Performing an ovariohysterectomy at the time of c-section does not pose an increase in risk of mortality, intra- or postoperative complications, or decreased mothering ability of the bitch

Kelsea E. Guest Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Kelsea E. Guest in
Current site
Google Scholar
PubMed
Close
 DVM
,
Robyn E. Ellerbrock Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Robyn E. Ellerbrock in
Current site
Google Scholar
PubMed
Close
 DVM, DACT
,
Daniel J. Adams Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Daniel J. Adams in
Current site
Google Scholar
PubMed
Close
 DVM
,
Rachel A. Reed Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Rachel A. Reed in
Current site
Google Scholar
PubMed
Close
 DVM, DACVAA
, and
Janet A. Grimes Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA

Search for other papers by Janet A. Grimes in
Current site
Google Scholar
PubMed
Close
 DVM, MS, DACVS

Click on author name to view affiliation information

Abstract

OBJECTIVE

Ovariohysterectomy (OVH) is frequently recommended at the time of c-section in canines, yet prior literature suggests poor mothering ability and increased morbidity to the bitch with c-section with concurrent OVH (CSOVH). The study objective was to compare maternal survival, complications, and mothering ability between bitches that underwent c-section alone (CS) or CSOVH.

ANIMALS

125 bitches.

PROCEDURES

Medical records from 2014 through 2021 were retrospectively reviewed; owners were surveyed for information up to weaning.

RESULTS

80 bitches undergoing CS and 45 bitches undergoing CSOVH were identified. There was no difference in anesthesia duration, intraoperative complications, postoperative complications, mothering ability, puppy survival to weaning, or other variables compared between groups. CSOVH bitches had longer surgery times (P = .045; 54.4 ± 20.7 min vs 46.9 ± 16.6 min) and longer time from delivery to nursing (P = .028; 75.4 ± 22.3 min vs 65.2 ± 19.5 min). Ninety (72%) owners responded to the survey. All 90 bitches survived until puppy weaning. CSOVH bitches were more frequently perceived as painful postoperatively (P = .015).

CLINICAL RELEVANCE

Performing an OVH at the time of c-section does not pose a significant increase in risk of mortality, intraoperative complications, postoperative complications, or decreased mothering ability of the bitch. The increased duration of surgery and increased time from delivery to nursing in the CSOVH group were clinically insignificant. Appropriate postoperative pain management should be emphasized post-CSOVH. Based on these results, OVH should be performed concurrently with c-section if indicated.

Abstract

OBJECTIVE

Ovariohysterectomy (OVH) is frequently recommended at the time of c-section in canines, yet prior literature suggests poor mothering ability and increased morbidity to the bitch with c-section with concurrent OVH (CSOVH). The study objective was to compare maternal survival, complications, and mothering ability between bitches that underwent c-section alone (CS) or CSOVH.

ANIMALS

125 bitches.

PROCEDURES

Medical records from 2014 through 2021 were retrospectively reviewed; owners were surveyed for information up to weaning.

RESULTS

80 bitches undergoing CS and 45 bitches undergoing CSOVH were identified. There was no difference in anesthesia duration, intraoperative complications, postoperative complications, mothering ability, puppy survival to weaning, or other variables compared between groups. CSOVH bitches had longer surgery times (P = .045; 54.4 ± 20.7 min vs 46.9 ± 16.6 min) and longer time from delivery to nursing (P = .028; 75.4 ± 22.3 min vs 65.2 ± 19.5 min). Ninety (72%) owners responded to the survey. All 90 bitches survived until puppy weaning. CSOVH bitches were more frequently perceived as painful postoperatively (P = .015).

CLINICAL RELEVANCE

Performing an OVH at the time of c-section does not pose a significant increase in risk of mortality, intraoperative complications, postoperative complications, or decreased mothering ability of the bitch. The increased duration of surgery and increased time from delivery to nursing in the CSOVH group were clinically insignificant. Appropriate postoperative pain management should be emphasized post-CSOVH. Based on these results, OVH should be performed concurrently with c-section if indicated.

Introduction

C-section is a commonly performed procedure in canines as both an elective or emergency surgery for the prevention or treatment of dystocia, respectively. Dystocia is a common problem in the bitch, with previous studies13 reporting dystocia occurring in up to 5% to 16% of all canine pregnancies. The most common risk factors for dystocia include breed, large fetal size, large litter size, uterine inertia, and fetal malpresentation.13 Canine dystocia can be life-threatening, not only to the puppies but also to the dam, with previous studies4,5 reporting maternal mortality rates from 0% to 4%.

Given the limited medical treatment and preventative options for dystocia, c-section is often pursued on an emergency basis or as a preventative measure in high-risk dams. Over 60% of dystocias result in surgical intervention based on prior literature.2,3,6 The highest rates of c-section occur in brachycephalic breeds, such as English Bulldogs, French Bulldogs, and Boston Terriers, with rates of c-section upwards of 80% in these breeds.2,7 Planned elective c-sections are considered to be safe for both mother and puppies and are associated with lower risk compared to those that must be performed on an emergent basis.7

Ovariohysterectomy (OVH) is often recommended at the time of c-section, particularly in the case of unplanned pregnancy or an older bitch. Prior literature suggests that OVH at the time of c-section could potentially pose risks to the bitch.2,4,6,817 The most common concerns reported with OVH at the time of c-section are increased risk of hemorrhage and increased risk of hypovolemic shock leading to decreased maternal survival.2,4,6,810,1217 These concerns have been perpetuated throughout the literature, although many of the sources making these claims are not substantiated with scientific evidence.2,4,6,817 Additional arguments against concurrent OVH include decreased milk production and decreased mothering responses, although milk production may remain normal if the bitch is hydrated and receives appropriate pain control.2,6,8,9,13 Some older references express concerns for a poor prognosis in bitches for which c-section with concurrent OVH (CSOVH) was performed to address severe uterine disease leading to secondary infection and toxemia in the bitch.9,11,13,14,16 These concerns, although valid in the case of sepsis and shock, seem to have been applied broadly in the subsequent literature to all CSOVHs, including those in which OVH is elective.2,4,6,810,12,13,15,17

To the authors’ knowledge, there are no studies evaluating the occurrence of these perceived risks. Conversely, potential benefits of CSOVH include prevention of pyometra, future uterine obstetrical emergencies, uterine or ovarian neoplasia, and the preclusion for additional surgery for sterilization in the future.8,18,19 These conflicting opinions can make the decision for OVH at the time of c-section a difficult choice for both clients and veterinarians who wish to make the safest decision for the bitch and puppies.

The objective of this study was to evaluate maternal outcomes in dogs that underwent a c-section alone (CS) or CSOVH. The hypothesis was that there would be no significant difference in maternal survival, intraoperative complications, postoperative complications, or mothering ability between groups.

Materials and Methods

ANIMALS

Medical records were retrospectively reviewed for all dogs undergoing a c-section from October 2014 through December 2021 at the University of Georgia Veterinary Teaching Hospital. For inclusion, dogs’ complete medical record, including anesthesia record, surgical report, and client discharge information, was required. All anesthetic events were supervised by a board-certified anesthesiologist or anesthesiology resident. As previously described,20 all surgical procedures were performed by a board-certified surgeon, surgery resident, or theriogenology resident supervised by a board-certified surgeon. A separate team was responsible for puppy resuscitation and care after delivery and was supervised by a board-certified theriogenologist, theriogenology resident, board-certified criticalist, and/or emergency and critical care resident.

Data collection

Preoperative information collected from the medical records included age, breed, body weight, and comorbidities of the bitch, number of previous litters, history of previous c-section, progesterone level on the date of surgery, estimated day of gestation, stage of labor at the time of presentation, whether oxytocin was used for medical management, the number of puppies that was expected, the number of puppies born prior to surgery, the average fetal heart rates at admission (measured via ultrasound), and whether surgery was elective or emergency. Bitches undergoing elective c-section showing no signs of labor were classified as in stage 0 labor; bitches displaying changes in behavior including panting, restlessness, nesting, anorexia, or vomiting were classified as in stage 1 of labor; bitches displaying active straining or evidence of abdominal contractions were classified as in stage 2 labor; and bitches who delivered at least 1 puppy were classified as in stage 3 labor.20,21

Intraoperative information collected from the anesthesia records included the duration of anesthesia, duration of surgery, duration of time between induction and puppy extraction, induction drugs used, whether an epidural was performed, whether a line block was performed at closure, type of inhalant gas used, intraoperative fluid type and rate, estimated total blood loss, lowest temperature recorded intraoperatively, and duration of hypotension and hypothermia if applicable. Hypotension was defined as a mean arterial blood pressure < 60 mm Hg or a systolic blood pressure < 90 mm Hg. Hypothermia was defined as a temperature of less than 36.7 °C. Intraoperative information collected from the surgery reports included the date of surgery, whether concurrent procedures were performed, how the c-section was performed (hysterotomy or en bloc OVH), whether OVH was performed, material used for vessel ligation during OVH (bipolar vessel sealing device or suture), and any other complications noted intraoperatively.

Postoperative information collected from the medical records included number of live births, number of still births, anatomic or physiologic abnormalities of the puppies, puppy body weight at time of birth, duration of hospitalization, whether an injectable NSAID was given during recovery, and any analgesic medications prescribed at discharge. Additional postoperative follow-up information was collected by contacting owners via email or telephone to complete a survey (Appendix) providing information on survival of the bitch to weaning, incisional complications, systemic complications, perceived pain, mothering ability, ability to provide adequate milk, and puppy survival at 1, 2, and 8 weeks of age.

Statistical analysis

Continuous data were assessed for normality by visual inspection of the histogram and normal quantile plot. Normally distributed continuous data are expressed as mean ± SD, and nonnormally distributed continuous data are expressed as median (range). Categorical data are expressed as a fraction (%). If bitches underwent multiple c-sections within the study time frame, each c-section episode was counted as an individual bitch for statistical analysis. The likelihood-ratio χ2 test, Fisher exact test, and Student t test were used to compare variables between groups (CS and CSOVH). Significance was set at P < .05.

Results

One hundred twenty-five c-sections met the inclusion criteria. The mean age of all bitches was 3.4 ± 1.7 years, and the median weight was 24.2 kg (2.1 to 51.6 kg). Thirty-seven different breeds were represented, with the most common breeds being the English Bulldog (28/125 [22.4%]), Golden Retriever (15/125 [12.0%]), and French Bulldog (11/125 [8.8%]). Fifty-three bitches (53/125 [42.4%]) underwent an elective c-section, and 72 bitches (72/125 [57.6%]) underwent an emergency c-section. Eighty-seven bitches had information on previous litters, with 41 bitches being primiparous (41/87 [47.1%]) and 46 bitches being multiparous (46/87 [52.9%]). Of the multiparous bitches, 27 (27/46 [58.7%]) had undergone a previous c-section. Progesterone level on the day of surgery was recorded in 45 bitches, with a median progesterone of 1.8 ng/mL (0.4 to 7.1 ng/mL). Estimated day of gestation was reported for 80 bitches, with a mean of 62.4 ± 2.6 days. Forty-five bitches were in stage 0 labor (45/125 [36.0%]), 25 bitches were in stage 1 labor (25/125 [20.0%]), 16 bitches were in stage 2 labor (16/125 [12.8%]), and 39 bitches were in stage 3 labor (39/125 [31.2%]). Medical management with oxytocin was attempted prior to c-section in 13 bitches (13/124 [10.5%]). The mean fetal heart rate of all puppies at the time of presentation was 174.9 ± 40.4 beats/min.

Propofol was the most commonly used induction agent (119/122 [97.5%]), with 3 bitches receiving alfaxalone for induction (3/122 [2.5%]). In the dogs receiving propofol, 4 dogs each also received fentanyl and ketamine at induction. Thirty-four dogs received maropitant, 8 dogs received metoclopramide, and 3 dogs received atracurium as part of the anesthetic protocol. Dogs were maintained on isoflurane (84/113 [74.3%]), sevoflurane (27/113 [23.9%]), or desflurane (2/113 [1.8%]), and all dogs received lactated Ringer solution during the procedure. The average total anesthesia time was 65.6 ± 21.5 minutes, and total surgery time was 49.6 ± 18.5 minutes. The average time from induction to delivery of the last puppy was 23.0 ± 10.0 minutes, and the average time from delivery of the last puppy to puppies nursing was 68.7 ± 21.0 minutes. Sixty-one dogs experienced hypotension under anesthesia for a median of 20.2 minutes (5 to 75 minutes).

Eighty dogs (80/125 [64.0%]) underwent hysterotomy only (CS) and 45 dogs (45/125 [36.0%]) underwent CSOVH (43 following hysterotomy and delivery of all puppies and 2 en bloc). An en bloc procedure was only performed if fetal death was confirmed prior to surgical intervention. A bipolar vessel sealing device was used in combination with suture to perform OVH in 34 dogs (34/45 [75.6%]), while OVH was performed using suture only in 11 dogs (11/45 [24.4%]). Volume of blood loss was not specifically recorded, but no surgery reports indicated significant blood loss in either group.

Postoperatively, an injectable NSAID was administered during recovery in 83 bitches (83/125 [66.4%]). Eighty-six bitches were prescribed an NSAID at the time of discharge (86/125 [68.8%]); 18 were discharged with no analgesic medications (18/125 [14.4%]); 16 were prescribed another medication such as gabapentin, tramadol, or buprenorphine (16/125 [12.8%]); and 5 were prescribed an NSAID in combination with one of these other medications (5/125 [4.0%]).

Variables were compared between CS and CSOVH (Table 1). Significant findings included that bitches in the CSOVH group were more likely to have an emergency c-section compared to bitches in the CS group (P < .001), bitches in the CSOVH group were also more likely to present in a higher stage of labor than bitches in the CS group (P = .004), bitches in the CSOVH group were more likely to have an increased surgery duration compared to bitches in the CS group (P = .045), and time from delivery of the last puppy to nursing was longer in the CSOVH group compared to the CS group (P = .028). There was no difference in any other variables evaluated between the groups.

Table 1

Comparison of descriptive variables among 80 bitches undergoing c-section alone (CS) and 45 bitches undergoing c-section with concurrent ovariohysterectomy (CSOVH).

Variable No. of dogs CSOVH CS P value
Emergency surgery 125 36/45 (80.0%) 36/80 (45.0%) < .001
Stage of labor 125 .004
  Stage 3 22/45 (48.9%) 17/80 (21.3%)
  Stage 2 7/45 (15.6%) 9/80 (11.3%)
  Stage 1 7/45 (15.6%) 18/80 (22.5%)
  Stage 0 9/45 (20.0%) 36/80 (45.0%)
Surgery time (min) 121 54.4 ± 20.7 46.9 ± 16.6 .045
Time from delivery to nursing (min) 98 75.4 ± 22.3 65.2 ± 19.5 .028
Age (y) 125 3.8 ± 1.8 3.2 ± 1.7 .087
Weight (kg) 124 22.3 (2.1–51.6) 25.0 (2.1–44.3) .964
Oxytocin 124 7/45 (15.6%) 6/79 (7.6%) .173
Average fetal HR (bpm) 93 160 ± 62 177 ± 36 .151
Cerenia 123 11/44 (25.0%) 23/79 (29.1%) .623
Line block 123 5/44 (11.4%) 8/79 (10.1%) .831
Epidural 123 10/44 (22.7%) 25/79 (31.6%) .288
Inhalant gas 113 .487
  Isoflurane 31/39 (79.5%) 53/74 (71.6%)
  Sevoflurane 8/39 (20.5%) 19/74 (25.7%)
  Desflurane 0/39 (0%) 2/74 (2.7%)
Anesthesia time (min) 120 69.7 ± 26.6 63.3 ± 19.3 .165
Time from induction to delivery of the last puppy (min) 120 21.8 ± 7.8 23.7 ± 11.0 .297
Number of puppies delivered via c-section 124 4.1 ± 2.7 4.7 ± 3.1 .280
Hypotension 123 23/44 (52.3%) 38/79 (48.1%) .657
Duration of hypotension (min) 61 16.9 (5–40) 22.1 (5–75) .146
Lowest intraoperative temperature (°C) 115 36.3 ± 0.78 36.2 ± 0.74 .423

Variables are reported as mean ± SD for normally distributed continuous variables, median (range) for nonnormally distributed continuous variables, or proportion (%) of bitches for categorical variables for which data were available.

bpm = Beats per minute. HR = Heart rate.

Owners of 90 (72.0%) bitches responded to the survey. The remaining 35 bitches were lost to follow-up, as owners were unable to be contacted. All 90 bitches with available follow-up information survived until weaning (Table 2). The only significant difference between groups was that bitches in the CSOVH group were more likely to be perceived to be painful postoperatively compared to the CS group (P = .017; 9/29 [31.0%] perceived as painful in the CSOVH group vs 6/61 [9.8%] perceived as painful in the CS group). The most commonly reported indication of pain was sensitivity around the incision site. Analgesic protocols between groups were similar, with no difference in the use of epidural, line block, NSAID injection, or medication prescription at discharge to control postoperative pain. Of the 15 bitches perceived to be painful postoperatively by their owners (15/90 [16.7%]), 9 were discharged with an NSAID only (9/15 [60.0%]; 3 CS and 6 CSOVH), 3 with no medication (3/15 [20.0%]; 3 CS and 0 CSOVH), and 1 each (1/15 [6.7%]; 0 CS and 3 CSOVH) with tramadol, gabapentin, or buprenorphine only.

Table 2

Comparison of descriptive variables among 61 bitches undergoing CS and 29 bitches undergoing CSOVH for which owners completed a follow-up survey.

Variable No. of dogs CSOVH CS P value Comments*
Perceived painful 15 9/29 (31.0%) 6/61 (9.8%) .017 Tenderness (6)
Unable to provide adequate milk 5 0/29 (0%) 5/61 (8.2%) .319 Required oxytocin (4), mastitis (1)
Systemic complications 9 4/29 (13.8%) 5/61 (8.2%) .462 Lethargy (5), diarrhea (3), mastitis (1), constipation (1)
Incision complications 8 3/29 (10.3%) 5/61 (8.2%) .709 Discharge (5), redness (3), dehiscence (2), foul odor (1)
Did not show good mothering ability 5 1/ 29 (3.4%) 4/61 (6.6%) 1.000 No interest in nursing (3), rough with puppies (1), disinterest in puppies (1)
Puppies required a bottle 13 3/29 (10.3%) 10/61 (16.4%) .747
Puppy death occurred prior to 1 wk of age 11 4/29 (13.8%) 7/61 (11.5%) .733 ≥ 1 puppy (10), all puppies (1)
Puppy death occurred between 1 and 2 wk of age 7 2/29 (6.9%) 5/61 (8.2%) 1.000 ≥ 1 puppy (6), all puppies (1)
Puppy death occurred between 2 and 8 wk of age 3 1/29 (3.4%) 2/61 (3.3%) ≥ 1 puppy (3)
Did not allow puppies to nurse 2 0/29 (0%) 2/61 (3.3%)
Maternal death prior to weaning 0 0/29 (0%) 0/61 (0%)

Variables are reported as proportion (%) of bitches for categorical variables for which data were available.

*Not all owners provided comments; some dogs had more than 1 comment listed for each finding. †Insufficient number of events to perform statistical analysis.

Discussion

Ovariohysterectomy at the time of c-section did not pose an increased risk of mortality, intra- or postoperative complications, or poor mothering ability of the bitch in this study. In prior studies,2,4,6,810,12,13,15 proposed risks of OVH at the time of c-section were increased risk of maternal mortality, longer anesthesia time, increased blood loss, greater risk of hypovolemic shock, decreased mothering ability, and decreased milk production. In the present study, there was a 100% maternal survival rate until weaning regardless of OVH and there was no difference in anesthesia duration, incidence of hypotension, postoperative complications, mothering ability, or milk production between CS and CSOVH groups; thus, the hypotheses were accepted. Based on the findings of this study, OVH should be performed concurrently with c-section if indicated.

Following hospital discharge, bitches perceived as painful by the owners were more likely to be in the CSOVH group despite no difference in analgesia usage postoperatively between groups. Interestingly, 18 dogs were discharged without at-home medications and only 3 were painful, all in the CS group. Lack of analgesia is considered inappropriate following OVH,22 and although no studies specifically evaluate pain management for c-section with or without OVH, perioperative multimodal analgesia should be used in dogs undergoing abdominal surgery. Despite this, there are limitations in relying on owner follow-up for pain evaluation, as there was not a standardized objective pain scoring system used in this study. Owner perception of pain may differ on the basis of their experience with postoperative recovery of a dog after any surgical procedure. Owners of bitches in the CSOVH group may have had negative preconceived opinions about the spay procedure and therefore may have been more likely to report postoperative pain. Owners of bitches in the CS group may have been less familiar with how to identify pain, or there may have been more stoic bitches in the CS group. Incision lengths were not recorded, but in general, the incision length for CS and CSOVH are similar, as the incision length required to exteriorize a gravid uterus for CS would provide sufficient visualization for CSOVH. Additional studies, such as prospective studies with objective pain scoring, are necessary to gather a more accurate representation of patient pain level and need for appropriate analgesia following CS and CSOVH.

Although duration of surgery was found to be longer in the CSOVH group compared to the CS group, the overall difference was clinically insignificant. Since the vast majority of OVHs performed in this study were performed after hysterotomy, the increased surgery time is likely secondary to the time taken to ligate the ovarian pedicles and uterus after hysterotomy was performed. The time is likely not clinically different due to the time required to close a hysterotomy incision in dogs undergoing CS without OVH being comparable to the time required to complete an OVH. Use of a bipolar vessel sealing device may have reduced the time taken for OVH, but 24.4% of OVHs were performed with suture only, which may be accomplished rapidly with an experienced veterinarian. In this study population, en bloc c-section was only performed if fetal death was confirmed prior to surgery. Hysterotomy followed by OVH was preferred over en bloc c-section, as en bloc procedures are associated with an increased risk of puppy hypoxia due to suppression of uterine blood flow and require a second trained team for puppy extraction and resuscitation.6,23 Additional studies are needed to determine the true time cost of OVH in addition to CS. Additionally, the duration of time from delivery to nursing was longer for those in the CSOVH group compared to the CS group. In theory, this increased time could negatively impact the early success of the puppies, but this difference was also clinically insignificant. This difference in time between groups was most likely secondary to the longer surgical duration seen in the CSOVH group.

In previous studies,4,6,8,12 increased anesthesia time was listed as a concern against performing an OVH at the time of c-section. In this study, there was no difference in anesthesia time between the CS and CSOVH groups. Additionally, there was no difference in blood pressure under anesthesia between groups. Although volume of blood loss was not specifically recorded in any case, no surgery reports indicated significant blood loss, reducing the concern for hemorrhage and hypovolemic shock as reason to not perform OVH at the time of c-section, as previously reported.2,4,6,8,10,12,15 Use of a bipolar vessel sealing device, as used in 75.6% of surgeries in this report, may reduce the risk of hemorrhage, but there was no reported hemorrhage in the 24.4% of surgeries in which suture only was used, indicating that placement of secure ligations is safe for bitches undergoing CSOVH.

A higher percentage of bitches in the CSOVH group underwent emergency c-section compared to those in the CS group. Additionally, those bitches in the CSOVH group were more commonly presented in a higher stage of labor compared to those in the CS group. This is likely due to owner demographic, as bitches owned by clients who intend to continue breeding may be more likely to schedule a planned elective c-section without OVH for breeds at risk for dystocia or to intervene with c-section without OVH prior to dystocia based on progesterone levels or estimated gestation length. In contrast, owners of bitches undergoing emergency c-section may be more likely to have been unaware of the pregnancy or the pregnancy may have been accidental, and these owners may be more likely to elect for OVH at the time of c-section to prevent additional unplanned pregnancies.

Limitations of this study included those inherent to all retrospective studies. While most medical records were complete and clear, some information in the medical records may have been incomplete or had to be inferred from available information. There were also limitations in relying on an owner survey for postoperative follow-up information. While the response rate of this study was comparable to previous surveys (72.0%), a more complete response rate could have altered the postoperative findings, particularly if owners with negative outcomes (eg, perceived pain of the bitch) were more likely to respond. Alternatively, owners of bitches that did not survive to weaning may have been less likely to reply to the survey. Additionally, many of these owners were also surveyed multiple years after their pets’ c-section, some upwards of 7 years later, which could have led to recall bias. However, the majority of owners surveyed in this study were long-term clients of the theriogenology service and experienced breeders with thorough historical records. This study evaluated surgical procedures performed in an academic setting under the direct supervision of multiple specialists, and the findings of this study may not directly compare to surgical procedures performed in a private practice setting. Additional studies are necessary to determine patient outcomes following CS and CSOVH in differing practice settings.

Overall, the results of this study showed that performing an OVH at the time of c-section does not pose an increased risk of mortality for the bitch, has no influence on mothering ability of the bitch, and does not increase the risk of intra- or postoperative complications. Consideration of the postoperative analgesic protocol and monitoring for postoperative pain should be performed when OVH is performed concurrently with c-section.

Acknowledgments

No external funding was used in this study. The authors declare that there were no conflicts of interest.

References

  • 1.

    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(8):786-791. doi:10.1111/j.1532-950X.2006.00223.x

    • Search Google Scholar
    • Export Citation
  • 2.

    Smith FO. Guide to emergency interception during parturition in the dog and cat. Vet Clin North Am Small Anim Pract. 2012;42(3):489-499, vi. doi:10.1016/j.cvsm.2012.02.001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Münnich A, Küchenmeister U. Dystocia in numbers - evidence-based parameters for intervention in the dog: causes for dystocia and treatment recommendations. Reprod Domest Anim. 2009;44(suppl 2):141-147. doi:10.1111/j.1439-0531.2009.01405.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Conze T, Jurczak A, Fux V, Socha P, Wehrend A, Janowski T. Survival and fertility of bitches undergoing caesarean section. Vet Rec. 2020;186(13):416. doi:10.1136/vr.105123

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    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. J Am Vet Med Assoc. 1998;213(3):365-369.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Traas AM. Surgical management of canine and feline dystocia. Theriogenology. 2008;70(3):337-342. doi:10.1016/j.theriogenology.2008.04.014

  • 7.

    De Cramer KGM, Nöthling JO. Towards scheduled pre-parturient caesarean sections in bitches. Reprod Domest Anim. 2020;55(suppl 2):38-48. doi:10.1111/rda.13669

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Robbins MA, Mullen HS. En bloc ovariohysterectomy as a treatment for dystocia in dogs and cats. Vet Surg. 1994;23(1):48-52. doi:10.1111/j.1532-950x.1994.tb00442.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Herron MR, Herron MA. Symposium on surgical techniques in small animal practice. Surgery of the uterus. Vet Clin North Am. 1975;5(3):471-476. doi:10.1016/s0091-0279(75)50062-6

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    C-section considerations for canine patients. AVMA PLIT Prof Liabil. 2022;41(3):1-3.

  • 11.

    Gaudet DA. Retrospective study of 128 cases of canine dystocia. J Am Anim Hosp Assoc. 1985;21(6):813-818.

  • 12.

    Gaudet DA, Kitchell BE. Canine dystocia. Compend Contin Educ Pract Vet. 1985;7:406-418.

  • 13.

    Freak MJ. Abnormal conditions associated with pregnancy and parturition in the bitch. Vet Rec. 1962;74:1323-1335.

  • 14.

    Jones DE, Joshua JO. Some problems of parturition. In: Jones DE, Joshua JO, eds. Reproductive Clinical Problems in the Dog. Wright-PSG Co; 1982:78-101.

    • Search Google Scholar
    • Export Citation
  • 15.

    Smith KW. Female genital system. In: Archibald J, ed. Canine Surgery. 2nd ed. American Veterinary Publications; 1974:751-779.

  • 16.

    Roberts SJ. Obstetrical operations for relieving dystocia. In: Roberts SJ, ed. Veterinary Obstetrics and Genital Diseases. 2nd ed. Edwards Brothers Inc; 1971:247-273.

    • Search Google Scholar
    • Export Citation
  • 17.

    Probst CW, Webb AI. Cesarean section in the dog and cat: anesthetic and surgical techniques. In: Bojrab MJ, ed. Current Techniques in Small Animal Surgery. 2nd ed. Lea and Febiger; 1983:346-351.

    • Search Google Scholar
    • Export Citation
  • 18.

    Howe LM. Current perspectives on the optimal age to spay/castrate dogs and cats. Vet Med (Auckl). 2015;6:171-180. doi:10.2147/VMRR.S53264

  • 19.

    Urfer SR, Kaeberlein M. Desexing dogs: a review of the current literature. Animals (Basel). 2019;9(12):9. doi:10.3390/ani9121086

  • 20.

    Adams DJ, Ellerbrock RE, Wallace ML, Schmiedt CW, Sutherland BJ, Grimes JA. Risk factors for neonatal mortality prior to hospital discharge in brachycephalic and nonbrachycephalic dogs undergoing cesarean section. Vet Surg. 2022;51(7):1052-1060. doi:10.1111/vsu.13868

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Runcan EE, Coutinho da Silva MA. Whelping and dystocia: maximizing success of medical management. Top Companion Anim Med. 2018;33(1):12-16. doi:10.1053/j.tcam.2018.03.003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Looney AL, Bohling MW, Bushby PA, et al.; Association of Shelter Veterinarians’ Spay and Neuter Task Force. The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs. J Am Vet Med Assoc. 2008;233(1):74-86. doi:10.2460/javma.233.1.74

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Biddle D, Macintire DK. Obstetrical emergencies. Clin Tech Small Anim Pract. 2000;15(2):88-93. doi:10.1053/svms.2000.6803

Appendix

Owner follow-up survey.

  1. Did your pet experience any of the complications listed below within 2 weeks after surgery?

    1. Lethargy

    2. Vomiting

    3. Diarrhea

    4. Inappetence

    5. Abnormal breathing

    6. Death

    7. Other

    8. None of these

  2. If yes, please provide further details here (ie, how severe was the complication and how long did it last?).

  3. Did your pet experience any of the following complications regarding her incision site?

    1. Discharge/drainage

    2. Dehiscence (opening of the incision)

    3. Foul smell

    4. Other

    5. None of these

  4. If yes, please elaborate here (ie, what color was the drainage, what was the consistency of the drainage, how much drainage was present, how much did the incision open, etc).

  5. Did your pet seem painful after surgery?

    1. Yes

    2. No

  6. Did your pet show good mothering ability?

    1. Yes

    2. No

    3. Not applicable

  7. If no, what were the issues, when did the issues begin, and did they resolve?

  8. Did your pet allow her puppies to nurse?

    1. Yes

    2. No

    3. Not applicable

  9. Was your pet able to provide adequate milk for her puppies?

    1. Yes

    2. No

    3. Not applicable

  10. Did any puppies need additional supplementation with the bottle?

    1. Yes

    2. No

    3. Not applicable

  11. If yes, how many of the puppies required supplementation and for how long?

  12. Did the dam (mother) survive until weaning?

    1. Yes

    2. No

  13. The following question evaluates puppy survival after being discharged from the hospital. Did all of the puppies that were discharged from the hospital survive? Please select the most applicable answer in each row.

    1. How many puppies survived past 1 week?

      1. Not applicable

      2. All of the puppies

      3. Some of the puppies

      4. None of the puppies

    2. How many puppies survived past 2 weeks?

      1. Not applicable

      2. All of the puppies

      3. Some of the puppies

      4. None of the puppies

    3. How many puppies survived past 8 weeks?

      1. Not applicable

      2. All of the puppies

      3. Some of the puppies

      4. None of the puppies

  14. If any of the puppies did not live to be 8 weeks of age, please provide further details here. How many of the puppies did not survive to be 8 weeks of age? How long did they survive for?

  15. Did you have any other concerns with your pet or her puppies following surgery? If so, please elaborate here.

All Time Past Year Past 30 Days
Abstract Views 3 0 0
Full Text Views 4726 3074 189
PDF Downloads 4118 2414 149
Advertisement