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FARM ANIMAL > 17.4.4: Post-partum period > Flashcards

17.4.4: Post-partum period Flashcards

1
Q

When should uterine involution be complete by in the cow?

A

3-6 weeks post-partum

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2
Q

True/false: Lochia is normal in the cow for 60 days after calving.

A

False
Lochia (red-brown/white discharge that lacks odour) is normal for ~23 days PP in the cow

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3
Q

True/false: late gestation immunosuppression continues in early post-partum.

A

True

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4
Q

Retained foetal membranes

A

the non-expulsion of foetal membranes beyond 24hrs post calving.
* Normal placental expulsion should occur within 6hrs of calving.

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5
Q

What substance links the foetal cotyledon and maternal caruncle?

A

Collagen

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6
Q

How is breakage of the collagen links between the cotyledon and caruncles facilitated?

A

Relaxin secretion and decline of progesterone

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7
Q

Use of which NSAID around calving has been associated with significantly increased risk of retained foetal membranes?

A

Flunixin

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8
Q

Risk factors for RFM

A
  • 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
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9
Q

How should you treat RFM?

A

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

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10
Q

Why should you not remove RFM by force? What could you do alternatively if they are getting in the way during milking?

A
  • Risk of haemorrhage and uterine tears
  • Can tie the RFM to the tail base, keeping them up and out of the way
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11
Q

Define retained foetal membranes in the cow and sheep

A
  • In both species, the placenta is usually expelled within 6hrs of parturition
  • Sheep = RFM if retained >18hrs
  • Cow = RFM if retained >24hrs
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12
Q

What are the risk factors for RFM in sheep?

A
  • Uterine trauma: C-section, dystocia
  • Selenium or Vitamin A deficiency
  • Infectious abortion
  • Obesity of dam
  • Hypocalcaemia
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13
Q

What is the difference between metritis and endometritis?

A

Metritis: infection of all layers of the uterus.
Endometritis infection of the endometrium only.
Metritis occurs <21 days PP, endometritis is after this.

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14
Q

Intrauterine antibiotics are appropriate for
a) metritis
b) endometritis
c) both
d) neither

A

b) endometritis

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15
Q

Define clinical metritis

A
  • Abnormally enlarged uterus with purulent uterine discharge
  • The animal is not systemically unwell
  • Occurs within 21 days post-partum
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16
Q

Define puerperal metritis

A
  • 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
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17
Q

How do we grade metritis in the cow? How is this different to the grading of endometritis?

A
  • 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
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18
Q

Risk factors for metritis in cows

A
  • 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
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19
Q

Risk factors for metritis in sheep

A

In sheep, metritis is often associated with:
* Dead foetuses
* Assisted delivery of multiple lambs without proper hygiene
* Uterine prolapse

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20
Q

Describe the grades of metritis in the cow

A
  • 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
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21
Q

Clinical signs of toxaemia as with Grade 3 metritis

A
  • Inappetance
  • Cold extremities
  • Depression
  • ± collapse
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22
Q

True/false: it is important to treat Grade 1 metritis.

A

False

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23
Q

If you have a case of metritis that requires antimicrobials, which will you choose and how will you deliver it/them?

A
  • Should give systemic antibiotics; intrauterine alone = insufficient
  • Penicillin/amoxicilin an appropriate choice
  • Need to give for 3-5 days
24
Q

Treatment protocol for metritis with systemic signs

A
  • Systemic antimicrobials e.g. penicillins/amoxicillin for 3-5 days
  • Supportive therapy: TLC, NSAIDs, fluid therapy, calcium borogluconate
  • Could consider uterine lavage
25
Q

What complications is a cow with Grade 3 metritis at risk of?

A
  • Sepsis
  • Peritonitis
  • UTI
  • Reproductive adhesions
  • Others: endocarditis, pneumonia, polyarthritis
26
Q

What constitutes TLC for a cow?

A
  • Deep straw bedding
  • Easy access to feed and water
  • Companions nearby but not enough cows to generate competition/bullying for resources
27
Q

Why is uterine lavage controversial for cows with metritis?

A
  • 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
28
Q

Clinical endometritis

A
  • Purulent uterine discharge (>50% pus) >21 days after parturition

OR

  • Mucopurulent uterine discharge (50% pus, 50% mucus) >26 days after parturition (“whites”)
29
Q

Subclinical endometritis

A
  • > 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
30
Q

Risk factors for endometritis

A
  • Trauma
  • Hygiene: calving environment, post-partum housing, personnel
  • Metabolitic state and NEB
  • Herd size - larger herds more at risk
31
Q

How could you diagnose clinical endometritis?

A
  • Transrectal palpation ± ultrasonography
  • Vaginal exam (inc. cervix): manual/metricheck
32
Q

How could you diagnose subclinical endometritis?

A
  • Cytology on cervical swabs or lumen flush
  • Uterine biopsy
33
Q

Describe the findings on this uterine ultrasound

A
  • Thickened uterine wall
  • “Snowglobe” appearance of pus (flocculant fluid) in the lumen
  • Suggestive of endometritis
34
Q

What is this and what is it used for?

A
  • Metricheck = rubber diaphragm on steel rod
  • Inserted into vagina, diaphragm collects fluid from vaginal floor
35
Q

True/false: you can use a metricheck (rubber diaphragm + steel rod device) to diagnose subclinical endometritis.

A

False
* Need cytology to diagnose subclinical endometritis
* Need to use a cytobrush (insert into uterus through cervix)

36
Q

What should you do before inserting a cytobrush into the uterus to investigate subclinical endometritis?

A
  • Make sure the brush is screwed on properly! There is a FB risk of the brush detaching in the uterus.
37
Q

What are the pros and cons of taking an endometrial biopsy in the cow?

A

✅ Predictive for subsequent fertility
❌ Costly
❌ Time consuming
❌ Not often clinically available
❌ May depress fertility

38
Q

What are the pros and cons of uterine cytology (e.g. using cytobrush) in the cow?

A

✅ Practical and relatively easy to do
✅ Can diagnose subclinical endometritis
❌ Does not produce a rapid diagnosis

39
Q

What are the pros and cons of uterine cytology (e.g. using cytobrush) in the cow?

A

✅ Practical and relatively easy to do
✅ Can diagnose subclinical endometritis
❌ Does not produce a rapid diagnosis

40
Q

How do we grade endometritis?

A
  • Based on colour and qualities of discharge
  • Grade 0-3
41
Q

What grade endometritis is this?

A

Grade 1
Mucus contains flecks of white or off-white pus.

42
Q

What grade endometritis is this?

A

Grade 2
Discharge contains <50% white or off-white mucopurulent material

43
Q

What grade endometritis is this?

A

Grade 3
Discharge containing >50% purulent material, usually white or ywllow but occasionally sangiuneous.

44
Q

What grade endometritis is this?

A

Grade 3
Discharge containing >50% purulent material, usually white or ywllow but occasionally sangiuneous

45
Q

True/false: culture and sensitivity is essential before beginning endometritis treatment.

A

False
Culture and sensitivity is rarely done as it is time-consuming and we need to treat the cow there are then.

46
Q

Which bacteria are most commonly implicated in endometritis?

A
  • *E. coli
  • T. pyogenes
  • F. necrophorum*
  • Other opportunistic bacteria
47
Q

True/false: some cases (approx. 33-46%) of endometritis in the cow spontaneously self-cure.

A

True

48
Q

What are the possible treatment options for endometritis in the cow?

A
  • Intrauterine infusion of antiseptics
  • PGF2a
  • Intrauterine antibiotics
49
Q

What are the pros and cons of using intrauterine infusions of antiseptics for treatment of endometritis?

A
  • Minimal pros really
  • These are of limited value
  • Risk of injury, peritonitis, septicaemia (uterine wall is inflamed and leaky)
50
Q

How can be PGF2a be helpful in treating endometritis?

A
  • Stimulates uterine defences
  • Luteolysis of CL -> reduced progesterone -> return to oestrus
  • Increased uterine tone and open cervix
51
Q

Which antibiotic is available for intrauterine use?

A
  • 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
52
Q

Pyometra

A

Purulent or mucopurulent material within the uterine lumen, causing uterine distension, in the presence of a closed cervix and a functional corpus luteum.

53
Q

How common is pyometra in cattle and small ruminants?

A

Uncommon

54
Q

How could you diagnose pyometra in cattle?

A
  • Transrectal palpation and ultrasound
  • History of anoestrus
55
Q

True/false: in a cow with pyometra, you would see discharge on vaginal exam.

A

False
The cervix is by definition closed so you would not see discharge on vaginal exam.

56
Q

What characteristics must an intrauterine antibiotic have?

A
  • 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
57
Q

What are the long term impacts of endometritis on the cow?

A
  • Reduced fertility (=reduced chance of conception)
  • Increased risk of cull (due to reproductive failure)

FARM ANIMAL (56 decks)

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