On physical examination, the animal was bright and alert. The vulva was approximately 3 the expected size for a spayed bitch; a dark red fluid, presumed to be blood, was pooled at the ventral commissure; and the surrounding hair coat was dotted with blood. Multifocal areas of erythema were noted on the ventral aspect of the abdomen.
Further examination was facilitated by sedating the bitch with acepromazine (Atravet; Ayerst Veterinary Laboratories, Guelph, Ontario), 0.05 mg/kg bodyweight (BW), IM, and hydromorphone (WCVM Teaching Hospital, University of Saskatchewan, Saskatooon), 0.1 mg/kg BW, IM. Vaginoscopy was performed with the dog in sternal recumbency by using a vaginoscope to visualize the vestibule and distal vagina and a pediatric proctoscope to visualize the vagina to the level of the cervix. The epithelium had a cobblestone appearance; blood was noted in the vestibule and vagina, but it could not be localized to any particular site of trauma or a lesion. No evidence of a distinct mass was found. Visualization of the urethral papilla revealed no evidence of bleeding from the urinary tract. Catheterization was accomplished easily and grossly no blood was seen in the urine. Vaginal cytologic examination determined that cells were typical of a bitch in estrus. Biopsy samples of the vaginal mucosa were fixed in 10% neutral buffered formalin, but they were archived and not submitted for pathologic examination at that time. Abdominal ultrasonography revealed a hyperechoic area cranial to the right kidney that was interpreted to be a potential mass. Serum progesterone was 5 ng/mL (normal in a spayed bitch is
Signs of estrus in the bitch include bleeding from the vagina, a cobblestone or crepe paper appearance to the vaginal epithelium, and the presence of largely or wholly cornified superficial cells on vaginal cytologic examination (1). Ovulation occurs near the beginning of estrus in the bitch and is indicated by a serum progesterone level between 3 and 8 ng/mL (1). In this case, these signs in a spayed bitch led to a presumptive diagnosis of ovarian remnant syndrome. Discovery of a mass on ultrasonography and exploratory laparotomy were consistent with this diagnosis and the histologic examination provided confirmation.
Four methods have been suggested to diagnose ovarian remnant syndrome: vaginal cytologic evaluation, resting hormone assays, hormone challenge testing, and exploratory laparotomy with biopsy (2). Ultrasonography of the abdomen can add further evidence that an ovarian remnant is present. Due to the estrogen produced by the remnant, vaginal cytologic examination may reveal cornified epithelial cells (3). An estrodiol concentration of > 20 pg/mL can be considered as evidence of ovarian remnant syndrome, but it is not thought to be as reliable as progesterone measurements. Progesterone should be measured when the bitch is showing signs of estrus or within 50 to 80 d after that with a level > 2 ng/mL indicative of functional corpora lutea (2). A hormone challenge test is more reliable in the queen, but it can be used in the bitch if a progesterone level of 2 ng/mL by 1 wk following the injection of human chorionic gonadotropin or gonadotropin releasing hormone (3). Confirmation of the diagnosis can only be made by exploratory laparotomy and histological confirmation of the presence of ovarian structures in conjunction with resolution of the signs (2).
Surgical excision of vaginal masses through episiotomy has been described as the treatment of choice [13,14,15]. However, because of a) the old age of these patients and the risk performing extensive episiotomy and b) the fact that the growth of these masses may be stimulated by ovarian steroids, the use of steroidal hormones receptor antagonists or surgical ovariectomy have been reported as successful treatments [16, 17]. Aglepristone (AGLE) (Alizin, Virbac) is a synthetic antiprogestogen marketed as an abortifacient in bitches in Europe and Australia and its off-label use for progesterone-related canine conditions has been reported . Alfaprostol is a synthetic prostaglandin F2apha (PGF2α) compound marketed for use in food animals and reported to be able to induce luteolysis also in bitches .
Because of the amount of bladder distension, a complicated cystitis with bladder wall invasion was suspected. Therefore, the initial choice of an antibiotic treatment for this bitch was enrofloxacin due to the ease and speed with which this drug achieves tissue penetration [27, 28]. When urinalysis was performed at day 8 of referral, the bitch was hyposthenuric (urinary specific weight of 1008) and no bacteria were present in the sediment. However, it has been described that low urinary specific weights might create a false negative bacteriuria in the sediment . The reason for adding amoxicillin-clavulanic acid a week later was to broaden the spectrum of coverage because of the increasing leukocytosis and the suspicious false negative bacterial cystitis. The use of fluoroquinolones and amoxicillin-acid clavulanic should be guided by culture and sensitivity results. Unfortunately, this was not done. A multi-resistant Klebsiella was found growing in urine culture on day 22: such a bacteria was certainly present in the bladder of this bitch already upon presentation although it is unknown whether or not it was already multi-resistant or if its multi-resistant status developed following the combined use of enrofloxacin and amoxicillin-clavulanic acid. As E. coli is frequently identified as a cause of cystitis and because of the close proximity of the prolapsed vaginal tissue with the anus, the occurrence of a complicated multibacterial ascending cystitis with E. coli and Klebsiella spp. upon presentation cannot be ruled out as the combined enrofloxacin and amoxicillin-clavulanic acid antibiotherapy may have eliminated the E.coli population.
Luteomas are considered sex cord-stromal tumors potentially able to secrete steroid hormones [3, 4, 12]. Sex cord-stromal tumors seem to be the most commonly reported ovarian tumors in the female with the least and the most common species being sows and queens, respectively . These tumors seem to be derived from the luteal cells of ovarian stroma [4, 9]. Human luteomas are rare benign tumors occurring either in pregnancy or after menopause . Human gestational luteomas are spontaneously regressing tumors which may cause virilization of female fetuses due to their androgen secretion [21, 32]. Only two cases of canine ovarian luteoma have been described [12, 33] with both cases developing from ovarian remnants in spayed bitches. The histological pattern of the ovary of this case (polyhedral cells with abundant vesicular cytoplasm) and the unusual secretion of P4 was compatible with an ovarian sex-cord tumor resembling luteoma.
To our knowledge this is the first report about a vaginal leiomyoma concomitant with an ovarian luteoma in a bitch with uncommon secretion of P4. This case demonstrates the importance of identifying and characterizing P4 related conditions as well as the importance of judiciously using a combined medical and surgical approach. OHE should always be considered when dealing with small animal reproductive conditions occurring in diestrus. This is particularly true when dealing with older patients in which an elective, uncomplicated OHE may be better than a longer and more invasive surgery. A medical approach using a P4-receptor blocker and/or a luteolytic agent may be indicated for patients who are poor surgical candidates.
A female dog is called a bitch, the male a dog. Birthing is called whelping or parturition, and the offspring are puppies. The length of pregnancy, called gestation, is 60 to 63 days (but can range from 57-70 days).
Before breeding your bitch, get her in good health. Obesity greatly increases the risks of pregnancy and whelping, and decreases fertility. She should receive a booster on her DHLP-PV within six months of breeding (but at least 2 weeks before the breeding date). Some dog owners will require a Brucella test; this is a contagious disease of dogs, transmittable to humans, that usually is passed during breeding. If a stud owner requires this test, they are doing so to protect both their dog and yours. To avoid injury to the male, let the dogs become acquainted while leashed. If the bitch acts aggressively or tries to injure the male, stop breeding attempts and re-introduce them after a vaginal smear to check her heat status, or after a day or two.
During breeding, the female will stand with her feet planted and her tail off to the side. The male will mount her, and after breeding will remain attached to the female for 5-20 minutes; this is called the tie. It is natural at this point for the dogs to be joined facing in opposite directions. Leave the dogs alone until the tie ends naturally. The bitch should be bred every other day until she rejects the male.
The approach of whelping is signaled by mammary gland and vulvar enlargement, and decreased activity. Your bitch may also exhibit restlessness, nesting behavior and lack of appetite for 12-24 hours before parturition starts. There are three stages of the birth process:
Some bitches will experience hypocalcemia (low blood calcium), especially if they are nursing large litters, in the first 3-4 weeks of lactation. These bitches are nervous and restless, progressing to panting, whining, incoordination and collapse. This is a medical emergency! Feeding calcium supplements during pregnancy increases the problem.
We will supply you with a safe dewormer to use on your bitch 2 weeks prepartum. She should be dewormed again after the pups are born, and the puppies should be dewormed at 3-4 weeks and 6-7 weeks of age. Pups should receive their first vaccinations at 6-8 weeks, and receive boosters every 3-4 weeks after that, through at least 16 weeks. Pups born in the spring and summer should receive heartworm preventive medication starting at 4-8 weeks. 041b061a72