Retained fetal membranes / retained fetus

• Failure of expulsion of fetal membranes during third stage of labor. Occasionally a dead or live fetus also retained.
• Treatment: conservative usually successful; hysterotomy or hysterectomy essential if conservative management fails or if the cat owner has no future breeding plans.
• Prognosis: failure to treat can result in toxemia, metritis and death.

• Sometimes a normal kitten may be present several days after the birth of the rest of the litter  .
• May be no clinical symptoms for several weeks post partum if only a small portion of the fetal membranes remains.
• Vulvar discharge.
• If several days post partum, systemically debilitated, febrile, toxemic and presence of dark, foul smelling vulvar discharge.

• Toxic syndrome a day after onset of vaginal delivery.
• Dystocia Dystocia: maternal Dystocia: fetal.
• Fetal membranes or fetus protruding from vulva.

• Young, pubertal animals becoming pregnant when body size <65% of adult size.

• If Caesarean section Cesarean section / hysterectomy Ovariohysterectomy required.

• Little known of the pathogenesis in cats.
  Remember that breaks of several days between the birth of kittens can be normal.
• May be an association with large litters (prolonged parturition may lead to partial primary uterine inertia; or fetal oversize  or obstruction may lead to dystocia and subsequently to secondary uterine inertia).

• Metritis   →   toxemia.

• Varies from hours to a few days.

• Post-partum vulvar discharge.

• Recent parturition.
• Persistent copious vulvar discharge post partum.
• Palpable masses (fetuses or fetal membranes) in the abdomen.

• Normal queen.
• Pyrexia.
• Anorexia.
• Depression.
• Lactation ceases Lactation failure.
• Copious odiferous vaginal discharge.
• Occasionally symptoms delayed for several weeks post partum if only a small amount of placenta remains.

• Abdominal palpation and ultrasonography Ultrasonography: uterus revealing mass consistent with enlarged uterus and retained kitten.

Radiography

• Will reveal dead retained kitten, or partial uterine enlargement indicating retained placenta.

Ultrasonography

• To determine fetal presence and viability            .

Other

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

• Vaginal abnormalities that cause a discharge, eg tears, tumors Vaginal neoplasia, infection Vaginitis.

• Urinary tract infections Feline lower urinary tract disease (FLUTD).

Retained fetal membranes

• Broad-spectrum antibiotics Therapeutics: reproductive system (if no retained fetus).

Retained fetal membranes

• Broad-spectrum antibiotics Therapeutics: reproductive system and oxytocin Oxytocin (2-5 USP units SC or IM, or 0.5-1.25 USP units of a diluted solution slowly IV).

Retained fetus

• If this fetus is not born after the usual attempts to stimulate uterine activity are made (3-5 USP units oxytocin IM Oxytocin following blood chemistry for calcium (5 ml of 10% calcium gluconate Calcium gluconate given slowly IV)) it can be monitored until expulsion of fetuses are observed. PGF2alpha (dinoprost Dinoprost trimethamine) 2 mg SC per cat or 0.1 mg/kg can also be used if no response to oxytocin. Caesarean section Cesarean section is a more pragmatic approach if no response is obtained.

• Observation of elimination of fetuses and retained fetal membranes following treatment.

Treatment

• Implement course of systemic antibiotics.

Monitoring

• Monitor patient overall demeanor, resolution of significant vulvar discharge; watch for signs of toxic metritis (fever, anorexia, purulent vulvar discharge, etc).

• Fair to good, depending on status of overall health (absence of toxemia, etc).

• Judicious use of oxytocin and calcium gluconate associated with antibiotic therapy is usually successful; surgical approach (hysterotomy or ovariohysterectomy) is invariably curative.

• Medical treatment not efficient if obstructive dystocia is present; however, surgical approach will resolve most conditions.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Ekstand C & Linde-Forsberg C (1994) Dystocia in the cat: A retrospective study of 155 cases. JSAP 35 (9), 459-464 VetMedResource.