CASE 10. Agalactia in a bitch
Case Information: You get a call from a client at home on a Saturday night. He has a 3 year old intact female Foxhound that had a C-section just hours ago. The owner had been monitoring the bitch's body temperature for three or four days and had never noted a temperature drop as often is seen prior to onset of labor. The bitch had first shown signs of labor, with panting, inappetance and restlessness, at about 10 am. She passed some clear fluid from her vulva at about 1 pm and had only intermittent abdominal contractions until about 4 pm, at which time she passed a large volume of dark green fluid. Your client went to the veterinary clinic nearest his home. The veterinarian there could feel no pups in the birth canal and performed abdominal radiographs (see below). The pups were born by C-section without incident. Since bringing the bitch and pups home, the bitch has refused to remain in the whelping box with the pups and no milk can be expressed from her mammary glands.
Question:
Was this bitch in dystocia? Why or why not?
Answer:
The radiographs shows normal mineralization. The pups do not appear to be excessively large or malpositioned. The passage of green vulvar discharge is worrisome because that green discharge arises from the marginal hematomas and suggests placental separation is occurring.
Question:
Why is this bitch showing poor mothering behavior and poor lactation?
Answer:
Milk production is stimulated by prolactin. Prolactin is secreted from mid-gestation
on in bitches but is excreted to a much larger extent after progesterone concentrations
decline at the time of parturition. This bitch may not yet have had a significant
decline in serum progesterone concentrations, as evidenced by:
- lack of a temperature drop - progesterone is thermogenic, so its precipitous
decline late in gestation often is accompanied by a transient decline in body
temperature
- lack of strong contractions - progesterone inhibits uterine contractility
- apparent lack of milk production
Milk let-down is stimulated by oxytocin. It is the pressure of a pup against the internal cervical os that causes endogenous oxytocin release. It may be that the first pup was positioned in such a way that no pressure was exerted against the cervix and the subsequent removal of all the pups by C-section precluded normal oxytocin release.
Question:
What recommendations can you make to this owner?
Answer:
Tube-feed the pups with milk replacer in the short-term. Consider administration
of serum from vaccinated adult dogs either orally (in the first 24 hours of
life) or subQ to provide antibodies against common diseases in the absence of
ingestion of colostrum.
Treat the bitch with oxytocin to see if the problem is with milk production
or milke let-down. If it is a problem with milk let-down, milk can be expressed
from the mammary glands immediately after oxytocin administration (see below).
If no milk can be expressed, therapies that may be attempted to encourage milk
production are:
- treatment with a luteolytic agent to ensure drop in progesterone
- massage of mammary glands to promote neuroendocrine reflex stimulating prolactin
production
- acupuncture
