The female reproductive system includes the ovaries, uterus, vagina and external genitalia as well as the mammary glands that produce milk for puppies. Diseases affecting the system are included herein, as well as information regarding pregnancy and nursing of pups.
Probably the most common disorder seen in intact female dogs, pyometra is a serious and life threatening infection of the uterus. Due to hormonal and uterine changes that occur in the older dog, an infection starts in the uterus and can lead to death due to sepsis or organ failure if not treated properly. (see cystic endometrial hyperplasia) It is possible in a very few spayed dogs for a small piece of uterus, usually left during spaying, to become infected.
The symptoms are most common in dogs over 8 years old unless the dog has been given hormones for a medical abortion and then any age dog can be affected. Usually 4-12 weeks after a heat has occurred, symptoms will begin. The symptoms observed outwardly, however, will depend on whether the cervix is open or closed.
In cases of open-cervix pyometra a thick, bloody and pus-like vaginal discharge is noted. The dog will often be lethargic, weak, anorexic, drink and urinate more frequently and may vomit or have diarrhea. If the cervix is closed, no discharge will be seen; symptoms will include abdominal enlargement, shock and coma. ((Pyometra))
Diagnosis is based on history, especially the fact that the female is not spayed (in most cases), analysis of vaginal discharges, culture, blood counts, serum chemistries, urinalysis, X-rays and ultrasound studies. This disease is serious and requires prompt and aggressive treatment.
TREATMENT OF PYOMETRA
All dogs should be stabilized with IV fluids, antibiotics and general supportive care. The best treatment is to perform surgery quickly to remove the uterus and ovaries (similar to a spay, but quite a bit more complicated) before any pus can leak into the abdomen. If the uterus remains in one piece and no organ damage occurs, the success rate is excellent. Where the uterus ruptures, the chances for survival are lessened, as peritonitis is a serious complication. The most common organ dysfunction secondary to pyometra is kidney failure.
Some persons, especially dog breeders, may hope to retain the reproductive capabilities of the bitch. If the dog has an open cervix pyometra, a drug called PGF-2alpha can be used along with antibiotic therapy. While this type of therapy does provide an option, it is advised only for selective cases, as there are many risks inherent to the procedure and the drug itself. Our advice is to surgically remove the affected organ and enjoy the dog.
While uncommon, there is a limit to how far the uterus can stretch. In some advanced cases of pyometra or dystocia, these limits may be exceeded and the uterus ruptures. If a pyometra ruptures, severe peritonitis and septic shock will ensue and the patient may die quickly without emergency care. If the uterus ruptures during labor, then puppies may be "born" into the abdomen and peritonitis will also occur. Prompt attention in either case is essential. Clinical signs include abdominal pain, collapse or extreme weakness, rapid respiration and shock. Diagnosis is based on history, physical examination, X-rays, aspiration of abdominal fluids and exploratory surgery.
TREATMENT OF UTERINE RUPTURE
While it may be possible to repair a ruptured uterus, the best course under most circumstances will be to remove the organ. If the dog is in labor, performing a modified C-section first is necessary to save the pups. With the uterus removed, the abdomen is cleaned and flushed many times, treated with antibiotic solutions and closed with or without some type of external drainage. Antibiotics and general supportive care will generally allow most dogs to recover.
Metritis is a bacterial infection of the uterus, but unlike pyometra, it progresses rapidly to cause sepsis, an infection that spreads in the blood. The problem always occurs soon after the birth of pups, usually within 1 week post-partum. Infection can enter the uterus directly from the outside; it can be initiated by placental parts left in the uterus, or by pieces of or whole puppies being left inside the uterus. Trauma due to dystocia or medical intervention can also cause the infection.
Symptoms include a foul smelling vaginal discharge, weakness, loss of appetite, vomiting or poor milk production. The patient will often be dehydrated, have a high fever and be very lethargic. Many dogs go into shock and collapse. Diagnosis is based on the history, physical examination, vaginal cytology, vaginal cultures, complete blood counts and serum chemistries, X-rays and ultrasound analysis. This disease can be prevented in most cases by having females checked after whelping and by giving a "clean out" injection to expel debris and shrink the uterus.
TREATMENT OF ACUTE METRITIS
Rapid attention is highly recommended. IV fluids and IV antibiotics are used to stabilize the patient. Injections of oxytocin or PGF2-alpha to help evacuate the uterus are often used. In some cases infusion of antibiotics directly into the uterus or surgically removing the uterus may be needed along with long-term oral antibiotics. Unfortunately, most dogs developing acute metritis will no longer be able to sustain their puppies, a task the owner may have to assume.
CEH is an abnormal thickening of the uterus including the formation of cysts, increased glandular activity and an infiltration of certain types of white cells into the uterine lining. This condition becomes more common as the female ages but may produce no serious disease for the pet. Nevertheless, the condition can predispose the dog to pyometra and other less serious types of infection. No treatment for this condition is needed per se, but again, spaying all dogs not used for breeding is highly advised.
In some dogs, one or both sides of the uterus may fail to develop. Sometimes a part of the uterus will be underdeveloped. Depending on the degree of improper development, fertility may be affected. Most often, the disorder is diagnosed when the veterinarian is spaying the dog; otherwise diagnosis is difficult. The problem will cause no harm in most cases except fertility may be affected. ((Uterine Aplasia))
When the uterus or part thereof, turns inside out and protrudes through the vagina, a prolapse occurs. The condition is rare in dogs. It occurs most often after whelping, especially if there have been difficulties with the birth process. An actual cause has not been determined.
Diagnosis is usually simple, based on seeing the uterus protrude, but other clinical signs may include straining, pain, restlessness, trouble moving, bleeding, shock, fever and vomiting. Other than direct examination, X-rays, blood counts and serum chemistries may all be needed to determine if this is the only problem.
TREATMENT OF UTERINE PROLAPSE
Treatment will depend on the condition of the animal as well as the condition of the prolapsed uterus itself. The first concern will be to stabilize the patient with fluids, electrolytes and other medications as needed. In some cases, the uterus can be directly replaced under anesthesia. In other cases, the uterus may be surgically removed from outside the body or replaced and then surgically removed. Antibiotics and oxytocin are also used to help promote healing.
Several different types of ovarian cysts can form in the dog from ovarian tissue or the actual egg-forming process. Most, which usually form in older dogs, are small and insignificant. Most produce no reproductive abnormalities. Some grow large and cause mild abdominal pain. One type, the follicular cyst, can create clinical signs.
These symptoms include heat cycles without receptivity to the male, altered heat cycles, failure to come into heat on a regular basis and twisting of the uterus. Diagnosis is based on history, clinical signs, hormone analysis and pathology of cysts discovered at surgery. ((Ovarian Cysts))
TREATMENT OF CYSTIC OVARIAN DISEASE
Dogs showing the above clinical signs or having cysts otherwise confirmed or suspected should be spayed. No other treatment is available.
Vaginitis is inflammation of the vagina, usually due to bacterial infection. The main clinical signs are a pus-like discharge, licking of the genitals, attraction of male dogs, a foul odor and swelling of the vulva.
Vaginitis can occur due to defects in vaginal structure, foreign objects, a weak immune system often true in young and immature puppies and lower urinary tract infections. Diagnosis is based on physical findings, vaginal cytology, urinalysis, blood counts, culture of vaginal exudates, X-rays and ultrasound. ((Vaginitis))
TREATMENT OF VAGINITIS
If there is an obvious predisposing cause of the vaginitis such as a foreign object, that should be corrected first. Oral antibiotics plus twice-daily douches with disinfectant solutions are most commonly used. Long-term treatment is required in some cases as the infections can be moderately resistant to treatment. Puppies may improve the most as they get closer to puberty.
It is normal for the vulva to swell and the vagina to thicken during the heat cycle. Sometimes, however, the swelling of the vagina may become so great as to be visible and even prolapse through the vulva. This condition is due to abnormal hormone levels or an abnormal response to the female hormones present during the heat.
Clinical signs include what appears to be a mass protruding from the vulva, difficulty urinating, abnormal behavior, licking the area and possibly a discharge. Diagnosis is simple, based on seeing the growth during the heat cycle.
TREATMENT OF VAGINAL HYPERPLASIA
Small masses, which cause no obstruction, need no treatment. Larger masses which block urination or become infected and begin to rot can be tucked back into the vagina and held in place with temporary sutures; surgical removal of the tissue is possible in some cases and the use of lubricants and antibiotics may be helpful. While spaying will prevent the condition from ever recurring, it will not speed the shrinkage of the tissues initially.
HYMENAL REMNANTS, thin bands of tissue that restrict the vaginal opening, may be corrected with surgery.
RECTOVAGINAL FISTULA is an abnormal connection or communication between the rectum and vagina where separate walls failed to completely form. Fecal material may come through the vagina. This may be corrected with surgery.
HYPOPLASIA is an abnormal vaginal narrowing which may preclude breeding; most commonly dogs are spayed and live normally.
Any female dog that does not want to be bred, fails to conceive when bred or fails to carry a litter to term is said to be infertile. Much of this type of problem relates to extensive inbreeding and/or poor selection or use of breeding dogs over time. As with male infertility, the causes of female infertility are quite numerous: hormonal imbalances, uterine dysfunction, genetic defects, endocrine disease, infections and so forth.
History will be important to ferret out the cause of any breeding failures. When did the dog first have a heat? Have the heat cycles been regular and normal? Has she been bred before and with what results? Has she ever been pregnant and delivered a litter? These questions will put the veterinarian on the right course to proper diagnosis.
Besides history, physical examination, vaginal cytology and culture, brucellosis testing, blood counts and serum chemistries, urinalysis, hormone analysis and ultrasonography may all be used to achieve a final diagnosis. Treatment will depend on the final accurate diagnosis. Any person serious about resolving a fertility problem will need to fund a complete and thorough diagnostic work-up. It cannot be forgotten that failure to conceive can be a problem involving the male dog and not the female.
On occasion, with or without breeding, a female dog can appear to be pregnant outwardly without any pups present internally. Why this occurs is not well understood, except we can say that the end stage of a normal heat cycle, known as the luteal phase, lingers or fails to terminate as quickly as it should. This causes progesterone levels in the blood to remain high, literally tricking the bitch's body into believing that puppies are present. When the luteal phase ends, the mother may show maternal behaviors towards toys or other objects or even produce milk.
Clinical signs include maternal behaviors such as mothering toys and nesting, loss of appetite, enlargement of the mammary glands with discharge, to which, on occasion, a mastitis can occur. Normal puppies will not be present. Diagnosis is based on history and physical examination in most cases.
TREATMENT OF PSEUDOCYESIS
There is some debate as to whether or not to treat this condition. Consensus is that if the dog has extreme behavioral changes or mammary disease, treatment should be given. Treatment may also be given just to relieve the associated discomforts. Female hormones, cortisone to relieve breast swelling and hot packs on the mammary glands will provide relief. Spaying the dog will be curative as the problem will most often otherwise recur.
After birth, the places inside the uterus where the placentas were attached must heal and the uterus must reconstruct itself. While this occurs, a bloody and greenish/black discharge may be noted from the vagina. When these "sites" do not heal normally, rather, more slowly than normal, it is termed subinvolution of placental sites and a persistent bloody discharge will occur. Clinical signs will simply include a bloody discharge lasting more than 6 weeks after whelping. Diagnosis is based on this symptom, vaginal cytology, X-rays and blood counts.
TREATMENT OF SUBINVOLUTION OF PLACENTAL SITES
Some dogs need no treatment and may heal in enough time. Spaying is advised if further breeding is not wanted. Antibiotics to prevent infection and the use of drugs to contract the uterus have proven useful.
Disorders or defects of the mother, pups or placenta can all result in termination of pregnancy. Uterine disease, ovarian disease, fetal deformities, infections including brucellosis, leptospirosis, herpesvirus, other organisms and certain drugs can all result in spontaneous abortion.
Clinical signs may or may not be observed other than no puppies being born when expected, depending upon the stage at which a given pregnancy was ended. Discharge or passing puppies prematurely may be observed. Fever, loss of appetite, vomiting and diarrhea can all occur. Diagnosis includes observation of clinical signs, X-rays, ultrasound, analysis of discharges, blood counts and serologic testing for brucellosis and leptospirosis where appropriate. Acute metritis and pyometra would be common post-abortion side effects.
TREATMENT OF ABORTION
While little can usually be done after the fact, dogs should receive medications to clean out the uterus, antibiotics to prevent infection and spaying if it seems preferable to no longer breed the bitch. It is important to obtain a proper diagnosis, as again, some causes of spontaneous abortion are communicable and need aggressive treatment to stop their spread.
Veterinarians are sometimes asked to terminate pregnancy either because breeding was unintentional or because the female bred may be ill suited to carry a litter. As a general rule, pregnancy termination by medical means should take place very soon after breeding rather than later. Female hormones, PGF2-alpha and cortisone medications have all been used but none is 100% successful. Furthermore, side effects including pyometra and damage to bone marrow can occur in a small percentage of cases. Spaying of any dog at almost any stage of pregnancy is always 100% successful in preventing any unwanted puppies.
Dystocia defines difficulty in giving birth or as more commonly used, trouble in getting the puppies out of the mother. This can occur for several reasons ranging from problems with uterine function, obstructions and fetal problems. To properly understand dystocia, we must first describe how a normal delivery should progress. See Physiologic data for more information.
Normal delivery, or parturition, is generally divided into three distinct stages. The first stage actually occurs before any labor has begun. In this stage, dogs will start to look for and/or build their bed or nest in preparation for the delivery. Their behavior may seem quite nervous or unusual and most will refuse food and water. The breasts will enlarge and should begin to have early milk production. A thick white gelatinous mucoid material will be passed vaginally about 48 hours prior to delivery. Also, rectal temperature will drop below 100 degrees F, usually to about 97-99 degrees F about 24 hours prior to the onset of labor.
The actual process of delivery or labor characterizes stage two. Contractions and straining begin and usually a membrane which appears generally as a fluid filled bubble appears at the opening to the vagina, often followed by passage of a green-black placental sac. Then, more forceful efforts to expel a puppy begin.
The third phase of labor consists of delivery of puppies, delivery of placental parts, a rest phase of 10 minutes to an hour and repeating the process until all puppies are born. The normal interval between births is 30-60 minutes, although in larger dogs with more puppies, several may be born, followed by a longer rest, then another group. Sometimes 2 pups are born followed by a longer rest. All would be considered normal and many patterns of delivery will be acceptable. Also, pups are normally born face or feet first so no need to panic.
The question is always asked, "How do I know when the mother is done?" Suffice it to say that when labor stops, she is done. Irrespective of that, the best way is to have had good prenatal examinations of the mother, including an X-ray or ultrasound analysis at about 45-50 days of term so that the number of puppies present can be clearly known. Also, females should be checked 24-48 hours post-partum by your veterinarian to look for any undelivered puppies as well as to give an injection to assist expulsion of any other retained materials.
The most common cause of dystocia is that of fetal (puppy) malpositioning which can occur for many reasons. Oversized puppies, often from small litters in small dogs, may have trouble coming out and puppies with "dome-shaped" heads such as Chihuahuas, Pekes and Bulldogs often have trouble being born.
Problems relating to the mother are the other reasons for dystocia. Small pelvic openings or pelvic size compromised by pelvic fractures or soft tissue growth will limit puppy expulsion. Mothers bothered too much by over-interested owners may have trouble. Twisting or tearing of the uterus will cause severe and life-threatening problems. The most common maternal difficulty, however, is known as Uterine Inertia.
Uterine inertia literally means that the uterus cannot push anymore. Primary uterine inertia occurs before any actual second stage labor begins. The reasons for this include advanced age of the mother, few puppies in a large dog, low blood calcium levels, low hormone levels, genetic disorders, obesity, or poor maternal condition in general.
Secondary uterine inertia occurs most often after a long labor and delivery process either due to exhaustion of the mother or greatly decreased blood calcium levels (from all that work being done)!
The clinical signs of dystocia, also known as "WHEN TO GET HELP", include being in second stage labor for 3-4 hours without a pup being born; more than 2 hours between puppy births; the mother seeming to be in increased distress while in labor; excess bleeding or a foul smelling discharge being passed; a female that is 63-68 days post breeding without delivery having occurred; and more than 4 hours passing between puppies (assuming more puppies are present). Diagnosis is based on historical information, physical examination, X-rays and ultrasound studies. ((Pup X-ray))
TREATMENT FOR DYSTOCIA
Treatment will depend upon the cause of the dystocia. To season that, the health of mother and pups may dictate the course of therapy even more so. Some dogs will benefit from administration of oxytocin and calcium containing fluids that will literally restart the delivery. Some dog breeders, however, mistakenly administer multiple oxytocin injections on their own and often endanger the health of mother and pups. We, therefore, strongly advise against this type of arbitrary therapy.
Sometimes, in cases of minor malpositioning, gentle manipulation and lubrication can allow delivery and bring forth the pups without surgery. In many cases, however, a cesarean section will be the only alternative. The decision to perform a cesarean section should not be delayed and the health of mother and pups as well as the likelihood of other therapies to be successful must all be taken into account. ((C-section))
Eclampsia is a condition of low blood calcium, which usually occurs 3-4 weeks after whelping, although rarely seen a week or so before birth of the pups. The cause of this condition is unknown, although the high demand for calcium used in milk production and an inability of the bitch to maintain that level ultimately produces the condition. As a general rule, calcium supplements should not be given to females until the birth actually occurs and then during the nursing process.
Clinical signs include nervousness, slight muscle tremors and trembling. This will progress to staggering, muscle spasms and seizures, along with a greatly elevated body temperature, respiratory distress and death. Diagnosis is based on history and these clinical signs as well as determination of blood calcium levels. Treatment is usually begun based on only the symptoms present.
TREATMENT OF ECLAMPSIA
Immediate therapy is required to save eclamptic dogs. IV fluids with a slow but significant level of bioactive calcium are given first. Treatment for the increased body temperature and careful patient monitoring is critical. Once the patient is stabilized and has returned to normal, the possibility of continued nursing must be evaluated. Some dogs can nurse with increased caloric intake and calcium supplementation orally. Other times, puppies must be removed from the mother, hand raised and the mother given oral calcium supplementation for 10-14 days. Eclampsia is likely to occur with subsequent pregnancies.
Mastitis is an infection of the mammary glands, or breasts of female dogs, most common while nursing puppies or in cases of false pregnancy. Bacteria enter into the breasts through open nipples and spread through the porous mammary tissues. Trauma from nursing and poor sanitary conditions most commonly contributes to the condition.
Clinical symptoms include one or more breasts being swollen, red, painful and warm. Fever and depression of the mother are common and puppies may be weak and dying from the toxins in the milk. Abnormally colored milk and/or discharges may be present. In some cases large abscesses which rupture and rot will come about and dogs may be outwardly much more ill. Diagnosis is based on history, physical examination, blood counts, milk cytology and cultures. This author recommends a culture always be performed because of the severity and difficulty killing the infections often present. ((Mastitis))
TREATMENT OF MASTITIS
Although antibiotics are needed, more often very potent and high quality medication will be required and should be based on culture results. Milking any affected glands is important. Puppies can be allowed to nurse if kept away from infected glands. Hot packs and good hygiene are important to help healing and control the spread of infection.
Where breast tissue has abscessed and ruptured drainage of the abscess and surgical removal of rotting tissues under sedation will be needed. In some cases a drain will be placed in the wound and topical medications as well as oral antibiotics will be needed. Badly damaged glands or glands which have had multiple infections should be surgically removed. If the infection has spread to the blood stream, IV fluids, antibiotics and hospitalization is needed until control of the infection is obtained.
AGALACTIA is a failure to produce adequate milk. It is most probably a hormonal condition, but may relate to poor glandular envelopment, or poor nutrition. Oxytocin nasal spray and improvement of nutrition may help but many times pups will have to be nursed by hand.
GALACTORRHEA is excess or unexpected milk production that relates to some type of hormonal imbalance. Hot compresses and hormonal therapy will help this resolve in a few days.
GALACTOSTASIS is milk accumulation in the mammary glands that may occur after weaning, if puppies are not nursing well or associated with mastitis. Milking the glands, treatment of any infection and the use of diuretics and cortisone type drugs are usually helpful.