Disorders of the Puerperium Flashcards
What is puerperium?
Periods after parturition when the uterus returns to the non-pregnant state
Shorter = desirable
What are the stages of puerperium?
Involution
Regeneration of endometrium
Elimination of contaminants
Resumption of ovarian cyclic activity
What disease can occur during puerperium?
Dystocia
Uterine prolapse
RFMs
Uterine disease
What happens during the involution process of the puerperium?
Shift from hypertrophy to atrophy Loss of smooth muscle and increase in collagen degeneration Reduction in size of myofibrils Reduction in size of uterus and cervix Myometrial contractions aid the process 26-50d process
Ho can involution be accelerated?
Prostaglandin use - main control
Oxytocin if given 2-3d postpartum
How does endometrial regeneration occur?
Uterine caruncle undergo degenerative change and undergo necrosis and sloughing of cups
Reduced in size 25d PP
Constituant of PP lochial discharge
Normal lochial discharge has no odour
Systemic response of acute phase proteins is observed
What is normal lochial discharge?
First week - lots, runny and red Second week - gloopy, amber Caruncle caps at 10-14d Third week - yellow-brown, sticky Fourth week - clear or none
Smell to determine if pathological
What are some species and sources of bacterial contamination of the puerperium uterus?
Uterine lume:
E. coli
Streps and staphs
Arcanobacterium
Lochial ascending infection
How is uterine bacterial contamination removed?
Phagocytosis by migrating leukocytes
Physical expulsion by uterine contraction
How does the ovarian cycle resume postpartum?
7-10d PP there is an increase in FSH due to follicular wave
Ovulation only occurs if follicles produce enough oestradiol to stimulate LH
Potentially silent ovulation
Suckling delays cyclic activity
What is a subsequent problem of dystocia?
Predisposes to RFMs and uterine disease
What happens with a uterine prolapse?
24hr PP - EMERGENCY
More common in older animals or difficult births
May need to treat for hypocalaemia
How do you treat a uterine prolapse?
Protect and support prolapse Calcium borogluconate Reduce ruminal tympany Epidural Clean uterus - remove foetal membranes are take up too much room Frog leg position, gentle replacement Ensure total inversion May need to suture ABs and NSAIDs Oxytocin
Why might foetal membranes be retained?
Failure of placental maturation
Failure of detachment of foetal and maternal villi of the placentome
Inadequate uterine contractions - hypocal or dystocia
What increases the risk of RFM?
Abortion/stillbirth Prolonged gestation or premature birth Dystocia Infectious placentitis Nutrient deficiencies Increasing age
What are the stages of separation and expulsion of placenta?
PLacental maturation
Exsanguination of foetal side and villi collapse due to uterine contractions
Distortion of placentomes
How can you treat RFMs?
Treat for metritis if showing signs
Antibiotics
Hormones
Collagenase infusion into stumps of umbilical arteries of RMs
What are the 3 main uterine diseases?
Metritis
Endometritis
Pyometra
Describe the difference in timings of endometritis and metritis
day 21 PP - endometritis
Describe treatment of endometritis in cows…
Wait until 4 weeks PP, no intrauterine infusion of antibs
Stimulation of uterine immunity: oestrus in both cyclic (PGF2alpha) and acyclic cows (3-5mg E2 or use GnRH)
Antibiotics intrauterine: metricure (cephapirin)
How is endometritis (whites) diagnosed?
Rectal palpation: poorly involuted uterus
Presence of discharge around cervical os
Presence of neutrophils in cervical swab
Describe whites in cattle..
Incidence: 6-43% does not affect general health but does affect fertility Opportunistic pathogens (e.g. E. coli) with subsequent overgrowth of A. pyogenes, F. necrophorum, Prevotella spp. Clinical signs: mucopurulent discharge in clinical cases, no systemic illness, neutrophils in uterine lumen fluid
Describe the host defence mechanisms and how they are overcome to produce infection in puerperium…
Physical barriers (cervix, vulva) - Dystocia increases pathogen loads causing tissue damage and physical deformities
Immune defence system - resumption of ovarian cyclical activity is critical:
- Role of E2 and P4 in local immunity
- Increase in blood supple, neutrophilia, phagocytosis
Describe metritis….
Systemic illness
Within a few days of parturition, usually with dystocia, uterine inertia, premature calving, RFMs etc
Purulent fetid watery discharge, elevated rectal temp (40-41), dullness, depressed milk drop, inappetence
Describe changes in the vaginal and vulva in metritis…
Sore, swollen, inflamed and deeply congested
Describe the systemic changes that occur with metritis…
Systemic toxaemia:
- Fast weak pulse, rapid resp, slow CRT, dehydration + toxaemia diarrhoea
Pyaemia:
- Concurrent peritonitis and mastitis
Describe the treatment of metritis…
Case dependent
Supportive care (fluids, NSAIDs)
Parenteral ABS - cephalosporins, ceftifur, broad spec penicillins, oxytet
Oestrogen contraindicated - increase absorption of endotoxins
Uterine lavage after stabilisation followed by antibiotics
Describe pyometra in the puerperium cow…
Accumulation of purulent material in the uterus in the presence of a persistent CL
EBD (tritrichomonas foetus) predisposing
Sequel to chronic endometritis
Uterine horns are large and distended, cervix closed
No signsof ill health
Absence of cyclicity
How do we diagnose pyometra in the puerperium cow?
Rectal palpation
- Thicker uterine wall
- No slipping of allontochorion
- No uterine caruncles
Transrectal US
- Speckled echotexture of uterine contents
Describe the treatment for pyrometra in the puerperium cow…
PGF2alpha or intrauterine cephaprin
Cull when subfertil
