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Current Approach to Maternal-Fetal Medicine in Canines

Review Article
Daniela Benavides Granja . Diana Milena Gonzalez Torres2 . Juliana Ramírez Molina3
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Mariana Peña Salguero4. Paula Andrea Rodríguez Novoa 5

Abstract

In mammals, the full success of the reproductive process is achieved by the birth, at the
physiologic term of pregnancy, of alive and viable offspring, able to survive and to become
adults. The process of birth is considered a challenge for the transition of a fetus to a neonate,
and also the first hours after birth could hamper the neonatal ability to adapt to the new,
extra-uterine, life. Therefore, the perinatal period, which pertains to the period immediately
before and after birth, is considered the most critical for the offspring. For the development of
this article, an exhaustive review of the literature was necessary that allowed us to present
information of great utility for canine neonatology such as the influence of some factors in
the presence of dystocia, abortion or premature death, even the most prevalent etiologies of
both infectious and non-infectious were described with respect to the presentation of these
problems, with the above was able to determine that the monitoring of the perinatal stage in
both the mother and the newborn and the analysis of different clinical parameters in both are
the most important factors to avoid or mitigate the events described before.

Key words: perinatology, neonates, dystocia, premature, abortions, maternal-fetal.

Objectives

Overall objective: Carry out a review article focused on perinatology in small animal
clinics. Topics such as neonatal care, the physiology of the fetus, the components of the
placenta, and pregnancy will be addressed. All this in order to relate the pathologies that are
seen in this area.

Specific objectives

● Establish which are the major pathologies in the area of ​perinatology in dogs, to
review their origin and management.
● Review why pregnancy failures and neonatal deaths occur, as well as diseases that
affect both the mother and the fetus.
● Determine the importance of the gestation period and maternal-fetal care, to avoid
losses and prevent neonatal diseases.

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Introduction
The care of the pregnant mother and
newborn puppies is a fundamental part to
reduce the presentation of maternal-fetal
diseases, abortions, and death of
newborns. Veterinary doctors must give
information to the owners about the
management of pregnant females and
puppies, not only to the owners of kennels
since this would generate a significant
economic loss but also to the owners of
females that become pregnant either by
carelessness or by planning the same. In
recent years this has increased and the
most worrying result is that this process
and the birth are carried out empirically,
often ignoring the risks for both the mother
and the puppies. Increasing in turn the
presentation of infectious or non-infectious
pathologies.
As has been mentioned, the fact that the
newborn leaves the amniotic sac to start
his extrauterine life is a highly stressful
event. Stress due to the multisystemic
adaptations that his body must present.
Veronesi, M (2016) in his neonatal care
study mentions that the most critical
change has to do with breathing since it
depends on it for its survival in the first
weeks of life and throughout it. The above
means that breathing in the newborn
puppies is one of the most important and
significant points in the early survival of
the animal .When the mother is about to
give birth to the fetus, the flow of oxygen
in the fetus blood is going to be
transformed into nitric oxide. Thanks to
this, it is possible to affirm that this
transformation of gases in the blood
together with the detachment of the
umbilical cord, are the two basic criteria
that could indicate us that the newborn
should begin to breathe. As a consequence
of the previous event, the lungs should
begin to inflate and given the close union
of respiratory processes with cardiac
physiology, an event called fetal blood
occlusion will occur.
Recent studies have shown that
maternal care provides not only
physiological development, such as licking
to be able to defecate and urinate but also
behavioral and cognitive development of
the offspring. In addition to that maternal
behavior can ensure the survival of
puppies in the first weeks of life. That is
why it is necessary to monitor maternal
behavior, childbirth, and breastfeeding
timing. As described by Lezama-García,
K., Mariti, C., Mota-Rojas, D.,
Martínez-Burnes, J., Barrios-García, H., &
Gazzano, A. (2019), human intervention is
necessary in many cases since dogs have a
reduced maternal behavior. That is the
challenge presented for veterinarians in
terms of information to the owner and
early resolution of the various pathologies
that may arise.
As already mentioned, even with the
necessary care and management, problems
may arise at the time of delivery, what it is
called dystocia, or infectious diseases may
be generated.
Dystocia is a problem that can occur in
the first or second stage of labor. It is an
emergency where the veterinarian must
diagnose the cause of dystocia, it may be
on the part of the mother such as uterine
inertia, being the principal cause of
dystocia described in bitches; or
inadequate size of the birth canal, or by
3
factors of the fetus such as the
accommodation of the fetus in the birth
canal or its size. (Haben, F., & Guesh, N.
2020), these dystocias can compromise the
life of both the mother and the fetus, and it
is difficult to identify them since their
symptoms are nonspecific to determine the
cause, it is necessary to take a good
anamnesis, history reproductive, complete
clinical examination. In addition to being
complementary with diagnostic and
preventive aids that have evolved in recent
years in the field of canine obstetrics as
described (Kumara Wickramasekara
Rajapakshage, B., & Dona Daphney
Niranjala, D. S. et al. 2019), among which
are ultrasound and abdominal radiography.
This same study showed some dog breeds
are more predisposed, such as
brachycephalic, and it is more frequent in
bitches between 2 and 4 years old.
In addition to dystocia, another factor to
take into account when caring for
pregnancy in canines is the possible
contagion that the mother may have
against contagious diseases. There are
teratogenic diseases, which means that
they cross the transplacental barrier and
will directly affect gestated puppies. One
of the main infectious pathologies that
generate abortions and even infertility in
bitches, is Brucella canis, which causes
interruption of pregnancy in the last third
of gestation. The importance of this
gram-negative bacteria is not only due to
the affection of the bitches, but also
because it is zoonotic, which implies
special handling for the infected individual
by both the veterinarian and the owners.
(Castrillón-Salazar, L., Giraldo-Echeverri,
C.A., Sánchez-Jiménez, M.M and
Olivera-Angel, M., 2013).
It is because of the above that it is
useful and necessary to share through this
article relevant and updated information
about the management of canine
perinatology and some of the alterations
and events that may occur around this field
of veterinary medicine for small species.
Theoretical framework
Canine perinatology is a branch of
small animal medicine, which breaks
down many fundamental components
when evaluating it, including the health of
both the fetus and the mother. Recently
perinatology has been driven by the need
to reduce the loss of puppies and even
mothers improving their care. Due to
ignorance about this doctrine, there is a
high perinatal loss in the vet. In species
that give birth to several puppies, the
process can take up to 12 hours before the
owner decides to call the doctor. That is
why there is a risk of increasing the loss of
puppies.
Veronesi et. al (2017) simply mentions
in his theriogenology work that neonatal
care is not something considered
overlooked in the canine clinic. Is
recommended knowing the physiology of
the fetus both to recognize healthy puppies
and to differentiate those that need special
attention and vigilance. Fetal fluids,
despite being understudied are useful
indicators when evaluating fetal growth
and development, fetal wellbeing, and
helping to guarantee the most suitable
environment for the fetus.
MC Veronesi et. al (2017) indicates
that both in human and veterinary
medicine the “Apgar'' is managed, which
consists of evaluating the canine neonatal
4

viability at birth, at 5 min and 60 min. evaluated taking into account both
Veronesi, in his work entitled Assessment respiratory rate (rpm) and vocalization:
of canine neonatal viability-the Apgar respiratory efforts were scored as 2 when a
score. Reproduction In Domestic Animals light cry was associated with> 15 rpm,
(2016) cites himself and his co-authors in scored as 1 when a light cry was
the (2009) paper about Theriogenology associated with 6-15 rpm and it was scored
when establishing the Apgar score; using as zero when there was no cry associated
the same five parameters proposed by Dr. with <6 rpm.
Virginia Apgar in babies, but with
modifications according to the canine Score Score Score
neonatal physiology in order to give a type
of scale or score to the clinical Parame 0 1 2
commitment of the puppy in its first ter
moments of life (Oliva, Queiroz,
Albuquerque, Carreira, Souza, Ferreira, Mucus Cyanoti Pale Pink
Abimussi & Vides., 2018) (Table 1). The colour c
first step consists of checking the mucous
Heart <180 180-220 >220
membranes, the pink color (which is the
rate
ideal in any living being) obtains a score
(bpm)
of 2, when they are pale it scores as 1 and
cyanotic, that is, purple due to failure in Reflex Absent Grimac Vigorou
the gaseous exchange, scores as 0. The irritabili e s
pulse is evaluated based on the HR, it was ty
established 2> 220 beats per minute (bpm),
it was scored as 1 when it was between Motility Flaccid Some Active
180 and 220 bpm, scored as 0 when it was flexions motion
<180 bpm. The facial expression that the
newborn makes when disturbed or irritated Respirat No Mild Clear
is called "grimace", this was through the ory crying / crying / crying /
gentle compression of the tip of a leg, and efforts <6 6-15 >15
the reaction: it was scored as 2 when there (vocaliz
is crying and it picks up the leg, scored 1 ation
when there is a weak reaction in the leg and
and vocalization was absent or weak, and rpm)
scored as zero when no response to the
stimulus in its entirety, that is, neither Table 1. Apgar score for canine
vocalization nor retraction. Neonatal newborn viability evaluation (Veronesi,
strength is part of the fitness assessment: it 2016 cited his own work as Veronesi et al,
was rated as 2 when force movements 2009 )
performed by the newborn spontaneously
without any effort were observed, rated as At this point it is important to know that
1 when slight movements were detected, canine females are a non-seasonal
and rated as zero for the absence of monostric species in which their gestation
neonatal movements. Respiration was lasts for 65 in some cases 66 days, this
5
depends mainly on luteinizing hormone
which can make the gestation longer or
shorter due to its function for follicular
development, in ovulation and in the
luteinization process (Concannon, 2011),
In carnivores such as bitches in this case,
their placenta is made up of trophoblasts
and the mesoderm, resulting in a
chorioallantoic placenta, that is, the
allantois joins the chorion, giving an
important function that is the exchange
between mother and fetus, during gestation
in the process of development of the fetus
implantation occurs in which the placenta
creates rounded areas which are the rings
formed by hematomas and these appear
when there are areas of blood in the
endometrial cavity as the pregnancy
progresses and there is much more
development of the fetus the innermost
layer of the trophoblast functions as an
anchor for the chorion contributing to the
formation of the syncytiotrophoblast
which is the outermost layer of the
trophoblast which has an important
function which is the production of
antibodies for the development of the
circulation thus allowing that chorionic
villi are formed producing an increase in
the exchange of nutrients from the mother
to the fetus, this being something very
important for fetal development and the
production of a healthy pregnancy and
without any type of alterations in both the
mother and the fetus.(Aralla, M. et al,
2013).
One of the most important and
determining non-infectious conditions for
both neonates and the mother is dystocia.
Known they can be caused by fetal or
maternal factors. In a study by Bolis et. al
(2017), this condition was mentioned to
represent 5% of deliveries in dogs.
However, dogs with characteristic
anatomical conformations such as the
brachycephalic (English bulldog) and
small miniature breed female dogs
(59.4%) have more episodes of dystocia. It
is well known that the
hypothalamic-pituitary-adrenal axis has
the function of secreting hormones that
participate in various physiological and
chemical processes; such as growth
hormone, sex hormones, among others. It
has been studied that birth is triggered by
fetal factors such as stress, once this has
ended it is followed by other changes that
are difficult for the neonate to adapt, such
as starting to survive outside the placenta,
forcing it to undergo metabolic changes
and physiological to survive in the new
environment. HPA is crucial for neonatal
adaptation to a new extrauterine life.
The etiology of puppy losses,
miscarriages, and embryonic death can be
divided into infectious and non-infectious,
but on the other hand, a large number of
them have an unknown etiology, an article
by Stefanetti, V., Compagnone, A.,
Sordini, C., Passamonti, F., Rampacci, E.,
Moscati, L., & Marenzoni, ML (2018)
describe that even 55% of causes of
abortion and neonatal losses in canines
have unknown etiology. Posing that many
of these pathogens are unusual and that
routine studies of these should be done, in
addition to carrying out studies and
research on them to determine if they
cause neonatal mortality and death.
Among the infectious causes, bacterial
pathogens have been described to affect
mainly puppies in the first two weeks of
life, and that causes the interruption of
pregnancy in bitches, these are
Staphylococcus spp., Streptococcus spp.,
6
Escherichia coli, Brucella canis,
Campylobacter spp. and Salmonella spp,
Leptospira icterohaemorrhagiae and
canicola paying important attention
because it is a zoonosis; but viral
pathogens have also been described that
directly affect the puppy and the mother,
these are canine distemper virus, herpes
virus and canine parvovirus. (Stefanetti, et
al. 2018).
Among the non-infectious pathologies
Zheng, JS, Wang, Z., Zhang, JR, Qiu, S.,
Wei, RY, Nie, J., & Zhu, TT (2018)
describe that ectopic pregnancy can occur
and can be of two ways. A tubal pregnancy
common in humans where the embryo
develops in the fallopian tubes, and an
abdominal pregnancy where the embryo
develops outside of the uterus, fallopian
tubes, and ovary. Ectopic pregnancy is also
known as extra-uterine pregnancy is one of
the causes that can lead to the loss and
interruption of pregnancy. Despite this,
there are not enough studies to establish
the exact cause, nor the anatomical
location in which the pregnancy is
established outside the uterus. The latter
mentioned is considered a problem since if
the location of the embryo implantation
outside the uterus is not known, it cannot
be classified whether it is a primary or
secondary extra-uterine gestation. One of
the possible causes or etiologies that this
pathology may have is the rupture of the
mother's uterus. (Oviedo, C. A. and
Molina, V. M., 2013).
As mentioned in the introduction,
infectious diseases that can course with
abortions and termination of pregnancy
must also be taken into account. One of the
most important in the veterinary field is
canine brucellosis caused by the
gram-negative bacteria Brucella canis.
This disease leads directly to abortions in
the last third of gestation, generally
between 45 to 55 days of pregnancy. This
pathology must be taken into account,
especially at the level of canine kennels,
since the reproductive part of the affected
female will be dysfunctional. In other
words, not only is the abortion of already
gestated puppies but in a subsequent
pregnancy there will be reabsorption and
therefore an embryonic death avoiding
future pregnancies (Ballut, J.C, Calderón,
A. and Rodríguez, V., 2013). To avoid and
prevent the contagion of the female, it is
essential to know that the form of
contagion of this bacterium is generally at
the time of mating, but it can also be due
to the contact that it may have with
infected fluids (vaginal secretions,
placenta or urine). Likewise, caregivers,
owners, and veterinarians who have
contact with infected fluids can become
infected. (Zavala, M and Morales S.,
2016). (Castrillón-Salazar, L. et al, 2013).
One of the most important aspects to
avoid problems both in pregnancy, as in
the birth of puppies, and pregnancy losses,
is the handling given to the female both in
the reproductive field and in the care of the
pregnancy. The first point to take into
account is to know the exact date of
ovulation of the female and the mount
(whether it has been planned or not) to
establish the possible date of delivery. By
having this exact date, there could be a
quick reaction to possible dystocia and if it
is necessary to schedule or perform a
cesarean section. At the time of delivery,
on many occasions, the death of the
gestated puppies is evidenced due to
hypoxia. This can be generated both by an
abrupt and early separation of the placenta
7
or directly by the lack of oxygenation at
the time of dystocia. This can be
accompanied by the ingestion of the
amniotic sac generating a the second third. It is necessary to
bronchoaspiration. This last cause is
evidenced especially in puppies that are
stuck in the birth canal (Somoza, R. and
Cusatti, A.C., 2019).
Dystocia can have two origins, they can
be of maternal or fetal origin and there
have even been cases in which there is a
relationship between the two. It should be
noted that there are some breeds
predisposed to this type of problem,
especially small breeds (very small birth
canal) and brachycephalic breeds (very
large puppy's head for the birth canal).
(Luz, M.R, Münnich, A. and Vannucchi,
C.I., 2015). Another aspect to take into
account is the mother's nutrition during
gestation since poor nutrition can lead to
dystocia and the birth of weak and even
dead puppies. Malnutrition or low birth
weight is considered one of the main
causes and one of the main risk factors for
neonatal deaths. (Somoza, R. and Cusatti,
A.C., 2019).
If a good follow-up of the pregnancy is
not carried out and that there is some
inconvenience during it that may represent
a danger to the bitch, measures must be
taken to interrupt the pregnancy. It is
essential to note that pregnancy is
maintained thanks to the sex hormone,
progesterone produced not only at the
level of the ovaries but also in the
placenta. There are different methods of
termination of pregnancy fundamentally
based on stopping the production of
progesterone, that is, an antiprogestin, anti
prolactin, and prostaglandin-containing
drugs are used. The use of prostaglandins
or analogs thereof, especially
prostaglandin F2 alpha (luteolytic) is
recommended to interrupt a pregnancy in
emphasize that the bitch will present
specific symptoms after the interruption of
pregnancy, which includes vomiting,
diarrhea, and even tachycardia, so owners
should be warned. Regarding this point,
that is, the interruption of pregnancy
should also take into account ethical
aspects. Is fundamental that pregnancies
should not be interrupted by unplanned
copulations and carelessness on the part of
the owners, but only in cases in which the
life of the pregnant bitch is at risk.
(Sánchez Riquelme, A. and Arias Ruiz, F.,
2018).
However, it is pertinent to emphasize
the importance of highlighting some of the
parameters clinically evaluated in newborn
puppies useful for determining neonatal
mortality or the influence of these criteria
on the different problems that may arise in
a postpartum situation. In a study realized
by Mila, Grellet, Dellebarre, Mariani,
Feugier, and Maillard in 2017 about the
monitoring of the newborn dog were
evaluated variables like the Apgar score,
glucose, lactate, beta-hydroxybutyrate,
body temperature, and urine specific
gravity in an attempt to describe a model
for predicting mortality in these
individuals (Table, 2). Due to the above, it
is presumed necessary and feasible to
analyze these parameters and their median
values in veterinary practice as an
indication either to prevent or predict
mortality in canine neonates. In relation to
the above, Vassalo, Simoes, Sudano,
Prestes, Lopes, Chiacchio and Lourenço
(2015) in their study on the study of
neonatal viability using laboratory
8
parameters, state that in early mortality in
neonates there are mainly two important
variables that correspond to the
temperature and glucose levels of the
puppy at birth. It is important to highlight
then that according to these authors
hypothermia, hypoglycemia and even
dehydration are criteria that directly
influence the fading of the animal after
birth, which in this specific vital stage
means a clear risk of death for the puppy.
Table 2: Median values of parameters
evaluated in puppies <8 h and at Day 1 of
life (Milla, H. 2017).
Methodology
For this review, it was necessary the
previous organization of the criteria to be
reflected and also the method to be
followed to facilitate the development. All
that with the aforementioned guideline it
was possible to determine in a concrete
way the systematic procedure followed to
achieve the proper execution of this
document. Following the above, the first
step to follow was the correct definition of
the topic to be considered. Taking into
account that it must be general enough to
allow an extensive bibliographic review,
but also specific to place the research in a
clear position facing the great variety of
debatable topics. Canine perinatology,
despite being a topic not dealt with very
frequently, is a doctrine on which the
possibility of deepening becomes an
opportunity to present an updated report of
the inherent bibliographic variants to the
same. This is why it was chosen to give an
article on the current and more precise
approach to some of the most fundamental
anomalies in the field of perinatal
medicine in the female canine.
Regarding the development of a work
plan as a tool for the optimal development
of this review, it was chosen to initially
carry out a broad bibliographic search
related to the topic of discussion. The
determination of a starting point was
facilitated for the construction of a
theoretical framework and an introduction.
The introduction not only in addition to
raising in a general way some of the
antecedents concerning the specific topic,
contributed to the exposition of the basic
universal pre-knowledge that was made
known to contextualize the reader and
favoring the understanding of the article.
In this order, for the selection process of
the required texts, the different databases
corresponding to indexed scientific
publications were searched, and through a
filter the options were shortened to only
those published from the year 2010 and
evidently to those directly related to our
topic of interest, the above was classified
as a helpful methodical component for the
construction of the bibliographic
framework within an updated scenario in
the small animal clinic, more specifically
speaking of the canine species. In other
words, to refine the search options, it was
decided to make this procedure more
9
efficient by using 3 main filters,
corresponding to the year of publication
(2010 onwards), the subject under
discussion (Perinatology), and the subject
species of interest (Canines).
Now, once a more precise set of
references had been formed with
exactitude, the individual analysis of them
began, and after having understood the
information collected, proceeded to
elaborate synthesis of it in order to make it
more feasible their stipulation in the
present work. Finally, for the writing of the
review article, the previously established
patterns were taken into account, and
based on them the elaboration of the
section was carried out with greater
efficiency and accuracy, visualizing the
importance of the mandatory inclusion of
different sections among which it
highlights the preparation of a summary,
an introduction, a theoretical framework,
structural development of the subject
evaluated and finally some conclusions. It
should be clarified that in terms of
materials it was simply necessary to use an
electronic device such as a computer or,
failing that, a cell phone to fulfill the
required bibliographic search.
Conclusions
Finally, as a conclusion, it is possible to
affirm that the care and perinatal
monitoring provided to both the pregnant
mother and the newborn is the most
important thing in canine neonatology to
prevent and avoid events such as abortions
and early death of newborn puppies.
Extrinsic factors to the puppy such as
maternal instinct, the possible presence of
a dystocia and the mother's contagion with
infectious conditions, can be significant in
determining the viability of either the
pregnancy, the delivery or the newborn.
On the other hand, it is important to
know the physiology of the fetus on the
way and also of the mother to be able to
detect any early abnormality both before
birth and in the first days of life. To detect
this state of clinical stability, we can use
the Apgar scale, with the sole purpose of
evaluating viability more efficiently by
analyzing 5 fundamental items which are
the color of the mucous membranes, the
heart rate, reflex irritability. , motility and
respiratory efforts. However, it is also
useful to measure other variables such as
glycemia, lactate, body temperature, and
the degree of dehydration since they serve
as coadjuvant factors to establish a
diagnosis and timely treatment. It is
important and necessary that more studies
be carried out on the incidence of
abortions or premature deaths in
neonatology in order to find more ways to
avoid them.
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