Flashcards in DIsorders of Puerperium Deck (46):
WHat is the puerperium?
period after parturition when rerpro tract returns to non-pregnant state
- shortest possible puerperium is desirable
What are the normal processes that occour during puerperium?
- endometrial regeneration
- elimination of contaminants of repro tract
- resuming ovarian cyclicity
WHat disorders affect normal puerperium?
- uterine pprolapse
- retention of foetal membrane
- uterine disease
when does greatest uterine involution occour?
1st few days affter calving (horns diameter halves in 5d, length halved 15d)
HOw long postpartum should whole uterus be palpable per rectum?
HOw long should complete involution take?
HOw long does the cervix take to return to normal size postpartum?
- 10-12 hours can not fit hand through
- 96hrs 2 fingers
HOw does diameter of the cervix change on rectal palapation?
- 15cm @ 2d
- 10cm @ 10d
- 7cm @ 30d
- 5cm@ 60d
how does involution occour physiologically? how may this be manipulated with drugs?
- shift from hypertorphy (^ collagen and sm. mm) to atrophy (vsm mm, v collagen)
-v size myofibrilss
-PGs control involution along with OT so exogenous use will speed up
WHat happens to the uterine caruncles postprtum? whhat clinical sign does this cause?
- degenerative changes due to ischaemia
- along with blood and foetal fluids -> post partum lochial discharge occouring at d2-9
- yellow or reddish brown
> providing there is no pus or odour this is normal
- systemic response acute phase proteins
- covering of caruncular and inter-caruncular surfaces with endothelial endometrium
Which bacterial spp are present in the uterine lumen?
- aranobacterium pyogenes
- e. coli
- strep and staph
- fusobacterium necrophorum
> opportunistic bacteria
What is the main mechanism of bacterial elimination?
- phagocytosis by migrating leucocytes
- physical expulsion by uterus
How long postpartum does the uterus become sterile again?
- @ 5 weeks 50% will be sterile
- @ 8-9 weeks majority
When does ovarian cycling activity resume postpartum?
- 7-10d ^ FSH -> follicular wave
- ovulation only occours if follicle produces enough E2 to s timulate LH secretion (role of LHRs and IGFBPs)
- dominant follicle on contra-lateral ovary and possibility of silent ovulation
- suckling delays cyclic activity
- luteal phase may be normal or shorter due t o poor luteinisation of the CL
How does dystocia affect normal puerperium? What does dystocia predispose to?
Brekaing host defense mechanism
- > deformitiy of vulva and cervix
- tissue damage
- uterine inertia
> lack of sterility with intervention
- predisposes RFM and uterine disease
which cows are uterine prolapse seen more commonly with?
pluriparous cows (not heifers)
When does uterine prolapse occour?
24 hrs postpartum
How does uterine prolapse affect future fertiltiy?
^ calving - conception interval
which conditions predispose uterine prolapse?
- Milk fever (hypocalceamia)
- foetal traction
- foetal oversize
- laxity of perneum and vulva
Tx of uterine prolapse?
- protect and support, clean uterus
- calcium borogluconate
- releive rumenal tympany
- frog leg position
- replace uterus and ensure total inversion
- stitch vulva
- ABx and NSAIDs
how comon are RFM?
15-40% with dystocia
What causes separation and expulsion of the placenta?
> placental maturation
- changes in P4 and E2 conc, collaginases, proteases and glucosamides
- v no. binucleate cells in trophectoderm
- exsanguination of foetal side of placenta and collapse of trophectodermal villi
- uterine contraction ->distortion of placentomes
- lack of antioxidants, stress, oxidative injury
- role of PGF and PGE synthesis
- IL8, leukocyte migration and collagenases *look up meaning of this! echo*
What are the 3 reasons for retention of foetal membranes?
- failrue of maturation of placenta (premature calving)
- failrue of detachment of foetal and maternal villli of placentome
- inadequate uterine contractions due to hypocalcaemia or dystocia
Predisposing factors for RFM>
- abortion or stillbirth
- multiple births
- dystocia or premature calving
- infectious pacentitis (brucellosis, salmonellosis)
- ^ age of dam
- prolonged gestation
- micronutrient deficiency (Se, Vit E and A
clinical features of RFM?
- lack of apetite
- v milk yield
WHen do myometrial contractions cease pp?
How does RFM affect future fertility?
- no effect if mating 60d pp
- along with metritis, ^ days open, services/ceonception, calving -> 1st oestrus/service interval
- wait until 5d postpartun for veterinary examination
- if pyrexic and depressed with v milk yield, treat for metritis
- hormones (PGs OT)
- collaginase infusion into stmps of umbilical arteries of retained membranes
- ABx parenteral or intrauterine *echo to check*
- endometirum and stratum spongisum of submucosa affected
- no systemic illness
- leukocytes but NO pus in uterine discharge
- deeper layers of uterus affected
- systemic illness (milk -> v severe)
- puerperal metiritis
- purulent exudate
how does uterine disease affect future fertility?
how does infection develop pp? 2 mechanisms
- physical barreirs of cervix and vulva
- hormonal effect on immune system (E2 nd P4 role in local immune system - resumption of ovarian cyclical activity critical)
> neutrophilia, ^ blood supply, phagocytosis, cervical/vaginal mucus
Which species are pathogenic in the uterus?
- arcanobacterium pyogenes
- fusoforum necrophorum
- e. coli
- prevotella species
- clostridium spp
- manhaemia haemolytica
Does endometritis affect general health? WHy is it important?
- does not affect general health
- affects fertility
Which pathogens cause endometritis?
- opportunistic pathogens
- E. coli
- subsequent overgrowth of A. pyogenes, F. necrophorum, provotella spp
Clinical signs associated with endometritis? FIndings on PE?
- mucopurulent discharge in clinical cases
- no systemic illness
- neutrophilsin uterine luminal fluid
- poorly involuted uterus on PE
- presence of discharge around cervical os with vaginoscope
- metricheck (for discharge) shows presence of neutrophils in cervical swabs
> 20-33d pp = > 18%
> 33-49d pp = >10%
> >50d pp = >5%
- stimulation of oestrus in both cyclic (PGF2a) and acyclic(GnrH/E2) cows
- intrauterine cephaprin (meticure, intravet)
Clinical signs of metritis?
- systemic illness
- purulent fetid fluid in uterine lumen
- distended, fluid filled atonic uterus
- pyrexic 40-41deg
- dull, depressed, innapetant, v milk yield
- within few days pp, following severe dystocia, uterine inertia, RFM
- sore, swollen and inflamed vagina and vulva
- systemic toxaemia: fast weak pulse, rapid resp, dehydration, slow CRT, D+
- pyaemia: concurrent peritonitis, mastitis
Tx of metritis? Prognosis?
> prognosis poor
> case dependant Tx
- supportive Tx (fluids and NSAIDs - flunixine meglumine 2.2mg/kg)
- parenteral ABx (cephalosporins, ceftiofur, broad-spec penicillins, oxytetracycline)
- uterine lavage (after stabilisation of circulation) followed by ABx eg. oxytet
What tx is contraindicated for metritis?
Oestrogens ^ absorption of endotoxin
What equipment is needed for uterine lavage?
- wide bore stomach tube
- normal saline
WHat is pyometra? What must it be differentiated from?
- accumulation of purulent material in the uterus in the presence of an active persistnet CL
- cervix closed, uterine horns large and distended
- sequel to chronic endometritis
- EBD (T. foetus) predisposing factor
- No signs of ill health
- Absence of acyclicity
> Differentiate from normal pregnancy by rectal palpation
- thickness uterine wall, membrane slip, caruncles
- transrectal ultrasonography (speckled echotexture of uterine contents v black anechoic appearance normal foetal fluids)
How much on average would RFM cost the farmer?
Direct costs £84