17.4.4: Post-partum period Flashcards
When should uterine involution be complete by in the cow?
3-6 weeks post-partum
True/false: Lochia is normal in the cow for 60 days after calving.
False
Lochia (red-brown/white discharge that lacks odour) is normal for ~23 days PP in the cow
True/false: late gestation immunosuppression continues in early post-partum.
True
Retained foetal membranes
the non-expulsion of foetal membranes beyond 24hrs post calving.
* Normal placental expulsion should occur within 6hrs of calving.
What substance links the foetal cotyledon and maternal caruncle?
Collagen
How is breakage of the collagen links between the cotyledon and caruncles facilitated?
Relaxin secretion and decline of progesterone
Use of which NSAID around calving has been associated with significantly increased risk of retained foetal membranes?
Flunixin
Risk factors for RFM
- Use of flunixin meglumine
- Induced parturition
- Shortened gestation
- Infectious disease e.g. BVDV
- Uterine trauma: C-section, dystocia, fetotomy
- Twinning
- Nutritional deficiency e.g. Vitamin E/selenium deficiency; NEB
- Abortion
- Immuno-suppression: failure to switch off immuno-protective mechanisms from pregnancy
How should you treat RFM?
There is no clear consensus on treatment. Options include:
* Manual removal (should only perform if no pressure required)
* Systemic antibiotic therapy but only if the cow is systemically unwell
* Benign neglect - RFM are usually expelled in 2-11 days and this seems to be the best outcome
Why should you not remove RFM by force? What could you do alternatively if they are getting in the way during milking?
- Risk of haemorrhage and uterine tears
- Can tie the RFM to the tail base, keeping them up and out of the way
Define retained foetal membranes in the cow and sheep
- In both species, the placenta is usually expelled within 6hrs of parturition
- Sheep = RFM if retained >18hrs
- Cow = RFM if retained >24hrs
What are the risk factors for RFM in sheep?
- Uterine trauma: C-section, dystocia
- Selenium or Vitamin A deficiency
- Infectious abortion
- Obesity of dam
- Hypocalcaemia
What is the difference between metritis and endometritis?
Metritis: infection of all layers of the uterus.
Endometritis infection of the endometrium only.
Metritis occurs <21 days PP, endometritis is after this.
Intrauterine antibiotics are appropriate for
a) metritis
b) endometritis
c) both
d) neither
b) endometritis
Define clinical metritis
- Abnormally enlarged uterus with purulent uterine discharge
- The animal is not systemically unwell
- Occurs within 21 days post-partum
Define puerperal metritis
- Toxic metritis
- Abnormally enlarged uterus with fetid watery red-brown discharge
- There are systemic signs of illness: decreased milk yield, dullness, inappetance, signs of toxaemia.
- Fever >39.5C
- Occurs within 21 days post-partum, usually <10 days
How do we grade metritis in the cow? How is this different to the grading of endometritis?
- Metritis - graded on the clinical signs in the cow. In practice, we tend not to do this - we just say if it is toxic or not.
- Endometritis - graded on the discharge
Risk factors for metritis in cows
- Following abnormal stage 1 or 2 of labour: severe dystocia, prolonged traction, damage to the birth canal
- Uterine inertia
- Premature calving and abortion
- Induced calving
- Twins
- RFM
- Dairy > beef
Risk factors for metritis in sheep
In sheep, metritis is often associated with:
* Dead foetuses
* Assisted delivery of multiple lambs without proper hygiene
* Uterine prolapse
Describe the grades of metritis in the cow
- Grade 1 = abnormally enlarged uterus with purulent uterine discharge; no systemic signs of ill health
- Grade 2 = above but with signs of systemic illness e.g. decreased milk yield, dullness, fever
- Grade 3 = a.k.a. pueperal/toxic metritis. Abnormally enlarged uterus with purulent uterine discharge + signs of toxaemia
Clinical signs of toxaemia as with Grade 3 metritis
- Inappetance
- Cold extremities
- Depression
- ± collapse
True/false: it is important to treat Grade 1 metritis.
False
If you have a case of metritis that requires antimicrobials, which will you choose and how will you deliver it/them?
- Should give systemic antibiotics; intrauterine alone = insufficient
- Penicillin/amoxicilin an appropriate choice
- Need to give for 3-5 days
Treatment protocol for metritis with systemic signs
- Systemic antimicrobials e.g. penicillins/amoxicillin for 3-5 days
- Supportive therapy: TLC, NSAIDs, fluid therapy, calcium borogluconate
- Could consider uterine lavage
What complications is a cow with Grade 3 metritis at risk of?
- Sepsis
- Peritonitis
- UTI
- Reproductive adhesions
- Others: endocarditis, pneumonia, polyarthritis
What constitutes TLC for a cow?
- Deep straw bedding
- Easy access to feed and water
- Companions nearby but not enough cows to generate competition/bullying for resources
Why is uterine lavage controversial for cows with metritis?
- The uterus is already inflamed and stretched
- There is an argument that by adding more fluid and increasing pressure we could push bacteria through the leaky wall, increasing the risk of peritonitis
- If doing this, use sterile saline only and remove the fluid you put in
Clinical endometritis
- Purulent uterine discharge (>50% pus) >21 days after parturition
OR
- Mucopurulent uterine discharge (50% pus, 50% mucus) >26 days after parturition (“whites”)
Subclinical endometritis
- > 18% neutrophils in uterine cytology sample collected 21-33 days after parturition
OR
- > 10% neutrophils in uterine cytology sample collected 34-47 days after parturition
- Uterine discharge is not yet seen
Risk factors for endometritis
- Trauma
- Hygiene: calving environment, post-partum housing, personnel
- Metabolitic state and NEB
- Herd size - larger herds more at risk
How could you diagnose clinical endometritis?
- Transrectal palpation ± ultrasonography
- Vaginal exam (inc. cervix): manual/metricheck
How could you diagnose subclinical endometritis?
- Cytology on cervical swabs or lumen flush
- Uterine biopsy
Describe the findings on this uterine ultrasound
- Thickened uterine wall
- “Snowglobe” appearance of pus (flocculant fluid) in the lumen
- Suggestive of endometritis
What is this and what is it used for?
- Metricheck = rubber diaphragm on steel rod
- Inserted into vagina, diaphragm collects fluid from vaginal floor
True/false: you can use a metricheck (rubber diaphragm + steel rod device) to diagnose subclinical endometritis.
False
* Need cytology to diagnose subclinical endometritis
* Need to use a cytobrush (insert into uterus through cervix)
What should you do before inserting a cytobrush into the uterus to investigate subclinical endometritis?
- Make sure the brush is screwed on properly! There is a FB risk of the brush detaching in the uterus.
What are the pros and cons of taking an endometrial biopsy in the cow?
✅ Predictive for subsequent fertility
❌ Costly
❌ Time consuming
❌ Not often clinically available
❌ May depress fertility
What are the pros and cons of uterine cytology (e.g. using cytobrush) in the cow?
✅ Practical and relatively easy to do
✅ Can diagnose subclinical endometritis
❌ Does not produce a rapid diagnosis
What are the pros and cons of uterine cytology (e.g. using cytobrush) in the cow?
✅ Practical and relatively easy to do
✅ Can diagnose subclinical endometritis
❌ Does not produce a rapid diagnosis
How do we grade endometritis?
- Based on colour and qualities of discharge
- Grade 0-3
What grade endometritis is this?
Grade 1
Mucus contains flecks of white or off-white pus.
What grade endometritis is this?
Grade 2
Discharge contains <50% white or off-white mucopurulent material
What grade endometritis is this?
Grade 3
Discharge containing >50% purulent material, usually white or ywllow but occasionally sangiuneous.
What grade endometritis is this?
Grade 3
Discharge containing >50% purulent material, usually white or ywllow but occasionally sangiuneous
True/false: culture and sensitivity is essential before beginning endometritis treatment.
False
Culture and sensitivity is rarely done as it is time-consuming and we need to treat the cow there are then.
Which bacteria are most commonly implicated in endometritis?
- *E. coli
- T. pyogenes
- F. necrophorum*
- Other opportunistic bacteria
True/false: some cases (approx. 33-46%) of endometritis in the cow spontaneously self-cure.
True
What are the possible treatment options for endometritis in the cow?
- Intrauterine infusion of antiseptics
- PGF2a
- Intrauterine antibiotics
What are the pros and cons of using intrauterine infusions of antiseptics for treatment of endometritis?
- Minimal pros really
- These are of limited value
- Risk of injury, peritonitis, septicaemia (uterine wall is inflamed and leaky)
How can be PGF2a be helpful in treating endometritis?
- Stimulates uterine defences
- Luteolysis of CL -> reduced progesterone -> return to oestrus
- Increased uterine tone and open cervix
Which antibiotic is available for intrauterine use?
- Cefapirin (Trade name Metricure)
- This is a 1st gen cephalosporin (Category C) but as yet the only product licensed for intrauterine use
- This may become more difficult to use in future on milk contracts with large retailers
Pyometra
Purulent or mucopurulent material within the uterine lumen, causing uterine distension, in the presence of a closed cervix and a functional corpus luteum.
How common is pyometra in cattle and small ruminants?
Uncommon
How could you diagnose pyometra in cattle?
- Transrectal palpation and ultrasound
- History of anoestrus
True/false: in a cow with pyometra, you would see discharge on vaginal exam.
False
The cervix is by definition closed so you would not see discharge on vaginal exam.
What characteristics must an intrauterine antibiotic have?
- Must work against gram +ve, gram -ve, aerobic and anaerobic bacteria
- Must work in a microaerophilic environment
- Must work in an evenly distributed fashion across the uterine lumen, with good penetration in endometrial layers
- Must work without inhibiting uterine defence mechanisms
- Must work without traumatising the endometrium (must not cause irritation)
- Must work without reducing fertility by producing irreversible changes
- Must be cost-effective
- Must have a known excretion pattern so appropriate withdrawal times can be applied
What are the long term impacts of endometritis on the cow?
- Reduced fertility (=reduced chance of conception)
- Increased risk of cull (due to reproductive failure)
