight to height ra-
tio a better metric than the weight as the weighting with
the height at withers will bring extreme values of the
weight nearer to the mean. The fact that the weight to
height ratio did not stay in the model probably is due to
missing measurements of the height that led to a loss of
about one third of the observations in comparison to
weight. The inbreeding coefficient of the dam had no
impact on the probability of the occurrence of a c-section,
which may be due to the relatively low inbreeding rates
with two thirds of the dams having an inbreeding coeffi-
cient below 10%. There was no influence of the whelping
season. The seasonal occurrence of c-sections ranged
from 11% (fall) over 14% (spring) and 15% (summer) to
16% (winter). Also the parity had no influence. Looking at
the 6 parities, the percentage of c-sections is more or less
evenly distributed over parities, ranging from 14% in par-
ity 3 to 18% in parity 4 with the exception of parities 2
and 6 with only 9% c-sections. Of the litter characteristics,
the weight of the heaviest puppy had an impact on the
probability of the occurrence of a c-section. It is plausible
that a heavier puppy is a greater physical challenge to the
whelping dam than a lighter puppy, due to feto-maternal
disproportion. The influence of the observer, here the
Dolf et al. BMC Veterinary Research (2018) 14:57
whelpers, on the observations as described in other stud-
ies [13, 14] was not taken into account because whelpers
were assigned to whelpings according to a schedule and
had to follow a clear protocol. Therefore, the occurrence
of c-sections does not reflect the presence of specific
whelpers but rather is the consequence of the procedure
in the protocol. The duration of a whelping was not con-
sidered in the analyses because it rather seems to be a
consequence of whelping problems than its source. Also
the number of stillborn puppies was not considered as a
predictor because the death of a puppy could also be
caused by factors leading to a c-section, e.g. suffocation
during a prolonged whelping.
Our data confirms that poor contractions of a dam, as
an indicator for uterine inertia, as well as malpositioned
fetuses increase the probability that a whelping has to be
assisted or that a c-section cannot be avoided. These fac-
tors can be related because contracting against a malpo-
sitioned fetus can lead to uterine inertia from exhaustion
of uterine muscles. Malpositioned fetuses are likely the
result of a feto-maternal disproportion or maternal char-
acteristics resulting in the vaginal vault being too small
for the fetus to reposition itself. Our study allowed for
the examination of two additional factors leading to c-
sections, the weight of the dam and the weight of the
heaviest puppy in a litter. Although not significant, dams
at first parity are with an average weight of 28.07 kg
lighter than dams at later parities with an average weight
of 28.31 kg. Dams at second or higher parity with a nor-
mal delivery on average were 0.60 kg heavier than dams
with a c-section that weigh on average 27.91 kg. In the
case of the first parity they are on average 1.46 kg heav-
ier. The weight of the dams certainly has a genetic back-
ground. In another colony of LR at The Seeing Eye in
New Jersey, heritabilities were estimated to be 0.44 for
adult weight and 0.46 for adult height [15]. The influ-
ence of the birthweight on the probability of requiring
assistance at delivery or a c-section was expected as this
phenomenon is known in cattle (e.g. [16, 17]). Besides
direct genetic effects, paternal and especially maternal
genetic effects could, as in cattle, also play a role in dog.
The genetic correlation between pelvic opening and the
maternal genetic effect of dystocia scores in cattle is high
with − 0.62 in heifers and − 0.77 in cows [18]. Heritabil-
ities of direct and maternal effects were 0.25 and 0.08 re-
spectively while heritability of cow pelvic opening was
0.21. Other authors obtained even larger heritabilities
for pelvic opening with h2 = 0.42 [19].
Conclusions
The four predictors, poor contractions, number of mal-
positioned fetuses, weight of the dam and the weight of
the heaviest puppy in a litter, had an impact on the
probability of the occurrence of a c-section in LR.
Page 8 of 9
Therefore, the consideration of the adult weight of the
dam may reduce the risk of c-sections in this colony.
Dams with an adult body weight substantially below
average should not be selected as breeders in this colony.
The problem of the weight of the heaviest puppy in a lit-
ter must be tackled on the genetic track resorting to the
estimation of breeding values that allow for maternal
and paternal effects.
Our findings apply to this colony of LR and are not
necessarily, but could be, also meaningful for breeds of
similar stature at large. To evaluate the impact of our re-
sults on the general LR population data on the weights
of the puppies at birth and the weight and possibly the
height of the dam at mating are needed. Whether our
findings help to improve the situation with respect to c-
sections in guide dogs depends heavily on how they can
be implemented in a breeding strategy that is focused on
the guiding abilities of the dogs.
Additional files
Additional file 1: Presenting the model development for the analysis of
EOW. (DOCX 531 kb)
Additional file 2: Presenting descriptive statistics for all variables in the
analyses. (DOCX 27 kb)
Additional file 3: Displaying for Figs. 1, 2, 3, 4, 5 and 6 the predicted
probabilities for the EOW outcomes, together with the P-values for the
tests of predicted probabilities being different from zero. (DOCX 31 kb)
Additional file 4: Displaying the data analyzed. (XLSX 111 kb)
Abbreviations
EOW: Ease of whelping; IR: Initial Rise; LR: Labrador Retriever
Acknowledgements
The authors want to thank Barbara Havlena, Guiding Eyes for the Blind, for
data editing and the two reviewers for their suggestions to improve the
manuscript.
Funding
Not applicable.
Availability of data and materials
The dataset analyzed during the current study is available from JR on
reasonable request.
Authors’ contributions
JR and LM provided the data files. GD, CG and CS did the data analyses. All
authors contributed to the writing and review of the manuscript and approved
of its submission.
Ethics approval
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Dolf et al. BMC Veterinary Research (2018) 14:57 Page 9 of 9

Author details
1
Institute of Genetics, Vetsuisse Faculty, University of Berne, Bremgartenstrasse
109a, 3001 Berne, Switzerland. 2Guiding Eyes for the Blind, 611 Granite Springs
Road, Yorktown Heights, NY 10598, USA. 3Clinic of Reproductive Medicine,
Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich,
Switzerland.

Received: 20 March 2017 Accepted: 20 February 2018

References
1. Davidson A. Problems during and after parturition. In: England GCW, von
Heimendahl A, editors. BSAVA manual of canine and feline reproduction
and neonatology. Gloucester: BSAVA; 2010. p. 121–34.
2. Bergström A, Nødtvedt A, Lagerstedt AS, Egenvall A. Incidence and breed
predilection for dystocia and risk factors for cesarean section in a Swedish
population of insured dogs. Vet Surg. 2006;35:786–91.
3. O’Neill DG, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Approaches
to canine health surveillance. Canine Genet Epidemiol. 2014; https://doi.org/10.
1186/2052-6687-1-2.
4. Evans KM, Adams VJ. Proportion of litters of purebred dogs born by cesarean
section. JSAP. 2010;51:113–8.
5. Berg-Lekås ML, Högberg U, Winkvist A. Familial occurrence of dystocia. Am
J Obstet Gynecol. 1998;179:117–21.
6. Algovik M, Nilsson E, Cnattingius S, Lichtenstein P, Nordenskjöld A, Westgren
M. Genetic influence on dystocia. Acta Obstet Gynecol Scand. 2004;83:832–7.
7. Ratajczak CK, Muglia LJ. Insights into parturition biology from genetically
altered mice. Pediatr Res. 2008;64:581–9.
8. Algovik M, Lagercrantz J, Westgren M, Nordenskjöld A. No mutations found
in candidate genes for dystocia. Hum Reprod. 1999;14:2451–4.
9. Algovik M, Kivinen K, Peterson H, Westgren M, Kere J. Genetic evidence of
multiple loci in dystocia – difficult labour. BMC Med Genet. 2010;11:105.
10. Gendler A, Brourman JD, Graf KE. Canine dystocia: medical and surgical
treatment. Compendium. 2007;29:551–63.
11. Eneroth A, Linde-Forsberg C, Uhlhorn M, Hall M. Radiographic pelvimetry
for assessment or dystocia in bitches: a clinical study in two terrier breeds.
JSAP. 1999;40:257–64.
12. Moon PF, Erb HN, Ludders JW, Gleed RD, Pascoe PJ. Perioperative management
and mortality rates of dogs undergoing cesarean section in the United States
and Canada. JAVMA. 1998;213:365–9.
13. Meyer F, Schawalder P, Gaillard C, Dolf G. Estimation of genetic parameters
for behavior based on results of German shepherd dogs in Switzerland.
Appl Anim Behav Sci. 2012;140:53–61.
14. Lauper M, Gerber V, Ramseyer A, Burger D, Lüth A, Koch C, Dolf G.
Heritabilities of health traits in Swiss warmblood horses. Equine Vet J.
2017;49:15–8.
15. Helmink SK, Rodriguez-Zas SL, Shanks RD, Leighton EA. Estimated genetic
parameters for growth traits of German shepherd dog and Labrador retriever
dog guides. J Anim Sci. 2001;79:1450–6.
16. Bellows RA, Lammoglia MA. Effects of severity of dystocia on cold tolerance
and serum concentrations of glucose and cortisol in neonatal beef calves.
Theriogenology. 2000;53:803–13.
17. Hickson RE, Morris ST, Kenyon PR, Lopez-Villalobos N. Dystocia in beef
heifers: a review of genetic and nutritional influences. New Zealand Vet
J. 2006;54:256–64.
18. Renand G, Vinet A, Krauss D, Saintilan R. Genetic relationship between pelvic
opening and calving ease in the Charolais cattle breed. Renc Rech Ruminants.
2010;17:451–4. Submit your next manuscript to BioMed Central
19. Upton WH, Bunter KL. Pelvic measurement as an aid to selection in beef
cattle. Proc Aust Assoc Anim Breed Genet. 1995;11:615–9. and we will help you at every step:
• We accept pre-submission inquiries
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 The Pharma Innovation Journal 2018; 7(4): 561-562

ISSN (E): 2277- 7695

ISSN (P): 2349-8242
NAAS Rating: 5.03 Cesarean section in canine: Case report
TPI 2018; 7(4): 561-562
© 2018 TPI
www.thepharmajournal.com
Received: 27-02-2018
J Shiva Jyothi and Kolipaka Rajesh
Accepted: 29-03-2018
Abstract
J Shiva Jyothi A case of dystocia was presented to people for animal (PFA) the owner has reported that the dog has
Department of Veterinary whelped two pups and is still under pain so when the animal was examined fetal bony structures can be
Microbiology, College of felt by palpation so a cesarean section was performed to relieve the animal from pain and remove the
Veterinary Science, fetus.
Rajendranagar, Hyderabad,
Telangana, India
Keywords: C-section, dystocia, whelping,
Kolipaka Rajesh
Department of Veterinary Introduction
Physiology, College of The frequency of conducting cesarean section to relieve dystocia in canine is far higher than in
Veterinary Science, large ruminants. It is possible that the small size of the animal, multiparous nature, a long
Rajendranagar, Hyderabad,
duration of delivery and the demands by the owner to deliver as many live puppies as possible
Telangana, India
due to commercial considerations may force the obstetrician to increasingly employ cesarean
section in bitches. Narasimha murthy et al., 2014 [10]. Cesarean section is performed on an
emergency basis 58% of the time. Dehydration, hypovolemia, hypotension, exhaustion,
hypothermia, toxemia, hypoxia, hemorrhage, and shock may be present if dystocia has been in
progress for some time. There is an increased mortality risk for dams and decreased puppy
survival when cesarean section is performed on an emergency basis Moon et al. 1988. Puppy
mortality associated with emergency cesareans was 12.7% compared with 3.6% for elective
cesarean delivery Moon-massat 2005 Small brachycephalic breeds (e.g., fetopelvic
disproportion), large breeds (e.g., uterine inertia), and primagravid dogs are more predisposed
to dystocia and are, therefore, more likely to undergo emergency cesarean section Gaud et al
1985 [6]. A variety of anesthetic protocols have been described for cesarean section in dogs.
The basis for many of these protocols is extrapolated from experimental animal studies and the
human literature. There are few controlled veterinary studies comparing various anesthetic
protocols (Funkquist et al. 1997; Thurmon et al. 1996; Brock N 2000, 1996; Paddleford 1992
Benson Gj1984; Evers 1996; Luna et al. 2004) [5, 12, 2-3, 11, 1, 7]

Results and discussion

Cases of dystocia that could not be relieved through vaginal manipulative procedures was
immediately subjected for caesarean section, since It was also the only line of treatment
carried out in protracted cases of dystocia characterized by fetal death. In the present study,
dystocia could be relived only by cesarean section and fetus was found be dead (Fig1, Fig2).
The surgical approach was carried out by anaesthezing the animal using xylazene and
ketamine @ 1mg/kg body weight and 10mg/kgwt respectively. Uterine suture were continous
suture pattern was employed for closing both the uterine and abdominal incison, followed by
interrupted suturing pattern for skin. Postoperative care was carried out by using a prolonged
antibiotic therapy with intacef, melonex, tribivet, followed by regular dressing on every
alternate day. The animal was under supervision till days 10 after surgery. A good recovery
with no complications was observed (Fig4).

Correspondence
Kolipaka Rajesh
Department of Veterinary
Physiology, College of
Veterinary Science,
Rajendranagar, Hyderabad,
Telangana, India
~ 561 ~
The Pharma Innovation Journal
Fig 1: Uterine Body with Dead Fetus
Fig 2: Dead Fetus
Fig 3: Continous Suture Pattern
Fig 4: Interrupted Suture Pattern
~ 562 ~
Conclusion
Our study aided in strengthening the performance of c-section
at critical time points wherein whelping fails to relieve the
animal from suffering.
References
1. Benson GJ, Thurmon JC. anesthesia for cesarean section
in the dog and cat. Mod vet pract. 1984; 65:29-32.
2. Brock N. anesthesia for canine cesarean section. Can vet j
1996; 37:117-118.
3. Brock N. veterinary anesthesia update: guidelines and
protocols for small animal anesthesia, ed, vol. Canada,
veterinary anesthesia northwest, 2000, 1(2).
4. Evers WH. epidural anesthesia in the dog: a review of
224 cases with emphasis on cesarean section. Vet med
small anim clin. 1968; 63:1121-1124.
5. Funkquist Pm, Nyman Gc, Lofgren Aj, et al. use of
propofol-isoflurane as an anesthetic regimen for cesarean
section in dogs. Javma. 1997; 211:313-317.
6. Gaudet da. retrospective study of 128 cases of canine
dystocia. Jaaha. 1985; 21:813-818.
7. Luna Sp, Cassu Rn, Castro Gb et al. effects of four
anaesthetic protocols on the neurological and
cardiorespiratory variables of puppies born by caesarean
section. Vet rec. 2004; 154:387-389.
8. Moon pf, Erb hn, Ludders jw et al. perioperative
management and mortality rates of dogs undergoing
cesarean section in the United States and Canada. Javma.
1998; 213:365-369.
9. Moon-massat pf, cesarean section. in slatter dh
(ed): textbook of small animal surgery, ed 3.
Philadelphia, saunders, 2003, 2597-2602.
10. Narasimha murthy, Devaraj M, Krishnaswamy A,
Honnappa TG. Relative Efficacy Of Various Treatment
Procedures Employed To Relieve Dystocia In Canines
Department of Veterinary Gynaecology and Obstetrics
Veterinary College, Hebbel, Bangalore. Indian Journal of
Animal Reproduction, 2014, 35(1)
11. Paddleford RR. anesthesia for cesarean section in the
dog. Vet clin north am small anim pract. 1992; 22:481-
484.
12. Thurmon Jc, tranquilli Wj, benson Gj et al. lumb & jones'
veterinary anesthesia, ed 3. Baltimore, Williams and
Wilkins, 1996.