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
1
Q
WHat is the puerperium?
A
period after parturition when rerpro tract returns to non-pregnant state
- shortest possible puerperium is desirable
2
Q
WHat disorders affect normal puerperium?
A
- dystocia
- uterine pprolapse
- retention of foetal membrane
- uterine disease
3
Q
when does greatest uterine involution occour?
A
1st few days affter calving (horns diameter halves in 5d, length halved 15d)
4
Q
HOw long postpartum should whole uterus be palpable per rectum?
A
8-10d
5
Q
HOw long should complete involution take?
A
26-50d
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
7
Q
HOw does diameter of the cervix change on rectal palapation?
A
- 15cm @ 2d
- 10cm @ 10d
- 7cm @ 30d
- 5cm@ 60d
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
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
10
Q
Which bacterial spp are present in the uterine lumen?
A
- aranobacterium pyogenes
- e. coli
- strep and staph
- fusobacterium necrophorum
> opportunistic bacteria
11
Q
What is the main mechanism of bacterial elimination?
A
- phagocytosis by migrating leucocytes
- physical expulsion by uterus
12
Q
How long postpartum does the uterus become sterile again?
A
- @ 5 weeks 50% will be sterile
- @ 8-9 weeks majority
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
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
15
Q
which cows are uterine prolapse seen more commonly with?
A
pluriparous cows (not heifers)
16
Q
When does uterine prolapse occour?
A
24 hrs postpartum
17
Q
How does uterine prolapse affect future fertiltiy?
A
^ calving - conception interval
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
clinical features of RFM?
- lack of apetite
| - v milk yield
25
WHen do myometrial contractions cease pp?
36hrs
26
How does RFM affect future fertility?
- no effect if mating 60d pp
| - along with metritis, ^ days open, services/ceonception, calving -> 1st oestrus/service interval
27
Tx RFM?
- 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
define endometritis
- endometirum and stratum spongisum of submucosa affected
- no systemic illness
- leukocytes but NO pus in uterine discharge
29
Define metritis
- deeper layers of uterus affected
- systemic illness (milk -> v severe)
- puerperal metiritis
30
Define pyometra
- chonic
- purulent exudate
- CL
31
how does uterine disease affect future fertility?
impaired
32
how does infection develop pp? 2 mechanisms
- 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
Which species are pathogenic in the uterus?
- arcanobacterium pyogenes
- fusoforum necrophorum
- e. coli
- prevotella species
- clostridium spp
- manhaemia haemolytica
35
Does endometritis affect general health? WHy is it important?
- does not affect general health
| - affects fertility
36
Which pathogens cause endometritis?
- opportunistic pathogens
- E. coli
- subsequent overgrowth of A. pyogenes, F. necrophorum, provotella spp
37
Clinical signs associated with endometritis? FIndings on PE?
- 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
Tx endometritis?
- stimulation of oestrus in both cyclic (PGF2a) and acyclic(GnrH/E2) cows
- intrauterine cephaprin (meticure, intravet)
39
Clinical signs of metritis?
- 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
Tx of metritis? Prognosis?
> 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
What tx is contraindicated for metritis?
Oestrogens ^ absorption of endotoxin
42
What equipment is needed for uterine lavage?
- wide bore stomach tube
- funnel
- normal saline
43
WHat is pyometra? What must it be differentiated from?
- 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
Tx pyometra?
PGF2a
| IU cephapirin
45
How much on average would RFM cost the farmer?
Direct costs £84
| Total £300-475
46
How much on average would uterine disease (endomet) cost the farmer?
Direct costs £71
Total £166
(Abverage herd spends £833 per 100 cows)
