Disorders of the puerperium Flashcards
peurperium - define
The period after parturition when reproductive tract
returns to its non-pregnant condition so that the female may become pregnant again
shortest time desirable
Normal processes that occur during the puerperium
Involution
Regeneration of endometrium
Elimination of contaminants of the reproductive tract
Resumption of ovarian cyclical activity
Disorders that affect normal puerperium
Dystocia
Uterine Prolapse
Retention of foetal membranes (RFM)
Uterine Disease
involution - uterus
Reduction in the size of uterus and cervix after calving
greatest decrease in uterine size in 1st few days
after calving [myometrial contractions; ease of discharge of fluids/tissue debris, compression of uterine vasculature]
diameter of the previously gravid horn will halve in a period of 5 days, length will be halved by 15 days postpartum.
By 8-10 days postpartum whole of the uterus should be palpable per rectum.
Complete involution occurs within 26-50 days; changes after 25 days pp are minimal
involution - cervix
Difficult to fit a hand through cervix into the uterus by 10-12hrs postpartum
by 96h postpartum only 2 fingers can be admitted through the cervix reduction in external diameter of the cervix is also appreciable when palpated per rectum;
In case of normal involution, by 25 days postpartum the diameter of the cervix starts to exceed than that of the previously gravid uterine horn.
involution
Shift from hypertrophy (due to increase in collagen and smooth muscle) to atrophy (due to loss of smooth muscle, and collagen degradation) Reduction in the size of myofibrils
Prostaglandins may control involution, so their (and possibly oxytocin) exogenous use may be used to accelerate involution
regeneration of endometrium
Uterine caruncles undergo degenerative changes probably due to vasoconstriction and ischaemia and this results in necrosis + sloughing of caruncular tissue. Size of caruncles is considerably reduced by 25 days pp
Necrotic material when sloughed, along with blood and foetal fluids, constitutes the post partum lochial discharge.
lochial discharge occurs at days 2-9 post-partum - usually yellowish or reddish brown
Volume of lochia is variable. Normal lochial discharge does not have fetid odour
A systemic response (Acute phase proteins) is observed
Covering of the caruncular and inter-caruncular surfaces withendometrial epithelium…centripetal growth of cells from UGs
bacterial contamination
Bacterial species from the uterine lumen include;
Arcanobacterium pyogenes, E. coli, streptococci Staphylococci, Fusobacterium necrophorum
Lochial material provides an ideal growth medium
elimination of uterine bacterial contamination
phagocytosis by migrating leucocytes plus physical expulsion by uterine contractions and secretions
By about 5 weeks, 50% will be sterile and by 8-9 weeks most animals will have a sterile uterine lumen
Resumption of Ovarian Cyclical Activity
-ve feedback effect of high P4 during pregnancy,
pituitary is refractory to GnRH postpartum.
7-10 days post-partum - increase in plasma FSH
concentrations, associated with 1st post-partum follicular wave.
Ovulation will only occur if the follicle produces enough oestradiol to stimulate adequate LH secretion [LH receptors +IGFBPs proteases].
Dominant follicle on contra-lateral ovary and possibility of silent ovulation. Suckling delays ovarian cyclical activity
Luteal phase may be of normal length, or may be much shorter due to poor preovulutary development of the follicle leading to inadequate luteinisation of the CL
dystocia
breaks the host defence mechanisms - physical barriers of vulva and cervix
tissue damage, so more prone to contamination,
uterine inertia
Lack of sterility/hygiene due to obstetrical interventions and poor practice inc load of pathogens in uterus
Predisposes RFM & Uterine Disease
uterine prolapse
Previously gravid horn becomes invaginated
0.1-0.6% of calvings
More in pluriparous cows than in heifers
More in grossly protracted and assisted parturitions Usually in the first 24hrs post calving
Abdominal straining and flaccid uterus - Hypocalcaemia
REQUIRES URGENT ATTENTION
Survival rate – 75 to 80%
Increased calving to conception interval
uterine prolapse - risk factors
Prolonged dystocia Foetal traction or oversize Extreme laxity of the perineum and vulva Hypocalcaemia Paresis Retained Foetal Membranes.
uterine prolapse - treatment
Protect and support the prolapse Calcium borogluconate Relieve ruminal tympany Restrain the cow Epidural Clean the uterus “Frog-Leg” position Gentle replacement Insure total inversion. (Stitch the vulva) Antibiotics + NSAIDs Oxytocin
retained foetal membranes
Common complication of bovine parturition
Predisposes to uterine infection and therefore, contributes to infertility
Overall incidence is 6-8% but with dystocia 25-40%