CLINICAL EFFICIENCY OF OXYTOCIN AND METOCLORPRAMIDE IN STIMULATION OF LACTATION IN BITCHES

S. Raheema1, C. Jayakumar2, J. Smitty and K. Devalal
1M.V.Sc. Student, 2Assistant Pofessor; Department of Animal Reproduction, Gynaecology and Obstetrics, College of
Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur.
[Received: 09.6.2018; Accepted: 28.1.2019]
{DOI 10.29005/IJCP.2019.11.1.035-037}

Though planned caesarean section is a management option feasible in canine high risk pregnancies, it may
adversely affect lactation compared to normal vaginal deliveries. The production of milk is controlled by interplay of
hormones, with prolactin being the predominant hormone. Methods aimed at stimulating release of prolactin from
anterior pituitary along with the ability of oxytocin in stimulating milk let down might improve the lactation in dogs
subjected to elective caesarean section. The clinical efficiency of a combination of metoclopramide and oxytocin in
stimulation of lactation in bitches subjected to elective caesarean section was studied. Satisfactory lactation in the
mother and a better neonatal wellbeing without any undesirable side effects was the outcome of the therapy.
Keywords: Elective caesarean section, Galactagogues, Lactation.

High-risk pregnancies are those in which high incidence of maternal, fetal and/or perinatal morbidity or mortality is expected to be higher. The criteria for categorization as high risk pregnancy were as described by Johnson (2008). The goals of managing highrisk pregnancies are to optimize maternal, fetal and perinatal health, maintain lactation
and maximize the survival of the pups. Fewer complications are associated with planned caesarean section over unplanned and emergency caesareans in dogs (Jayakumar et al., 2013). However, planned caesarean sections may adversely affect lactation compared to vaginal deliveries. Milk production is essential for optimal feeding of
newborn and has a direct impact on growth, development and health in the neonatal period. Two mechanisms involved in establishment of successful lactation include the release of prolactin and the release of oxytocin. The release of prolactin from the anterior pituitary stimulates the production and secretion of milk, while the release of
oxytocin from the posterior pituitary aids in the contraction of myoepithelial cells within the mammary gland, resulting in milk letdown (Gabay, 2002). Most of the existing galactagogues act by increasing the production and release of prolactinfrom the anterior pituitary gland (Zuppa et al., 2010). Metoclopramide antagonize the effect of

dopamine in the central nervous system which increased prolactin levels and so, was used in small animals to treat cases of secondary hypogalactia or agalactia (Kahn, 2010). The present study, hence, aimed to assess the clinical efficacy of metoclopramide and oxytocin instimulation of lactation in dogs subjected to elective cesarean section.

Materials and Methods
The study was carried out in six dogs of different breeds with high risk pregnancy presented to the University Veterinary Hospital, KVASU, Kokkalai, Thrissur. Two Beagle dogs and one British Bull dog with previous history of caesarean section; two Labrador retriever dogs with a high litter size of more than eight puppies as determined by
radiographic examination and one Rottweiler dog that suffered complete loss of puppies at birth from complete primary uterine inertia. The elective caesarean was scheduled after recording the first signs of parturition on
vaginoscopic examination or until the progesterone level falls below 2ng/mL, to avoid immaturity of the fetus. In two cases, where the dogs were brought from distant places and where professional service was lacking nearby, caesarean was scheduled when the peripheral progesterone declined to ≤ 5ng/mL. In these dogs, Dexamethasone
@1mg/kg to promote lung surfactant production in the puppy was provided and an elective caesarean was planned the following day. Before the elective caesarean, the viability of fetuses was assessed by transabdominal
sonography. On clinical examination, the mammary glands though appeared normal; no milk was evident on
mild strippingof the teats.

Treatment and Discussion
Elective caesarean was performed in all the six dogs under propofol induction and maintenance with isoflurane anesthesia. These dogs subjected to elective caesarean were administered oxytocin @ 1 IU, S/C, every two hours with concurrent administration of metoclopramide @ 0.1mg/kg, S/C, every 8 hours until lactation was adequate and was further continued with oral administration of metoclopramide alone @ 0.2 mg/kg, tid, orally for a day. The
neonates were removed from the dam before each injection and returned 10 minutes later to suckle. When suckling was not vigorous, mammary glands were gently hand stripped. Lactation was adequate in all the treated dogs
within 12 to 24 hours with a mean of 16.66 ± 4.50 (mean ± SD) hours of initiation of treatment as evinced by engorged mammary glands, vigorous suckling by puppies and excellent neonatal survival rate (Table-1 and Fig.1). The live birth rate was 91.11 per cent (41/45) and no undesirable effects were noticed in the puppies and dams. The
neonatal mortality upto 48 h was 4.88 per cent (2/41), upto first week of birth was 7.31 per cent (3/41) and no puppy mortality was noticed in the second week. The overall neonatal mortality was 12.19 per cent (5/41).

Galactogogues are synthetic or plants molecules used to induce, maintain, and improve milk production working either directly or indirectly on the hormonal pathways that control lactation as also reported by Mortel and Mehta (2013). The activation of dopamine receptors on prolactin-secreting cells inhibits the release of prolactin. So the medications used to induce lactation generally exert their effects through antagonism of the dopamine receptor, which results in a subsequent increase in prolactin release. Metoclopramide, antagonize the release of dopamine in the central nervous system and increased prolactin levels. Oxytocin induces smooth muscle contraction in mammary myoepithelial cells that surround the alveoli and milk ducts and is the principal hormonal factor for milk letdown as also mentioned by Gimpl and Fahrenholz (2001). The higher live birth rate (91.11 %) in the study signifies the safety of elective cesarean in dogs with high risk pregnancy. The overall neonatal mortality rate recorded in the animals subjected to elective caesarean and lactation promoted with a combination of metoclopramide and oxytocin was lower (12.19 %). The high neonatal survival rates (87.81%) observed in the study could be attributed to the elective caesarean performed in high risk pregnancy and the optimal milk feeding of newborn. This highlights the clinical efficacy and safety of combined oxytocin and metoclopramide treatment instimulating lactation in high risk pregnancy dogs subjected to elective caesarean section.

References
Gabay, M.P. (2002). Galactogogues: medications that induce lactation. J. Hum. Lact., 18: 274–279.

Gimpl, G. and Fahrenholz, F. (2001). The oxytocin receptor system: structure, function, and regulation. Physiol. Rev., 81: 629–683.

Jayakumar, C., Krishnaswamy, A., Sudha, G. and Honnappa, T.G. (2013). Planned cesarean section and other obstetrical interventions in dogs: A comparative evaluation based on neonatal survival. Indian J. Canine Pract., 5: 136-141.

Johnson, C.A. (2008). Pregnancy management in the bitch. Theriogenology, 70: 1412-1417.

Kahn, C.M. (2010). The Merck Veterinary Manual. 10th edn., Merck and Co., Inc. Whitehouse station, New Jercy, U.S.A., Pp. 2945.

Mortel, M. and Mehta, S.D. (2013). Systematic review of the efficacy of herbal galactogogues. J. Hum Lac., 29:
154–162.

Zuppa, A.A., Sindico, P., Orchi, C., Carducci, C., Cardiello, V., Romgnoli, C. and Catenazzi, P. (2010). Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J. Pharm. Sci., 13: 162–174.

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