Retention of fetal membranes and fetus

• Cause: failure of expulsion of fetal membranes during third stage of labor. Fetal membranes usually follows birth of each puppy but several may be expelled at once because puppies may be born from one horn before some fetal membranes have left the contralateral horn.
• Unusual problem, but true prevalence unknown.
• Suspect if there is a copious, dark greenish vulvar discharge 24 h post-partum.
• Most bitches do well despite retention of one or more fetal membranes; some affected bitches, however, will need treatment to prevent toxemia, metritis and death.
• Treatment: antibiotics, ecbolics (oxytocin, PGF2alpha).
• Conservative management usually successful.
• Hysterectomy essential if conservative management fails.
• Occasionally dead fetus retained as well.
• Prognosis: good for life and future fertility.

• Bitch is usually normal.
• Dark green vulvar discharge beyond 24 h post-partum.
• If several days post-partum - systemically debilitated, febrile, toxemic and have a foul smelling vulvar discharge.

• Anecdotally, toy breeds over-represented.

• If Caesarean section is required Cesarean section.

• Usually treated with broad-spectrum antibiotics, ecbolics; hospitalization to provide intensive care is needed in some cases.

• Acute, metritis causing systemic debility, septicemia, toxemia and even death.

• Little is known of the pathogenesis in dogs.
• May be an association with large litters ( → prolonged parturition → secondary uterine inertia); or fetal oversize (single puppy → dystocia Dystocia → secondary uterine inertia).
• Hypocalcemia Hypocalcemia could predispose to condition because of relative uterine inertia.

• Metritis may rapidly ensue → toxemia.

• Diagnosed and resolved within the first week after whelping.

• Unknown.

• Post-partum vulvar discharge.

• Recent whelping.
• Persistent copious, dark green or brown vulvar discharge 24 hours post-partum.
• Palpable masses (fetuses or fetal membranes) in the abdomen.

• No single ubiquitous clinical presentation.
• Dark green or brown vulvar discharge, occasionally malodorous.
• Bitch is usually bright, alert and responsive but can be debilitated.

• Palpation of abdominal mass consistent with retained puppy may be possible in relaxed bitches.

• For retained puppy - more than one fetus may be retained, especially after protracted whelping.

• To determine fetal presence and viability.
• Excessive intra-uterine fluid.

• Vaginal cytology:
  • May show hairs and striated muscle if a fetus is undergoing autolysis.

• Vaginal abnormalities that cause a discharge (tears, tumors, infection, etc).
• Vaginal trauma associated with parturition and dystocia resulting in vaginitis Vaginitis.

• Urinary tract infections.
• Post-partum metritis Acute metritis.

• Broad-spectrum antibiotics (if no retained fetus).

• Broad spectrum antibiotics.
• PGF2 alpha 0.1 mg/kg SQ BID-SID.
• Hysterotomy to remove retained fetal membranes and fetus (sometimes decomposing fetal parts).
• Hysterectomy.

• Complete involution of the canine uterus is relatively slow when compared to other domestic species. Vaginal smears may reveal red blood cells up to 40 or 50 days postpartum. Vaginal cytology should be consistent with normal diestrus/anestrus in that time. Involution of the placental sites is complete by 12 weeks postpartum. Ultrasonographic appearance of the postpartum uterus is similar to the echogenicity of the anestrous uterus by 15 weeks postpartum.

• Good for both survival and future breeding if a bitch does not become septicemic.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Grundy S A, Davidson A P (2004) Theriogenology question of the month. Acute metritis secondary to retained fetal membranes and a retained nonviable fetus. JAVMA 224 (6), 844-847 PubMed.

Other sources of information

• Johnston S D, Root-Kustriz M V, Olson P N S (2001)Canine and Feline Theriogenology.Philadelphia, W B Saunders Co.