39 - the puerperium Flashcards
what is the puerperium period?
“after parturition” ==> the window of time btwn parturition and readiness to fall pregnant again / conceive the next pregnancy
t/f
the puerperium is a well defined time line for all species
false
the time is hard to define well for one species
and is highly variable among species
how long is the puerperium in the cow?
horse?
bitch?
cow: 45 days
horse: 10 d
bitch: 5-6 mos
what occurs during the puerperial process w/in the reproductive tract?
3 important facets:
return to a state that allows establishment of a new pregnancy
1 - uterine involution
2 - elimination of bacT
3 - resumption of ovarian cycles
what are 2 aspects to uterine involution?
gross size
histologic repair
what size change occurs in the uterus of the cow during the pueperium ?
in what time frame?
10 kg to 1 kg in 12-13 days
0.5 kg by 30 days
during the epithelial repair of uterine involution in the cow, what occurs around day 7?
after this occurs, what is present in the uterus?
day 7: caruncles slough off
de nuded caruncles are present - bright red b/c the epithelium has shed
after caruncle sloughing, what process occurs and is complete by day 30 of uterine involution in the cow?
re-epitheliazation occurs and is complete by day 30
what is lochia?
when is it present?
cellular debris -> millions of NTs and bacT
present during uterine involution of the cow
what is the appearance of lochia and how does it change in the first 10 days of involution?
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
if lochia is watery and smelly, what has occurred?
bacT has overwhelmed the body defenses
should not smell and should be thick and mucoid
at what point in uterine involution does lochia becomes clear?
day 13 - clear with flecks
day 16 - clear
as a result of uterine involution, how many days post partum should the cow have no bacT in her uterus?
day 35
t/f
resumption of ovarian activity occurs after involution of the uterus is complete
false
resumption of ovarian activity occurs during involution
how many days post partum does the cow experience her first follicular wave?
7 days post partum
what is a silent ovulation?
ovulation occurs but there is no detectable sign of estrus
what % of cows experience 2 silent ovulations post partum?
50%
how many days post partum does the first ovulation occur in the cow?
14-20 days
why does the cow have a short luteal period on her first follicular wave post partum?
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
when does the 2nd follicluar wave typically occur in the post partum cow?
30-35 days post partum
when does the first overt estrus occur post partum in the cow?
what number post partum follicular wave is this?
50-60 days (about 55 days) post partum
typically is 3rd ovulation post partum
why is the usual voluntary waiting period btwn parturition and breeding 60 days in the cow?
b/c prior to 60 days, it is not physiologically favorable for her to get pregnant
a common complication of the pueperium is vaginal trauma that occurred during the birthing process.
how is this treated?
Antimicrobial
Sx repair
Clamp any bleeding vessels
Px adhesion formation
what are 3 common causes of uterine lacerations / rupture during the peuperium?
obstetric interventions
fetal emphysema
dehiscence of hysterotomy
how are uterine lacerations / rupture treated if fresh?
what is a complications that may occur, which would complicate treatment?
fresh - repair and systemic Abx
peritonitis may occur -> if it does, then Tx is likely not successful
why does peritonitis often result if the uterus is torn?
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
when does uterine prolapse occur?
w/in a few hours after calving
what c/s are associated w uterine prolapse?
cachexia
uterine intertia
hypocalcemia
excessive traction
how to differentiate retained fetal membranes from uterine prolapse?
very obvious difference
membranes are smaller and dangle
uterus is large and inside out so you can see caruncles
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?
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
how is uterine prolapse treated?
confine the cow - protect her and her uterus from further damage
use Cd epidural anesthesia
clean the tissue
massage
use hygroscopic agents
what hygroscopic agents are used to Tx uterine prolapse?
how do they function?
glycerol or finely ground sugar - draws the accumulated fluid out of the tissue
dec edema
makes tissue more pliable
if the cow is standing, how should you handle the uterine tissue?
elevate it
if the cow is recumbent, how should she be positioned?
sternal recumbency
head downhill
hind legs pulled caudally
t/f
the caruncles in the uterine tissue are helpful handles to use to help pull the uterus back into the body
false
do NOT grab them or you will pull them off ==> hemorrhage
what function does the epidural anesthesia serve during uterine prolapse Tx?
it stops the cow from straining and pushing with her abdomen so you can put the uterus back in
what kind of suture is placed around the vulva to keep the uterus in after prolapse?
brunner suture
t/f
NSAIDs and fluids are given to a cow during uterine prolapse Tx
true
after the uterus is replaced back into the body, why is the cow at risk of dying acutely?
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
what is used to stimulate uterine contractions during prolapse tx?
why is this helpful?
oxy
Ca
it will contract the myometrium and shorten the uterus
prognosis after uterine prolapse repair?
fresh prolapse: fair to good
t/f
after a uterine prolapse, culling the cow is suggested
false
if she recovers, culling is NOT necessary
what causes retained fetal membranes?
not known completely
PgF?
hypo Ca?
dystocia?
inadequate maturation - collagen breakdown?
t/f
if parturition was not induced normally, stage 3 of parturition will be compromised, leading to retained fetal membranes
true
t/f
retained fetal membranes is a critical 1* dz that must be addressed aggressively and immediately
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
what is considered normal time post partum that e cow deliver the fetal membranes?
12 hours post partum
what is occurrence of retained fetal membranes in dairy cows and beef cows?
dairy: 10%
beef: 2%
what fails to happen, leading to the retained fetal membranes?
failure of cotyledons to separate from caruncles
c/s of retained fetal membranes?
obvious tissue hanging from vulva
transient dec in appetite and milk production
approximately what % of cows w retained fetal mem will develop metritis?
25%
how are retained fetal membranes managed?
manual removal
myometrial stimulants
how does manual removal of fetal membranes lead to metritis?
trauma inhibits activity of NTs
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?
true
prevents the tearing of small pieces of shredded membrane
is gentle and a little better for the cow
t/f
PgF2a is very helpful in cases of retained fetal membranes
false
endogenous PGs are already elevated
inconsistently helpful to give more
t/f
intra uterine abx are very helpful to reducing infection associated with retained fetal mem
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
under what circumstances in retained fetal membrane cases are systemic abx used?
if / when metritis sets in
what abx are used if metritis occurs after retained fetal membranes?
- penicillin
- ceftiofur Na
- ceftiofur hydrochloride
t/f
if metritis does not develop, the reproductive ability of a cow is still compromised after having retained fetal membranes
false
she is fine - retained fetal mem are NOT shown to be a recurring problem or to impact her reproductive performance
how to Px retained fetal membranes?
immunize against dzz that cause abortion
allow cows adequate dry period
balance ration for Ca and P
Se/vit E supplementation if needed
what bacT persist in the uterus after contamination at calving and may contribute to post partum metritis?
Arcanobacterium pyogenes
synergistic w gram neg anaerobes - bacteroides and fusobacterium
causes of post partum metritis?
overfeeding during the dry period (fat cow syndrome) improper Ca:P ratio contaminated calving environment RFM dystocia
c/s of metritis?
fever anorexia endotoxemia mastitis laminitis dec milk production, toxic milk
metritis tx?
local Abx - for anaerobic environment
systemic penicillin for 30 days post partum
Ceftiofir Na / hydrochloride
oxy tet - NOT effective
supportive therapy for post partum metritis?
tetanus prophylaxis
PgF2a
fluids - hypertonic saline
NSAIDs
prognosis of metritis?
very poor
what nerves are often damaged during parturition?
nerves on the inside of the bony pelvis
obturatoor and peroneal Nn
she cannot adduct her legs
Tx of Nn damage in post partum cow?
px further injury
isolate her
give her good footing and maybe hobbles
NSAIDs to help w Mm damage
what is endometritis?
persistence of bacT infection beyond day 35 post partum
how common is clinical endometritis?
less common
purulent discharge
how common is sub clinical endometritis?
very common
what does sub clinical endometritis lead to?
infertility
what bacT often present in endometritis?
Arcanobacterium pyogenes +/- anaerobe
Tx of endometritis?
PgF - induce luteolysis to inc days in heat [dilate cervix] AND induce myometrial contractions
abx maybe
lavage maybe
what is the cause of cystic ovarian dz?
insufficient LH surge -> partial surge results in partial LH effects
GnRH center NOT primed or “reset”
follicular waves but NO ovulation
in cases of cystic ovarian dz, what does Tx with GnRH do?
CIDR?
PG?
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
what is the ovsynch protocol?
GnRH - ovulation OR lutenization of follicular cyst
PgF - luteolysis of luteinized cyst or CL, 7 days later
- add CIDR
