Management of uterine haemorrhage

Floss needed help to deliver a precious bundle over the weekend. At emergency section, she had a complication . Before closing her abdomen, I wasn’t happy with a slow bleed from one site on her uterine wall. It was where we peeled the placenta away of the little puppy with the cleft palate in a previous post.

I watched and waited at surgery, but the slow bleed wasn’t stopping. It wasn’t dramatic, but it was enough to worry me. We routinely give oxytocin intraoperatively which is a hormone which has multiple effects including helping the uterus to contract down after birth. It’s quite amazing to watch it during surgery; the uterus literally shrinks and contracts down in size as the hormone takes effect on the muscle in the wall if the womb.

When her bleed wasn’t stopping, I gave an additional dose. She wasn’t haemorrhaging from the incision in her womb; it was internal in the wall where the placenta was attached.

Traditionally we always spay if there is an unacceptable amount of haemorrhage at c-section surgery; but I really don’t like spaying during a caesarean because it’s increased risk for the mother. You’re removing a huge, blood filled organ. You’re taking away the ovaries with all of their hormonal switches. You’re inducing menopause in a mum with a litter of puppies. It has enormous psychological, physiological and emotional effects on the mum.

Also, if there’s bleeding where there shouldn’t be, there’s a chance we’re dealing with a dog that has poor clotting ability, and they can bleed much more heavily from the spay surgery and have increased risk.

I was talking to my fab surgeon sister about the problem recently, and she told me that in humans, they pack the uterus tightly with swabs. So I decided to offer that option to the owner. I’m 22 years in practice, and still trying new things!

As it was a slow bleed, I was happy to isolate the area and pack the horn of the uterus where it was coming from. I closed her up and slept soundly knowing she wouldn’t haemorrhage internally overnight. She was very happy, and relaxed at home and nursed her puppies beautifully overnight. I took her back to theatre after 24 hours and removed the swabs; and everything was perfect. She bounced out of her anaesthetic and was quickly nursing her puppies again peacefully.

Floss can be safely spayed now in a much lower risk surgery once the pups are weaned at eight weeks. So far she’s been an amazingly relaxed and happy mum, and I’m delighted to have had a really good and safe option for managing her bleed.

Collaboration with my surgeon sister has been fun lately. She’s full of great ideas; but she also loves to hear about the variety we deal with. I’ll let her stick to humans; I’m pretty happy with my furry patients. Secretly, I’m actually extremely squeamish when it comes to humans…. anybody else…. ??