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Therio - Bovine - Postpartum Period 2

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drraythe's version from 2017-09-10 02:08

RETAINED FETAL MEMBRANES + METRITIS + Endometritis + Pyometra

Question Answer
Def of Retained fetal Membranes (RFM)?Membranes that are not expelled w/in 12 hours of completion of stage II
How common is RFM?MOST COMMON post-partum complication
5 possible etiologies for RFM?(1) Vit/mineral deficiency eg. Vit E/Selenium
(2) Abortion
(3) dystocia
(4) Partus induction
(5) True multifactorial Dz
What are normal processes, which result in detachment of the placenta?Softening of collagen in placentomes, Intrapartal pressure, Postpartal anemia of fetal villi, Decreased size of caruncles w/ uterine contractions
What are the 2 basic processes that result in RFM?(1) Uterine inertia (<10% of cases)
(2) Failure of loosening process
What are some reasons there would be failure of the loosening process of the placentomes? (6)(1) Immaturity of placentomes
(2) Edema or hyperemia of chorionic villi
(3) Necrotic areas in villi
(4) Placentitis
(5) Metritis
(6) Leukocyte inactivity
What is the prog for RFM?Uncomplicated RFM not associated w/ serious consequences & affected animals have normal production & fertility (+/- 50 % of cases)
RFM can lead to what types of complications/ inc the risk of.. (5)Metritis
Endometritis
Pyometra
Ketosis
Displaced abomasum
How do you go about Tx of RFM?Depends on timetable...
(1) SHORTLY after calving (24hrs) you can give Oxytocin (help inc uterine contractions, might help get it out)
(2) If not just after birth, LEAVE HER ALONE & monitor her... appetite, habitus, milk production, nature of lochia, & rectal temp. If any of these go downhill, may need to interfere
*Do you want to give ABx in the case of a RFM?NO!!! Bacterial action, autolysis & putrefaction will assist in loosening + expulsion, which is why you don’t want to give AB’s
If you need to remove the RFM, what DO you do?After a few days, re-examine & gently cord (twist) RFM, while massaging uterus per rectum
**If you need to remove the RFM what DONT you do?DO NOT attempt to manual “peel” off placentomes – hemorrhage, leave bits of cotyledon behind, impair leukocytes work
What are Ecbolics? Examples?They cz contractions-- ex are Oxytocin, calcium, PGF.
Are Ecbolics useful for RFM?(Drugs which cz contractions) Limited value unless given very early (24 h post-partum) when uterus is still sensitised
How useful is intrauterine administration of therapeutics for RFM?Not very... Doesn’t penetrate deeper tissues (where problem lies), Persistence is short, Absorbed systemically (NB! Milk withdrawal), Suppression of uterine defenses, introduce new infxn, Uneven distribution of drug
Which ABx would you rather use for RFM- tetracycline, or Penicillins?Tetracyclines are drug of choice; they are broad spectrum & active in pus. (Inactivated by Penicillinase produced by mixed flora in early post-partum period. also inactivated w/ pus & narrow spectrum.. can use in late post-partum tho)
*When do you use uterine antiseptics? Examples?DO NOT use unless in very chronic cases of Endometritis...usually things like Formaldehyde/Iodine, which can burn the entire endometrium.
What is usually more preferable to uterine antiseptics?Would rather you instilled large volumes of tap water to help flush out uterus, w/o compromising uterine defenses excessively.
What are the 2 kinds of metritis?(1) Acute puerperal metritis
(2) Subacute metritis
When does acute puerperal metritis occur? How does lochia present? How does it feel upon rectal palpation?Happens w/in 5 days post-partum. Lochia: dark red/black, watery, foul smelling. Rectal palp: large, fluid-filled, flaccid uterus
When does subacute metritis occur? How does lochia present? How does it feel upon rectal palpation?Usu. 2nd wk post-partum. Lochia: Purulent. Rectal palp: Firmer (“doughy”) & thick walled
How do metritis & RFM relate?Metritis often preceded by, or occurs concurrently w/ retained fetal membranes (RFM)
**Etiological factors for metritis?Hygiene at calving, Dystocia (NB! Iatrogenic!)
Poor uterine contractions (clean out all the gunk)
Concurrent systemic Dz
Gram +ve & Gram –ve + anaerobes
If you suspect metritis (cow is systemically ill), you know the metritis involves _________, & these problems are associated w/ (3 problems)Deeper layers of uterine tissue
This means can also be associated w/ Toxemia &/ septicemia, peritonitis, & death
What are the CSs of metritis? (5)Inappetence
Dehydration
Decreased production
Increased temperature
Abnormal Lochia (ACute: dark red/black; watery, foul smelling. SUBacute: purulent)
How does metritis feel upon rectal palp if it is an ACUTE case?Large, flaccid, fluid filled bag
How does metritis feel upon rectal palp if it is a SUBACUTE case?Becomes firmer (“doughy”) + thick walled
**What should you know about performing uterine manipulations on a cow w/ metritis?NB!! Uterus VERY FRIABLE…. Any manipulation may result in perforation unless performed VERY CAREFULLY.
IV fluids are very very expensive for a large cow-- what other option do you have if cow isnt too compromised?May use oral rehydration
When do you use Oxytocin for uterine contractions in a cow w/ metritis?Only effective when responsive, which is like w/in 24hrs of birth
Metritis → Once systemic condition has improved, you want to flush the uterus' contents-- what do you do? Once flushed, how do you get the rest out?Valuable cow: isotonic saline solution. Less valuable: tap water. To get it out, rectal massage to manipulate fluid out of uterus
Which is more severe- Endometritis or metritis?METRITIS-- potential for systemic illness
What are the drugs/therapies you want to do on a cow w/ metritis? (5)(1) Aggressive antibiotic Tx → Oxytetracycline/Penicillin
(2) Anti-inflammatories (Finadyne, Metacam (Remember withdrawal periods) )
(3) Shock therapy if valuable cow
(4) Oxytocin To aid uterine contraction + rid the uterus of fluid. (Remember, only responsive for a short time)
(5) Drench w/ Rumex to save rumen if systemically ill
What are the 3 main Consequences of metritis?Protracted recovery phase, Delayed involution, Endometritis
What is Endometritis?Inflammation LIMITED TO THE superficial layers of the uterus ie. Endometrium
When does Endometritis usually occur?Usu. ≥ 2 wks after calving
What is Endometritis usually a result of?Usu. as a result of failure to eliminate Infxn during involution. May also result from unhygienic AI or specific venereal pathogens (tritrich, campy...)
List of some predisposing factors to Endometritis (read over)Retained fetal membranes
Dystocia
Caesarian section or assisted calving
Induced parturition
Still Birth
Twins
Unhygienic calving environment
Ovarian inactivity
Parity
Concurrent Dz
Nutrition
What are 2 examples of Concurrent Dz & nutrition inc rates of Endometritis? (Prolly not SUPER important to know..)Fatty Liver Dz & Hypocalcemia
Is there any reasons seasons might have an effect on Endometritis rates?Has to do w/ unhygienic environments - inclds seasonal effect as indoor calving has higher Endometritis rates
How is Endometritis a cost drain on the farmer?Increased inter-calving interval, Increased services per conception, increased culling
*Main culprit of Endometritis?T. pyogenes often in combo w/ F. necrophorum
Which is associated w/ systemic illness- metritis or Endometritis?Metritis, NOT ENDO
What are the CSs of Endometritis? (2)(1) Purulent vaginal discharge (may not appear at vulva) called "whites"
(2) Irregular cycles
What is "whites"?Purulent vaginal discharge (may not appear at vulva)
What is a Metricheck?Rubber scooper to check for purulent discharge into fornix of vag
How does Endometritis present on a rectal exam?Enlarged cervix, Enlarged asymmetrical uterine horns, Thick walled & doughy consistency of uterus (NB! Stage of cycle?), Preg. Horn still remarkably enlarged. Active ovaries – can be at any stage in cycle
What is the Tx of Endometritis? (Remember, May resolve spontaneously) (3-4 options)(1) Intrauterine ABx (Cephalosporins) → NB! Culture & antibiogram if non-responsive
(2) Systemic ABx (Penicillin/Tetracyclines)
(3) PGF2α (Two doses 11-14 days apart → Returns cow to estrus w/ all the resultant beneficial effects)
(4) (Estrogens = she has a frowny face here)
How does PGF2α help w/ Endometritis?Give 2 injxn 11-14d apart so she goes into estrus, & then you get the benefits of estrus (high defenses, open cervix, etc)
Metritis vs Endometritis → how do the timetables differ?Metritis is usually 1st 5d post-partum. Endo is >2wk PP
Metritis vs Endometritis → what microbes usually cz metritis? Endo?Metritis is Gram +ve, Gram –ve & anaerobes
ENDO is usually T. pyogenes + F. necrophorum
What is pyometra?Accumulation of pus in uterus in the presence of a fxnl CL (so, progesterone is predom so cervix closed, pus trapped inside. Also depressed uterine defenses+ Glandular secretions)
How do you ID pyometra on rectal exam?Uterus is grossly enlarged
What usually czs pyometra (in general, not specific pathogens)Usu. results from persistence of Infxn (metritis/Endometritis) into the late postpartum period [Active CL perpetuates the condition]. ALSO can occur from Embryonal/fetal death w/ retention of septic material in a closed uterus – eg. Trichomoniasis
*Which PATHOGENS usually cz pyometra? T. pyogenes
F. necrophorum
Bacteroides
Does pyometra show systemic dz?NO
What kinda discharge do you see w/ pyometra?Trick question - NO DISCHARGE, Cervix closed
How do you Dx pyometra?Dramatically enlarged uterus that is asymmetrical, fluid-filled, thick walled, atonic, & there is a CL (not necessarily ipsilateral to larger horn)
How do you Tx pyometra? What is the prognosis?GOOD PROGNOSIS, give a Single Injxn of PGF2α (Allow 1 cycle before attempting to breed)
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