Bovine Fertility Examination and PD

Question 1

Why do vets put their arms in cows?

Answer 1

• Monitor repro health of herd.
• Aim to get cow to calve at optimum time (historically 365d index).
• If index exceeded:-
  – Less milk obtained.
  – Less calves produced.
  – Lower margins on farm.

Question 2

Why does the farmer pay the vet to come regularly?

Answer 2

Farm = a business, so needs to be investment.
Spotting repro problems early is the key to the business.
No calf&raquo_space; no milk&raquo_space; no farm&raquo_space; no client for vets.

Question 3

Veterinary herd fertility services.

Answer 3

• Motivation of client to achieve targets.
• Regular visits e.g. fortnightly routine call.
  – Larger herds will need more visits.
• US scanning for early pregnancy and ovarian structures.
• Oestrous synchronisation programmes.
• Post natal checks.
• Collect fertility data and log to computer.
  – Send printouts with cows flagged to be checked.

Question 4

Which cows are to be selected before the vet visit?

Answer 4

• PNC = post natal check cows calved >21d.
  – Check for trauma, involution, discharge (endometritis).
• PD on cows 30d post AI by scanning or >42d manual.
• Cows where ONO (oestrus not observed) by 42d.
• Recheck cows +ve pregnant but recently “in oestrus”/ twins.
• Cows that have aborted.
• Repeat breeders >3 AI services.
• Check cows with other illnesses that may affect repro e.g. previous dystocia, lameness etc.

Question 5

What do you need in your car for the vet visit to the farm?

Answer 5

Equipment: Gloves, lube, tissue roll, syringes/needles, Device introducers, US scanner?
Hormone drugs: PGF2a, GnRH, Prog, Oxytocin etc.
Antibiotic: SPECTRUM and PENETRATION, considering WITHDRAWALS.
– Metricure (cephapirin).
– Cephalexin, Oxytert.
NSAID.
Pen and paper/clipboard – audio notes.

Question 6

What to do with all the cows on the list.

Answer 6

Record ID.
GET A HISTORY.
Record BCS.
Record health status (incl. lameness, rumen fill) and meds given.
Communicate findings and instructions to the farmer.
Record findings and actions.
Optional: teat scores, cleanliness scores, faecal score etc.

Question 7

1. What is the aim of the post partum check?
2. Vaginal examination of the post calved cow.
3. What if endometritis found?
4. What else can be checked and how?

Answer 7

1. • Check each cow calved is healthy and returning to cyclicity.
     - Look for discharges and endometritis.
     – Grade 1-3.
     - Record BCS.
2. LOOK and SMELL, incl. under tail.
   Use CLEAN gloves.
   – rectal glove on one hand (clean) and latex on other hand (dirty).
   Lube rectal gloved hand.
   Tear off enough tissue to clean area.
   Lift tail with dirty hand and place on elbow of the clean hand.
   Wipe vulva TOWARDS anus with tissue until clean with dirty hand.
   Lift tail with dirty hand and insert clean, lubed hand into vagina.
   NOTE:-
   – Vaginal wall –> Tears.
   – Cervix (gently) size and open/closed.
   – Urethral fossa and false UF (Diverticulum).
   – Any discharge.
   Alternatively use speculum.
3. May need to “wash out”.
   – Cephapirin infusion.
   – Normal saline.
   – Systemic antibiotic.
   – PGF2a.
4. Check for uterine health and ovarian activity rectally.

Question 8

The rectal examination technique.

Answer 8

Have a rectal glove on one hand w/ lube and a latex glove on the other for lifting tails.
Helps to develop rectalling technique w/ BOTH hands.
Wipe lube liberally around the anus and insert hand. Some insert to length of arm first and others do it the opposite way.

Question 9

The rectal examination – what do you feel?

Answer 9

Temperature.
Faeces (good for consistency and nutrition info).
Peristalsis (indication of health).
Rectal wall.
Internal structures e.g. kidney rumen etc. – LANDMARKS.

Question 10

The rectal examination – landmarks.

Answer 10

Left kidney (just to right of midline)
– multilobed and should not give reaction from cow.
Rumen – Large and doughy, note fill.
Small intestine/caecum.
Aorta (dorsal to hand). Pulse.
Pelvic brim – bony, ovular w/ ridge in bottom centre (pubic symphysis), feel the entire circumference.
Cervix – proximal to the uterus – tube-like and slightly thicker and tougher.

Question 11

1. Tips for finding the uterus on rectal examination.
2. What action may be necessary if the uterus cannot be felt within the pelvis.

Answer 11

Variable position and size.
Tube-like soft tissue structure w/ cranial bifurcation and dorsal ridge depicting 2 horns.
May extend over pelvic brim in older, multiparous cows.
In cows on heat, may be small, bunched and harder than normal.
2. Grip cervix and drag back towards you to retract uterus into pelvis to make it easier to feel structures.

Question 12

The rectal examination – ovaries.

Answer 12

Ovular, reasonably solid structures about size of grapes to apricots.
Can have structures on them.
To find the ovaries:
– Follow length of the horn and feel a few cm around tip.
– Find the uterine bifurcation and bring hand to the side of the uterus and bring hand to the side of the uterus and back towards you about 1/3rd length of uterus. Bring hand about hand’s breadth to side of uterine body and curl fingers towards palm.
Hold ovaries between fingers and palpate w/ thumb.
– Hard, circular structure (like knuckle) most likely CL.
– Softer, circular structure (like bubble wrap) most likely follicle.
– If larger than 2.5cm (or thumb tip to first joint) then may be a cyst.

Question 13

Rectal exam… where is the bladder?
What does it feel like?

Answer 13

Beneath repro tract.
Thin-walled and flaccid relative to cervix and uterus.

Question 14

1. From what stage can an ultrasound determine pregnancy?
2. What else can it detect?

Answer 14

1. <30d.
2. Structures on the ovaries, fluid in uterus, see foetal heart beat, sizing and aging of foetus, good diagnostic tool for other conditions in caudal abdomen.

Question 15

1. What probe is used for US scanning?
2. What does increasing frequency achieve? – when would you want this?
3. What does decreasing frequency achieve?
4. How can you tell which way you are holding the probe once inside the cow.
5. how to hold probe inside of cow?
6. Order of viewing?

Answer 15

1. 5.0-7.5MHz Linear Probe.
2. Increased resolution. – when viewing ovarian structures.
3. Increased depth. – when viewing PDs >55d.
4. Probe usually has long groove in centre opposite flat scanning surface.
5. between thumb and first 2 fingers. Place on structures gently for best views.
6. Uterus first then ovaries.

Question 16

ONO…
1. First action?
2. Then?
3. Then?

Answer 16

1. Look at whole cow as reason may become clear from this: low BCS, sick, lame, chronic endometritis etc. TAKE A HISTORY!
2. Check for presence of fluid in uterus or even pus or mummified foetus etc.
3. Look at ovaries:
   – May be acyclic (small), normal (cycling), cystic.
   – Beware metoestrus –> combine with vaginal exam for bloody discharge.

Question 17

1. Cause of cystic ovarian disease.
2. Precautions with treatment?

Answer 17

1. Failure of LH surge at ovulation OR failure of follicle to respond to LH surge.
   So follicle fails to ovulate and grows to form a cyst.
   Follicle initially produces oestradiol and prevents further follicles forming, then becomes inactive and can persist for weeks, or may produce progesterone.
2. Beware the ONO cow that is pregnant – don’t use PGF2a if there is any possibility of pregnancy.

Question 18

1. What is the first target of the PD?
2. What would you feel at early stage of pregnancy? (6wks).

Answer 18

1. Uterus.
2. Small swelling in pregnant horn at crania end and underneath bifurcation only - v. difficult to feel. Cup hand around bifurcation and compare the 2 horns for firmness/fluidity. Foetus too small to feel.

Question 19

1. What would you feel at 7 weeks pregnancy?
2. What would you feel at 8 weeks pregnancy?

Answer 19

1. Distinct swelling and fluid feel to cranial pregnant horn and significantly different to firm non-pregnant horn. Foetus too small to feel.
2. Pregnant horn now size of half-filled water balloon. No placentomes. Can still feel difference to other horn. Foetus size of mouse (do not feel!). CL on ovary associated w/ larger uterine horn.

Question 20

1. What would you feel at 10 weeks of pregnancy?
2. What would you feel at 12 weeks of pregnancy?

Answer 20

1. Fluid feel now usually in both horns. Bifurcation around level of pelvic brim. No placentomes. Uterus size of water filled balloon. Gentle patting of bifurcation end may feel golf-ball size foetus.
2. Uterus usually over pelvic brim. Ovaries may be out of reach. Placentomes starting to become palpable (like peas when gently sweep over uterus). Foetus size of rat.

Question 21

1. What would you feel at 4 months pregnancy?
2. What would you feel of 5 months pregnancy?

Answer 21

1. Arm in fully and sweep downwards. Uterus immediately palpable. V fluid. Placentomes size of corks. Gently pat uterus at bifurcation end and can feel foetus but no features. No fremitus. Foetus size of small cat.
2. Arm in fully and sweep downwards. Uterus is beyond reach and large placentomes present. Uterine artery = thickness of stethoscope but no fremitus. VERY DIFFICULT – feels like not pregnant.

Question 22

1. What would you feel at 6 months pregnancy?
2. How could the middle uterine artery be identified?

Answer 22

1. Arm in fully and sweep downwards. Uterus goes beyond reach and large placentomes present. Patting now reveals foetus w/ discernable features (head). Fremitus present approx. hand breadth in from tuber coxae and vertical. Uterine artery is thickness of stethoscope and pulses with “whoosh”. Foetus size of JRT.
2. Much more mobile than others around it.

Question 23

1. What would you feel at 7 months pregnancy?
2. What would you feel at 8 months pregnancy?

Answer 23

1. Insert arm and feel head beyond pelvic brim w/ front feet. Feet feel small. Foetus size of border collie.
2. Very difficult to tell when due to calve from 7 months onwards but head will feel like small calf w/ larger front feet. Foetus size of labrador.

Question 24

1. How can false negatives occur?
2. How can false positives occur?

Answer 24

1. Unable to palpate uterus correctly.
   Recorded service date incorrect.
   Cow may have been served again since recorded date.
2. Unable to palpate uterus correctly.
   Uterus not completely involuted (HISTORY).
   Pyometra/mucometra.
   Subsequent prenatal death.

Question 25

Definitive signs of pregnancy.

Answer 25

Amniotic vesicle.
Allantochorion membrane slip.
Placentomes.
Foetus.

Question 26

1. What comprise the placentomes?
2. What does a “not pregnant” diagnosis require?

Answer 26

1. Cotyledon on foetal side and caruncle on maternal side.
2. Complete palpation (or scan) of entire body and both horns of uterus.
   Retraction of uterine horns.
   Uncoiling of uterine horns.

Question 27

What is palpation-based aging of foetus based on?

Answer 27

Amniotic vesicle size.
Foetus size.
Placentome size – variable in size and number.
Uterine horn size.
Middle uterine artery size and fremitus.

Question 28

Risk of pregnancy diagnosis by palpation?

Answer 28

Membrane slip plus palpation of amniotic vesicle increase risk of abortion especially in early stages of pregnancy.
– Can damage/burst vesicle.
– Can damage foetus.
– Can damage foetal membranes.
—»> ALL RISK ABORTION!!!

Question 29

Lab based tests for PD.

Answer 29

Milk progesterone.
Oestrone Sulphate – expensive but v accurate after 105d so long as foetus alive.
Bovine pregnancy-associated glycoprotein (PAGs) –> 35d – IDEXX Milk Pregnancy Test.
Bovine pregnancy specific protein-B (produced by trophoblast) –> 24d (not commercially available).

Question 30

Milk Progesterone Test.

Answer 30

Testing for NON-pregnancy.
Relies on testing progesterone levels 18-24d after AI when they should be decreased if NOT pregnant.
High level of false results (positives).
– Cow inseminated at wrong time (dioestrus).
– Persistent CL (due to chronic infection).
– Luteal cyst.
– Shorter than average interval between oestruses.
– Prenatal death after sampling.
NEGATIVES.
– Inadequate mixing of milk sample.
– Exposure of sample to heat or UV light.
– Incorrect ID of sample.
Relatively inexpensive (compared to vet visit).