A long long time ago, in a country far away now...
I don’t keep good memories of my nights at the emergency veterinary clinic. You know that a case can show up any minute. When you give sleeping a try, you wake up frequently, wondering if you did not hear somebody ringing at the front door. And when you finally fall asleep, those consultations start showing up also in your dreams… No doubt that the job is important, but believe me, the associated stress is real.
And it happened in the middle of one of those scattered sleeps. The doorbell rang heavily and woke me up from this weird state I was floating into. I checked the clock : 2am. A quick stretch to get myself straight, I jumped into my scrub that was hanging right next to me and in a heartbeat I was back on the clinic floor. Ready to help the couple I could see via the surveillance camera waiting at the front door. It was a cold winter night, but they were not wearing any kind of coat. They must have come in a hurry, and the answer might have been in this carrier I could see they were holding.
« It’s an emergency, our dog has a problem, they said when I spoke to them over the comm. » I could feel in their voice that they were stressed a lot.
I let them in and directed them to the consultation room. From the carrier emerged a small Yorkshire terrier bitch. I assumed it was a bitch because well, a quick glance at her belly made me suspect « she » was pregnant.
« So tell me guys, what’s happening ? »
They looked at each other briefly and the man started explaining me the situation.
« I think she has difficulties delivering her puppies. We think we saw some contractions during the afternoon but to tell you the truth, we are not really sure. This is the first time we face this... »
I nodded, telling them I understood. Always hard to know for sure what to expect when it comes to canine parturition in my opinion, and if they never experienced this situation before, well, i was not surprised that they were a bit uncertain on what was going on.
While I was looking for a glove, I took a look at the genital area of the bitch… and automatically stopped in motion. Something was terribly wrong here, from what I could guess behind the dog’s tail, the shape of the vulva was just not… right ?!?! It was looking swollen… and abnormally pink ?!?!? I blinked my eyes twice (maybe I wasn’t fully awake… or maybe I was still in one of those dreams I mentioned earlier). But no. I was wide awake. And no doubt : something was definitely wrong there !
The owners might not have noticed the change of expression on my face because they kept talking.
« We were so worried we called a friend… He gave us this… and told us to give her 1cc subcutaneously. It was supposed to help but apparently it did nothing... »
I turned back to them, still puzzled about what I just observed. In their hands, they were holding a small vial that I was way too familiar with not to immediately recognize. Things automatically became crystal clear, as soon as I could see those small characters : O.X.Y.T.O.C.I.N. What I saw was probably NOT the vulva. But there were unfortunately good chances that it was « something » belonging to a puppy. Probably an internal organ...
Quick explanation : oxytocin is a hormone that plays a role in uterine contractions at the time of parturition. It is something that we veterinarians have in our therapeutic arsenal when it comes to obstetrics. I still hear too often that when it comes to parturition, « a shot of oxytocin will always do the trick. » Unfortunately, it is a little bit more complicated than that. And I truly believe this drug should ONLY be used under veterinary supervision.
There are indeed some contra-indications to the use of oxytocin. One of them is what we call "fetal malposition" (a fetus that is not correctly placed in the genital tract at the time of parturition), especially something we call transverse position (find out more in this blog). And this is NOT something that can be assessed just by looking at the bitch…
The dose of oxytocin administered to the bitch is also of EXTREME importance. There are many different commercial presentations. The one I recognized in the consultation room on this night was one we used in bovine medicine… And the dose that was injected to this small 3kg Yorkie was similar to what we would have administered… to a 600kg cow !
When very high doses are injected, two things can happen :
- « best » case scenario, it will saturate all the oxytocin receptors the uterus contains : it will cause what we call a spastic contraction. Basically, the uterus contracts in an uncoordinated way, which cannot lead to fetal expulsion.
- worst case scenario : it induces a very very strong contraction… which can, if there is an obstacle, lead to a rupture… of a puppy in a case of malposition... or even worse, of the uterus itself. Something NOBODY wants, for sure.
That’s probably what happened here...
It was indeed a puppy's intestinal loop that I could see hanging out from the vulva… I was able to manually extract the puppy that was obstructing the birth canal. It was certainly dead for a while. There were still puppies in the abdomen, and we ended up performing a C-section that gave birth to 3 perfectly healthy newborns.
The story ends well, but I still believe the outcome would have been even better if oxytocin had not been used blindly in this case. Don’t get me wrong, oxytocin is a great drug that helps a lot in veterinary obstetrics. But again, I believe it should ONLY be used under veterinary supervision. When used blindly - and I know this is done still too often - , no doubt that the consequences can be terrible…
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