Periparturient emergencies

Question 1

when do cervical/ vaginal prolapses occur

Answer 1

pre-partum- occasionally in oestrus

Question 2

how to tell difference between uterine and cervical/vaginal prolapses

Answer 2

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

Question 3

describe a grade 1 cervicovaginal prolapse

Answer 3

Small intermittent vaginal prolapse only present when animal lies down

Question 4

describe a grade 2 cervicovaginal prolapse

Answer 4

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

Question 5

describe a grade 3 cervicovaginal prolapse

Answer 5

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

Question 6

describe a grade 4 cervicovaginal prolapse

Answer 6

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

Question 7

List 2 risk factors of a uterine prolapse

Answer 7

hypocalcaemia
difficult calving

Question 8

List 4 risk factors of cervical/vaginal prolapse

Answer 8

limited exercise
hereditary
increased abdominal pressure
hypocalcaemia

Question 9

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

Answer 9

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

Question 10

Describe how to replace cervical/ vaginal prolapse

Answer 10

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

Question 11

List 3 potential complications of cervical/ vaginal prolapse

Answer 11

ruptured bladder
ringwomb
ascending infection –> placentitis and fetal death

Question 12

what is ringwomb

Answer 12

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

Question 13

Describe how to treat uterine prolapse

Answer 13

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

Question 14

List 3 potential complications of replacing uterine prolapses

Answer 14

haemorrhage
metritis
reduced subsequent reproductive performance

Question 15

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

Answer 15

Avoid excessive movement of animal
Careful handling of everted uterus

Question 16

Describe the history associated with a uterine torsion

Answer 16

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

Question 17

Describe what you feel on vaginal exam with uterine torsion

Answer 17

folds palpable in vagina –> in direction of the torsion

Question 18

Describe what you can feel on rectal exam with uterine torsion

Answer 18

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

Question 19

what direction do most uterine torsions occur

Answer 19

2/3 of cases are anti-clockwise

Question 20

List 3 treatment options for uterine torsion

Answer 20

manual de-rotation
roll cow
c-section

Question 21

Describe manual de-rotation of uterine torsions

Answer 21

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

Question 22

Describe rolling method of treating uterine torsion

Answer 22

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

Question 23

when is an episiotomy useful

Answer 23

soft tissue obstruction

Question 24

describe how to perform an episiotomy

Answer 24

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

Question 25

Decsribe how to close episiotomy

Answer 25

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

Question 26

describe how to treat minor tears of the vulva

Answer 26

don’t need treatment
leave to heal by secondary intention

Question 27

Describe a 1st degree perineal tear

Answer 27

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

Question 28

Describe a 2nd degree perineal tear

Answer 28

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

Question 29

Describe a 3rd degree perineal tear

Answer 29

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

Question 30

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

Answer 30

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

Question 31

Describe how to treat 3rd degree perineal tear

Answer 31

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

Question 32

Describe how to treat mild to moderate uterine bleeding

Answer 32

oxytocin - to stimulate myometrial contration

Question 33

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

Answer 33

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

Question 34

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

Answer 34

clamp with haemostats
leave in place for 3 days

Question 35

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

Answer 35

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

Question 36

Describe how to treat hypovolaemic shock in cow

Answer 36

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