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Reproduction > DIsorders of Puerperium > Flashcards

DIsorders of Puerperium Flashcards

0
Q

What are the normal processes that occour during puerperium?

A
  • involution
  • endometrial regeneration
  • elimination of contaminants of repro tract
  • resuming ovarian cyclicity
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1
Q

WHat is the puerperium?

A

period after parturition when rerpro tract returns to non-pregnant state
- shortest possible puerperium is desirable

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2
Q

WHat disorders affect normal puerperium?

A
  • dystocia
  • uterine pprolapse
  • retention of foetal membrane
  • uterine disease
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3
Q

when does greatest uterine involution occour?

A

1st few days affter calving (horns diameter halves in 5d, length halved 15d)

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4
Q

HOw long postpartum should whole uterus be palpable per rectum?

A

8-10d

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5
Q

HOw long should complete involution take?

A

26-50d

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6
Q

HOw long does the cervix take to return to normal size postpartum?

A
  • 10-12 hours can not fit hand through

- 96hrs 2 fingers

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7
Q

HOw does diameter of the cervix change on rectal palapation?

A
  • 15cm @ 2d
  • 10cm @ 10d
  • 7cm @ 30d
  • 5cm@ 60d
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8
Q

how does involution occour physiologically? how may this be manipulated with drugs?

A
  • shift from hypertorphy (^ collagen and sm. mm) to atrophy (vsm mm, v collagen)
  • v size myofibrilss
  • PGs control involution along with OT so exogenous use will speed up
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9
Q

WHat happens to the uterine caruncles postprtum? whhat clinical sign does this cause?

A
  • degenerative changes due to ischaemia
  • sloughing
  • along with blood and foetal fluids -> post partum lochial discharge occouring at d2-9
  • yellow or reddish brown
    > providing there is no pus or odour this is normal
  • systemic response acute phase proteins
  • covering of caruncular and inter-caruncular surfaces with endothelial endometrium
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10
Q

Which bacterial spp are present in the uterine lumen?

A
  • aranobacterium pyogenes
  • e. coli
  • strep and staph
  • fusobacterium necrophorum
    > opportunistic bacteria
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11
Q

What is the main mechanism of bacterial elimination?

A
  • phagocytosis by migrating leucocytes

- physical expulsion by uterus

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12
Q

How long postpartum does the uterus become sterile again?

A
  • @ 5 weeks 50% will be sterile

- @ 8-9 weeks majority

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13
Q

When does ovarian cycling activity resume postpartum?

A
  • 7-10d ^ FSH -> follicular wave
  • ovulation only occours if follicle produces enough E2 to s timulate LH secretion (role of LHRs and IGFBPs)
  • dominant follicle on contra-lateral ovary and possibility of silent ovulation
  • suckling delays cyclic activity
  • luteal phase may be normal or shorter due t o poor luteinisation of the CL
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14
Q

How does dystocia affect normal puerperium? What does dystocia predispose to?

A 
Brekaing host defense mechanism 
- > deformitiy of vulva and cervix
- tissue damage
- uterine inertia 
> lack of sterility with intervention
 - predisposes RFM and uterine disease
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15
Q

which cows are uterine prolapse seen more commonly with?

A

pluriparous cows (not heifers)

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16
Q

When does uterine prolapse occour?

A

24 hrs postpartum

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17
Q

How does uterine prolapse affect future fertiltiy?

A

^ calving - conception interval

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18
Q

which conditions predispose uterine prolapse?

A
  • Milk fever (hypocalceamia)
  • dystocia
  • foetal traction
  • foetal oversize
  • laxity of perneum and vulva
  • paresis
  • RFM
19
Q

Tx of uterine prolapse?

A
  • protect and support, clean uterus
  • calcium borogluconate
  • releive rumenal tympany
  • epidural
  • frog leg position
  • replace uterus and ensure total inversion
  • stitch vulva
  • ABx and NSAIDs
  • OT
20
Q

how comon are RFM?

A

6-8% overal

15-40% with dystocia

21
Q

What causes separation and expulsion of the placenta?

A

> placental maturation

  • changes in P4 and E2 conc, collaginases, proteases and glucosamides
  • v no. binucleate cells in trophectoderm
  • exsanguination of foetal side of placenta and collapse of trophectodermal villi
  • uterine contraction ->distortion of placentomes
  • lack of antioxidants, stress, oxidative injury
  • role of PGF and PGE synthesis
  • IL8, leukocyte migration and collagenases look up meaning of this! echo
22
Q

What are the 3 reasons for retention of foetal membranes?

A
  • failrue of maturation of placenta (premature calving)
  • failrue of detachment of foetal and maternal villli of placentome
  • inadequate uterine contractions due to hypocalcaemia or dystocia
23
Q

Predisposing factors for RFM>

A
  • abortion or stillbirth
  • multiple births
  • dystocia or premature calving
  • infectious pacentitis (brucellosis, salmonellosis)
  • hypocalcaemia
  • hydrallantois
  • ^ age of dam
  • prolonged gestation
  • micronutrient deficiency (Se, Vit E and A
24
Q

clinical features of RFM?

A
  • lack of apetite

- v milk yield

25
Q

WHen do myometrial contractions cease pp?

A

36hrs

26
Q

How does RFM affect future fertility?

A
  • no effect if mating 60d pp

- along with metritis, ^ days open, services/ceonception, calving -> 1st oestrus/service interval

27
Q

Tx RFM?

A
  • wait until 5d postpartun for veterinary examination
  • if pyrexic and depressed with v milk yield, treat for metritis
  • hormones (PGs OT)
  • collaginase infusion into stmps of umbilical arteries of retained membranes
  • ABx parenteral or intrauterine echo to check
28
Q

define endometritis

A
  • endometirum and stratum spongisum of submucosa affected
  • no systemic illness
  • leukocytes but NO pus in uterine discharge
29
Q

Define metritis

A
  • deeper layers of uterus affected
  • systemic illness (milk -> v severe)
  • puerperal metiritis
30
Q

Define pyometra

A
  • chonic
  • purulent exudate
  • CL
31
Q

how does uterine disease affect future fertility?

A

impaired

32
Q

how does infection develop pp? 2 mechanisms

A
  • physical barreirs of cervix and vulva
  • hormonal effect on immune system (E2 nd P4 role in local immune system - resumption of ovarian cyclical activity critical)
    > neutrophilia, ^ blood supply, phagocytosis, cervical/vaginal mucus
33
Q

Which species are pathogenic in the uterus?

A
  • arcanobacterium pyogenes
  • fusoforum necrophorum
  • e. coli
  • prevotella species
  • clostridium spp
  • manhaemia haemolytica
35
Q

Does endometritis affect general health? WHy is it important?

A
  • does not affect general health

- affects fertility

36
Q

Which pathogens cause endometritis?

A
  • opportunistic pathogens
  • E. coli
  • subsequent overgrowth of A. pyogenes, F. necrophorum, provotella spp
37
Q

Clinical signs associated with endometritis? FIndings on PE?

A
  • mucopurulent discharge in clinical cases
  • no systemic illness
  • neutrophilsin uterine luminal fluid
    > PE
  • poorly involuted uterus on PE
  • presence of discharge around cervical os with vaginoscope
  • metricheck (for discharge) shows presence of neutrophils in cervical swabs
    > 20-33d pp = > 18%
    > 33-49d pp = >10%
    > >50d pp = >5%
38
Q

Tx endometritis?

A
  • stimulation of oestrus in both cyclic (PGF2a) and acyclic(GnrH/E2) cows
  • intrauterine cephaprin (meticure, intravet)
39
Q

Clinical signs of metritis?

A
  • systemic illness
  • purulent fetid fluid in uterine lumen
  • distended, fluid filled atonic uterus
  • pyrexic 40-41deg
  • dull, depressed, innapetant, v milk yield
  • within few days pp, following severe dystocia, uterine inertia, RFM
  • sore, swollen and inflamed vagina and vulva
  • systemic toxaemia: fast weak pulse, rapid resp, dehydration, slow CRT, D+
  • pyaemia: concurrent peritonitis, mastitis
40
Q

Tx of metritis? Prognosis?

A

> prognosis poor
case dependant Tx
- supportive Tx (fluids and NSAIDs - flunixine meglumine 2.2mg/kg)
- parenteral ABx (cephalosporins, ceftiofur, broad-spec penicillins, oxytetracycline)
- uterine lavage (after stabilisation of circulation) followed by ABx eg. oxytet

41
Q

What tx is contraindicated for metritis?

A

Oestrogens ^ absorption of endotoxin

42
Q

What equipment is needed for uterine lavage?

A
  • wide bore stomach tube
  • funnel
  • normal saline
43
Q

WHat is pyometra? What must it be differentiated from?

A
  • accumulation of purulent material in the uterus in the presence of an active persistnet CL
  • cervix closed, uterine horns large and distended
  • sequel to chronic endometritis
  • EBD (T. foetus) predisposing factor
  • No signs of ill health
  • Absence of acyclicity
    > Differentiate from normal pregnancy by rectal palpation
  • thickness uterine wall, membrane slip, caruncles
  • transrectal ultrasonography (speckled echotexture of uterine contents v black anechoic appearance normal foetal fluids)
44
Q

Tx pyometra?

A

PGF2a

IU cephapirin

45
Q

How much on average would RFM cost the farmer?

A

Direct costs £84

Total £300-475

46
Q

How much on average would uterine disease (endomet) cost the farmer?

A

Direct costs £71
Total £166
(Abverage herd spends £833 per 100 cows)

Reproduction (30 decks)

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