Friday, April 10, 2009

Pregnancy termination and Metritis

Bubbles is a 6-year-old female shih tzu at presentation (now she's 7) with fishy-smelling brown vaginal discharge. She is 6 weeks pregnant: positive for fetal forms and activity at ultrasound earlier (from a sister clinic). Is she terminating her pregnancy? Is she aborting? Why?

Rechecking her status: Active at presentation, pale mucous membranes, shivering, normal body temperature, tick infested!!! 1st time to breed.

Things to consider: Age, presence of ticks, Ultrasound: about 2 fetal balls in vesicles still with activity and heartbeat. Another 2 vesicles containing non-moving fetal balls.

Bloodworks were also taken into consideration: Increasing white counts, and lymphocyte counts with decreasing hemoglobin concentration...
Ehrlichia testing resulted positive, Brucella testing however was not done.

For several days, Bubbles was monitored at the clinic for further discharges and daily ultrasound from day 1

Day 5 of confinement revealed no fetal activity is all the vesicles. The vesicles were also in disarray and the boundaries were not as defined as it was days ago. Blood count revealed increasing white counts, lymphocytes, monocytes ang granulocytes... But we have a happy dog but without vaginal discharge and contractions...

Now, if she terminated her pregnancy, will it still be reabsorbed? at 6 weeks not really. It should be expelled. We waited for her to expel the fetuses while giving medications with caution.

Two days later, there was nothing. We opted for ovariohysterectomy. Here's what we saw.

Enlarged uterus with a closed cervix!

I decided to open up the uterus to see what it contains...

Brown mucoid material surrounding the fetuses which are not viable and are already decomposing.

I asked several colleagues prior to surgery including the referring doctor. Some were actually gave a GO signal for the surgery, others a NO.
But the important thing for me is Bubbles leaving the clinic alive, happy and healthy.

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