Cesariana em animais de companhia: opções cirúrgicas e fatores de risco
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2016-04-01
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O estudo retrospetivo incluiu quarenta e duas cadelas e quinze gatas sujeitas a cesariana por distócia (grupo CD e GD, respetivamente) e treze cadelas sujeitas a cesariana eletiva (grupo CE). Todos os casos foram recolhidos no Hospital Referência Veterinária Montenegro, durante o período de Março de 2008 até Junho de 2014.
A cesariana pode ser indicada durante a gestação tardia em cadelas e gatas para resolução de casos de distócia ou remover um feto não viável. O objetivo deste estudo retrospetivo foi o de avaliar, em cadelas e gatas, as indicações para cesariana, a técnica cirúrgica aplicada, os protocolos anestésicos usados e analisar a influência que certas variáveis (idade, tamanho da fêmea/raça, raça braquicéfala, tamanho da ninhada, gestações anteriores, distócias prévias, tempo de gestação, dados ecográficos de viabilidade fetal, doseamento de progesterona, causa da distócia, cesariana por distócia/eletiva) têm sobre as taxas de sobrevivência dos neonatos nos três diferentes grupos.
A média (DP) de idades no grupo CD foi de 3,59 ± 1,78 anos (intervalo 1-8), no grupo CE de 3,35 ± 1,43 anos (intervalo 1-5) e no grupo GD de 3,13 ± 2,1 anos (intervalo 1-8). As raças com maior risco de distócia incluíram as de pequeno e grande porte, com maior incidência nos pinshers, yorkshire terrier, boxers, são bernardos e boieiros de berna. Nas gatas, o europeu comum foi a raça mais representada. A média da idade gestacional no momento da apresentação foi de 59,95 ± 2,34 dias (intervalo 56-65) no grupo CD e no grupo CE de 61,83 ± 1,72 dias (intervalo 60-65). Nas cadelas, 23,6% (n=13) dos casos de cesariana foram procedimentos eletivos e 76,4% (n=42) procedimentos para resolução de distócia. Nas gatas todas as cesarianas ocorreram por distócia. Neste estudo, retirando as causas de inércia secundária não conhecidas (16,7%; n=7 nas cadelas e 40%;n=6 nas gatas) 88,6% (n=31) e 55,6% (n=5) das distócias foram de origem materna nas cadelas e gatas, respetivamente. As distócias com origem fetal foram de 9,5 % (n=4) e 26,7% (n=4) nas cadelas e gatas, respetivamente. A inércia uterina primária foi diagnosticada em 69% (n=29) dos casos nas cadelas e 33,3% (n=5) dos casos nas gatas.
A cesariana foi realizada através de abordagem pela linha média ventral. A maioria dos protocolos anestésicos inclui a indução anestésica com propofol, seguido de intubação e manutenção com isoflurano e oxigénio. A taxa de sobrevivência foi de 100% para todas as fêmeas e nos neonatos foi de 89,2%, 76,4% e 71,8% no grupo CE,CD e GD, respetivamente.
A taxa de sobrevivência neonatal não foi influenciada por nenhuma das variáveis nos grupos CD e CE. Já no grupo GD esta foi influenciada pelo número de distócias prévias. No entanto, seria benéfico um aumento do número de amostras em cada grupo para melhor avaliação dos fatores de risco sobre a taxa de sobrevivência neonatal.
The retrospective study included forty two bitches and fifteen queens subjected to cesarean section for dystocia (group DB and DQ, respectively) and thirteen bitches subjected to elective cesarean section (EB group). All cases were collected in Hospital Referência Veterinária Montenegro during the period of March 2008 until June 2014. A cesarean section may be indicated during late pregnancy in bitches and queens for resolving cases of dystocia or remove a non-viable fetus. The aim of this retrospective study was to evaluate, in biches and queens, the indications for cesarean section, the surgical technique, the anesthetic protocols and analyze the influence of certain variables (age, female size/breed, brachycephalic breed, litter size, previous pregnancies, previous dystocia, gestational age, viability data of fetal ultrasound, progesterone assays, causes of dystocia , cesarean section for dystocia/elective) on the survival rates of neonates in three different groups. The mean (SD) age of the DB group was 3.59 ± 1.78 years (range 1-8), in EB group of 3.35 ± 1.43 years (range 1-5) and the group DQ of 3.13 ± 2.1 years (range 1-8). Breeds with higher risk of dystocia included the small and large ones, with the highest incidence in pinshers, yorkshire terrier, boxers, saint bernard and bouvier bernois. In queens, the common european breed was the most represented. The mean gestational age at presentation was 59.95 ± 2.34 days (range 56-65) in the DB group and EB group 61.83 ± 1.72 days (range 60-65). In bitches, 23.6 % (n=13) cases of cesarean section were elective procedures and 76.4 % (n=42) procedures for resolving dystocia. In all queens cesarean section was performed due to dystocia. In this study, removing the unknown causes of secondary inertia (14,3 %, n= 6 in bitches and 40%, n = 6 in queens) 73,8% (n = 31) and 55.6 % (n=5) of dystocia were of maternal origin in bitches and queens, respectively. The dystocia with fetal origin were 9.5% (n=4) and 26.7 % (n=4) in bitches and queens, respectively. Primary uterine inertia was diagnosed in 69 % (n=29) cases in bitches and 33,3 % (n=5) cases in queens. Cesarean section was performed through ventral midline approach. Most anesthetic protocols included the induction of anesthesia with propofol, followed by intubation and maintenance with isoflurane and oxygen. The survival rate was 100 % for all females and neonates was 89, 2 %, 76, 4 % and 71,8yy % in EB , DB and DQ group , respectively. Neonatal survival rate was not influenced by any of the variables in the DB and EB groups. In the DQ group survival rate was influenced by the number of queen’s previous dystocia. However, it would be beneficial to increase the number of samples in each group in order to obtain a more precise evaluation of risk factors on neonatal survival rate.
The retrospective study included forty two bitches and fifteen queens subjected to cesarean section for dystocia (group DB and DQ, respectively) and thirteen bitches subjected to elective cesarean section (EB group). All cases were collected in Hospital Referência Veterinária Montenegro during the period of March 2008 until June 2014. A cesarean section may be indicated during late pregnancy in bitches and queens for resolving cases of dystocia or remove a non-viable fetus. The aim of this retrospective study was to evaluate, in biches and queens, the indications for cesarean section, the surgical technique, the anesthetic protocols and analyze the influence of certain variables (age, female size/breed, brachycephalic breed, litter size, previous pregnancies, previous dystocia, gestational age, viability data of fetal ultrasound, progesterone assays, causes of dystocia , cesarean section for dystocia/elective) on the survival rates of neonates in three different groups. The mean (SD) age of the DB group was 3.59 ± 1.78 years (range 1-8), in EB group of 3.35 ± 1.43 years (range 1-5) and the group DQ of 3.13 ± 2.1 years (range 1-8). Breeds with higher risk of dystocia included the small and large ones, with the highest incidence in pinshers, yorkshire terrier, boxers, saint bernard and bouvier bernois. In queens, the common european breed was the most represented. The mean gestational age at presentation was 59.95 ± 2.34 days (range 56-65) in the DB group and EB group 61.83 ± 1.72 days (range 60-65). In bitches, 23.6 % (n=13) cases of cesarean section were elective procedures and 76.4 % (n=42) procedures for resolving dystocia. In all queens cesarean section was performed due to dystocia. In this study, removing the unknown causes of secondary inertia (14,3 %, n= 6 in bitches and 40%, n = 6 in queens) 73,8% (n = 31) and 55.6 % (n=5) of dystocia were of maternal origin in bitches and queens, respectively. The dystocia with fetal origin were 9.5% (n=4) and 26.7 % (n=4) in bitches and queens, respectively. Primary uterine inertia was diagnosed in 69 % (n=29) cases in bitches and 33,3 % (n=5) cases in queens. Cesarean section was performed through ventral midline approach. Most anesthetic protocols included the induction of anesthesia with propofol, followed by intubation and maintenance with isoflurane and oxygen. The survival rate was 100 % for all females and neonates was 89, 2 %, 76, 4 % and 71,8yy % in EB , DB and DQ group , respectively. Neonatal survival rate was not influenced by any of the variables in the DB and EB groups. In the DQ group survival rate was influenced by the number of queen’s previous dystocia. However, it would be beneficial to increase the number of samples in each group in order to obtain a more precise evaluation of risk factors on neonatal survival rate.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Complicações do trabalho de parto , Distócia , Procedimentos cirúrgicos eletivos , Animais de estimação , Taxa de sobrevivência neonatal