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Therio - Bovine - Postpartum Period 1

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drraythe's version from 2017-09-10 01:56

Post-partum

Question Answer
What is Puerperium? How long is it?Postpartum period from end of Stage II of calving, until histological involution has occurred, ovarian Fxn has resumed & the genital tract has return to its non-pregnant state. +/- 85 days (Basically, the period when reproductive tract returns to its non-pregnant condition so that the female may become pregnant again)
What is happening in the puerperium period?(The time of rest during the yr when the cow isn't preg) This is the time for involution, lactation, new routine, new social groups. Reconception at this time would be HIGH RISK as she is under nutritional stress from lactation
What are some examples of Economic impact of extended puerperium?Lost lifetime productive days
Decreased production (remember... Dystocias!)
Cost of discarded milk (eg. ABx, milk withdrawal times
Increased culling (poor reproductive performance)
cost of Tx (ABx)
What is some of the events in the Physiology of Involution?Decreased size
Tissue Loss
Tissue Repair
Elimination of bacteria
Resumption of cyclicity
How does the repro tract dec in size during the puerperium period?Result of myometrial contraction (Oxytocin), highly coordinated atrophy of myometrium & tissue loss
How does Oxytocin dec the size of the uterus?Facilitates discharge of fluid & tissue debris from uterus
Compress uterine vasculature & minimize possibility of hemorrhage
Reduce size of uterus
How does Oxytocin release get naturally stimulated?Suckling-- so consider dairy cows w/ calves removed in 24h
What is the tissue that is lost during involution?Endometrium that hypertrophied during pregnancy all undergoes necrosis + sloughs off. Caruncles exposed, therefore result in red color (blood) of lochia
What is lochia?Discharge seen shortly after partus, consisting of blood-tinged fluid containing remnants of fetal placenta & endometrial tissue
Is blood-tinged fluid containing remnants of fetal placenta & endometrial tissue normal? What’s it called? When is it abnormal?Normal = Lochia
Abnormal = Stinky, watery (vs. mucoid), purulent & black
Is lochia usually watery or mucousy?Mucousy = Normal
How do the caruncles react/change post-partum?After separation of cotyledons (fetus) from caruncles (maternal) vasoconstriction occurs at caruncular stalk → Results in necrosis of caruncle which slough & become part of the lochia. Caruncle begins to undergo repair & is eventually re-covered w/ endometrial epithelium. (Intercaruncular repair also occurs, but at a faster rate that caruncles that need to slough 1st)
*If you notice a lot of bacteria in the uterus post-partum, are you concerned?Not unless there is a reason to be - mostly NON-pathogenic bact in uterus
REMEMBER: bacterial contamination is not always associated w/ pathology (BEWARE of wiping out the “easy to kill” non-pathogenic bacteria w/ ABx, douches etc. as they provide competition for pathogens)
Under what hormones influence are the uterus' defenses high?ESTROGEN (promotes leukocytosis)
List some uterine defenses against invasion of bacteria during & post-partumUnder the influence of estrogen (promotes leukocytosis)
Myometrial contraction (Oxytocin) to get rid of fluid, Neutrophils + macrophages (phagocytosis)
Normal anatomy + barriers (vulva, vagina, cervix)
*What is the BEST way to inc uterine defenses against invasion of bacteria during & post-partum?Resumption of cyclicity so reproductive tract under the influence of estrogen
Failure to eliminate bacterial contamination will... (3)(1) Prolong uterine involution
(2) Prolong puerperium
(3) Delay subsequent pregnancy
Ovarian steroids (NB! Estrogen) are important for uterine defenses during involution (3 ways of doing this are..)Leukocytosis
Open cervix
Increased mucus secretion & cilial action
Delayed uterine involution results in delayed ___Ovarian Fxn
Where does the PGF2α come from naturally to cz luteolysis?Inflamed endometrium
Involution should be completed by ___ post-partum30 days
**When is the ABSOLUTE EARLIEST you can breed by, & why not before that?Full histological repair complete by 50 days, therefore DO NOT breed before this is complete
Do 1st time calvers involute faster or slower?SLOWER bc under sig. stress
Which helps involution- suckling or lactating?Suckling results in Oxytocin release which czs myometrial contractions
How does weather affect the timetable of involution?Summer is slower due to heat stress
What might you do ultrasound on a post-partum exam?Can see intraluminally (look for fluid) Will give an accurate assessment of size of ovaries (+ structures) & of horns... not commonly used post-partum though
**Most post-partum conditions are not associated w/ signs of systemic Dz EXCEPT...Metritis
How is a cow’s production/appetite affected by involution?A cow undergoing normal involution w/ have normal appetite & production
What does normal lochia look like?Pale brown to red in color becoming clear/opaque, mucoid, no smell & decreases in volume. Maybe some pus
When does lochia normally go away?Disappears by about 3 wks post-partum
What does ABnormal lochia look like? (Various possibilities, not all necessarily present)Stinking (malodorous)
Dark red to black in color
Watery consistency (vs mucoid)
Purely purulent discharge
Persisting beyond 3 wks post-partum
Increasing in volume
When is uterus low tone, when is it high tone?Low: Diestrus
High: Estrus
As involution takes place, the uterus gets progressively (how would it feel on rectal palpation?)Becomes progressively smaller, smoother & softer
By ___(time)___, cervix + uterine horns should be back to normal size (+/- 3-5 cm diameter) w/ < 1cm difference btwn them21 days
How do ovaries feel in anestrus vs in active cycling?Anestrus: Small (1x1x1cm), smooth, inactive ovaries. In cycle, will feel CL & follicles
What are things that shouldn’t been in the vagina during your postpartum vaginal exam? (2) What might these indicate?Air
Urine
(disruption of normal barriers ie. Vulvar lips, vestibulo-vaginal Jxn)
Normal cervix will not allow insertion of hand by _________(time)_________24-36 hr post-partum
Puerperal Dzs are integrally related to...Management & nutrition
Factors that contribute to Puerperal Dz (3)Incld Pre-partum factors
Intrapartal factors
Post-partum factors
Partus induction often results in what Dz?RFM
memorize

BIRTH TRAUMA + POST PARTUM HEMORRHAGE + UTERINE PROLAPSE

Question Answer
Concisely compare Grade 1, 2, & 3 of Perineal lacerations*Grade 1:* Superficial mucosa & submucosal lacerations
*Grade 2:* Full depth vaginal or vulva tear
*Grade 3:* Rectovaginal fistula or cloaca
What is a grade 1 perineal laceration? How do you treat?Laceration which involves the superficial mucosa & submucosal lacerations. Use topical disinfectants, prevent fly strike, Systemic ABx are indicated if deep bruising present to prevent abscessation
When might systemic ABx be used on a grade 1 perineal laceration?If deep bruising present to prevent abscessation
What is a grade 2 perineal laceration? How do you Tx?Full depth vaginal or vulva tear. Try to suture immediately if possible, along w/ topical disinfectants, & systemic ABx. However, Access is sometimes very difficult, may be left to heal by 2nd intention & corrected at later date if value of cow warrants this (2nd intention = let heal on its own)
What is a grade 3 perineal laceration? How do you Tx?Rectovaginal fistula or cloaca. Left to heal by 2nd intention & then repaired according to principles laid down for equine perineal lacerations
What are possible Sequelae/complications that can arise from a grade 3 perineal laceration?(Rectovaginal fistula or cloaca). Stenosis, adhesions, abscesses, Pneumo- or urovagina, & may impact future fertility
How bad of a prob is a cervical tear? How to Tx?Can lead to severe repercussions, incld infertility & obstructive dystocia in the future. Successful repair is rare (difficult to access, Fibrous nature of bovine cervix, Importance of re-establishing normal Fxning)...perhaps consider slaughter after raising calf
Hemorrhage from endometrium/ myometrium can usually be controlled w/....Oxytocin (contract & shrink tissue)
If there is Trauma in vagina w/ laceration of vaginal artery, there will be copious bleeding from the vulva. What should you do?Emergency 1st aid kit-- Apply digital pressure/apply artery forceps; ideally apply ligature, but often difficult access. May need IV fluids (crystalloidSQolloids)
How can you tell if there is hemorrhage from uterine vasculature?Difficult to detect as bleeding occurs into abdomen, but will see Cow will become pale & “shocky" (Delayed CRT, pale mucous membranes, dry gums)
How do you Tx a uterine vasculature HGE?Oxytocin & pray to your own personal deity or Murphy if you have none.... Shock Tx – i/v fluids (NB! Massive volumes (10+ L so not really financially viable!!)Emergency laparotomy (unlikely to be able to find source of hemorrhage)
How worried should you be about a uterine prolapse? ExplainLIFE THREATENING CONDITION → prolapse leads to Rupture of major blood vessels of uterus leading to hypovolemic shock. Also, Absorption of toxins, especially when prolapse is replaced, leading to endotoxic shock. There is also risk of Thrombus formation resulting in emboli, as well as Trauma & necrosis of prolapsed tissue
When do cows usually die from uterine prolapse?Sudden death! Usually once you’ve gone to all the trouble to replace the prolapsed uterus!!!
WHEN do MOST uterine prolapses take place?Usually w/in 12 hours of partus
What are some predisposing factors to uterine prolapse?Increased abdominal pressure (dystocia, over conditioning)
Decreased uterine tone (Inertia (NB!!! Subclinical hypocalcaemia!!!)
Decreased resistance (poor condition)
What is a hygroscopic agent?Draws fluid out of tissue (eg. Acriflavine glycerine)
What are some ways to get the edema out of a prolapsed uterus?Apply hygroscopic agent, Can prick prolapse w/ 18G needle to try & get rid of some fluid, & wrap prolapse from tip to base in a blanket w/ hygroscopic agent on it to try to squeeze out fluids
Before replacing uterus from a prolapse, what structure should you consider?Palpate to try to ascertain if bladder has also prolapsed inside uterine prolapse – may need to catheterise & empty
If there is a uterine prolapse, where should you remember the urethral opening is?Remember urethral opening will be ventral, close to vulva lips, underneath the prolapse
When replacing a prolapsed uterus manually, how should you be careful of your hands?Use your FISTS to push, not your fingers-- your fingers might tear the flesh
What should you do if the cow w/ the prolapsed uterus is recumbent?get her in the “froggy legged” position (slide 57 pic) to tilt pelvis forward. If she won’t allow this, then try & elevate hindquarters eg. On hay bale or something to get gravity to help you
Once uterus is back inside, you should make sure it is...EVERTED!! use a clean lube bottle or 1L coke bottle to push tips of horns back into normal position during vaginal examination (or try to fill w/ water)(otherwise high chance of reoccurrence)
Once the uterine prolapse is replaced, how do you retain it?Place Buhner stitch (remove about 7-10d later)
What are 4 types of medications you give after a uterine prolapse has been fixed?(1) Oxytocin for contracting back in & involuting more (may need to wait a few hrs for tocolytic (Clenbuterol) to wear off)
(2) ABx
(3) Anti-inflammatories esp. Finadyne if cost not an issue (anti-endotoxic)
(4) Calcium borogluconate (Hypocalcemia is the biggest predisposing factor)
If you think the prognosis of the uterine prolapse is poor, or replacement not possible & you wish to salvage slaughter the cow, how do you address the prolapse?Amputate!
Surgical hysterectomy or External ligation
memorize