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