Chapter 7: Table of Contents
Remove the puppy located within the uterine body first, then, ‘milk’ puppies/kittens out one by one by externally massaging the horn and pushing each puppy/kitten towards the incision. When the puppy/kitten is close to the incision, the surgeon can also gently grasp it to help retrieval. Once exposed, open the amniotic sac to free up the puppy/kitten.
Identify the umbilical structures, double clamp these structures, transect between the clamps to release the puppy/kitten and pass it to a non-sterile assistant for resuscitation and ligation of the umbilical structures. Do not hold the puppy/kitten by the umbilical clamp as you pass it over as this can lead to umbilical hernia. Then, gently pull on the placenta, using the remaining umbilical clamp, to separate it from the uterus. If the placenta is well adhered or if significant bleeding occurs when separation is attempted, leave the placenta in-utero and move on to the next puppy/kitten. Retrieve each puppy/kitten, one by one, and make sure to palpate the entire uterus from ovary to uterine body to ensure that a puppy/kitten has not been left behind.