Periparturient emergencies Flashcards

1
Q

when do cervical/ vaginal prolapses occur

A

pre-partum- occasionally in oestrus

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2
Q

how to tell difference between uterine and cervical/vaginal prolapses

A

uterine- postpartumn- cotyledons visible
carvical/ vaginal- pre-partum

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3
Q

describe a grade 1 cervicovaginal prolapse

A

Small intermittent vaginal prolapse only present when animal lies down

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4
Q

describe a grade 2 cervicovaginal prolapse

A

Continuous vaginal prolapse. Can rapidly progress to grade 3. Bladder may be included

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5
Q

describe a grade 3 cervicovaginal prolapse

A

Vagina and cervix continuously prolapsed with exposure of mucus plug which may liquify allowing ascending infection.

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6
Q

describe a grade 4 cervicovaginal prolapse

A

Long standing grade 3 prolapse resulting in necrosis and fibrosis of mucosa. May lead to peritonitis

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7
Q

List 2 risk factors of a uterine prolapse

A

hypocalcaemia
difficult calving

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8
Q

List 4 risk factors of cervical/vaginal prolapse

A

limited exercise
hereditary
increased abdominal pressure
hypocalcaemia

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9
Q

describe how to use gravity to help replacae cervical/vaginal prolapse

A

If animal is recumbent place in sternal with hindlimbs ‘frog legged’
If animal is standing, make sure is a flat or downhill surface

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10
Q

Describe how to replace cervical/ vaginal prolapse

A

epidural
Clean prolapse
Apply firm cranial pressure to the prolapsed vagina (+/- cervix) with a flat hand
Prolapse will evert and replace
Perform Bühner suture
Give pain relief +/- antibiotics

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11
Q

List 3 potential complications of cervical/ vaginal prolapse

A

ruptured bladder
ringwomb
ascending infection –> placentitis and fetal death

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12
Q

what is ringwomb

A

Failure of cervix to fully open at parturition
May need C-sec

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13
Q

Describe how to treat uterine prolapse

A

epidural
use gravity
remove placenta and clean prolapsed uterus
Starting at vulva, carefully use fists to massage the uterus back into place
Ensure uterine horns fully everted
give calcium and oxytocin and pain relief and ABs

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14
Q

List 3 potential complications of replacing uterine prolapses

A

haemorrhage
metritis
reduced subsequent reproductive performance

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15
Q

Describe how to reduce the risk of haemorrhage when replacing uterine prolapse

A

Avoid excessive movement of animal
Careful handling of everted uterus

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16
Q

Describe the history associated with a uterine torsion

A

History consistent with prolonged 1st stage labour/failure of progression
“thought was calving but didn’t get on with it”

17
Q

Describe what you feel on vaginal exam with uterine torsion

A

folds palpable in vagina –> in direction of the torsion

18
Q

Describe what you can feel on rectal exam with uterine torsion

A

Broad ligament palpably stretched across uterus
Dorsal aspect –> ligament stretched in direction of torsion
Ventral aspect —> ligament stretched ventrally away from torsion

19
Q

what direction do most uterine torsions occur

A

2/3 of cases are anti-clockwise

20
Q

List 3 treatment options for uterine torsion

A

manual de-rotation
roll cow
c-section

21
Q

Describe manual de-rotation of uterine torsions

A

only possible if can feel calf feet
Grasp calf’s feet and swing calf until flips over

22
Q

Describe rolling method of treating uterine torsion

A

roll in same direction of twist (as viewed from behind)
e.g. Anti-clockwise (left) twist – cast onto left side and roll over in anti-clockwise direction

23
Q

when is an episiotomy useful

A

soft tissue obstruction

24
Q

describe how to perform an episiotomy

A

epidural
start at mucocutaneous junction
Make incision with scalpel at 10 o’clock or 2 o’clock position of vulva
up to 10cm length
DO NOT make incision at 12 o’clock position

25
Q

Decsribe how to close episiotomy

A

epidural needed
absorbable sutures
simple continuous pattern mucosal layer does not need sutures

26
Q

describe how to treat minor tears of the vulva

A

don’t need treatment
leave to heal by secondary intention

27
Q

Describe a 1st degree perineal tear

A

Skin and mucosa of vagina/vestibule/vulva affected only. Rarely require surgery

28
Q

Describe a 2nd degree perineal tear

A

full thickness tear of the vagina/ vestibule/vuvla but not the rectal wall or anus

29
Q

Describe a 3rd degree perineal tear

A

full thickness tear of the vagina/vestibule/ vulva as well as the rectal wall +/- anus - a rectovaginal fistula may be present

30
Q

Describe how to treat 1st and 2nd degree perineal tear

A

not emergencies
most heal by secondary intention
can be managed with caslick procedure- not done often

31
Q

Describe how to treat 3rd degree perineal tear

A

Surgical repair - which is delayed for 6-8 weeks
Not day 1 skill
advise farmer to consider if they want to cull

32
Q

Describe how to treat mild to moderate uterine bleeding

A

oxytocin - to stimulate myometrial contration

33
Q

What first aid advice do you give in cases of arterial haemorrhage

A

Digital occlusion of offending artery if end can be found
Pack vagina as tightly as possible- e.g. Clean bedsheets/towels

34
Q

If you can find offending artery in arterial haemorrhage what do you do

A

clamp with haemostats
leave in place for 3 days

35
Q

if you can’t find the offending artery in cases of arterial bleeds what do you do

A

Pack vagina tightly
Leave in place for ~3 days
Guarded prognosis

36
Q

Describe how to treat hypovolaemic shock in cow

A

Treat with fluids initially –> volume expansion
Blood transfusion may be required (taught elsewhere) - > 10L blood lost