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A Veterinary Guide to Spaying a Pregnant Cat (Pregnancy Spaying Procedure):
What is spaying surgery (spaying cats) and why do we do it?
Spaying or desexing is the surgical removal of a female (queen) cat's internal reproductive structures,
including her ovaries (the site of ova/egg production), Fallopian tubes, uterine horns (the two long tubes
of uterus where the foetal kittens develop and grow) and a section of her uterine body
(the part of the uterus where the uterine horns merge and become one body).
The picture on the
right shows a feline uterus that has been removed by cat spaying surgery - it is labeled
to give you a clear indication of the reproductive structures that are removed at surgery.
Basically, the parts of the female reproductive tract that get removed are those
which are responsible for egg (ova) production, embryo and fetus development and the
secretion of the major female hormones (oestrogen and progesterone being the main ones).
Removal of these structures plays a big role in feline population control; feline genetic disease control;
the prevention and/or treatment of various reproductive medical disorders and female cat
behavioral modification (e.g. estrogen is responsible for many feminine behavioral traits
that some owners find problematic - i.e. roaming, calling for males - and spaying,
by removing the source of estrogen, may help to resolve these behavioral issues).
The purpose of this page - why I have chosen to include a page on pregnant spaying (surgical abortion).
Although the vast majority of cat owners are responsible people who do elect to get their female cats desexed well
before they manage to mate and become pregnant, there are some owners who delay
getting their cats spayed only to find themselves with a pregnant cat and the prospect of
unwanted kittens arriving. In these unwanted-pregnancy situations, many pet owners will often elect to have their
pregnant cats spayed rather than allowing the kittens to be born. It seems such a simple
quick-fix option - just spay her before the kittens come along and voila, problem solved ...
But is it right?
The picture on the right shows a pregnant cat uterus that has been removed by cat spaying surgery.
The uterus contains three kittens.
The purpose of this page is to visually demonstrate to cat owners exactly what it is that they
are doing to their pet cat/s and those unborn kittens when they fail to get their pets spayed early and end up desexing them
whilst they are pregnant.
The moral and ethical implications of spaying a pregnant cat:
Although the feline pregnant-spay procedure is safe enough to perform when it comes to
the life of the mother cat (it is rare for pregnant cats to die during the spaying procedure),
owners electing this pregnant-spay procedure should be aware that the spay procedure in question
does result in the death of the fetal kittens contained within the mother cat's womb
(spaying deprives the uterus and therefore the kittens of a life-giving blood supply).
The procedure is, therefore, a form of surgical abortion and there is the potential
for the unborn kittens to suffer during the procedure, particularly if the kittens
in question are in the later stages of fetal development (within 2-3 weeks of being born).
The image on the right is one of the fetal kittens that was present within the pregnant
uterus pictured above. You can see how well-developed and clearly-recognisable as
a kitten it already is. It even has a tail and toenails!
This of course poses a number of ethical dilemmas and questions for the vet and the cat owner:
- given that vets aim to help animals, is it right for the vet to agree to perform a
surgery that he or she knows will result in the death of a number of unborn kittens?
- how much do the unborn kittens really suffer?
- what stage of gestation (pregnancy) do the kittens have to be in order to feel pain and to therefore suffer?
- is there an age/stage of gestation beyond which the surgery should never be performed?
- is the suffering of the unborn kittens enough to be considered cruelty?
- do society's demands for the control of cat populations warrant the use of such surgeries in order to limit cat numbers? i.e. do the ends justify the means?
- given that unwanted kittens are likely to experience suffering and neglect at the hands of humans, is it perhaps kinder to destroy them before they are born?
Now, I do not have the answers to all of these questions. There are perhaps several answers to
each of these questions - all of them dependent upon the circumstances surrounding each individual case.
The point I am trying to make is that there are important ethical and moral issues associated
with desexing a pregnant animal and pet owners should be aware of these before they decide to
get the surgery done (or allow their pet to become pregnant in the first place).
In addition to the moral implications of desexing a pregnant cat, there are also
physical consequences associated with performing this surgery:
- A longer incision line is needed: Because the uterus of a pregnant cat is so much larger
than the uterus of a non-pregnant cat, a much longer incision is required in order to
get the organ out. This longer incision is naturally more painful for the female cat
(when compared to the tiny skin incision made during a non-pregnant spay) and carries with it
a greater risk of intra-surgical bleeding, post-operative peritonitis and a greater
likelihood that the female cat will lick and disturb the surgical site, resulting in wound breakdown.
- The pregnant uterus is larger, with a massive blood supply: The uterus of a pregnant cat is much larger in
size than the uterus of a non-pregnant cat and the blood vessels supplying it
(uterine and ovarian arteries and veins) are much larger and more friable than the vessels
supplying a non-pregnant uterus. Because of this, there is a much greater chance
that a pregnant spay uterus will tear or 'fall apart' during surgery, resulting in major, life-threatening
hemorrhage and even death.
- The surgery is being performed on a more debilitated animal: Although one wouldn't necessarily call
pregnancy a debilitation, it is true that pregnancy puts a lot of strain on the pregnant
animal's bodily resources. The mother cat has to put a lot of nutrients,
energy and body-fat into growing her kittens. What this means is that, in spaying a
pregnant cat, the surgeon is essentially performing a large surgery on an animal that is already
under a lot of nutritional and physiological strain. Therefore, it should be expected that the
risk of anaesthetic and/or post-operative complications is greater when a pregnant cat
is desexed compared to a non-pregnant cat, who is not under such strain.
- There is an increased risk of mammary hyperplasia and post-operative lactation: After the
spay procedure has been performed, there is a much greater chance of a pregnant-spay cat developing
post-operative lactation and severe, potentially debilitating mammary enlargement
(mammary hyperplasia), when compared to a non-pregnant-spay cat.
The purpose of this page is to illustrate and emphasise the importance of desexing female cats
before they come into heat and manage to become pregnant. For those of you who
do manage to find yourselves with a pregnant cat (yes, accidents do happen), this page
should illustrate to you the importance of getting the animal in question desexed as
soon as possible. It is far better to have a pregnant cat desexed early on in the pregnancy than
it is to have the cat desexed when she is almost full term.
The rest of this page contains a step-by-step pictorial guide to the process of
spaying a mid-to-later-term pregnant cat (the spaying operation that your veterinarian will perform).
We can't quite provide you with a video on cat spaying procedure, however, we do hope that our
detailed virtual guide to pregnant feline spaying will provide you with enough visual information
to help you to understand the pregnant-spaying process and its potential consequences.
The whole pregnant feline spaying procedure, excluding anaesthesia induction and skin preparation time, takes around 10-30 minutes.
WARNING - IN THE INTERESTS OF PROVIDING YOU WITH COMPLETE AND DETAILED INFORMATION, THIS PAGE
DOES CONTAIN EXPLICIT MEDICAL AND SURGICAL IMAGES, INCLUDING IMAGES OF SURGICAL ABORTION, THAT MAY DISTURB SENSITIVE
READERS.
PREGNANT CAT SPAYING PROCEDURE STEP 1: The pregnant cat is placed under anaesthesia.
 
Images 1 and 2: The pregnant cat must be anesthetized prior to surgery being performed, both so
that it will not move whilst the procedure is being performed and also so that it will
not experience any pain. The cat is given a series of injectable sedative and general anesthetic drugs to make it go to
sleep (fall unconscious); an endotracheal (ET) tube is placed down its trachea (main airway) to help it to
breathe better and to keep its airway free of vomit and other secretions and the cat is
maintained under anesthesia by the addition of anesthetic gas vapours to the oxygen that
it breathes (the oxygen and anesthetic gas vapors are supplied by an anesthetic machine,
which is linked to the cat's endotracheal tube).
PREGNANT SPAY PROCEDURE STEP 2: The pregnant cat's belly is shaved (clipped free of fur).

Image 3: This a picture of a cat's belly (abdomen) being clipped free of fur prior to
the desexing surgery being performed. It is important to remove all of the fur
so that there will be minimal hair and bacterial contamination of the surgical site.
Author's note: although veterinary nurses take great care to avoid cutting the female cat's nipples
with the clippers during pre-surgical shaving, these nipples are tiny and easily nicked.
It is not uncommon for the occasional nipple to be cut during pre-surgical clipping. If you see a cut nipple,
don't worry! These nipple lacerations generally heal up fine.
Picture 4: This is what the pregnant cat's belly will look like when it has been clipped.
SPAYING CATS PROCEDURE STEP 3: The surgical site is scrubbed.
Picture 5: This is a picture of a female cat's abdomen (the surgical site) being scrubbed
with an antiseptic, antibacterial solution (chlorhexidine scrub and alcohol) prior to desexing surgery.
This pre-surgical skin preparation reduces the amount of bacterial contamination that is present
on the skin prior to the first incision being made.
PREGNANT CAT SPAYING PROCEDURE STEP 4: Draping the cat spay site.

Picture 6: This is a close-up picture of the spay site, taken just prior to placing the surgical
drape on the pregnant cat's abdomen. The cat's head is located towards the right of the image. The image shows the abdominal
landmarks that most veterinarians use to guide the position of their first spay incision. The first incision
(which can be anywhere from 2-5cm long in a pregnant cat) is usually made about an inch
below the animal's umbilical scar (the small white scar in the centre of the cat's abdomen where its fetal umbilical cord
once attached), on the midline of the abdomen.
Image 7: A sterile surgical drape is placed around the surgical site. This drape acts
to focus the veterinary surgeon's attention on the spay site. It also acts to cover up
the non-surgically-prepared, contaminated regions (e.g. the furred, unclipped regions)
located outside of the shaved and prepped area, so that the veterinarian can not accidentally
touch them and inadvertently contaminate the surgical site. Additionally, the drape also
provides a sterile surface for the vet to rest instruments on periodically during surgery.
PREGNANT CAT SPAYING PROCEDURE STEP 5: The skin is incised and the cat's abdomen entered.

Photograph 8: An incision is made in the pregnant cat's belly skin, approximately
1 inch below the umbilical scar on the abdominal midline. This incision is usually around
2cm long, but it can be up to 3-5 cm in length (particularly in late-term pregnancies),
depending on the diameter of the foetal kittens in the uterus.
Picture 9: The veterinary surgeon has made the first incision. The subcutaneous fat
(the fat located between the animal's skin and abdominal wall muscles) is clearly visible, along with
some bleeding. The fat is the white, shiny substance in the centre of the incision line.
There is generally a lot of fat located between the cat's skin and its abdominal wall
muscles. The veterinarian will often trim a small amount of this fat away, allowing easy access to
and visualisation of the cat's abdominal wall muscles.
What you will notice from this image is that there is greater bleeding incurred when
a pregnant cat's belly skin is incised, compared to a non-pregnant cat's belly. This is because
a pregnant cat often has large, engorged blood vessels supplying her mammary chains (lines of
udders) in preparation for birth and lactation (milk production). These blood vessels often criss-cross
the cat's abdominal mid-line from left to right, just beneath the skin, and the veterinarian usually has to cut through
them, resulting in moderate bleeding. It is not usually life-threatening.
Author's note: post-operative skin irritation and even wound breakdown will occasionally occur
when a heavily pregnant or lactating cat is operated on using a midline (belly)
approach that goes between the two lines of feline mammary glands. In these animals,
it can be very difficult for the vet surgeon to avoid lacerating the mammary glands
of the animal during the first incision (the breast tissues are huge and delicate and pretty much
meet in the middle of the cat's belly). Cutting into these glands can result in milk
leaking into the fatty tissues under the animal's skin. Milk is irritant and foreign to the body when it ends up
under the skin and the body's immune system will often react against it with an aggressive inflammatory reaction
that can result in pain, swelling and even wound break down at the spay site.
Once the veterinarian incises through the skin and subcutaneous fat layers of the
pregnant cat's abdomen, he will reach the abdominal wall muscles enclosing the cat's internal
organs. Image 10 on the right is a post-mortem photo of a deceased cat, whose abdominal skin
and fat layers have been removed (to orientate, the cat's head is located above the top of the image).
The abdominal wall muscles (red) are clearly visible.
Also visible (marked in white arrows) is the line of scar tissue (called the linea alba) joining the
right and left sides of the cat's abdominal wall musculature.
The veterinarian enters the pregnant cat's abdominal cavity by incising through the abdominal
wall muscles, on the midline of the abdomen. The veterinarian aims to cut along the
central line of scar tissue that joins the right and left sides of the animal's abdominal wall.
This line of scar tissue is called the linea alba (literally meaning - "white line").
By cutting through scar tissue, rather than the red muscle located either side of the linea alba,
the veterinarian reduces the amount of bleeding incurred in entering the cat's abdominal cavity.
SPAYING A PREGNANT CAT STEP 6: The first uterine horn is revealed.

Image 11: A spay hook (a special hook-shaped instrument) is inserted into
the pregnant cat's abdominal cavity to hook and draw up the first uterine horn. Often
the pregnant uterus is so large that the vet does not need a spay hook to find it.
Photograph 12: This is a picture of the first uterine horn being lifted up and
drawn out through the abdominal incision line. See how large and wide this pregnant uterus is?

Image 13: This is another picture of the first pregnant uterine horn being
lifted from the cat's body.
Photograph 14: The entire uterus has been lifted out of the cat's abdominal cavity
in this image. Some surgeons do this to make desexing surgery on the pregnant uterus easier
to perform. The right and left uterine horns, along with the central uterine body, make a shape like a
backwards number 3.
See how enormous the pregnant uterus is?! Notice how large the blood vessels supplying the fetal
kittens are (the red, branching structures on the surface of the uterus)? It should be obvious
to you what a disaster it could be for the mother cat if something went wrong and the uterus were to tear: severe
bleeding and even death could be the result.
SPAYING A PREGNANT CAT STEP 7: The ovarian blood vessels supplying the first ovary and uterine horn are clamped and ligated.

Image 15: The blood vessels (the ovarian artery and vein) supplying the cat's ovary (the left ovary,
in this individual) are elevated and clamped off using instruments called mosquito hemostats (also called
artery forceps). These hemostats crush and traumatize the ovarian blood vessels, causing them to spasm and narrow
in diameter. This helps to prevent excessive ovarian pedicle hemorrhage from occurring once the ovary is cut off.
What you will notice from this image is that the blood vessels supplying the ovaries of a
heavily pregnant cat are very large and wide. They are also quite thin-walled. Thus, there is
always the risk that these vessels could tear apart whilst they are being clamped and tied off
(next image), resulting in severe, possibly life-threatening hemorrhage.
Author's note - this particular surgeon has also placed a second hemostat clamp between
the ovary and the uterine horn, in addition to the one placed below the ovary.
This additional clamp prevents blood from leaking backwards out of the uterine blood vessels
(the blood vessels of the uterine horns do have continuous links with the ovarian vessels)
when the ovary is cut from its attachments.
Picture 16: A suture (called a ligature) is placed around the blood vessels supplying the ovary (the general
term for the blood vessels - the artery and vein - supplying the ovary is the ovarian pedicle).
This ligature ties off and occludes the blood vessels supplying the ovary,
thereby preventing excessive ovarian pedicle hemorrhage from occurring when the ovary is cut off.

Picture 17: Once the ligature has been tied and knotted tightly, the long suture ends
are trimmed away leaving only a small knot behind.
SPAYING PREGNANT CATS PROCEDURE STEP 8: The ovarian pedicle is cut above the sutures.
A scalpel blade is used to cut through the ovarian pedicle (the ovarian artery and vein)
supplying the ovary. The cut is made above the level of the ovarian pedicle ligature
so that the blood vessels (in particular, the ovarian artery) will not bleed when they are incised,
but below the ovary such that the ovary will be removed from the ovarian pedicle when the cut is made
(image 18).

Image 18: This is the appearance of the ovary after the ovarian pedicle has been
incised. The ovary remains with the uterine body and is removed along with it. The ovary,
still attached to its uterine horn, is reflected caudally (towards the animal's tail).
SPAYING A PREGNANT CAT STEP 9: Steps 6-8 are repeated for the second ovary and uterine horn.

Image 19: The blood vessels (the ovarian artery and vein) supplying the cat's ovary (the right ovary
in this individual) are elevated and clamped off using mosquito hemostats (artery forceps). These
hemostats crush and traumatize the ovarian blood vessels, causing them to spasm and narrow
in diameter. This helps to prevent excessive ovarian pedicle hemorrhage from occurring once the ovary is cut off.
What you will notice from this image is that the blood vessels supplying the ovaries of a
heavily pregnant cat are very large and wide. They are also quite thin-walled. Thus, there is
always the risk that these vessels could tear apart whilst they are being clamped and tied off,
resulting in severe, possibly life-threatening hemorrhage.
Picture 20: A suture (called a ligature) is placed around the blood vessels supplying the ovary
(the ovarian pedicle). This ligature ties off and occludes the ovarian blood vessels
supplying the ovary, thus preventing excessive ovarian pedicle bleeding from occurring when the ovary is cut off.
 
Pictures 21 and 22: Once the ligature has been tied and knotted tightly, the long suture ends
are trimmed away leaving only a small knot behind. These two images show the surgeon lifting
up the suture ends and cutting them off with scissors.

Image 23: The knot.

Picture 24: Following placement of the ligature, a scalpel is used to cut
through the ovarian pedicle vessels supplying the second ovary. The cut is made above
the level of the hemostat and the ovarian ligature so that the blood vessels
(in particular, the ovarian artery) will not bleed when they are incised,
but below the ovary such that the ovary will be removed from the ovarian pedicle
when the cut is made. The ovary remains with the uterine body
and is removed along with it. The ovary, still attached to its uterine horn, is
reflected caudally (towards the animal's tail).
PREGNANT SPAY PROCEDURE STEP 10: The uterine body is revealed and ligated.
  Pictures 25 and 26: The two uterine horns are pulled caudally (towards the cat's tail) until
the uterine body (the place where the two uterine horns merge and become one uterus body) is revealed
and elevated above the level of the skin incision (where it is easily accessible to the surgeon).
One or more hemostats are clamped across the uterine body, below the level of the uterine
horns and just above the level of the cervix (the cervix is a sphincter-like muscle band
located further down the uterine body, which forms a physical barrier between the abdominally-located
uterus and the pelvically-located vagina). These hemostats crush and traumatize the
uterine blood vessels, causing these blood vessels to spasm and narrow in diameter.
This helps to prevent excessive uterine vessel hemorrhage from occurring when the uterine body is
transected (cut off) at the end of surgery. These hemostats also crush and traumatize the uterine
body itself, forming nice grooves for the ligatures (next images) to sit in.
What you will notice from these images is that the uterine body of a
heavily pregnant cat is very large and wide and fleshy. In some individuals, it can also
be quite friable (prone to falling apart). Consequently, there is always the risk
that the uterine body will tear apart whilst it is being clamped and tied off,
resulting in severe, possibly life-threatening hemorrhage. In this case, no such problems arose.
 
Images 27 and 28: In this animal, the surgeon has elected to tie off each of the
uterine blood vessels separately, rather than attempt to place a single suture around the
entire uterine body girth. The uterine body has two main blood supplies: a uterine artery and vein
that runs along the left side of the uterine body and a uterine artery and vein
that runs along the right side of the uterine body. Both have to be occluded well, otherwise the
animal will hemorrhage severely when the uterine body is transected (cut off).

Image 29: In this image, you can clearly see the two sutures located on the left and
right sides of the uterine body. One suture is tying off the left side of the uterine body,
where the left uterine vessels run and the other suture is tying off the right side of the uterine body,
where the right uterine vessels run.
Author's note: If the uterine body is smaller in size, some surgeons elect to place the
first uterine body ligature around the whole circumference of the uterine body.
This single ligature will occlude the uterine arteries and veins on both sides of the uterine
body at the same time. With bigger uterine bodies (e.g. as seen in this case), however, many surgeons
are concerned that a single suture will not have the strength needed to occlude both vessels
sufficiently enough: thus they choose to tie each of the vessels off individually.
PREGNANCY SPAYING PROCEDURE STEP 11: A second ligature is placed around the uterine body.
 
Images 30 and 31: Termed "double-ligating", it is not uncommon for many veterinary surgeons
to place a second ligature around the entire girth of the uterine body (in addition to the first ligature/s) for
extra security.
In this situation where the uterine vessels have been tied off individually, this second
ligature, encompassing the entire circumference of the uterine body, is essential.
The circumferential suture's role is to close off the tunnel leading into the uterus
from the outside world. This will prevent bacteria from entering the abdominal cavity,
via ascension from the vagina, once the uterus is removed.
This second uterine body ligature also acts to doubly-occlude the uterine blood vessels,
which run along each side of the uterine body, thereby stopping them from
hemorrhaging once the uterine body has been excised (cut off).

Pic 32: This is the appearance of the fully-ligated uterine body.
SPAYING A PREGNANT CAT PROCEDURE STEP 12: The uterine body is transected (cut off).
 
Pics 33 and 34: The uterine body is transected (cut off) above the level of the ligatures using scissors
or a scalpel.
This essentially completes the process of removing the uterus from the pregnant female cat. The animal will now
no longer be able to reproduce. This is an irreversible surgical procedure.
Because the foetal kittens will often still be alive inside this removed uterus, the kittens
inside the uterus will often be injected with euthanasia solution so that they pass away more swiftly.
SPAYING CATS WHILST PREGNANT STEP 13: The abdominal wall is sutured closed.
Picture 35: The surgeon uses absorbable suture material to close the hole in
the abdominal wall musculature (linea alba). Because the linea alba is essentially
a tendon-like, collagenous structure (made of collagen), it has less blood supply
than red muscle and, therefore, takes longer to heal than muscle would. To take this slower
healing into account, the veterinarian often uses a longer-lasting suture (a suture
that is slower to lose its strength and slower to absorb) to close the linea alba. Because
this suture absorbs over time, the vet does not have to remove it later on.

Images 36 and 37:The linea alba has been sutured closed.
SPAYING PREGNANT CATS PROCEDURE STEP 14: The subcutaneous fat layer is sutured closed.

Photos 38 and 39: The subcutaneous fat layer (also called the SC or sub-q layer) is sutured closed.
This layer closure acts to reduce the amount of open space (called 'dead space') located
between the abdominal wall and skin layers, thereby reducing the risk of a large, fluid-filled swelling
(called a seroma) forming at the surgery site. Basically, whatever space/gap you leave in a surgery site, fluid
will pool in - by closing down this open space (dead space), the vet surgeon essentially
leaves fewer sites available for inflammatory fluids to pool in.
PREGNANT CAT SPAY PROCEDURE STEP 15: The skin layer is sutured closed.

Images 40 and 41: The surgeon has closed the skin using absorbable skin sutures
(also called intradermal skin sutures). These will not need to be removed.
NOTE: non-absorbable skin sutures can also be placed. These need to be removed in 10-14 days time.
To go from this spaying a pregnant cat procedure page to the Pet Informed home page, click here.
Complete feline spay page coming soon.
Copyright January 28, 2009, www.pet-informed-veterinary-advice-online.com.
All rights reserved, protected under Australian copyright. No images or graphics on this Pet Informed website may be used without written permission of their owner, Dr. Shauna O'Meara.
Please note that this surgical technique for pregnant feline desexing is only what
we use in our own clinic (we do not seem to have encountered many problems with
this particular method of desexing). Other clinics and veterinarians may disagree
with the technique illustrated on this page or elect to use a different variation of this technique.
This is fine. There are many desexing techniques described in the veterinary literature
these days and all have their pros and cons.
To all the pet owners reading this page: this page is designed to give you a visual
idea of what pregnant female cat spaying procedures might look like. It is hoped that you will
see these graphic images and choose to be responsible by getting your cat desexed before she
manages to become pregnant and needs such a big surgery. This page is NOT an instructional
manual for you to try this surgery at home on your own pets! Veterinary expertise and general
anaesthesia is required by law to perform this desexing procedure - performing it on a conscious patient
would be considered cruel and might well result in the death of your pet or someone else's.
To all the animal rights groups and pro- or anti-abortion groups reading this page: please note
that in choosing to put up such a potentially confronting page, I am NOT endorsing nor outright condemning
the desexing of pregnant cats. I am just showing the realities of the surgery as it is currently
performed by the millions all over the world. It is always the aim of veterinarians to
convince owners to desex their female cats well before they become pregnant, in order
to avoid the sad waste of life that occurs when
a pregnant cat is spayed. I hope that, by showing this surgical procedure in all of its graphic
reality, more owners might be convinced to get their female cats desexed much sooner.
Alternative, including slang and misspelled, synonyms for cat desexing: neuter, neutered, neutering,
nuter, nutered, nutering, sterilise, sterilisation, sterilising, sterilize, sterilization,
sterilizing, desex, desexing, desexed, fix, fixed, fixing, spay, spayed, spaying, spey, speyed,
speying, the "snip", the "chop", ovariohysterectomy, hysterectomy.
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