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IP 11 Theriogenology > 39 - the puerperium > Flashcards

39 - the puerperium Flashcards

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
Q

how are uterine lacerations / rupture treated if fresh?

what is a complications that may occur, which would complicate treatment?

A

fresh - repair and systemic Abx

peritonitis may occur -> if it does, then Tx is likely not successful

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26
Q

why does peritonitis often result if the uterus is torn?

A

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

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27
Q

when does uterine prolapse occur?

A

w/in a few hours after calving

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28
Q

what c/s are associated w uterine prolapse?

A

cachexia
uterine intertia
hypocalcemia
excessive traction

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29
Q

how to differentiate retained fetal membranes from uterine prolapse?

A

very obvious difference

membranes are smaller and dangle

uterus is large and inside out so you can see caruncles

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30
Q

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?

A

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

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31
Q

how is uterine prolapse treated?

A

confine the cow - protect her and her uterus from further damage

use Cd epidural anesthesia
clean the tissue
massage
use hygroscopic agents

32
Q

what hygroscopic agents are used to Tx uterine prolapse?

how do they function?

A

glycerol or finely ground sugar - draws the accumulated fluid out of the tissue

dec edema

makes tissue more pliable

33
Q

if the cow is standing, how should you handle the uterine tissue?

A

elevate it

34
Q

if the cow is recumbent, how should she be positioned?

A

sternal recumbency
head downhill
hind legs pulled caudally

35
Q

t/f

the caruncles in the uterine tissue are helpful handles to use to help pull the uterus back into the body

A

false

do NOT grab them or you will pull them off ==> hemorrhage

36
Q

what function does the epidural anesthesia serve during uterine prolapse Tx?

A

it stops the cow from straining and pushing with her abdomen so you can put the uterus back in

37
Q

what kind of suture is placed around the vulva to keep the uterus in after prolapse?

A

brunner suture

38
Q

t/f

NSAIDs and fluids are given to a cow during uterine prolapse Tx

A

true

39
Q

after the uterus is replaced back into the body, why is the cow at risk of dying acutely?

A

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
Q

what is used to stimulate uterine contractions during prolapse tx?

why is this helpful?

A

oxy
Ca

it will contract the myometrium and shorten the uterus

41
Q

prognosis after uterine prolapse repair?

A

fresh prolapse: fair to good

42
Q

t/f

after a uterine prolapse, culling the cow is suggested

A

false

if she recovers, culling is NOT necessary

43
Q

what causes retained fetal membranes?

A

not known completely

PgF?
hypo Ca?
dystocia?
inadequate maturation - collagen breakdown?

44
Q

t/f

if parturition was not induced normally, stage 3 of parturition will be compromised, leading to retained fetal membranes

A

true

45
Q

t/f

retained fetal membranes is a critical 1* dz that must be addressed aggressively and immediately

A

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
Q

what is considered normal time post partum that e cow deliver the fetal membranes?

A

12 hours post partum

47
Q

what is occurrence of retained fetal membranes in dairy cows and beef cows?

A

dairy: 10%
beef: 2%

48
Q

what fails to happen, leading to the retained fetal membranes?

A

failure of cotyledons to separate from caruncles

49
Q

c/s of retained fetal membranes?

A

obvious tissue hanging from vulva

transient dec in appetite and milk production

50
Q

approximately what % of cows w retained fetal mem will develop metritis?

A

25%

51
Q

how are retained fetal membranes managed?

A

manual removal

myometrial stimulants

52
Q

how does manual removal of fetal membranes lead to metritis?

A

trauma inhibits activity of NTs

53
Q

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?

A

true

prevents the tearing of small pieces of shredded membrane

is gentle and a little better for the cow

54
Q

t/f

PgF2a is very helpful in cases of retained fetal membranes

A

false

endogenous PGs are already elevated

inconsistently helpful to give more

55
Q

t/f

intra uterine abx are very helpful to reducing infection associated with retained fetal mem

A

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
Q

under what circumstances in retained fetal membrane cases are systemic abx used?

A

if / when metritis sets in

57
Q

what abx are used if metritis occurs after retained fetal membranes?

A
  • penicillin
  • ceftiofur Na
  • ceftiofur hydrochloride
58
Q

t/f

if metritis does not develop, the reproductive ability of a cow is still compromised after having retained fetal membranes

A

false

she is fine - retained fetal mem are NOT shown to be a recurring problem or to impact her reproductive performance

59
Q

how to Px retained fetal membranes?

A

immunize against dzz that cause abortion

allow cows adequate dry period

balance ration for Ca and P

Se/vit E supplementation if needed

60
Q

what bacT persist in the uterus after contamination at calving and may contribute to post partum metritis?

A

Arcanobacterium pyogenes

synergistic w gram neg anaerobes - bacteroides and fusobacterium

61
Q

causes of post partum metritis?

A 
overfeeding during the dry period (fat cow syndrome)
improper Ca:P ratio
contaminated calving environment
RFM
dystocia
62
Q

c/s of metritis?

A 
fever
anorexia
endotoxemia
mastitis
laminitis
dec milk production, toxic milk
63
Q

metritis tx?

A

local Abx - for anaerobic environment

systemic penicillin for 30 days post partum
Ceftiofir Na / hydrochloride
oxy tet - NOT effective

64
Q

supportive therapy for post partum metritis?

A

tetanus prophylaxis
PgF2a
fluids - hypertonic saline
NSAIDs

65
Q

prognosis of metritis?

A

very poor

66
Q

what nerves are often damaged during parturition?

A

nerves on the inside of the bony pelvis

obturatoor and peroneal Nn

she cannot adduct her legs

67
Q

Tx of Nn damage in post partum cow?

A

px further injury

isolate her
give her good footing and maybe hobbles
NSAIDs to help w Mm damage

68
Q

what is endometritis?

A

persistence of bacT infection beyond day 35 post partum

69
Q

how common is clinical endometritis?

A

less common

purulent discharge

70
Q

how common is sub clinical endometritis?

A

very common

71
Q

what does sub clinical endometritis lead to?

A

infertility

72
Q

what bacT often present in endometritis?

A

Arcanobacterium pyogenes +/- anaerobe

73
Q

Tx of endometritis?

A

PgF - induce luteolysis to inc days in heat [dilate cervix] AND induce myometrial contractions

abx maybe

lavage maybe

74
Q

what is the cause of cystic ovarian dz?

A

insufficient LH surge -> partial surge results in partial LH effects

GnRH center NOT primed or “reset”

follicular waves but NO ovulation

75
Q

in cases of cystic ovarian dz, what does Tx with GnRH do?
CIDR?
PG?

A

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
Q

what is the ovsynch protocol?

A

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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