CASE 23: Abnormal behavior post-partum in a bitch
Case Information: A client calls you asking for advice. You performed a C-section on a 3-year-old Dachshund two nights ago; she had been actively pushing for over 4 hours and was passing green vulvar discharge. Radiographs showed seven pups so you went straight to surgery. Six pups were born alive and one was stillborn. That pup was not submitted for necropsy. The bitch recovered from anesthesia well and was discharged from your clinic shortly after surgery. Yesterday the pups all gained weight and the bitch ate and drank well. Since this morning, the pups have been crying more and the bitch seems reluctant to allow them to nurse. She is eating and drinking but not with the vigor she did yesterday. She appeared hesitant to jump out of the whelping box to go out to urinate and defecate but when the owners tried to pick her up, she reacted strangely, almost as if she didn't recognize them.
Question:
The clients want to know if you need to see the bitch, what the possible reasons are for these changes in behavior, and what tests you might do to help figure this out.
Answer:
The most common problems seen post-partum in bitches are hypocalcemia, mastitis, and metritis.
Hypocalcemia may be associated with neurologic signs, including changes in mentation, and with neglect of the pups. Ataxia or weakness could explain her hesitance to jump from the whelping box. She is nursing a large litter so it is not foolish to worry about her ability to pull enough calcium from stores in bone and to take in enough from her diet to support heavy lactation. Hypocalcemia can be life-threatening so the bitch should be seen ASAP to rule it out. Diagnosis is via blood testing to determine calcium concentrations and physical examination including a brief neurologic examination.
Mastitis is inflammation of one or more mammary glands. Mastitis is painful and can cause bitches to neglect the pups, to avoid activities like jumping out of the whelping box, and to react strangely when picked up. Fever associated with mastitis may be associated with inappetance. Diagnosis is by visual inspection and examination of milk expressed from the mammary glands. If mastitis does appear to be present, culture of expressed milk should be performed to guide antibiotic therapy.
Metritis is inflammation of the uterus and usually occurs secondary to an insult. This bitch suffered several such insults; she was in prolonged labor and then had uterine surgery. Fever associated with metritis may be associated with inappetance and lethargy. It is not uncommon for bitches with metritis to neglect the pups. Diagnosis is by visual inspection, and microscopic evaluation and culture of the vulvar discharge.