A 2-year-old Great Dane presented to the primary veterinarian for presumptive uterine inertia after failure to whelp beyond the birth of 2 puppies. The dog was treated with several appropriately calculated doses of oxytocin IM and a dose of calcium borogluconate SC for presumptive hypocalcemia. Seven fetuses and 7 placentae were delivered during initial medical therapy. Uterine contractions ceased after this point, and manual removal of 3 additional fetuses without placentae was performed. In total, 12 puppies (10 alive and 2 dead) were delivered with 9 placentae. Two additional oxytocin doses were administered after whelping to assist with delivery of placentae, and the dog was discharged 8 hours after whelping in stable condition. The patient presented to the primary veterinarian 15 hours postdischarge for depression and reluctance to stand, and was referred to a specialty clinic for shock and severe hypovolemia. Abdominal ultrasonography revealed abnormally thickened uterine walls, ascites, and multiple hyperechoic gas bubbles consistent with a pneumoperitoneum. Exploratory surgery was performed; purulent free fluid (4 L) and 2 free-floating placentae were identified in the abdomen. The uterus was grossly erythematous and swollen. Ovariohysterectomy was performed and a gastrotomy tube was placed; closure was performed with a modified open-abdomen technique to facilitate drainage. The dog was hospitalized for 5 days and released in stable condition. Abdominal fluid culture revealed Escherichia coli and Proteus species, which were sensitive to enrofloxacin and metronidazole. The dog was separated from her puppies during her illness; all puppies were hand-reared but reportedly died within 1 to 2 weeks of birth. The authors suggested that this case of uterine rupture may have occurred secondary to manual manipulation of canine fetuses and oxytocin administration.

Commentary: Manual manipulation of canine fetuses is extremely uncommon due to size and logistic considerations of the bitch. This study supports manual manipulation as a judicious, last resort technique to be used only when referral to a surgical facility is not an option. However, use of the technique is contraindicated if oxytocin has already been administered. The dramatic mortality rate of the litter and evaluation of necropsy findings were not discussed. Other potential causes of uterine rupture, including infectious uterine necrosis, were mentioned but not described in this case report. There are few descriptions of uterine rupture in the veterinary literature as it is an extremely rare clinical condition in the dog, and most studies originate in the human literature. This is problematic due to differences between the species in oxytocin dosing administration and the presence of previous uterine trauma and scar tissue. The uterus was not biopsied at the time of surgery, and it is unclear whether histopathologic findings supportive of trauma or etiologic agents would have been helpful in defining this patient’s outcome.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)

Uterine rupture and septic peritonitis following dystocia and assisted delivery in a Great Dane bitch. Humm KR, Adamantos SE, Benigni L, et al. JAAHA 46:353-357, 2010.