ABORTION AND PREGNANCY LOSS IN DOGS 

What are abortion and pregnancy loss in dogs? 

Abortion is the delivery of one or more foetuses that cannot live outside the uterus. The foetus may be alive or dead at the time of deliver; if alive, it dies shortly after birth. Pregnancy loss includes all causes of termination of pregnancy, such as death of embryos, reabsorption of foetuses, abortion at any stage of pregnancy, and stillbirth. Embryos are developing puppies early in the pregnancy, before they have a recognizable form. A foetus is the unborn puppy that has developed to the point of being recognizable as a puppy. 


What causes abortion or pregnancy loss in dogs? 

Abortion or pregnancy loss may be caused by problems with the foetus or the bitch. The bitch is the mother dog. The causes of abortion in dogs include:

  • Infectious causes, such as Brucella canis, canine herpes virus, Toxoplasma, Escherichia coli, Streptococcus
  • Uterine causes, such as infection of the uterus (pyometra) 
  • Trauma 
  • Cancer 
  • Drugs, such as chemotherapeutic drugs, chloramphenicol, oestrogen, high dose steroids, or prostaglandins 
  • Hormonal problems, such as hypothyroidism (inadequate production of thyroid hormone by the thyroid gland) or insufficient progesterone production 
  • Foetal defects 
  • Difficult birth (dystocia) caused by the foetus, such as abnormal position of the foetus, excessively large size of the foetus, or breed-related delivery problems (seen in bulldogs, where the large head size of the puppy compared to the size of the bitch's pelvis leads to difficulty in delivery) 
  • Difficult birth (dystocia) caused by maternal (bitch) problems, such as a small pelvis, lack of strong uterine contractions, twisting or malformation of the uterus, or medical conditions leading to weakness or fatigue 

How is abortion or pregnancy loss diagnosed in dogs? 

Abortion or pregnancy loss is recognized by failure of the mother dog (bitch) to have her puppies on time, a decrease in her abdominal size, or the delivery of recognizable foetuses or placenta. The bitch may have vomiting and diarrhoea, poor appetite, depression, dehydration, or fever. She also may have vulvar discharge, abdominal straining, and discomfort. The vulvar discharge may be bloody or may contain pus.

Pregnancy loss is confirmed, if necessary, by disappearance of foetuses formerly identified by the veterinarian feeling the developing puppies (palpation), radiographs (X-rays), or ultrasound (visualization of developing puppies by ultrasonic waves). Radiographs help identify foetal structures in later stages of pregnancy. Ultrasound is useful in identifying uterine size and contents and allowing assessment of the fluid in the uterus and the remains of foetuses. It also can indicate the presence of foetal heartbeats, indicating live puppies in the uterus. The veterinarian may perform serologic tests for Brucella canis, canine herpes virus, and Toxoplasma to rule out these infectious causes. If no infectious agents are identified, thyroid hormone and progesterone concentrations are measured to rule out hormonal problems. Other diagnostic procedures may include vaginoscopy (inserting a lighted scope into the vagina and examining the vagina), bacterial cultures of the female reproductive tract, and examination and bacterial culture of foetal and placental tissue. 



How is abortion or pregnancy loss treated in dogs? 

Affected dogs should be confined and isolated while the cause of the abortion or pregnancy loss is determined. Antibiotics are indicated if a bacterial infection is suspected or confirmed. The bitch may be given fluids to correct dehydration. An attempt can be made to salvage the remaining live foetuses in bitches that have had partial abortions. Uterine evacuation after abortion can be accomplished by ovariohysterectomy or, if breeding is important, the administration of prostaglandin. Vulvar discharge should be evaluated daily; resolution of disease is indicated by a decreasing amount of discharge and by an increasing amount of mucus in the discharge.

Brucella canis is highly infectious to other dogs. If Brucella canis has been identified and confirmed as the cause of the abortion, the first recommendation is to consider euthanasia of the bitch to prevent spread of the disease. Treatment of dogs with brucellosis frequently is unsuccessful. If euthanasia is not an option, the second recommendation is to perform an ovariohysterectomy (spay) followed by long-term administration of antibiotics.

What is the prognosis for dogs having an abortion or pregnancy loss? 

The prognosis (outcome) for dogs having an abortion or pregnancy loss depends on the underlying cause. Ovariohysterectomy (spay) and other specific treatments of the cause often lead to a good prognosis in dogs with non-infectious causes of abortion. With infectious causes, the prognosis depends on the infectious agent, severity of infection, and aggressiveness of treatment.  

CANINE LOST PREGNANCY
Diagnosis and Prevention

Establishing and maintaining pregnancy is dependent on many biological interactions between the embryo or fetus and the pregnant female. For approximately 12 days after fertilization, free-floating embryos are dependent on the fluid environment within the uterus for development. If this environment is inhospitable (due to inflammation, hormonal imbalances, infection etc.), embryos may not survive. Death of embryos during this period often goes unnoticed because the embryos are resorbed before pregnancy has been detected. Most embryonic losses occur during this period and at implantation, when attachment to the uterus first takes place. These losses are collectively referred to as early embryonic deaths. After implantation, embryos depend almost entirely on the dam and will not survive if she is unable to adjust to the physical requirements and demands of pregnancy. Factors that lower the odds for survival include fetal or maternal abnormalities, nutritional deficiencies, environmental stresses or infectious causes. Infectious agents are the most common cause of canine abortion.

A number of pathogens are associated with canine abortion. Brucella canis is most prevalent in kennel situations where contact with infective discharges and fetal tissues may result in infection and possible abortion in susceptible females. Infected males may spread the disease to non-infected females at breeding. Breeding kennels should routinely test all animals for B. canis. To date, there is no permanent cure for B. canis infection in the dog. Therefore, infected animals must not be bred again and should be removed from contact with other breeding animals. 

Neospora caninum can infect the brain and spinal cord of developing fetuses or neonates. Newborns have progressive muscular weakness leading to death. Toxoplasma gondii is a protozoal parasite causing mild disease in adult dogs. It’s affects may be more severe when present with distemper virus, which is known to suppress the immune system. Fetal infection may occur and T.gondii has been found in the milk of lactating bitches. Mycoplasma and Ureaplasma species have been cultured from the cranial vagina and prepuce of healthy, fertile animals. However, when females are housed in crowded kennels, close contact and environmental conditions can lead to increased numbers of these organisms, resulting in infertility and pregnancy losses. Providing adequate space, a clean environment and separation of individual breeding animals will greatly reduce the risk of abortion resulting from these and other bacterial infections. 

Canine distemper and adenoviruses may cause spontaneous abortion with or without fetal infection. Canine herpes virus abortions have been associated with chronic infertility and cannot be effectively treated at present. Affected females should be isolated from susceptible pregnant animals. Viral abortions are most often due to the stress of clinical disease in the bitch. These can be prevented by routine vaccinations. Pregnant females should not be vaccinated with modified-live vaccines, as these could adversely affect fetal survival. 

To control infectious causes of abortion, bitches should be vaccinated regularly and tested for potential abortion-related pathogens prior to breeding. HealthGene Laboratory is offering two problem-specific DNA profiles that include the combination of DNA tests for most common pathogens causing abortion in dogs: Canine Loss Pregnancy Profile (Brucella canis, Staphylococcus aureus, Streptococcus spp, Mycoplasma spp., Ureaplasma spp., Canine herpes virus, Chlamydophila spp.).

With any abortion, the bitch should be presented to a veterinarian as soon as possible for a complete physical examination and collection of samples for diagnostic testing. In most cases, these diagnostic procedures will not save the pregnancy, but they will help identify the appropriate supportive medical therapy and the management practices necessary to prevent future abortions. We recommended submitting a blood sample (EDTA tube) as well as a vaginal swab in a sterile container from bitches with the recent case of abortion or which will be used for the future breeding. Also, our laboratory recommends testing the sire that was used or will be used for breeding by submitting a blood as well as a semen sample. DNA tests on the semen can be done using our Canine Semen Profile (Brucella canis, Mycoplasma spp., Ureaplasma spp., Chlamydophila spp., Canine herpes virus, Leptospira spp.)

One of the most important but often overlooked diagnostic procedures is the examination of the aborted fetuses and their associated membranes. In some cases, the bitch may consume aborted fetuses before they can be retrieved, but when these fetuses are available, they should be collected in as clean a manner as possible and taken to the veterinarian with the bitch. DNA testing of selected fetal tissues may be recommended. 


Health Gene
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CANINE ABORTION



Abortion is defined as the expulsion before full term of a conceptus that is incapable of independent life. Abortion is uncommon in the bitch, but when it does occur, owners should be aware of the treatment options and the prognosis for future fertility.

Establishing and maintaining pregnancy is dependent on many biological interactions between the embryo or fetus and the pregnant female. For approximately 12 days after fertilization, free-floating embryos are dependent on the fluid environment within the uterus for development. If this environment is inhospitable (due to inflammation, hormonal imbalances, etc.), embryos may not survive. 

Death of embryos during this period often goes unnoticed because the embryos are resorbed before pregnancy has been detected. Most embryonic losses occur during this period and at implantation, when attachment to the uterus first takes place. These losses are collectively referred to as early embryonic deaths (EED). 

After implantation, embryos depend almost entirely on the dam and will not survive if she is unable to adjust to the physical requirements and demands of pregnancy. Factors that lower the odds for survival include fetal or maternal abnormalities, nutritional deficiencies, environmental stresses or infectious causes. Abortions occur most commonly because placental function is compromised due to one or more of these reasons. Several possible non-infectious and infectious causes of EED and abortion are listed in Tables 1 and 2. 

Table 1
Non-infectious conditions associated with loss of pregnancy in the bitch

  • Embryonic/fetal defects
    These and related conditions have been associated with an increased incidence of early miscarriage in women. In the bitch, these could result in early embryonic death and infertility.
  • Aged gametes
    Breeding at inappropriate times may lead to aged eggs or sperm cells that have reduced fertility and may lead to abnormal development and death.
  • Chromosomal defects
    Defects in the genetic makeup may be incompatible with embryo survival.
  • Developmental defects
    Abnormal development of organ systems may not be compatible with fetal survival, leading to death and resorption or abortion.
  • Maternal environmental stresses
    These conditions often produce an adverse uterine environment that is incompatible with fetal development. Fetal death may occur at any stage of pregnancy, resulting in abortion.
  • Hypothyroidism
    Associated with increased danger of miscarriage in women. Lower than normal levels of circulating thyroid hormone may cause infertility in the bitch. 
  • Hypoluteoidism
    Deficient progesterone has been suggested as a cause of abortion in several animal species. Progesterone is required for the maintenance of pregnancy in the bitch. 
  • Nutritional deficiencies
    Energy and vitamin demands increase during pregnancy. If these are deficient, fetal survival may be compromised. 
  • Structural abnormalities
    Developmental (hypoplasia) or acquired (scar tissue) abnormalities result in compromised placental function that is unable to meet the demands of the growing fetus. 
  • Exposure to drugs/compounds
    The effects of many drugs/compounds on fetal development are unknown. Dexamethasone, a commonly used anti-inflammatory agent, has been reported to cause intrauterine death and resorption of fetuses when given to pregnant bitches. 

Table 2
Infectious conditions associated with loss of pregnancy in the bitch

  • Maternal environmental stresses
    Infectious agents gain access to the pregnant uterus via the blood stream or through the cervix. These can cause placental dysfunction leading to fetal death and in some cases may infect fetuses directly.
  • Brucella canis
    The most common bacterial cause of abortion in the bitch. Abortion occurs between 45 and 55 days of pregnancy. Infertility follows infection and abortion. Vaginal discharges and aborted fetal tissues are highly infectious to other females. 
  • Escherichia coli, Staphylococcus aureus, Streptococcus spp., other bacterial isolates
    These are frequently cultured from vaginal discharges or from fetal tissues after abortion. Their role in causing abortion is unknown. May be associated with infertility, persistent vaginal discharge and repeat abortions in older bitches. 
  • b-hemolytic Streptococcus
    Fetal infection has been reported, resulting in abortion or the birth of weak, nonviable pups.
  • Mycoplasma and Ureaplasma
    These are opportunistic organisms normally found in the vaginal canal. In large enough numbers, they may cause infertility, EED, resorptions, abortion, stillbirths and weak, nonviable pups. 
  • Canine herpesvirus
    Infections in newborn puppies are fatal. Causes vaginitis in the bitch. This virus can cross the placenta and infect puppies, resulting in fetal death, mummification, abortion, premature birth or delivery of weak, nonviable pups. 
  • Canine distemper virus
    May cause spontaneous abortion with or without fetal infection. Often abortion results from the stress of the clinical disease. 
  • Canine adenovirus (infectious hepatitis)
    May cause spontaneous abortion with or without fetal infection. Often abortion results from the stress of the clinical disease. 
  • Toxoplasma gondii
    Protozoal parasite causing mild disease in adult dogs. May be more severe when present with distemper virus, which is known to suppress the immune system. Fetal infection may occur and T. gondii has been found in milk of lactating bitches. 
  • Neospora caninum
    Recently identified protozoal parasite that resembles T. gondii, can infect brain and spinal cord of developing fetuses or neonates. Newborns have progressive muscular weakness leading to death. 

Diagnostic work-up
With any abortion, the bitch should be presented to a veterinarian as soon as possible for a complete physical examination and collection of samples for diagnostic testing. In most cases, these diagnostic procedures will not save the pregnancy, but they will help identify the appropriate supportive medical therapy and the management practices necessary to prevent future abortions. 

The attending veterinarian will want to know the breeding history of the bitch, including the breeding dates for this and previous pregnancies, sire(s), previous whelping dates and the results of previous pregnancies (number of puppies, assisted or unassisted delivery, abortion, etc.). The vaccination history of the bitch and the results of previous Brucella canis serology tests should be given also. Any clinical illness and medications given during pregnancy should be noted at this time as well. Type of housing and diet should be recorded. This information will assist the veterinarian in determining appropriate immediate care as well as recommendations for future breedings. 

The physical examination will provide information pertaining to general health, nutritional status and the possibility of an endocrine or other disease process. Abdominal palpation and radiographic or ultrasonographic examination will determine if additional fetuses are present in the uterus. Some or all fetuses may be aborted, or remaining live fetuses may be born normally at term. 

Laboratory diagnostic tests should include a complete blood count, serum chemistry profile, urinalysis, serologic test for B. canis infection and serum thyroid hormone level determination. These tests will require that one or more blood and urine samples be collected and submitted to a diagnostic laboratory. Most test results can be obtained in less than 24 hours. A culture of the anterior vagina or vaginal discharge should be taken to identify any potential bacterial infection and the appropriate antibiotic treatment. 

One of the most important but often overlooked diagnostic procedures is the examination of the aborted fetuses and their associated membranes. In some cases, the bitch may consume aborted fetuses before they can be retrieved, but when these fetuses are available, they should be collected in as clean a manner as possible and taken to the veterinarian with the bitch. Brucella canis infection has been reported in humans; therefore, aborted tissues suspected of being infected should be handled with extreme care. 

Histopathology and culture of selected fetal tissues may be recommended. If a bacterial cause is suspected, fetal stomach contents may be cultured, because fetuses swallow amniotic fluid as a normal process of pregnancy. These tests often require that samples be sent to a diagnostic laboratory. It may take several days for results to be returned. Chromosome analysis can be performed in the dog if abnormalities are suspected; however, the analysis is not commonly available. 

A bitch with a history of a difficult delivery resulting in trauma to the uterus or cervix may have scar tissue development that is incompatible with maintaining subsequent pregnancies. Exploratory surgery may be required to identify abnormal conditions of the ovaries and uterus in some bitches. Excessive scarring of the reproductive tract is often untreatable and correction of developmental uterine defects cannot be advised. Both of these conditions carry a poor prognosis for future pregnancies. 

Treatment
The bitch should be hospitalised to permit close observation, diagnostic evaluation and supportive therapy if needed. Intravenous fluids may be required to help stabilize a severely ill animal. Blood, urine and culture samples should be taken immediately. Antibiotics should be administered if the blood cell analysis and/or rectal temperature are consistent with the presence of infection. 

Compounds are available that increase uterine tone and aid in the evacuation of the uterus. These may be given if all of the fetuses have been aborted and if membranes are retained or if there is heavy bleeding from the uterus. The bitch should remain hospitalised while these compounds are administered and monitored with radiography or ultrasonography for complete emptying of the uterus. 

Prevention
Abortion is preventable primarily by maintaining good health prior to and during pregnancy. Females to be bred should have a good vaccination history and a negative B. canis titer. 

Supplemental vitamins should not be necessary provided a nutritionally complete commercial dog food is fed during pregnancy. The amount of food fed should be increased gradually throughout pregnancy to accommodate fetal growth. Pregnant females should gain about 30 percent of their non-pregnant weight by the end of pregnancy. 

For females with a history of abortion, a thyroid profile should be evaluated and supplemental thyroxine administered if indicated, beginning prior to breeding. 

Supplemental progesterone has been shown to maintain pregnancy in cases where low serum levels are suspected. However, this has proven difficult to validate experimentally because levels are known to be highly variable during pregnancy. Under the influence of progesterone, the uterus is more prone to infection. Also, external genitalia of female fetuses may be masculinized by the administration of progesterone during pregnancy. Therefore, supplemental progesterone should be given only after all other possible causes for repeated abortions have been eliminated. The effects of many other drugs on fetal development are unknown; therefore, if medical treatment is required during pregnancy, it should be done with this in mind. 

To control infectious causes of abortion, bitches should be vaccinated regularly prior to breeding and managed under strict sanitary conditions. Brucella canis is most prevalent in kennel situations where contact with infective discharges and fetal tissues may result in infection and possible abortion in susceptible females. Infected males may spread the disease to non-infected females at breeding. Breeding kennels should routinely test all animals for B. canis. To date, there is no permanent cure for B. canis infection in the dog. Therefore, infected animals must not be bred again and should be removed from contact with other breeding animals. 

Mycoplasma and Ureaplasma have been cultured from the cranial vagina and prepuce of healthy, fertile animals. However, when females are housed in crowded kennels, close contact and environmental conditions can lead to increased numbers of these organisms, resulting in infertility and pregnancy losses. Providing adequate space, a clean environment and separation of individual breeding animals will greatly reduce the risk of abortion resulting from these and other bacterial infections. 

Canine herpesvirus abortions have been associated with chronic infertility and cannot be effectively treated at present. Affected females should be isolated from susceptible pregnant animals. Viral abortions are most often due to the stress of clinical disease in the bitch. These can be prevented by routine vaccinations. Pregnant females should not be vaccinated with modified-live vaccines, as these could adversely affect fetal survival. 

Consulting a veterinarian prior to beginning a breeding program can help establish preventive management practices that will result in the birth of healthy litters. 


Jeanette L. Floss
David K. Hardin
College of Veterinary Medicine 
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MISMATING AND PREGNANCY TERMINATION

Dogs may be bred accidentally, or may get away from the owner when they are in heat with subsequent possible breeding. The average female dog is most fertile when she has been in heat about a week, and remains fertile for about another week. Several options exist for pregnancy termination.

Ovariohysterectomy (OHE) - Ovariohysterectomy is spaying. Pregnancy is terminated by physical removal of the ovaries and uterus. This is a successful and permanent contraceptive technique. Your veterinarian may not be comfortable spaying your dog when she is in an advanced stage of pregnancy, so please contact them as soon as possible after the accidental breeding. This is the preferred method of pregnancy termination in dogs that are not specifically intended for breeding.

"Mismate" shot = Estrogen - Estrogen injections terminate pregnancy by altering movement of the fertilized egg(s) into the uterus. For estrogen shots to be effective, they must be given after the dog has released eggs from the ovary (evidenced by concentration of progesterone in blood greater than 4-10 ng/ml) but before she goes out of heat (evidenced by assessment of vaginal cells on a swab). If the shot is given before she ovulates, it will not work. If the shot is given after she has gone out of heat, there is a relatively increased risk of inducing uterine disease (pyometra). We do not administer estrogen mismate shots at the University of Minnesota Veterinary Teaching Hospital.

Prostaglandin - Prostaglandins are a class of hormones that are naturally released in dogs at the end of their heat cycle. Prostaglandin F2alpha is the drug most commonly used for pregnancy termination in dogs. It terminates pregnancy by stopping production of the hormone progesterone, which is required for pregnancy maintenance, and by causing uterine contractions, which physically break down the pregnancy. Prostaglandin F2alpha can be used safely throughout pregnancy, allowing us to definitively diagnose the dog as pregnant before any medication need be given. Pregnancy diagnosis should be done one month after the accidental breeding. If the dog is not pregnant at that time, nothing need be done. If she is pregnant, prostaglandin F2alpha can be administered twice daily for four days. At this point of pregnancy, the pups will be reabsorbed, not aborted. Side-effects of the drug are short-lived, and include vomiting and salivation. Prostaglandin F2alpha is the drug preferred for pregnancy termination in dogs at the University of Minnesota Veterinary Teaching Hospital


Margaret V. Root Kustritz, DVM, PhD, DACT 
Department of Small Animal Clinical Sciences 
University of Minnesota College of Veterinary Medicine 
St. Paul, MN 55108 
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