Premature Puppies by C-Section.

RE: Premature Puppies by C-Section.

grumpyoldman — Sun, 11 Nov 2018 20:09:46 GMT

[quote user="Julie Innes"]As well as they fact they were well advised against breeding the bitch in the first place...[/quote]

Agreed , but that falls on stoney ground as well , the driving force is £2000 per puppy and what the breeder says.

RE: Premature Puppies by C-Section.

Julie Innes — Wed, 07 Nov 2018 08:43:58 GMT

[quote user="grumpyoldman"] I have had this a few times and looked back wistfully on the history to the point where they ignored the recommendations for a BOAS work up. The puppies don't do well and survival rates are poor. [/quote]

As well as they fact they were well advised against breeding the bitch in the first place...

RE: Premature Puppies by C-Section.

grumpyoldman — Sat, 03 Nov 2018 16:17:03 GMT

As much as anything else this is about breeders jumping the gun and forcing peoples hands because they want it done to suit there needs , protect the potential investment returns , and most importantly avoid a £2000 bill at Vetsnow. My advice would be wait until it starts whelping and ignore them. If they won't have it they will be off down the road to lean on someone else , let them. We only do them early if there are BOAS problems threatening the bitch. I have had this a few times and looked back wistfully on the history to the point where they ignored the recommendations for a BOAS work up. The puppies don't do well and survival rates are poor.

RE: Premature Puppies by C-Section.

Nicola Cole — Tue, 30 Oct 2018 21:18:26 GMT

[quote user="vetbl.locum"].

Is any practice/hospital delivering this level of care?

[/quote]

Not heard of any practices offering this and to be honest would be very surprised if they did.

From distant memory doesn’t maturation with regards to viability happen very late on in dogs?

RE: Premature Puppies by C-Section.

rhmrcvs — Tue, 30 Oct 2018 19:58:17 GMT

1 wk early is a significant amount of gestation, the icu treatment of human prem babies is massive and not without risk / problems. Surviving doesn't mean normality. Not teaching you to suck eggs, your success rates sound high, sometimes can't fight the physiology.

RE: Premature Puppies by C-Section.

vetbl.locum — Tue, 30 Oct 2018 13:42:55 GMT

Leaving aside the ethics of elective surgery to suit breeders.

Is any practice/hospital delivering this level of care?

[quote user="Nicola M"] the earlier they are the more intervention is usually needed but it’s not uncommon for a baby just a few weeks early delivered by C-section to need a couple of days/weeks of assisted breathing-whether piped oxygenated air, CPAP, or less likely full ventilation. They can also need stomach tubing and if on respiratory support of any kind often can’t be fed by stomach tube for first few days and is via vein. This is usually not the case for a vaginal delivery and they can get away with being earlier due to expelling all the gunk from the lungs during natural delivery[/quote]

Should we be looking to refer premature pups if this is available? Or we just prolonging the inevitable ?

Regards

RE: Premature Puppies by C-Section.

Nicola Cole — Mon, 29 Oct 2018 07:37:42 GMT

From a human comparison point of view (as that was what the question hinged on). Steroids are given in advance of impending labour/c section, ideally 2 doses on consecutive days. This is from a lung maturation point of view.These must take some time to work as they try and hold delivery off as long as possible from that point and every day counts.

***The ‘break even’ point in humans at which there is no difference between an early section and a natural delivery in terms of outcome is 39 weeks!***

Thats not to say that all babies born by section before that day do badly, just that (in usually just the short term if not long before this) they may need assistance.

Obviously the earlier they are the more intervention is usually needed but it’s not uncommon for a baby just a few weeks early delivered by C-section to need a couple of days/weeks of assisted breathing-whether piped oxygenated air, CPAP, or less likely full ventilation. They can also need stomach tubing and if on respiratory support of any kind often can’t be fed by stomach tube for first few days and is via vein. This is usually not the case for a vaginal delivery and they can get away with being earlier due to expelling all the gunk from the lungs during natural delivery.

The earlier they are the more intervention they are likely to need.

Obviously im talking humans and I don’t know what the ‘break even’ point is in dogs (don’t think the studies have been done)-but it is surprisingly late in humans (39/40ths of pregnancy) and once in SCBU/NICU there is a huge amount of intervention that I dont see would be possible in dogs.

RE: Premature Puppies by C-Section.

Dinu Catilina — Sun, 28 Oct 2018 21:21:59 GMT

Jamie, I can understand your frustration that we didn't help but honestly I don't think there is an answer to your question. There is no specific treatment/ drug for premature puppies that can keep them alive (at least to my knowledge) and comparing the treatments from human medicine is futile, puppies developed very differently that human babies and the last week is very important.

In my opinion giving steroids at birth is too late and will change nothing, they will still be born with immature lungs without surfactant and they will be dead before the steroids can make any difference.

But one thing I really don't understand:

[quote user="jamie winstone"]I never promote elective c-section surgery but I am prepared to do it if breeders decide [/quote]

Why? Why not let them go to term? Why encourage this practice? What is the benefit for the bitch or the pups? I am not picking on you but curious why, I can tell you one good medical reason but I'll let you go first.

RE: Premature Puppies by C-Section.

jamie winstone — Sun, 28 Oct 2018 20:20:44 GMT

I had hoped to initiate a discussion on any treatment available for premature pups. I never promote elective csection surgery but I am prepared to do it if breeders decide and a list of options would always have been given before hand. The progesterone test would have been offered. The rights and wrongs of the surgery was not my point.

As people mentioned the lengths that the medical profession goes to, to preserve life at all costs is questionable but not all premature babies are at the extreme end and those children born several weeks early would all be expected to be nurtured and eventually go home.

I had wondered if steroids should be given to the pups as soon as they were born and how often or how much and whether keeping them in an oxygen tent might help etc and what the medics are monitoring for.

RE: Premature Puppies by C-Section.

Michael Woodhouse — Sun, 28 Oct 2018 18:39:25 GMT

Dogs are not my area really but cortisol is responsible for initiating birth in most species. Lung maturation and turning on surfactant production via the type 2 pneumocystes are the main roles, I believe.

As I recall, the cortisol is less important in dogs for initiating birth, but still spikes.

RE: Premature Puppies by C-Section.

David Mills — Sun, 28 Oct 2018 18:28:47 GMT

[quote user="Silvia Maldonado"]

[quote user="Lucy Fleming"]

Certainly nothing practical that I can think of. Like Dinu said, perhaps an injection of corticosteroid to the bitch 24 hours before? That's the only thing I can thing of.

[/quote]

I may be asking something silly, but would not that help initiating the parturition, rather than the foetal development? Or would that somehow increase the chances for survival?

[/quote]

Corticosteroids rise 24-48h before birth and lead to lung development. They are routinely given in humans who are giving birth prematurely.

RE: Premature Puppies by C-Section.

Silvia Maldonado — Sun, 28 Oct 2018 16:56:59 GMT

[quote user="Lucy Fleming"]

Certainly nothing practical that I can think of. Like Dinu said, perhaps an injection of corticosteroid to the bitch 24 hours before? That's the only thing I can thing of.

[/quote]

I may be asking something silly, but would not that help initiating the parturition, rather than the foetal development? Or would that somehow increase the chances for survival?

RE: Premature Puppies by C-Section.

Rob Loxley — Thu, 25 Oct 2018 22:31:32 GMT

[quote user="jamie winstone"]Of course I do realise that it is best to avoid premature puppies but except for in perfect practices they do occur occasionally[/quote]

I suspect these are 'elective' bulldog caesarians and the reason they are premature is the vagaries of timing the actual conception (as above) rather than bitches that have gone into premature labour? Why not run an in-house Premate progesterone test before elective c/section (apart from cost..)?

[quote user="jamie winstone"]My question was, is there anything we can do to help them survive.[/quote]

You could look at aglepristone, there are reports of its use before c/sections when the progesterone had not fallen low. But again I'd be aiming to improve the timing of any elective c/section.

RE: Premature Puppies by C-Section.

Dinu Catilina — Thu, 25 Oct 2018 21:12:53 GMT

[quote user="Clive Ansell"]The idea of giving a corticosteroid injection 24 hours prior to an elective C-section for client convenience reasons is to me totally unethical. Again, just wait until parturition begins.[/quote]

Some bitches may not make it alive full term, for example in an unusually big litter or hydrops. An elective caeasarian can be ethical. It is not ethical in a healthy bitch with normal pregnancy.

RE: Premature Puppies by C-Section.

Robin Grimmer — Thu, 25 Oct 2018 15:39:24 GMT

[quote user="jamie winstone"]

Of course I do realise that it is best to avoid premature puppies but except for in perfect practices they do occur occasionally. My question was, is there anything we can do to help them survive. So far I think the answer is NO.

[/quote]

I think trying to save premature pups is likely to be time consuming and fruitless. Prevention is better than cure. Also using progesterone assays, you could use them to pinpoint ovulation and therefore give an exact parturition date.

RE: Premature Puppies by C-Section.

Clive Ansell — Thu, 25 Oct 2018 13:16:15 GMT

[quote user="Lucy Fleming"]Certainly nothing practical that I can think of. Like Dinu said, perhaps an injection of corticosteroid to the bitch 24 hours before? That's the only thing I can thing of.[/quote]

The idea of giving a corticosteroid injection 24 hours prior to an elective C-section for client convenience reasons is to me totally unethical. Again, just wait until parturition begins.

I equally not convinced by the argument for giving the c/s in the event of a so called emergency. If an emergency C-section is needed to save the life of the bitch, it either needs doing asap or it doesn't need doing. If a genuine emergency could one wait 24 hours for the c/s to work?

RE: Premature Puppies by C-Section.

Clive Ansell — Thu, 25 Oct 2018 11:57:08 GMT

[quote user="Julie Innes"]One of my friends is a NICU nurse. She works with premmies as young as 22 weeks and with some severe deformities and congenital issues. She says that sometimes it feels awful trying to save these babies that will then need 20-odd more surgeries to have anything resembling a normal life[/quote]

A relative had a premature baby 6 years ago. It was 50:50 whether he would survive or not, and he had major surgery before the point he should have even been born to correct a ventricular septal defect, to remove necrotic intestine and have a temporary ileostomy, and amputate necrotic toes, all due to anoxia. There was also concern he had suffered anoxic brain damage.

Many of us, me included, debated at time whether it was fair to let him carry on. He survived, proved us all wrong, and is now a normal, happy and healthy little boy (less 2 toes).

RE: Premature Puppies by C-Section.

Lucy Fleming — Thu, 25 Oct 2018 11:56:52 GMT

[quote user="jamie winstone"]My question was, is there anything we can do to help them survive. So far I think the answer is NO[/quote]

Certainly nothing practical that I can think of. Like Dinu said, perhaps an injection of corticosteroid to the bitch 24 hours before? That's the only thing I can thing of.

RE: Premature Puppies by C-Section.

Clive Ansell — Thu, 25 Oct 2018 11:44:16 GMT

[quote user="jamie winstone"]My question was, is there anything we can do to help them survive. So far I think the answer is NO.[/quote]

I have very little experience with trying to save premature puppies, but what about corticosteroids either systemically or nebulised and inhaled?

Is it fair and humane to try if the prognosis is hopeless? should they just be pts? not saying they should or shouldn't, just seems a reasonable question to ask.

RE: Premature Puppies by C-Section.

Julie Innes — Thu, 25 Oct 2018 08:42:48 GMT

One of my friends is a NICU nurse. She works with premmies as young as 22 weeks and with some severe deformities and congenital issues. She says that sometimes it feels awful trying to save these babies that will then need 20-odd more surgeries to have anything resembling a normal life

RE: Premature Puppies by C-Section.

jamie winstone — Thu, 25 Oct 2018 08:10:43 GMT

RE: Premature Puppies by C-Section.

Dinu Catilina — Wed, 24 Oct 2018 22:07:48 GMT

I do a lot of reproduction work but would never do an elective unless there is a reason for it (like a singelton pregnancy). Even then I would do it when the progesterone is under 2 ng (6-7 nmols) but I can run progesterone in house which you probably can't? All bitches from all breeds should be given a chance to self whelp.

My advice is always to let them start whelping and bring them in if the bitch contracted for more than an hour and had no pups.

3 days early is safe, any longer you have to be lucky for the pups to survive. The lung surfactant is produced in the last 3 days when the cortisol is rising. If you do have to do an early caesarian (a massive bulldog bitch struggling to breathe) then you could give steroids the day before but there isn't any evidence that it works.

RE: Premature Puppies by C-Section.

Julie Innes — Wed, 24 Oct 2018 20:04:17 GMT

I refuse to do a section unless they have started whelping. As Michael said you can be a week out with conception date even if mating date is completely accurate (and bearing in mind bitches are often mated several times). I explain to people that as canine pregnancy is nine weeks as opposed to human mind months a puppy which is a week undercooked is equivalent to a human baby a month premature at least.

lots of breeders don't like my stance (mainly because it might mean going to out of hours, which will cost them much more) but I'm happy to not have lots of breeders! I only have 2 bulldog breeders and they both endeavour to have bitches self whelp, and usually manage.

RE: Premature Puppies by C-Section.

Michael Woodhouse — Wed, 24 Oct 2018 19:36:27 GMT

Dog sperm has a long period of viability in the reproductive tract (up to 7 days according to some sources). The learning point from this isn't "how do I help premature puppies" but how to avoid early caesers. I wouldn't dream of doing one until parturition had started.

RE: Premature Puppies by C-Section.

Lucy Fleming — Wed, 24 Oct 2018 18:45:00 GMT

[quote user="jamie winstone"] I can`t help thinking that although premature, these pups are nowhere near as early as the babies delivered at the local hospital[/quote] don't forget how much intervention many of these babies will get. My understanding is that those that are delivered up to 2 weeks before 'due date' are still full term (someone who has had, or at least has some interest in, pregnancy and babies may be able to give you better info. Not really my thing, I'm afraid) Those who are genuinely premature get a lot of support, especially for under-developed lungs (thinking ventilators, in many cases). For a pregnancy that is so much shorter than a human one, even a few days early is probably equivalent to several weeks pre-term...