Primary Uterine Inertia Research Articles

Retrospective Studies on Primary Uterine Inertia in Female Dogs

Retrospective Studies on Primary Uterine Inertia in Female Dogs

Comparative Studies on Uterine Tocodynamometry in Cases of Primary Complete Uterine Inertia and Spontaneous Whelping Dogs

Comparative Studies on Uterine Tocodynamometry in Cases of Primary Complete Uterine Inertia and Spontaneous Whelping Dogs

Successful Surgical Management of Dystocia in a Cat

In the polytocus small animals there may be a complete or a partial failure of the uterus to start contracting. In partial failure the uterus may bring the first fetus to the pelvic inlet from where it is delivered by abdominal straining. No further fetuses were present and uterine contraction ceases. An idiopathic type of primary uterine inertia has been described, in which delivery starts normally and several members of the litter are delivered normally. There is no evidence of obstruction to birth through maternal or fetal cause. The uterus stops contracting and does not resume unless ecbolic therapy is given. It could be argued that this could be classified as a partial rather than a complete primary uterine inertia (Peter Jackson, 2004).Uterine inertia that is lack of normal physiologic uterine contraction during or after parturition, is a common condition encountered in bovine. However, it is comparatively less reported in canine and feline.

Increased incidence of peri-parturient problems in ewes with pregnancy toxaemia

In total, 16 ewes with pregnancy toxaemia and 12 healthy animals were monitored for peri-parturient problems (dystocia, perinatal death of offspring, post-partum genital disorders). Mean duration of pregnancy was significantly shorter in ewes with pregnancy toxaemia (145.75 days) than in healthy animals (148.42 days) (P<0.001). In all cases, comparison between ewes with pregnancy toxaemia and healthy animals revealed a significantly higher incidence of peri-parturient problems in the former animals. Incidence of dystocia (mainly expulsive deficiency, likely as the consequence of primary uterine inertia) was 0.500 in ewes with pregnancy toxaemia and 0.083 in healthy animals (P=0.01), incidence of perinatal mortality of offspring was 0.375 in the former animals and 0.083 in the latter (P=0.039) and incidence of post-partum genital disorders was 0.250 and 0.000, respectively (P=0.031). Finally, mean blood concentration of β-hydroxybutyrate at the end of gestation was higher in ewes that developed dystocia (3.71mmolL−1) or post-partum genital disorders (3.90mmolL−1) than in ewes that did not (1.91mmolL−1 and 2.18mmolL−1, respectively; P=0.003 and P=0.094).

Evaluation of protein metabolism and activity of cellular energy metabolism enzymes in primary uterine inertia in primiparas

Evaluation of protein metabolism and activity of cellular energy metabolism enzymes in primary uterine inertia in primiparas

Dystocia in a young ferret (Mustela putorius furo) with a possible “single kitten syndrome”

Summary A one-year-old ferret with 45 days of pregnancy was presented for a slight onset depression and brownish vulvar discharge. Because of her inability to expulse her fetuses at the end of her normal delay gestation, a diagnosis of dystocia was established. Abdominal radiographs showed a single fetus. A foetal death was revealed by ultrasound. A surgical treatment was elected. A caesarean section was performed and allowed to remove the single fetus with normal appearance. Clinical recovery of the female ferret was excellent at 15 days post-operatively. Cases of dystocia in the ferret are rarely described in the literature. This case is original because a “single ferret kitten syndrome” was suspected in order to explain a primary uterine inertia causing dystocia. Moreover the caesarean section was a successful alternative to ovario-hysterectomy or medical management. In this case, this choice prevented the risk of uterine rupture and protected the reproductive potential of the jill.

Dystocia in a cat due to an ectopic artery

DYSTOCIA in cats occurs in 3.3 to 5.8 per cent of all parturitions (Pretzer 2008) and is an important cause of stillbirth and early neonatal death (Gunn-Moore and Thrusfield 1995)....

Primary Uterine Inertia in Four Labrador Bitches

Uterine inertia is a common cause of dystocia in the bitch and is designated as primary (i.e., uterine contractions fail to ever be initiated) or secondary (i.e., uterine contractions cease after a period of time but before labor is completed). The etiology of primary uterine inertia is not well understood. The accurate diagnosis of primary uterine inertia requires the use of tocodynamometry (uterine monitoring). Primary uterine inertia has been postulated to result from a failure of luteolysis resulting in persistently elevated progesterone concentrations. In this study, primary uterine inertia was diagnosed in a series of four bitches in which luteolysis was documented suggesting some other etiopathogenesis for primary uterine inertia.

Uterine Rupture and Septic Peritonitis Following Dystocia and Assisted Delivery in a Great Dane Bitch

A Great Dane bitch was treated for presumed primary uterine inertia with repeated doses of oxytocin and manually assisted whelping. She was diagnosed with uterine rupture and septic peritonitis the following day. The uterine rupture is hypothesized to have occurred as a result of the management strategy used to treat dystocia. The dog underwent ovariohysterectomy, and the septic peritonitis was managed with open peritoneal drainage. The dog recovered well and was discharged 5 days later. No previous reports of canine uterine rupture associated with manual intervention appear to have been published. This report highlights the potential dangers involved in such an approach.

Hormonal concentrations in bitches with primary uterine inertia

Normal labor is accompanied by sequential changes in blood concentrations of prostaglandin F2α (measured as 15-ketodihydro-PGF2α = PGFM), progesterone, estradiol, oxytocin, vasopressin, and of elevated cortisol levels. The aim of this study was to investigate hormone concentrations in dogs diagnosed with primary uterine inertia before and during treatment by cesarian section. The hypothesis was the dogs would have abnormally low plasma concentrations in one or several of the hormones involved in parturition. The study comprised seven bitches with total primary uterine inertia (dystocia group) treated with cesarian section and six healthy bitches (control group) subjected to planned cesarean section. Blood samples were taken before anesthesia, before surgery started, on delivery of the first puppy and on delivery of the last puppy. The progesterone:PGFM ratio in plasma was higher in the dystocia group than in the control group, but the serum estradiol concentration did not differ between groups. The plasma concentrations of oxytocin and vasopressin increased in both groups when the first puppies were delivered, but both hormones were more elevated in the control group than in the dystocia group on delivery of the last puppies. The plasma cortisol concentration increased to the same level in both groups. In conclusion, the ratio between progesterone and PGFM was higher and the oxytocin and vasopressin concentrations lower in the dystocia dogs than in the control dogs. The findings indicate that these hormones are involved in the pathophysiology of total primary uterine inertia in bitches.

Calcium, parathyroid hormone, oxytocin and pH profiles in the whelping bitch

Despite the high prevalence of primary uterine inertia in whelping bitches, the underlying pathogenesis remains unclear. The objectives were to i) determine serum concentrations of total calcium, ionized calcium (iCa), parathyroid hormone (PTH), and blood pH in normally whelping bitches throughout the peri-parturient period; and ii) investigate relationships among iCa, PTH, and acid-base status, and the role that they and oxytocin may have in the underlying pathogenesis of canine uterine inertia. Bitches were randomly selected from a population of German Shepherd Dog bitches with a history of uncomplicated parturition (Group 1; n=10), and from a population of Labrador bitches with a clinical history of an increased incidence of uterine inertia and stillbirths (Group 2; n=20). Jugular blood samples were collected daily from -4 d to the onset of whelping (t=0h), and then every 4h until the last pup was born. Overall, bitches from Group 2 had higher mean±SEM serum concentrations of PTH (4.72±2.45pmol/L, P<0.001), lower iCa (1.31±0.08pmol/L, P<0.05), and higher venous pH (7.41±0.03, P<0.005) than bitches from Group 1 (2.9±1.44pmol/L, 1.38±0.06mmol/L, and 7.33±0.02, respectively) during the periparturient period. However, there was no significant difference between Groups 1 and 2 for serum oxytocin concentrations during the periparturient period (45.5±40 and 65.5±82pg/mL). We inferred that low iCa resulting from a rising pH and decreasing PTH during the periparturient period may have contributed to decreased uterine contractility and increased risk of stillbirths. Therefore, manipulating the cationic/anionic difference in diets of pregnant bitches, similar to the bovine model for hypocalcamia, may reduce the incidence of stillbirths in the bitch.

A survey of dystocia in the Boxer breed

BackgroundDystocia occurs more commonly in some breeds of dogs than others. The Boxer breed is one of the highrisk breeds for whelping problems. The aim of this study was to document some reproductive parameters and the frequency of dystocia in Boxers.MethodsTwo questionnaires were sent to the breeders of Boxers in Sweden during 1994 to 1997. Data from 253 whelpings and 1671 pups was received, which constitutes 56.5% of all Boxer litters registered with the Swedish Kennel Club during these years. Data was analysed using Chi-square test, and Fischer's exact test.ResultsDystocia occurred in 32% of the individual bitches, and in 27.7% of all the whelpings. Caesarian section was performed in 22.8% of all the whelpings and in 80.1% of the cases of dystocia. Medical treatment was tried in 20 cases but was successful only in 5 (25%). The dystocia was of maternal origin in 68.6% and of fetal origin in 28.6% of cases. The most common reasons for dystocia were primary uterine inertia (60%) and malpresentation of the fetus (26%). Dystocia increased with increasing age of the bitch from four years of age. Average litter size was 6.6 (± 2.2) pups born, and 5.0 (± 2.1) pups registered. Pup mortality was 24%. Stillbirths accounted for 6.1% of the pup deaths and 1% died in the neonatal period, while 15.6% of the pups were euthanised, the majority because they had disqualifying white coat colour. Cryptorchidism was observed in 9.8% of the male pups born and in 13.4% of the male pups that were registered.ConclusionThe Boxer suffers a high frequency of dystocia, mainly due to uterine inertia, but also fetal malpresentation. Breeders should be adviced to include easy whelpings in their breeding program.

Primary uterine inertia in 27 bitches: aetiology and treatment

To evaluate two treatment methods in bitches with primary uterine inertia in relation to blood concentrations of oxytocin, calcium and glucose. A prospective study where 27 bitches with primary inertia were randomly allocated to treatment groups I and II. Blood samples were collected before and after treatment. Group I was treated with a combination of intravenous calcium solutions and oxytocin and group II with oxytocin only. If unsuccessful, caesarean sections or additional medical treatment was pursued. Plasma oxytocin concentrations were 35+/-15 pmol/l in group I and 30+/-15 pmol/l in group II. Before treatment, the total serum calcium concentrations were 2.1+/-0.2 mmol/l in both the groups, and blood glucose values were 7.0+/-0.5 mmol/l (group I) and 7.3+/-1.4 mmol/l (group II). The number of bitches subjected to caesarean sections and the number of puppies born did not differ between the two groups. This study indicates that low plasma oxytocin levels is a cause of primary inertia in bitches with normal serum calcium concentrations and aggravates the condition in bitches with low calcium levels. Hypoglycaemia was not observed. The outcome of labour did not differ between groups I and II.

The Grand Multipara in Modern Obstetrics

From April 1985 to March 1986, 1,252 women were admitted for delivery at the Al Hada Armed Forces Hospital, Taif, Saudi Arabia. Of these, 224 (17.9%) were grand multiparas (GM) defined as mothers of parity greater than or equal to 6. History, labor and delivery as well as postpartum and neonatal courses were recorded using computerized records for later statistical calculations. The obstetric and perinatal outcome was calculated comparing the GMs to para-1 mothers and para-2-5 patients (P2-5), respectively. The latter group being empirically considered as the 'ideal' patient group. On comparing the GM group to that of P2-5, significantly higher frequencies of intercurrent diseases, especially diabetes mellitus and gestational diabetes, were found. Among GMs, transverse lie, primary uterine inertia, fetal heart rate abnormalities, failure to progress and postpartum hemorrhage were encountered significantly more often than in the other groups. The incidence of placenta previa was likewise significantly increased among the GMs as was the number of cesarean sections, particularly those of the primary emergency type. There was no maternal mortality. The perinatal morbidity was significantly higher in the GM group. However, no significant difference in perinatal mortality was found between the groups. It is concluded that with few exceptions the GM can be safely delivered by means of modern obstetric management.

Effect of segmental epidural block on the course of labour and the condition of the infant during the neonatal period.

Epidural block for vaginal delivery was given to 242 women during a 6-month period. Of these, 178 with a spontaneous start of labour and vaginal delivery were studied with respect to the effect of epidural block with bupivacaine-adrenaline on the course of labour and the condition of the infant in women with normal uterine activity and women with primary uterine inertia treated with oxytocin infusion. On average, the 178 women had already had a longer course of labour before the block was applied than women in control groups. The block per se had only a slight effect on the first stage of labour, but the effect on the second stage was more obvious, leading to outlet extraction in 50% of the primiparous women, compared to 12% of the controls. Transitory asphyxia at birth was observed in 4.5% of the infants of mothers with epidural block, but after 5 min, only 1% had an Apgar score of less than 7. Infants of mothers with epidural block were more often placed under observation or treated in the neonatal ward than infants in control groups.

Grand multiparity—its obstetric implications

3105 cases of infants of at least 20 weeks gestation delivered at Hazard and Whitesburg Memorial Hospitals during the period April 1956-March 1961 were reviewed and grand multiparas (6 or more pregnancies terminated after at least 20 weeks gestation) were compared to women of parity 1-5 to determine the relationship between average birth weight maternal weight gain during pregnancy incidence of stillborn infants number of prenatal visits and number of neonatal deaths. Also comparisons were made relating age and parity of the mother to a variety of obstetrical factors and complications of pregnancy. There were 725 grand multipara deliveries by 516 women. Average birthweight was greater among multiparas. Occurrance of infants of 2500 gm or less was unrelated to parity while incidence of infants 10 pounds or more was greater among multiparas. The incidence of stillborns increased in the grand multipara 2.86% as compared to 1.31% para 1-5 and increased with age. Maternal factors were responsible for the majority of stillbirths regardless of parity. Increasing parity was unrelated to neonatal deaths or length of gestation. Transverse lie face and brow presentations increased among grand multiparas. Several maternal complications were also more frequent including heart disease and diabetis mellitus. Hypertension as a complication of pregnancy and preeclampsia both increased with grand multiparity and with age of patient. Grand multiparas also showed increases in incidence of primary uterine inertia prenatal anemia and postpartum hemorrhage.

Prolonged labor—a necessary evil?

Here is a vignette of an obstetric nightmare: A primipara is admitted for induction of labor. Primary uterine inertia develops, necessitating acceleration of labor. The baby is discovered to be in the occipitoposterior position. Secondary uterine inertia then sets in. Two alternatives present themselves. Either cervical dystocia and pelvic arrest have to be dealt with, or absolute disproportion becomes apparent and a cesarean section is resorted to.On the flyleaf of Irving Potter's The Place of Version in Obstetrics is the following dedication:To the “Woman in Travail”In the reverent hope thather “hour” may be shortened,her “anguish” lessened, andher “joy” made complete.We have presented the circumstances and conditions that may have a detrimental effect on labor and delivery.

Observations on the spontaneous motility of human uterine muscle in vitro

1.1. The capacity of human uterine muscle for spontaneous shortening was found to decrease with age, and the activity of myometrial samples from old, postmenopausal women was characterized by relatively rapid, feeble contraction waves.2.2. Myometrial samples excised from uteri with secretory endometria exhibited a slower rate of spontaneous motility than did those from uteri in the proliferative phase. Muscle shortening, however, was found to be unaffected by the ovarian cycle.3.3. Repeated pregnancies and labors, the presence of leiomyomas else-where in the uterus, sedatives, analgesics and anesthetic agents administered at the time of operation, as well as race, were found to be of no statistical significance as factors influencing the spontaneous motility of myometrial strips excised from the nongravid human uterus.4.4. Muscle samples removed from gravid uteri (from 2 months' gestation until term) exhibited no statistical differences in regard to motility, when compared with tissues from the nongravid viscus.5.5. In a limited number of tests, myometrial tissues from patients with primary uterine inertia exhibited a significantly reduced muscle shortening with increased frequency of contraction when compared with “normal” tissues from both nongravid and gravid uteri.

Experiences with Di-hydro-ergotamine in the Treatment of primary uterine inertia: Gill, Robert C., and Farrar, James M., J. Obst. & Gynaec. Brit. Emp. 58: 79, 1951

Experiences with Di-hydro-ergotamine in the Treatment of primary uterine inertia: Gill, Robert C., and Farrar, James M., J. Obst. & Gynaec. Brit. Emp. 58: 79, 1951

The use of dilute infusion of pituitrin in obstetrics

1.1. Dilute Pituitrin by the slow intravenous route was used in labor in 36 cases of uterine inertia.2.2. Thirty-four of the patients having either primary or secondary uterine inertia were primiparas.3.3. Twenty-five per cent of the primiparous patients with primary uterine inertia in labor failed to respond to stimulation with dilute Pituitrin infusion.4.4. One hundred per cent of the multiparous patients in labor with secondary uterine inertia responded successfully to stimulation with the Pituitrin infusion.5.5. The failure rate in the combined cases of primary and secondary uterine inertia was 11 per cent.6.6. Dilute Pituitrin by the intravenous drip was used for the induction of labor in 63 patients.7.7. Twenty-one per cent of these patients failed to respond to induction by this method.8.8. The success of induction by this method was determined by the condition of the cervix at the time of induction. A favorable cervix was followed by successful induction in 94.6 per cent of the cases with the intravenous drip of dilute Pituitrin. Induction in the presence of an unfavorable cervix was successful in only 57 per cent.9.9. Since there is more than a 50 per cent chance of success for induction with the use of dilute Pituitrin infusion, this method of induction is recommended for trial in all cases where a definite obstetrical indication exists.10.10. The use of dilute Pituitrin by the slow intravenous drip is recommended for the control of hemorrhage in the postpartum period.