In pregnant bitches, is elective caesarean section more effective than vaginal delivery at improving puppy survival?

  • Mullika Borisoot Langford Vets Small Animal Referral Hospital



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PICO question

In pregnant bitches due to whelp, is elective caesarean section more effective than vaginal delivery to improve puppy survival?


Clinical bottom line

Category of research question

The category of the research question is regarding the incidence of puppy mortalities as a result of vaginal delivery, emergency caesarean section and elective caesarean section.

The number and type of study designs reviewed

Two retrospective articles were reviewed and critically appraised; one retrospective study with high single canine breed bias and one study on different canine breeds but limited support in directly answering the PICO question.

Strength of evidence

The studies selected both had strong uses of experimental designs but together provided weak evidence to determine a definitive answer to the PICO question.

Outcomes reported

The outcomes from both retrospective studies suggests that the mortality rates of newborn puppies can be reduced if pregnant bitches are scheduled ahead for elective caesareans, in comparison to undergoing an emergency caesarean section when complications develop, particularly in breeds with higher risks of dystocia. Therefore, there is some evidence to support that it may be advantageous to consider the breed, age and overall health of the bitch during pregnancy to determine whether elective caesarean sections, for the safe delivery of puppies, should be considered.


There are currently insufficient studies, literatures and evidence in veterinary medicine for caesarean sections to become a routine procedure in first opinion practices. Future prospective studies should be conducted and include the optimum anaesthetic protocols with the lowest associated risks for the pregnant bitch and puppies.


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Alonge, S. & Melandri, M. (2019). Effect of delivery management on first-week neonatal outcome: How to improve it in Great Danes. Theriogenology, 125, pp.310–316. DOI:

Cornelius, A., Moxon, R., Russenberger, J., Havlena, B. & Cheong, S. (2019). Identifying risk factors for canine dystocia and stillbirths. Theriogenology, 128, pp.201–206. DOI:

Dolf, G., Gaillard, C., Russenberger, J., Moseley, L. & Schelling, C. (2018). Factors contributing to the decision to perform a cesarean secton in Labrador retrievers. BMC Veterinary Research, 14(1). DOI:

Oliva, V., Queiroz, M., Albuquerque, V., Carreira, J., Souza, T., Ferreira, G., Abimussi, C. & Vides, J. (2018). Vitality evaluation methods for newborn puppies after cesarean section performed under general inhalation anestesia. Pesquisa Veterinária Brasileira, 38(6), pp.1172–1177. DOI:

Proctor-Brown, L., Cheong, S. & Diel de Amorim, M. (2019). Impact of decision to delivery time of fetal mortality in canine caesarean section in a referral population. Veterinary Medicine and Science, 5(3), pp.336–344. DOI:

Vol. 5 No. 3 (2020): The third issue of 2020

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  / 

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