The Use of Misoprostol for Cervical Dilation for a Dystocia in an Atlantic Bottlenose Dolphin (Tursiops truncatus)
Cetacean dystocias are one of the most challenging emergencies marine veterinarians face.5,6 With severe limitations for surgical intervention, dystocias pose a risk to both the cow and calf. Management options for these cases have been documented but risk include uterine laceration or rupture, secondary septicemia, and/or excessive hemorrhage.1,5,6
Misoprostol, a prostaglandin E1 analog, used commonly in veterinary medicine for treating gastrointestinal ulcerations, has also been used in human abortifacient and labor induction protocols.2,4 By empirical evidence only, misoprostol is utilized for cervical relaxation in canine and equine species. In human medicine, this medication is used either intravaginally or orally for cervical ripening and relaxation during labor induction.2,3
A nine-year-old female Bottlenose dolphin (Tursiops truncatus) transitioned into stage two labor with protrusion of the distal most aspect of the right fluke. After 56 minutes, with no progression of labor and increased contraction rates, the female was asked to gate into the medical pool where a voluntary ultrasound was performed to determine viability of the fetus. The calf was observed to be malpositioned with external presentation of the right fluke laterally and internal impediment of the left fluke at the level of the dam's ischium. At this time, 25 mcg of misoprostol was administered intravaginally. There was no administration of oxytocin or calcium. Twenty minutes post administration, the female was removed from the water and placed in right lateral decumbency.
During the vaginal examination, it was determined the left fluke was folded and fixed at the cranial aspect of the cervical folds. Using manual manipulation, the calf was repulsed cranially and the left fluke was readjusted. The calf's peduncle and flukes were then rotated into the correct ventral position. The female was immediately returned to the water, and a live calf was delivered within 67 minutes with no further intervention. Both cow and calf had no additional complications post-calving.
The authors thank the staff and trainers at Gulf World by Dolphin Discovery.
* Presenting author
1. Dalton LM, Robeck TR, McBain J. Dystocia in two beluga whales (Delphinapterus leucas). In: Proceedings from the International Association for Aquatic Animal Medicine 25th Annual Conference; 1994; Vallejo, CA.
2. Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labor. Cochrane Database Syst Rev. 2010;(10):CD000941. doi: 10.1002/14651858.CD000941.pub2.
3. Plumb D. Plumb's Veterinary Drug Handbook. 8th ed. New York, NY: John Wiley and Sons; 2015:999–1001.
4. Schaff EA, Fielding SL, Westhoff C, Ellertson C, Eisinger SH, Stadalius LS, Fuller L. Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion: a randomized trial. J Am Med Assoc. 2000;284:1948–1953.
5. Walsh MT, Beussee D, Robeck T, Dalton L, Townsend FI. Perinatal complications in cetaceans and manatees, diagnostic and treatment considerations. In: Proceedings from the International Association for Aquatic Animal Medicine 32ed Annual Conference; April 28–May 2, 2001; Tampa, FL.
6. Walsh MT, Gearhart S. Intensive care. In: Dierauf LA, Gulland FM, eds. CRC Handbook of Marine Mammal Medicine. 2nd ed. Boca Raton, FL: CRC Press LLC. 2001:689–702.