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IP 11 Theriogenology > 39 - the puerperium > Flashcards

39 - the puerperium Flashcards

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1
Q

what is the puerperium period?

A

“after parturition” ==> the window of time btwn parturition and readiness to fall pregnant again / conceive the next pregnancy

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2
Q

t/f

the puerperium is a well defined time line for all species

A

false

the time is hard to define well for one species

and is highly variable among species

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3
Q

how long is the puerperium in the cow?

horse?

bitch?

A

cow: 45 days
horse: 10 d
bitch: 5-6 mos

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4
Q

what occurs during the puerperial process w/in the reproductive tract?

3 important facets:

A

return to a state that allows establishment of a new pregnancy
1 - uterine involution
2 - elimination of bacT
3 - resumption of ovarian cycles

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5
Q

what are 2 aspects to uterine involution?

A

gross size

histologic repair

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6
Q

what size change occurs in the uterus of the cow during the pueperium ?

in what time frame?

A

10 kg to 1 kg in 12-13 days

0.5 kg by 30 days

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7
Q

during the epithelial repair of uterine involution in the cow, what occurs around day 7?

after this occurs, what is present in the uterus?

A

day 7: caruncles slough off

de nuded caruncles are present - bright red b/c the epithelium has shed

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8
Q

after caruncle sloughing, what process occurs and is complete by day 30 of uterine involution in the cow?

A

re-epitheliazation occurs and is complete by day 30

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9
Q

what is lochia?

when is it present?

A

cellular debris -> millions of NTs and bacT

present during uterine involution of the cow

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10
Q

what is the appearance of lochia and how does it change in the first 10 days of involution?

A

is thick and mucoid discharge

day 2-3: red brown mucus
day 6-7: may see plugs of caruncle epithelium in the lochia

day 10: will be somewhat hemorrhagic

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11
Q

if lochia is watery and smelly, what has occurred?

A

bacT has overwhelmed the body defenses

should not smell and should be thick and mucoid

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12
Q

at what point in uterine involution does lochia becomes clear?

A

day 13 - clear with flecks

day 16 - clear

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13
Q

as a result of uterine involution, how many days post partum should the cow have no bacT in her uterus?

A

day 35

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14
Q

t/f

resumption of ovarian activity occurs after involution of the uterus is complete

A

false

resumption of ovarian activity occurs during involution

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15
Q

how many days post partum does the cow experience her first follicular wave?

A

7 days post partum

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16
Q

what is a silent ovulation?

A

ovulation occurs but there is no detectable sign of estrus

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17
Q

what % of cows experience 2 silent ovulations post partum?

A

50%

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18
Q

how many days post partum does the first ovulation occur in the cow?

A

14-20 days

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19
Q

why does the cow have a short luteal period on her first follicular wave post partum?

A

at the time when the CL develops after ovulation, there is a lot of activity and remodeling occurring in the uterus so PG levels are high -> this causes lysis so a shorter lived CL

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20
Q

when does the 2nd follicluar wave typically occur in the post partum cow?

A

30-35 days post partum

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21
Q

when does the first overt estrus occur post partum in the cow?

what number post partum follicular wave is this?

A

50-60 days (about 55 days) post partum

typically is 3rd ovulation post partum

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22
Q

why is the usual voluntary waiting period btwn parturition and breeding 60 days in the cow?

A

b/c prior to 60 days, it is not physiologically favorable for her to get pregnant

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23
Q

a common complication of the pueperium is vaginal trauma that occurred during the birthing process.

how is this treated?

A

Antimicrobial
Sx repair
Clamp any bleeding vessels
Px adhesion formation

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24
Q

what are 3 common causes of uterine lacerations / rupture during the peuperium?

A

obstetric interventions
fetal emphysema
dehiscence of hysterotomy

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25
how are uterine lacerations / rupture treated if fresh? what is a complications that may occur, which would complicate treatment?
fresh - repair and systemic Abx peritonitis may occur -> if it does, then Tx is likely not successful
26
why does peritonitis often result if the uterus is torn?
b/c it is full of bacT after the birthing process - it has not cleaned itself out yet all of the bacT goes straight into the abdominal cavity
27
when does uterine prolapse occur?
w/in a few hours after calving
28
what c/s are associated w uterine prolapse?
cachexia uterine intertia hypocalcemia excessive traction
29
how to differentiate retained fetal membranes from uterine prolapse?
very obvious difference membranes are smaller and dangle uterus is large and inside out so you can see caruncles
30
what structure holds the uterus in the body? if twisted or stretched, consequences may result in death d/t which structures that are contained in the above structure?
broad lig holds uterus in body contains the uterine vessels -> artery needed to maintain life of uterine tissue if compromised, uterus may become hypoperfused if V is compromised, uterus may become very large and edematous
31
how is uterine prolapse treated?
confine the cow - protect her and her uterus from further damage use Cd epidural anesthesia clean the tissue massage use hygroscopic agents
32
what hygroscopic agents are used to Tx uterine prolapse? how do they function?
glycerol or finely ground sugar - draws the accumulated fluid out of the tissue dec edema makes tissue more pliable
33
if the cow is standing, how should you handle the uterine tissue?
elevate it
34
if the cow is recumbent, how should she be positioned?
sternal recumbency head downhill hind legs pulled caudally
35
t/f the caruncles in the uterine tissue are helpful handles to use to help pull the uterus back into the body
false do NOT grab them or you will pull them off ==> hemorrhage
36
what function does the epidural anesthesia serve during uterine prolapse Tx?
it stops the cow from straining and pushing with her abdomen so you can put the uterus back in
37
what kind of suture is placed around the vulva to keep the uterus in after prolapse?
brunner suture
38
t/f NSAIDs and fluids are given to a cow during uterine prolapse Tx
true
39
after the uterus is replaced back into the body, why is the cow at risk of dying acutely?
d/t reperfusion injury - partially necrotic uterine tissue carries toxins back into the cow and she dies when the uterine tissue is reperfused and carries the toxins away acute toxic shock may occur d/t blood clot d/t acute blood loss d/t thromboembolism
40
what is used to stimulate uterine contractions during prolapse tx? why is this helpful?
oxy Ca it will contract the myometrium and shorten the uterus
41
prognosis after uterine prolapse repair?
fresh prolapse: fair to good
42
t/f after a uterine prolapse, culling the cow is suggested
false if she recovers, culling is NOT necessary
43
what causes retained fetal membranes?
not known completely PgF? hypo Ca? dystocia? inadequate maturation - collagen breakdown?
44
t/f if parturition was not induced normally, stage 3 of parturition will be compromised, leading to retained fetal membranes
true
45
t/f retained fetal membranes is a critical 1* dz that must be addressed aggressively and immediately
false this is not a dz itself - it may become a dz if it gets infected and infection spreads to uterus -> metritis -> life threatening if she does not have systemic c/s that prompt intervention, let her be to see if she expels them on her own
46
what is considered normal time post partum that e cow deliver the fetal membranes?
12 hours post partum
47
what is occurrence of retained fetal membranes in dairy cows and beef cows?
dairy: 10% beef: 2%
48
what fails to happen, leading to the retained fetal membranes?
failure of cotyledons to separate from caruncles
49
c/s of retained fetal membranes?
obvious tissue hanging from vulva transient dec in appetite and milk production
50
approximately what % of cows w retained fetal mem will develop metritis?
25%
51
how are retained fetal membranes managed?
manual removal myometrial stimulants
52
how does manual removal of fetal membranes lead to metritis?
trauma inhibits activity of NTs
53
t/f the best method for removal of retained fetal membranes is to chord them then gently ease it out of the cow why or why not?
true prevents the tearing of small pieces of shredded membrane is gentle and a little better for the cow
54
t/f PgF2a is very helpful in cases of retained fetal membranes
false endogenous PGs are already elevated inconsistently helpful to give more
55
t/f intra uterine abx are very helpful to reducing infection associated with retained fetal mem
false putting abx into the uterus puts them into the membranes too, which are dead, so have not blood supply - > cow does NOT benefit may actually prolong time of retention of membranes
56
under what circumstances in retained fetal membrane cases are systemic abx used?
if / when metritis sets in
57
what abx are used if metritis occurs after retained fetal membranes?
- penicillin - ceftiofur Na - ceftiofur hydrochloride
58
t/f if metritis does not develop, the reproductive ability of a cow is still compromised after having retained fetal membranes
false she is fine - retained fetal mem are NOT shown to be a recurring problem or to impact her reproductive performance
59
how to Px retained fetal membranes?
immunize against dzz that cause abortion allow cows adequate dry period balance ration for Ca and P Se/vit E supplementation if needed
60
what bacT persist in the uterus after contamination at calving and may contribute to post partum metritis?
Arcanobacterium pyogenes synergistic w gram neg anaerobes - bacteroides and fusobacterium
61
causes of post partum metritis?
``` overfeeding during the dry period (fat cow syndrome) improper Ca:P ratio contaminated calving environment RFM dystocia ```
62
c/s of metritis?
``` fever anorexia endotoxemia mastitis laminitis dec milk production, toxic milk ```
63
metritis tx?
local Abx - for anaerobic environment systemic penicillin for 30 days post partum Ceftiofir Na / hydrochloride oxy tet - NOT effective
64
supportive therapy for post partum metritis?
tetanus prophylaxis PgF2a fluids - hypertonic saline NSAIDs
65
prognosis of metritis?
very poor
66
what nerves are often damaged during parturition?
nerves on the inside of the bony pelvis obturatoor and peroneal Nn she cannot adduct her legs
67
Tx of Nn damage in post partum cow?
px further injury isolate her give her good footing and maybe hobbles NSAIDs to help w Mm damage
68
what is endometritis?
persistence of bacT infection beyond day 35 post partum
69
how common is clinical endometritis?
less common purulent discharge
70
how common is sub clinical endometritis?
very common
71
what does sub clinical endometritis lead to?
infertility
72
what bacT often present in endometritis?
Arcanobacterium pyogenes +/- anaerobe
73
Tx of endometritis?
PgF - induce luteolysis to inc days in heat [dilate cervix] AND induce myometrial contractions abx maybe lavage maybe
74
what is the cause of cystic ovarian dz?
insufficient LH surge -> partial surge results in partial LH effects GnRH center NOT primed or "reset" follicular waves but NO ovulation
75
in cases of cystic ovarian dz, what does Tx with GnRH do? CIDR? PG?
GnRH -> to convert follicular cyst to lutenized cyst CIDR -> to prime GnRH surge center so more responsive to e2 PG -> to destroy luteal cyst, 1 wk later
76
what is the ovsynch protocol?
GnRH - ovulation OR lutenization of follicular cyst PgF - luteolysis of luteinized cyst or CL, 7 days later * add CIDR

IP 11 Theriogenology (15 decks)

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