Small animal veterinary case study - feline dystocia

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Case study

The patient was a 1.5-year old, 4.8kg, female (spayed), Domestic Long Haired cat that presented with a 2-week history of polyphagia and abdominal distension with a 12-hour history of straining to defaecate. The patient had been in the owner’s possession for 5 months. The previous owner had acquired her at 7 months of age. According to the history provided by the previous owner, the patient had been spayed and vaccinated and lived strictly indoors.

The current owner kept the patient as a primarily outdoor cat, however she would be brought into the house at night during the winter months.

Clinical Signs
On presentation, the patient was bright, alert and responsive. She had a body condition score of 6/9 with a pendulous, distended abdomen. Oral mucous membranes were pink and moist with a capillary refill time of <2 seconds. Heat rate was 180 beats per minute and thoracic auscultation was within normal limits. On abdominal palpation, several firm, spherical structures were palpable throughout the abdomen. Mammary development with milk production was also observed. The remainder of the physical examination was unremarkable.

Investigation
Despite the previous owner’s history reporting that the cat had been spayed, the current history and clinical examination findings, particularly the detection of suspected foetal skulls within the abdomen on palpation, was consistent with pregnancy. The possibility of dystocia was also present due to the 12-hour history of tenesmus.

An abdominal ultrasound examination was performed in the conscious patient to further evaluate the suspected pregnancy. On ultrasonography, several late gestation foetuses with apparent mineralisation of the skeleton are observed (Image 1).


All other abdominal organs have a normal ultrasonographic appearance.

As the mating date was unknown, the approximate age of the foetuses was determined using direct measurement of head diameter in the transverse plane and this numerical value was used in the following formula for estimating gestational age: Gestational age = (25 x Head Diameter) + 3. The average head diameter of three of the foetuses is 2.28cm. Therefore, the estimated gestational age is 60 days.

A digital vaginal examination was performed to determine if an underlying cause of the suspected dystocia was present. A vertebral column lying in the transverse plane cranial to the pelvic canal was detected. Therefore, obstructive dystocia secondary to foetal malpresentation was considered likely.

Foetal viability was also assessed through visualisation of foetal movement and a heartbeat in four of the foetuses. Colour flow Doppler was also employed to enable bloodflow through the heart to be demonstrated more clearly to the owner (Image 2).


The initial list of possible differential diagnoses for this case included pregnancy with or without dystocia, constipation, stranguria, obesity, gastrointestinal parasitism and abdominal neoplasia.

Diagnosis
Based on the clinical examination and ultrasonographic findings, a diagnosis of pregnancy with dystocia due to foetal malpresentation was made.

Treatment/procedure
The primary treatment option in this case was delivery of the kittens via caesarean section with or without concurrent ovariohysterectomy. Manual correction of the malpresentation digitally or through the use of instrumentation was not attempted due to the small size of the feline vaginal canal. The owner consented and opted for concurrent ovariohysterectomy to be performed.

The patient was placed under general anaesthesia and a caesarean section was performed with successful delivery of four live kittens. Ovariohysterectomy was performed and the surgical site closed routinely.

Outcome
The patient recovered without complications and she successfully reared four healthy kittens.

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