Dystocia is a frequent problem in the dog, with regard to breed-specific factors, litter size, duration of expulsion, various intervals between puppies and various causes of maternal, foetal or combined origin. In the present study, results were obtained from management of 530 dogs of 54 breeds, between 1 and 13 years of age, presented with dystocia over a period of 8 years in an obstetrical clinic with mostly identical diagnostic and therapeutic schedules. Data on age of the dam, parturition number, breed size, causes of dystocia, duration of expulsion time, kind of obstetrical aid, and last but not least, the influence of all therapeutic aspects on survival of the puppies were analysed. Dams of miniature and small breeds (59.4%) had a high incidence for dystocia in this population. Uterine forces (inertia and spasm), malpresentation of the foetus and litter size (single pup pregnancies, hyperfoetation) were the most common causes for dystocia. Duration of expulsion stage had the highest influence on puppy survival (p < 0.001). In the case of medical treatment, medication with oxytocin led to higher puppy losses compared with other medicaments. Older primiparous bitches (>6 years of age) had a significantly higher risk to have special obstetric conditions and stillbirths compared with young primiparous bitches. The scope of this study was to analyse the parameters that were most useful for a rapid diagnosis to maximize puppy survival, to avoid false diagnosis and to choose the best therapeutic strategy. The present data show that in addition to the established criteria for management of dystocia in the dog, new diagnostic approaches are necessary to improve obstetrical care.