BLBS078-CF_A01 BLBS078-Tilley July 23, 2011 2:42 2 Blackwell’s Five-Minute Veterinary Consult A Abortion, Spontaneous (Early Pregnancy Loss)—Cats r r loss, discovery of fetal material, behavior Urethral obstruction Intestinal foreign r change, anorexia, vomiting, diarrhea. body, pancreatitis, peritonitis Trauma r BASICS Physical Examination Findings Impending parturition or dystocia Purulent, mucoid, watery, or sanguinous CBC/BIOCHEMISTRY/URINALYSIS DEFINITION r r r vaginal discharge; dehydration, fever, May be normal. Inflammatory leukogram Spontaneous abortion—natural expulsion abdominal straining, abdominal discomfort. or stress leukogram depending on systemic r of a fetus or fetuses prior to the point at which CAUSES disease response. Hemoconcentration and they can sustain life outside the uterus. r Infectious azotemia with dehydration. Early pregnancy loss—generalized term for r OTHER LABORATORY TESTS any loss of conceptus including early Bacterial—Salmonella spp., Chlamydia, Brucella; organisms implicated in causing Infectious Causes embryonic death and resorption. r PATHOPHYSIOLOGY abortion via ascending infection include Cytology and bacterial culture of vaginal r Escherichia coli, Staphylococcus spp., discharge, fetus, fetal membranes, or uterine Infectious causes result in pregnancy loss by Streptococcus spp., Pasteurella spp., Klebsiella contents (aerobic, anaerobic, and r directly affecting the embryo, fetus, or fetal spp., Pseudomonas spp., Salmonella spp., mycoplasma). FeLV—test for antigens in membranes, or indirectly by creating Mycoplasma spp., and Ureaplasma spp. r r queens using ELISA or IFA. FHV-1—IFA debilitating systemic disease in the queen. Protozoal—Toxoplasma gondii— r r or PCR from corneal or conjunctival swabs, Non-infectious causes of pregnancy loss uncommon. Viral—FHV-1; FIV; FIPV; viral isolation from conjunctival, nasal, or r result from any factor other than infection FeLV;FPLV—virusesarethemostreported pharyngeal swabs. FIPV—PCR for mRNA that leads to the death or premature expulsion cause of infectious abortion in the queen. of the M gene of feline coronavirus of the conceptus (e.g., inadequate maternal Non-infectious (Molecular Diagnostics, College of Veterinary nutrition, endocrine dysfunction, toxicity, r Medicine, Auburn University, genetic defects). Uterine—CEH-pyometra complex, chronic endometritis, mechanical trauma to uterus or http://www.vetmed.auburn.edu/ SYSTEMS AFFECTED r feline infectious peritonitis virus2). r r r fetus. Ovarian—hypoluteoidism; genetic r Endocrine Reproductive Other FIV—ELISA—confirm positive results with defects are more prevalent; early termination r systems—any debilitating illness can result in of corpora lutea function causes a decline in Western blot. FPLV—viral isolation from pregnancy loss. serum progesterone concentrations, resulting fetuses submitted for necropsy; document r GENETICS in early parturition (abortion). Fetal— seroconversion in the queen. Genetic defects more prevalent in highly chromosomal abnormalities resulting in Non-infectious Causes abnormal or arrested development and r inbred individuals; heritability of r Hypoluteoidism—serum progesterone susceptibility to FIPV very high. embryonic or fetal death. Systemic—taurine levels; low levels do not indicate a primary deficiency; vitamin A deficiency or toxicity; cause unless documented prior to the INCIDENCE/PREVALENCE r malnutrition; severe non-reproductive illness; abortion. To rule out anovulatory cycle, Unknown—pregnancy frequently not exogenous drug administration: estrogens, confirm progesterone rise greater than 1.5 ng/ confirmed, owners may not recognize late r glucocorticoids, prostaglandin F2α,and ml 1 week following mating. Behavioral pregnancy loss if the queen is fastidious; early dopamine agonists (cabergoline, evidence of estrus and vaginal cytology can embryonic death is difficult to document; bromocriptine) will disrupt normal corpus confirm estrus; repeatedly obtaining vaginal genetic abnormalities account for ∼15% of luteum function; fetotoxic or teratogenic cytology samples may induce ovulation. pregnancy loss in cats, including abortion. drugs: chemotherapeutic agents, anti-fungal IMAGING SIGNALMENT agents (griseofulvin), steroids, some r Abdominal ultrasound—confirm antibiotics (trimethoprim-sulfonamides, Species pregnancy; screen for evidence of resorption; quinolones, tetracyclines, gentamicin), Cats evaluate health and viability of fetus(es) and antiepileptic medications (phenytoin); Breed Predilections associated fluid and membranes; abnormal modified live vaccines. Purebred cats—higher incidence of uterine fluid accumulation and RISK FACTORS r non-infectious abortion; in-breeding increases r non-reproductive disease. Radiograph— Previous history of pregnancy loss risk of genetic disease; abortion is a r r evaluates relative size, number, and position of Concurrent systemic disease Recent consequence of certain forms of heritable r fetal skeletons; can be used to screen for fetal trauma Purebred cat with high degree of diseases (lethal genetic defect, fatal r monsters, fetal malpresentation, and COPYRIGHTEDin-breeding Very young or old MATERIAL queen chromosomal error). r r non-reproductive disease. Mean Age and Range Malnourishment Overcrowded or DIAGNOSTIC PROCEDURES unsanitary environment r Infectious abortion seen in all ages; Genetic defects—necropsy aborted non-infectious abortion seen more commonly fetus(es); submit samples from aborted and in young and aged queens. stillborn fetus to lab for karyotyping. r SIGNS Nutrition—submit sample of diet for DIAGNOSIS General Comments nutritional analysis if concerned about taurine or vitamin A levels in diet, of particular Early embryonic death and resorption DIFFERENTIAL DIAGNOSIS r importance when queen is fed a homemade frequently have no clinical symptoms; any Early pregnancy loss ◦ Failure to r r diet. Complete history and evaluation of combination of historical and physical conceive ◦ Anovulatory cycle Vulvar pedigree to calculate coefficient of examination findings may occur, with some discharge ◦ Pyometra, mucometra, uterine r in-breeding. Evaluate cattery for vaccination queens displaying no symptoms. stump pyometra ◦ Vaginitis, metritis, cystitis ◦ Impending parturition or dystocia protocols, feeding regime, general sanitation Historical Findings procedures, and quarantine procedures for ◦ Neoplasia or trauma of urinary bladder, r Failure to deliver litter at expected time, ◦ pregnant queens and new arrivals. Submit return to estrus sooner than expected, urethra, vagina, or uterus Estrus—very little discharge typically seen reproductive tract (uterus, ovaries, uterine decrease in abdominal diameter and weight r Abdominal straining or discomfort tubes) to reproductive pathologist to evaluate for anatomical and pathological changes. BLBS078-CF_A01 BLBS078-Tilley July 23, 2011 2:42 Canine and Feline, Fifth Edition 3 Abortion, Spontaneous (Early Pregnancy Loss)—Cats A r r Send aborted, stillborn, mummified depending on bacterial culture results. determine stopping point. Serial ultrasound r fetus(es) and fetal membranes (fresh, Dinoprost tromethamine (PGF2α) 0.05– evaluation q 5–7 days to evaluate fetal viability refrigerated, on wet ice) to reproductive 0.2 mg/kg SC Q 6–12 hours for evacuation of for queens receiving tocolytics drugs if not pathologist for gross necropsy, histopathology, uterine contents; continue until uterine monitored daily with tocodynamometry. cultures, and viral isolation; serum from dam; evacuation complete based on PREVENTION/AVOIDANCE r r fetal stomach contents and fetal blood useful. ultrasonographic evaluation. Terbutaline Institute infectious disease prevention, r 0.08–1.0 mg PO as needed based on control, and surveillance plan. Replace tocodynamometry; 0.03 mg/kg PO q8h if r infertile queens with more reproductively fit r tocodynometry not available. Progesterone individuals. Avoid exposure to abortifacient, TREATMENT in oil—2.0–3.0 mg/kg IM as needed based on teratogenic, or fetotoxic drugs. tocodynamometry; q72h if tocodynometry APPROPRIATE HEALTH CARE not available. POSSIBLE COMPLICATIONS r ◦ r r Outpatient management: Typically no CONTRAINDICATIONS Depends on etiology. Metritis, medical management required for r endometritis, uterine rupture, sepsis, shock. r non-infectious stable queens; queens with PGF2α—intended pregnancy, respiratory Diabetes, CEH, masculinization of female compromise, renal compromise, severe infectious disease should be isolated and r fetuses with progesterone treatment. treated appropriately. ◦ Hypoluteoidism— uterine pathology. Terbutaline—cardiac or respiratory disease, pyometra, infectious EXPECTED COURSE AND PROGNOSIS can be managed on an outpatient basis with r r disease, hypertension. Progesterone in oil— Infectious disease—normal pregnancy, tocolytics drugs in combination with repeated abortion, or infertility possible with diabetes, pyometra, infectious disease, CEH. r tocodynamometry if value of queen outweighs viral disease. Poor prognosis for normal potential to perpetuate this possibly heritable PRECAUTIONS r pregnancy in queens with severe CEH. r r condition. Inpatient medical management: Queens tolerate PGF2α treatment well Good prognosis for successful pregnancy ◦ Required for systemic illness and treatment compared to bitches but clients should give r with treatment for hypoluteoidism; significant with prostaglandin F2α. Surgical informed consent prior to instituting therapy; monitoring required for good outcome. ◦ r management: OHE for queens