The topic of reproductive emergencies immediately brings to mind the whelping bitch and the potential requirement for emergency veterinary intervention. From this point however, my knowledge of all other reproductive emergencies becomes somewhat hazy perhaps because I have rarely encountered other types of reproductive emergencies in my veterinary career. I also don’t remember being taught much about this subject matter at vet school.  Elizabeth Thomovsky DVM, MS, DACVECC who led this recent webinar agreed she had also experienced the same lack of education around reproductive emergencies but unlike me had far more experience dealing with them. Elizabeth was able to give us the benefit of her extensive experience within this webinar and offered a guiding light on this black hole of veterinary medicine.

Dystocia, the most common reproductive emergency, was discussed by Elizabeth in depth and if you were ever in doubt about when a client needs to seek veterinary help for their whelping bitch and what interventions should be made, this webinar will deliver clarity and should not be missed. I did however want to point out some of the less common presentations of reproductive emergencies discussed by Elizabeth within this blog. Testicular torsion falls into this category and to my knowledge, I have yet to encounter this condition in practice but of course there may well be a chance I could have just missed a case. Elizabeth explained this condition is usually seen in dogs with an undescended testicle which is, more often than not, neoplastic with the boxer breed being predisposed. Often these patients present with a painful abdomen but interestingly usually have no gastrointestinal signs. Diagnosis is by ultrasound location of the testis (which will have diminished or absent blood flow) and surgical removal of this affected testis is the treatment of choice.

Uterine torsion, although rare, can also present as an emergency and is usually seen in multiparous animals in the later stages of pregnancy. It can also be occasionally seen in animals suffering from pyometra. Typically, only one horn is twisted at the base and patients usually present with vomiting and restlessness. They may also have a haemorrhagic discharge and could present in hypovolaemic shock. An exploratory laparotomy is usually required to make a definitive diagnosis and Elizabeth advises when performing an ovariohysterectomy in an affected patient to always remove the twisted uterus en bloc and do not perform a derotation which would cause the harmful systemic release of inflammatory mediators.

Prostatitis is another condition discussed by Elizabeth and as it happens a condition I only recently encountered as an out of hours emergency. These cases usually present as male entire dogs with caudal abdominal pain associated with vomiting, anorexia and pyrexia. These dogs may also have a preputial discharge and will be very painful on rectal examination. Urinalysis usually reveals a haematuria, pyuria and bacteriuria and ultrasound shows an enlarged prostate with mixed echogenicity. Four to six weeks of antibiotics which are able to penetrate the blood prostate barrier should be used and include TMS, clindamycin and fluoroquinolones. Castration can also be useful to reduce the size of the prostate in the long term. Prostatitis can however lead to complications such as a prostatic abscess and/or sepsis. An abscess needs to be drained using ultrasound as guidance or will require surgical intervention. Sepsis is however a serious concern especially where an abscess has formed and indicators for the development of this potentially fatal condition include hypoalbuminaemia, leucopenia with a left shift, hypotension, pyrexia and peripheral oedema. Supportive care which includes systemic antibiotics and aggressive fluid therapy is necessary to treat these cases. Sadly, the case I encountered in practice presented as an obtunded dog with severe caudal abdominal pain and a purulent preputial discharge which eventually succumbed to sepsis demonstrating just how serious and life-threatening these cases can be.

Elizabeth gave an excellent overview of the types of reproductive emergency cases we are likely to see in practice and although rare, it is essential we are aware of their presenting signs so we always consider them as part of our differential list in appropriate patients. I am now very pleased to say that where there once was a black hole in my knowledge of this particular area of emergency medicine, Elizabeth has successfully closed this gap by delivering an engaging, practical and informative webinar.