Employ a synthetic monofilament absorbable suture [such as 3-0 or 4-0 polydioxanone (PDS), polyglyconate (Maxon) or poliglecaprone
25 (Monocryl)] with a taper needle. Local lavage is generally sufficient, unless gross contamination of the abdomen with uterine
contents has occurred. If this is the case, the laparotomy pads are removed and the peritoneal cavity is copiously lavaged
with warm, 0.9% saline. At this point it is appropriate to change contaminated gloves and instruments. It will now be easy
to identify and arrest any persistent hemorrhage, such as from a traumatized uterine vessel. Inspect the other abdominal organs
for evidence of disease or injury. Finally, the omentum should be drawn over the ventral aspect of the uterus.
If the owners do not plan future breedings, an ovariohysterectomy can be performed after hysterotomy. Alternatively, an en bloc ovariohysterectomy can be performed, with the puppies removed from the uterus by the recovery team.
The abdominal wall is closed routinely in three layers (rectus sheath, subcutaneous tissue and skin), using local anesthetic
if not previously performed. It is preferential to close the skin with a subcuticular suture pattern with a synthetic absorbable
monofilament suture material (such as Monocryl).
External skin sutures are a source of irritation for the mother and the puppies, and puppies will frequently suckle or scratch
at them, increasing the chance of incisional irritation or infection. This also obviates the need to remove the sutures at
some point in the future.
Addressing the puppies
Each pup is handed off to an assistant, generally with the amniotic sac and placenta still attached. The amniotic sac is ruptured
and peeled away from the puppy. The umbilicus is clamped with a mosquito hemostat and transected. The puppy is rubbed vigorously,
both to dry it off and to stimulate breathing. The nares and nasopharynx are gently suctioned with a bulb syringe to remove
residual amniotic fluid.
If the puppy is not breathing spontaneously, or if the heart rate is low (<180 bpm), doxapram is administered sublingually
(one drop per puppy). If opioids have been administered to the bitch prior to delivery, they should be antagonized with a
drop of naloxone, sublingually. If this does not stimulate respiration, epinephrine is administered, also one drop sublingually.
Flow-by oxygen is administered if the puppy is cyanotic and/or brachypneic.
For orally administered mediations to achieve any effect, there must be adequate perfusion of the oral mucosa. If the heart
rate is low or absent, compression of the thoracic wall is performed; mouth-to-mouth artificial respiration may be necessary.
Once the puppy is stable, the umbilicus can be ligated with a single, encircling ligature of absorbable suture material. The
umbilical stump is disinfected with povidone-iodine solution. The puppy is examined for evidence of birth defects (such as
cleft palate, umbilical hernia, atresia ani or limb deformities) and placed in an incubator set at 90 degrees to 95 degrees.
The puppies are introduced to the mother only after she has completely recovered from anesthesia, to minimize the risk of
her traumatizing them. The bitch and litter should be discharged from the hospital as soon as they are stable. This will minimize
the chance of nosocomial infection, and will minimize the stress on the bitch, thereby increasing the likelihood of her engaging
in appropriate mothering behavior.
Antibiotics generally are not necessary for hysterotomies. Exceptions include cases of fetal putrefaction, uterine infection
and gross contamination of the peritoneal cavity with uterine contents. If fetal putrefaction or uterine infection is suspected,
a broad-spectrum antibiotic (such as cefazolin, 22 mg/kg IV) should be administered pre-operatively. Post-operative antibiotic
therapy is only warranted if there has been gross contamination during surgery.
For healthy bitches and puppies undergoing hysterotomy, reported neonatal survival rates are 70 percent to 90 percent. The
rates are considerably lower if the mother is in poor condition or has undergone a prolonged dystocia pre-operatively. Maternal
mortality rates are reportedly 0 to 2 percent in dogs and cats.
Intra-operative endometrial hemorrhage is possible, especially at sites of placental attachment. If this occurs, administer
oxytocin and apply pressure. If bleeding is profuse and intractable, ovariohysterectomy should be recommended.
Potential post-operative complications include persistent hemorrhage, pyometra, mastitis, wound infection and peritonitis.