Do you routinely scan post-partum bitches?

RE: Do you routinely scan post-partum bitches?

Silvia Maldonado — Thu, 26 May 2016 03:11:20 GMT

[quote user="bob lehner"]

On a similar note there have apparently been cases where a vet has scanned a pregnant bitch and said there are definitely x number of pups. Then on the subsequent caesarean it turns out in fact to be x-1 pups - whereupon the owner accuses the vet of having pocketed the 'missing' pup for his/her own financial gain! (Moral - never say there are definitely x pups on a scan).

[/quote]

Very true! my last pug was scanned at her vet, 4-5 pups. On C-section there were only 2. My previous C-section, a dalmatian brought by her owner because there were 5 puppies on a scan, and only 4 had been produced. However, there were another 7 inside yet.

Xray is definitely more reliable.

RE: Do you routinely scan post-partum bitches?

Lucy Fleming — Tue, 24 May 2016 12:53:47 GMT

[quote user="villagevet"]Not so great at testing,[/quote]

I read somewhere (may have been BSAVA manual) that blood levels may not be that helpful as even normo-calcaemic bitches benefit from supplementation. Thought to be possibly acting at a cellular level. I'm not a big fan of medical management of dystocia (having used oxytocin once after discussing all the risks etc but the owner really wanted to try and then subesquently found at caesar that the uterus was very close to rupturing!) but more comfortable and have had some success with calcium.

RE: Do you routinely scan post-partum bitches?

Lindsey Edwards — Tue, 17 May 2016 18:08:12 GMT

I routinely use calcium in dystocia cases especially if older bitch and/or large litters, panting/twitching or restless behaviour always. Routinely supplement with high energy recovery/recuperation supplements also. Not so great at testing, don't have on site calcium test and don't pull out glucometer every hour

RE: Do you routinely scan post-partum bitches?

Kathryn Burton — Tue, 17 May 2016 07:11:45 GMT

On a (slightly) related note, how many people routinely check glucose and calcium levels in dystocia cases?

RE: Do you routinely scan post-partum bitches?

Bob Russell — Tue, 03 May 2016 13:33:59 GMT

At Edinburgh we were shown an X-ray with foetal structures present. All within the GI tract so this does not seem too rare!

I have been confused by a firm, involuting uterus feeling very much like a remaining puppy.

In the old days I suspect vets dealt with many more pregnancies than we do now. I have always struggled with pregnancy diagnosis by palpation on its own!

RE: Do you routinely scan post-partum bitches?

Lindsey Edwards — Sun, 01 May 2016 23:56:36 GMT

I would see 3-4 a year in bitches whelped without assistance or post op checks for same, and yes Michael, viable is of little consequence in my opinion, much more concerned about toxaemia, metritis and reduced survival of existing healthy pups - alive or dead the uterus needs to be empty

RE: Do you routinely scan post-partum bitches?

Michael Woodhouse — Sun, 01 May 2016 21:59:46 GMT

[quote user="Glen McIntosh"]

There might be non-skeletonized macerated foetuses present that don't show up on X-ray, but that doesn't matter (for the purposes of this X-ray) because there is 0% chance that those pups will be viable, no matter what we do.

An xray will always get this right, either you see skeletons or you don't, there is no potential for error.

[/quote]

I'm not going to go into detail but irrespective of whether they are viable or not - 2 macerated dead puppies ending up in the abdomen + peritonitis after an xray showing clear didn't go down particularly well.........

With hindsight some shadows on the film could have been the puppies, but no visible skeletons. I realise now with digital they would have been easier to see with image manipulation.

I don't believe owners care if the puppies are viable - they care if anything is retained that may threaten the life of their bitch. Therefore your sensitivity fails to achieve 100%

RE: Do you routinely scan post-partum bitches?

Sarah Mark — Sun, 01 May 2016 17:29:17 GMT

Just to add yet another xray / whelping anecdote, I xrayed a pug bitch who had delivered 3 live pups fine then stopped straining, couldn't palpate anything left behind. I advised an xray to check, and lo and behold, another puppy. Caesarian, revealed a normal empty uterus. Yikes! Took another look at the rad - the puppy was in the cranial abdomen - that would be the stomach then.

The owner was very understanding and when I told him he thought it was the funniest thing ever, saying the dog had hidden under the bed for a bit and she must have delivered and eaten the puppy.

In other circumstances that could have been a very embarrassing vds call!

RE: Do you routinely scan post-partum bitches?

Gillian Mostyn — Sun, 01 May 2016 06:41:19 GMT

[quote user="villagevet"]Does post partum check for bitch and pups ok not include ruling out common complications?[/quote]

Not sure what point you are trying to make? Do you mean that a retained pup is a common complication of a normal whelping?

RE: Do you routinely scan post-partum bitches?

Lindsey Edwards — Sat, 30 Apr 2016 23:43:53 GMT

Does post partum check for bitch and pups ok not include ruling out common complications?

RE: Do you routinely scan post-partum bitches?

Glen McIntosh — Sat, 30 Apr 2016 16:55:13 GMT

[quote user="Gillian Mostyn"]

I wouldn't be rushing to check this bitch for any remaining foetuses unless there was an indication it was needed. In the same way I wouldn't be recommending that every bitch should be brought in and checked with a radiograph after whelping.

Obviously hind sight is a wonderful thing, but I really don't think that the OP did anything different to what, in my experience, most vets would have done in the same situation.

[/quote]

Having reread the OP again more closely , I tend to agree with this, and doubt I would have recommended imaging of any sort either, since the dog was there really just for a post whelping check, not for whelping assistance.

The owner did ask about a scan, but I also probably would have given advice similar to the OP that it wasn't necessary under the circumstances. Sometimes our job is to advise against some diagnostics when they aren't necessary.

Still, a bit embarrassing with hindsight, but like Gillian says, most vets would have done the same thing. But that's veterinary science for you. If you can't take a joke...

RE: Do you routinely scan post-partum bitches?

Gillian Mostyn — Sat, 30 Apr 2016 16:01:31 GMT

[quote user="Gareth C."] I would also scan if I'd whelped it in practice Def would scan before sending home. [/quote]

I agree - either scan or radiograph after any intervention. But I think that is where I am puzzled. This dog whelped on its own overnight at home. The last pup was delivered live and happy at 8am, with the bitch, to all intents and purposes, being absolutely fine since. It was brought in at 4pm to check the pups and bitch were OK, which they obviously were. As I said initially, I wouldn't be rushing to check this bitch for any remaining foetuses unless there was an indication it was needed. In the same way I wouldn't be recommending that every bitch should be brought in and checked with a radiograph after whelping.

Obviously hind sight is a wonderful thing, but I really don't think that the OP did anything different to what, in my experience, most vets would have done in the same situation.

(Oh, and if this pup hadn't been born within 8 hours of the last pup, it was presumably already dead when the bitch was brought in? Obviously can never know for certain though.)

RE: Do you routinely scan post-partum bitches?

Glen McIntosh — Sat, 30 Apr 2016 03:10:21 GMT

[quote user="villagevet"]With regards to xray vs scan will xray really distinguish macerated disolved fetus from placenta better than scan? [/quote]

No, it won't, but for the purposes of this discussion in the context outlined in the OP, we are not imaging for this purpose.

We are doing the imaging for 2 reasons:

1. To be 100% certain that there is no possibility of live pups remaining, thereby ensuring that no potentially viable pups are lost unnecessarily by being missed when using other detection methods.

2. To provide indisputable documented proof that there were no potentially viable pups remaining when the animal left our care.

X-rays succeed in achieving both of these goals perfectly. Ultrasound fails on both counts.

Let me explain.

Firstly, to be 100% certain that there is no possibility of live pups remaining, all we have to show is that there are no skeletonized foetuses present. So if we see a foetal skeleton on X-ray, then there is a potentially viable pup remaining and we will take action. If we do not see any skeletonized foetuses, then we can be 100% certain that there are no potentially viable pups remaining. There might be non-skeletonized macerated foetuses present that don't show up on X-ray, but that doesn't matter (for the purposes of this X-ray) because there is 0% chance that those pups will be viable, no matter what we do.

An xray will always get this right, either you see skeletons or you don't, there is no potential for error.

Ultrasonography fails because even the best ultrasonographers could miss a live foetus during a scan. The chance of this (missing the foetus) may be very small but it is definitely not 0%.

In terms of sensitivity and specificity, for the purposes of the test we want to perform - to be 100% certain that there is no possibility of live pups remaining:

Xrays will be 100% sensitive, but not 100% specific. That is, X-rays might give us false positives (i.e. X-rays could show the presence of a skeleton in a foetus that is already dead) from time to time. But that is ok. It is the 100% sensitivity that is important in this test.

Ultrasonography will be 100% specific, but not 100% sensitive, hence its failure as a detection method for the purposes of this particular test.

Secondly, to provide indisputable documented proof that there were no potentially viable pups remaining when the animal left our care, X-rays are ideal because they can clearly and indisputably and permanently show the negative - that there are NO potentially viable pups remaining.

Ultrasonography simply cannot do this. It can document a positive (that there ARE potentially viable pups remaining), but there is no way ultrasonography can ever indisputably document the negative. Hence it also fails this requirement for our test.

[quote user="villagevet"]Depends on relative proficiency of operator with both modalities?[/quote]

Proficiency of the operator really only applies to the ultrasonographer, where proficiency is indeed highly variable between operators.

If a veterinarian is not proficient enough at radiography to take an X-ray that will show the presence of foetal skeletons, then they really shouldn't be practicing. (To be clear, I am talking about getting a good exposure here, not about restraint of the animal for X-ray, which might carry another set of problems, but even these can be overcome if you really do want to get an X-ray). If it is a machine problem, they really need to get a better machine, or refer the case to a practice that has a suitable machine.

[quote user="villagevet"]I scan as much to guide intensity of monitoring and management post partum as to identify pups as most are palpable uf gentle and patient[/quote]

And this is the point of the whole thread. Palpation is not 100% sensitive, if it were then we wouldn't be having this discussion, i guess. And neither is ultrasonography.

I also use ultrasonography in the management of dystocia, but not for the purposes of confirming and documenting the absence of any remaining potentially viable pups.

RE: Do you routinely scan post-partum bitches?

Gareth C. — Fri, 29 Apr 2016 17:46:35 GMT

[quote user="Busybee"]

[quote user="Charlotte Marshall"]Unfortunately it has been known for pups to get missed when they were down near the cervix in ceasers.[/quote]

For this reason, when doing a caesarean, once I think I've got all the pups out, I'll ask the nurse to put on a pair of sterile gloves and feel per-vagina for any pups still in the birth canal. And obviously I'll check from the intra-uterine side!

[/quote]

I do that too. Check from ovaries to the outside! I would also scan if I'd whelped it in practice Def would scan before sending home.

RE: Do you routinely scan post-partum bitches?

Gareth C. — Fri, 29 Apr 2016 17:45:54 GMT

[quote user="Busybee"]

[quote user="Charlotte Marshall"]Unfortunately it has been known for pups to get missed when they were down near the cervix in ceasers.[/quote]

[/quote]

I do that too. Check from ovaries to the outside! I would also scan if I'd whelped it in practice Def would scan before sending home.

RE: Do you routinely scan post-partum bitches?

Lindsey Edwards — Fri, 29 Apr 2016 17:02:15 GMT

With regards to xray vs scan will xray really distinguish macerated disolved fetus from placenta better than scan? Depends on relative proficiency of operator with both modalities? I scan as much to guide intensity of monitoring and management post partum as to identify pups as most are palpable uf gentle and patient

RE: Do you routinely scan post-partum bitches?

Sorrel Proctor — Fri, 29 Apr 2016 13:38:28 GMT

[quote user="Will McMullan"]I saw her for a routine check and to check the pups. They were all fine and she was showing no signs of distress. I couldn't feel anything else in her abdomen. Her owner asked if we should scan her and I said there was no indication[/quote]

It's not as if the owner asked you to do it, just whether you should. And I feel for you because I would have said the same - no indication. And if she was my bitch I would have thought the same! Maybe in future I'll make sure I add 'but if you want to be as sure as possible that there's nothing left then we can take an x-ray'...

RE: Do you routinely scan post-partum bitches?

Lindsey Edwards — Fri, 29 Apr 2016 08:55:38 GMT

I will always offer to scan and advise owner re presence or absence of foetal bones and presence of placenta / membranes etc which must be passed. Often declined but informed decision by owner that palpation is not certain. All phone queries offered appointment within 12hs of pupping, feel its preferable to telling them she's probably finished and facing alternative in 3-5days

RE: Do you routinely scan post-partum bitches?

Braden Collins — Fri, 29 Apr 2016 05:40:14 GMT

[quote user="Neil Wheadon"]

Can I ask the folks who routinely X-Ray

How do you

1) Justify the cost?

2) Take the X-Ray?

You'd need to sedate in some cases and would clients want a slightly sleepy bitch with puppies that can be squashed? (I wouldn't hold a bitch)

Neil

[/quote]

1) It's not up to me to judge what it is worth to the client. I know what it costs, so it's up to the client whether they perceive the value in the procedure. My basic approach to anything is always to ask "what would I recommend if there was no charge?" From there, it's up to the client to decied if they can/will pay.

2) This is the only area I have some concern. I find I can normally do this with sandbags, but if the dog is a complete nut-bar then I often won't continue depending on the risk/benefit ratio of continuing with sedation.

RE: Do you routinely scan post-partum bitches?

mariette asselbergs — Thu, 28 Apr 2016 22:41:28 GMT

Specificity is the ability to correctly identify a negative result. Or more precise: the chance that a negative result is false. In this case I would say it is correct to worry about the specificity of an X ray/Ultrasound. Is not seeing puppies 100% sure that there isn't one left, e.g. a macerated one with no bones visible as earlier posted?

Mariette

RE: Do you routinely scan post-partum bitches?

Michael Woodhouse — Thu, 28 Apr 2016 22:20:49 GMT

[quote user="Kate Richardson"]I disagree that xray is 100% specific[/quote]

You are confusing sensitivity and specificity! If you see a puppy you can be 100% certain it is a puppy - nothing else looks the same (specificity).

I can also attest that radiography doesn't offer 100% sensitivity (ie false negatives occur).......

RE: Do you routinely scan post-partum bitches?

Nicola Cole — Thu, 28 Apr 2016 22:17:52 GMT

[quote user="Neil Wheadon"]

Can I ask the folks who routinely X-Ray

How do you

1) Justify the cost?

2) Take the X-Ray?

You'd need to sedate in some cases and would clients want a slightly sleepy bitch with puppies that can be squashed? (I wouldn't hold a bitch)

Neil

[/quote]

If a client comes in as bitch needs assisting then I will always offer an X-ray so that we know what she has to pass/when whelping is complete. if the owner says no then that's up to them and is their risk. I would justify the cost in the same way-I'll have palpated (abdominal ly and vaginally) and if I can't feel anymore pups then will advise them I can't feel anymore but the only way to be sure is to X-ray. If they say no then I document it and say any concerns give me a call. If they are part way through whelping and needed oxytocin and things get moving again then I'll offer X-ray so they know how many present so we know when they've finished or if things slow down again whether they need more intervention. One radiograph costs much less than they are going to sell any remaining puppy (if alive) for.

I wouldn't sedate the bitch-the vast majority I think you can get a quick lateral abdomen/dog o gram with heavy sandbags. If the bitch is un-xrayable (not sure that's a word!) without sedation then I would offer ultrasound but discuss the limitations, and if I didn't have ultrasound as an option then I would be highly unlikely to sedate to X-ray (will discuss the risks with owner but suggest more of a wait and see approach but again, advise of the limitations).

if the bitch needs a c section then I just go straight for section and check the uterus and vaginal canal thoroughly.

RE: Do you routinely scan post-partum bitches?

Kate Richardson — Thu, 28 Apr 2016 18:28:13 GMT

[quote user="bob lehner"]

[quote user="Glen McIntosh"]any remaining pups (alive or dead). The sensitivity of u/s for this purpose, while probably better than palpation, it is certainly not 100%, whereas an X-ray will be 100% sensitive and 100% specific for detecting the presence or absence of near term pups[/quote]

I agree - scanning is such a trendy thing that people forget that in some cases X ray is the better option

[/quote]

I disagree that xray is 100% specific- I remember one case we xrayed, showed no more pups, enlarged soft tissue structure we assumed was uterus, scanned it to be certain and there was a dead foetus. I presume it had been dead for some time and thus bone either hadn't mineralised enough to be visible on xray? So yes, ultrasound isn't perfect (and also very operator dependent, xray isn't always perfect either!

RE: Do you routinely scan post-partum bitches?

bob lehner — Thu, 28 Apr 2016 17:24:28 GMT

[quote user="Glen McIntosh"]I guess it is possible that there never was a pup left behind, and it is simply a case of an unscrupulous owner trying to get a payout for one of the pups born during the caesar that had subsequently died[/quote]

RE: Do you routinely scan post-partum bitches?

Neil Wheadon — Thu, 28 Apr 2016 17:19:18 GMT

Can I ask the folks who routinely X-Ray

How do you

1) Justify the cost?

2) Take the X-Ray?

You'd need to sedate in some cases and would clients want a slightly sleepy bitch with puppies that can be squashed? (I wouldn't hold a bitch)

Neil