Caesarian section and antibiotics

RE: Caesarian section and antibiotics

Dave Cumber — Wed, 08 Mar 2017 08:58:50 GMT

Many thanks for all the responses.

The VDS response was that each case should be assessed and the decision lies with the veterinary surgeon. VDS were fantastically helpful and I wrote a very long letter justifying our decision to do things the way that we did. I agreed to a significant discount on the cost of the subsequent treatment for peritonitis as a gesture of goodwill. The client paid their bill and they are still a client.

We had a meeting to discuss how we might make changes and accepted that if the cervix was open at the time of the C-section, it is probably wise to offer antibiotics.

Thank you again to all those who took the trouble to reply.

Dave

RE: Caesarian section and antibiotics

Clive Ansell — Wed, 08 Mar 2017 08:33:52 GMT

[quote user="Dave Cumber"]Many thanks for the replies so far. Interesting split of opinions. I am compiling a letter of reply which will be run past VDS. [/quote]

Dave - what was the outcome, and opinion of the VDS?

Seems mixed opinions on this. I don't routinely use antibiotics if no complications, and cannot recall any problems. Equally, I can accept the argument for their use.

RE: Caesarian section and antibiotics

Marni Miller — Tue, 07 Mar 2017 22:14:59 GMT

No, I do not routinely give antibiotics. Perform maybe 4 or 5 a year over the last 20 years and can't remember any problems that I could associate with the lack of antibiotics.

PS spelling is caesarean not caesarian isn't it? This is from someone who has been misspelling inflamed for many many years BTW!

RE: Caesarian section and antibiotics

Mark Rowland — Mon, 06 Mar 2017 02:11:19 GMT

I agree with Michaels earlier post.

There is a direct communication with the outside world via the vagina.

So in an op of this magnitude in a stressed (immunocompromised ) patient. I think antibiosis is justifiable and prudent.

RE: Caesarian section and antibiotics

Evelyn Barbour-Hill — Sun, 05 Mar 2017 17:12:26 GMT

[quote user="Anthony Todd"]

Remember, "an injection", any injection, has pan-aetiological, therapeutic, and anti-legal properties.

[/quote]

Only if the client watches you doing it.

That's what vitamin B12 was for (44 years ago)

RE: Caesarian section and antibiotics

Tomas B — Sat, 04 Mar 2017 17:26:15 GMT

If there is any conspurcation of the medical field with placenta or amniotic fluid at manipulation of the uterus.

Its something the vets here have done til now, and no problems. No evidence based i think

RE: Caesarian section and antibiotics

Michael Woodhouse — Sat, 04 Mar 2017 17:22:39 GMT

[quote user="Tomás Basto"]Sometimes i do penicilline intra-abdominal after the c section before suture if the asseptic measures werent the best[/quote]

Why? What is your rationale and evidence base?

Why wouldn't your 'aseptic measures be the best'?

RE: Caesarian section and antibiotics

Tomas B — Sat, 04 Mar 2017 17:19:32 GMT

Sometimes i do penicilline intra-abdominal after the c section before suture if the asseptic measures werent the best

RE: Caesarian section and antibiotics

Anthony Todd — Sun, 15 Jan 2017 11:41:30 GMT

[quote user="Martin Atkinson"]

[quote user="Dave Cumber"]I am compiling a letter of reply which will be run past VDS. [/quote]Not a bad idea but I'd be pretty sure that as there is no case to answer as there is no consensus on routine antibiosis. Post op complications and infections occur and that is no-one's fault unless you've been shown to be grossly negligent.

[/quote]

Would the VDS and the nasty facebook have been avoided if an A/B had been given?

Gee you can buy chloramphenicol eye drops over the counter for a weepy eye, so I can't see that a shot of antibiotic is going to change the bacterial landscape.

Remember, "an injection", any injection, has pan-aetiological, therapeutic, and anti-legal properties.

RE: Caesarian section and antibiotics

Michael Woodhouse — Sat, 14 Jan 2017 16:30:27 GMT

[quote user="Dinu Catilina"]This is a very interesting point. Would you do the same regardless the species or just dogs and cats? What about cows? Why is a cesarian unethical? [/quote]

I agree that breeding any animal that we know is very unlikely to give birth naturally is unethical, but I've done caesarians on many species that have later gone on and given birth naturally. Having one doesn't make another inevitable.

I'm also sure it's going to take a lot longer to spay the cows than just caeser them!

RE: Caesarian section and antibiotics

Dinu Catilina — Sat, 14 Jan 2017 01:12:07 GMT

[quote user="David Mills"]And arguably, ethically, anything needing a caesar should or ought to be spayed.[/quote]

This is a very interesting point. Would you do the same regardless the species or just dogs and cats? What about cows? Why is a cesarian unethical?

RE: Caesarian section and antibiotics

Glen McIntosh — Fri, 06 Jan 2017 10:27:41 GMT

[quote user="David Mills"]

Don't be nervous

The main supply comes from the uterine I.e. Cervical bit. Double Clamp ovaries first, cut, then cervix, cut, out, easy peasy.

You get about a minute or 2 from the cervical bit.

[/quote]

Agree.

I do enbloc routinely these days if spaying as well.

In my experience it is at least as fast and as safe as a hysterotomy. I think blood loss is actually less using en bloc compared to hysterotomy, since there is often significant and ongoing blood loss into the uterus that can be difficult to control with the latter no matter how gently you remove placentas. Not to mention close to zero potential for abdominal contamination with en bloc.

Unfortunately I cant mandate spaying with caesarian since I am in private practice, but I will always offer spaying at no extra cost with caesarian (since it is quicker and easier doing en bloc anyway), and advise that, by removing the uterus, potential complications such as post op uterine infections and ongoing blood loss are removed (as well as removing the potential need for further caesarians).

I usually flush the abdomen with warmed saline and give antibiosis routinely with caesarians, regardless of what surgical method I use.

RE: Caesarian section and antibiotics

Martin Atkinson — Fri, 06 Jan 2017 10:02:44 GMT

RE: Caesarian section and antibiotics

David Mills — Fri, 06 Jan 2017 01:12:05 GMT

[quote user="Beats"]

[quote user="David Mills"]uterus out en bloc then open which is cleaner.[/quote]

I've seen pictures, but never had the guts to try this

I assume you place clamps (how many? any must-do tips?) on both stumps and caudal to cervix, then cut all 3 and lift out uterus and then take the pups out as normal prior to going back to place ligatures? It makes me nervous just typing it.

[/quote]

Don't be nervous

The main supply comes from the uterine I.e. Cervical bit. Double Clamp ovaries first, cut, then cervix, cut, out, easy peasy.

You get about a minute or 2 from the cervical bit.

RE: Caesarian section and antibiotics

Beats — Fri, 06 Jan 2017 01:04:12 GMT

[quote user="David Mills"]uterus out en bloc then open which is cleaner.[/quote]

I've seen pictures, but never had the guts to try this

RE: Caesarian section and antibiotics

David Mills — Fri, 06 Jan 2017 01:04:08 GMT

[quote user="Dinu Catilina"]

[quote user="David Mills"] We'd never do it without spaying so it's uterus out en bloc then open which is cleaner.[/quote]

Why is that? I thought that loosing all that blood may increase the morbidity. Am I wrong? I would avoid to spay at the same time unless there is a medical reason for it.

[/quote]

Charity, protocol, don't support breeders through our subsidised prices. Almost all go home 2h post op and are absolutely fine. It's extra blood they produce during pregnancy so they don't miss it, and it's naff all compared to total volume.

And arguably, ethically, anything needing a caesar should or ought to be spayed.

RE: Caesarian section and antibiotics

Dinu Catilina — Thu, 05 Jan 2017 23:38:57 GMT

[quote user="David Mills"] We'd never do it without spaying so it's uterus out en bloc then open which is cleaner.[/quote]

Why is that? I thought that loosing all that blood may increase the morbidity. Am I wrong? I would avoid to spay at the same time unless there is a medical reason for it.

RE: Caesarian section and antibiotics

David Mills — Thu, 05 Jan 2017 23:13:41 GMT

[quote user="cathal rafferty"]

Clean contaminated surgery justifies the use of iv antibiotics at induction and q 2 hrs after that until the body is closed. The idea is that tissue concentrations are adequate during surgery. Same applies to cystotomy, enterotomy etc. if significant spiage occurs then abdomen is flushed and post op antibiotics justified.

i would say the uterine lumen in labour is not sterile.

I'd be interested to know if the 'prophylactic abs' referred to in the human studies refer to this intra-op use only

[/quote]

Hmm. IM amoxiclav reaches iv levels at about the same rate and lasts longer at required tissue mic. One of the main reasons I don't like iv amoxiclav.

It depends on how you do the surgery. We'd never do it without spaying so it's uterus out en bloc then open which is cleaner. If you're opening intra abdomen then suturing back up then yes antibiotics justified for short course after.

RE: Caesarian section and antibiotics

Robin Grimmer — Thu, 05 Jan 2017 20:28:16 GMT

I think Rimadyl injection isn't contra-indicated for lactating, but the tablets are.

RE: Caesarian section and antibiotics

Eilidh Corr — Thu, 05 Jan 2017 20:18:43 GMT

To muddy the waters, I had a section 9+ years ago (feeling my age here!) and was given a single dose of intravenous co-amoxiclav at the beginning of the procedure. It was all over and done with in half an hour and I received no further antibiotics. Interestingly though, this was not an emergency section and was carried out prior to the onset of labour so with a closed cervix, not technically clean contaminated?!

I will usually give antibiotics, not least because the wound gets a hammering from pendulous mammary tissue and squirming puppies, but I always give NSAIDs. Mention that they're off license to the owner, but anyone with an ounce of sense prefers decent pain relief. I spoke to Boehringer years ago about using Metacam following seconds, and off the record they were really happy for it to be used during lactation but less so during pregnancy.

RE: Caesarian section and antibiotics

cathal rafferty — Thu, 05 Jan 2017 18:12:13 GMT

My wife had a section 7 weeks ago. No antibiotics post-op. Don't know about intra-op

RE: Caesarian section and antibiotics

Clive Ansell — Thu, 05 Jan 2017 18:11:50 GMT

[quote user="Dinu Catilina"]My goal is always to have the pups out in 20 minutes max once the bitch is in the practice. Synulox reaching therapeutic levels half an hour post surgery is pointless, can just as well not bother at all. [/quote]

I have never used iv antibiotics for C-sections, even ones with obvious infections and a uterus full of dead putrid puppies. Never used for pyometras either. Never had any problems.

I think you're on thin ice using off licence antibiotics iv, certainly without specific signed consent. If a breeder client has puppies die, they look to blame someone, and off licence drug use makes you a sitting duck (I think there have been previous VDS cases around the use of nsaid for C-sections)

RE: Caesarian section and antibiotics

cathal rafferty — Thu, 05 Jan 2017 18:10:41 GMT

i would say the uterine lumen in labour is not sterile.

I'd be interested to know if the 'prophylactic abs' referred to in the human studies refer to this intra-op use only

RE: Caesarian section and antibiotics

Clive Ansell — Thu, 05 Jan 2017 17:59:32 GMT

[quote user="Rob Davis"]I don't routinely give antibiotics (though we don't do many caesarians), but Michael's posts are interesting and may make me reconsider.[/quote]

+1. I have never given routine antibiotics to C-sections without complication, and in 20 years cannot remember one going belly up. I've seen some that are pyrexic and have a discharge at post op check, which then get antibiosis and do just fine. Maybe we should only use if there is evidence of infection from regular and close post op monitoring?

That said, this is an interesting debate and Michael does make a sound and sensible argument for routine usage, and it would be good to hear opinion form some of the specialists, as well as hearing what the VDS take on it is.

RE: Caesarian section and antibiotics

Neil Wheadon — Thu, 05 Jan 2017 15:58:02 GMT

All I can say is that I have worked in a practice full of French Bulldogs with lots of caesarians. They are valuable and many caesarians are done. Routine antibiotic use isn't on the agenda. I'm back there in a month and will ask, so if different I promise to post it

Neil