Lecture 31 - Complications of Pregnancy

Question 1

Tx of hernias during pregnancy

Answer 1

Support body wall for as long as possible until as close to term as possible until we can deliver a mature fetus - via induction of labor or c/section

Question 2

Rupture of body wall is MC in what species?

Answer 2

Mares

Question 3

Special type of body wall rupture in the pregnant mare is due to rupture of the _______ tendon.

Answer 3

Pre-pubic

Question 4

What can predipose mare to rupture of the body wall?

Answer 4

Hydrops, twins, excessive ventral edema

Question 5

Early signs of pre-pubic tendon rupture in the mare:

Answer 5

blood in the teats

Question 6

Later signs of pre-pubic tendon rupture in the mare:

Answer 6

Teats point backward

Question 7

Tx of rupture of pre-pubic tendon in the mare

Answer 7

Body wrap, induce fetal maturation if time permits.

Terminal c/section in severe cases to save the neonate

Assisted delivery at the minimum

Question 8

If a terminal c-section is decided upon during a rupture of the body wall due to an imminent disaster, what is the procedure?

Answer 8

Use a stun gun to the mare - do not want to anesthetize the mare, because it will anesthetize the foal, and we want the foal to get up on its legs as soon as possible.

When you use a stun gun, it puts the mare into an anesthetized and comatose state but her heart will still be working just for enough time to perform the c-section so that the fetus still gets oxygenated blood.

As soon as the mare is out, sever the carotid arteries of the mare to bleed her out - thus killing her.

Question 9

Uterine torsions in the cow are most commenly encountered during the late ____ stage or early ___ stage of labor.

Answer 9

late 1st or early 2nd stage

Question 10

In the cow, it is more common for a uterine torsion to turn _______ (to the dam’s _____)

Answer 10

counter-clockwise; left

Question 11

A uterine tosion in a cow will at least partially occlude the _____

Answer 11

birth canal

Question 12

Most uterine torsions int he mare occur between ____ months and ____. The presenting complaint is ____. I

Answer 12

8 months - term; colic (if occurs at term presenting complaint is dystocia)

Question 13

how to diagnose uterine torsion in the mare?

Is the vagina usually involved?

Answer 13

Trans-rectal exam - vagina is NOT usually involved.

Question 14

Uterine torsion in the hembra may occur in ____ gestation.

Answer 14

Late (pre-term)

Question 15

Can you use a trans-rectal exam to to diagnose uterine torsion in a pregnant hembra?

Answer 15

No! You would need tiny hands.

Question 16

During a transrectal exam, we asses the tension of the broad ligaments to know what side the uterine torsion is. How do we know the difference between torsion to the right vs left?

Answer 16

Right - right broad ligament is pulled downward and under the uterus or vagina; left broad ligament is pulled over the top of the cervix and twoard the right.

Left - right broad ligament is pulled over the top of the cervixand toward the left; the left broad ligament is pullsed downard and uner the uterus or vagina.

Question 17

Tension on the broad ligaments and uterine arteries suggests the ____ of uterine torsion.

Answer 17

degree

Question 18

A vaginal exam on an animal with a uterine torsion often reveals a twist within the dorsal ____ folds. How do the folds twist in regards to the side of the uterine torsion?

Answer 18

vaginal - if your fingers get dragged over to the right, you have a right uterine torsion, if your fingers are dragged to the left side, you have a left sided torsion (folds in dorsal wall will point in the direction of the torsion)

Question 19

A vaingal exam is important in an animal with uterine torsion because we can assess the degree of occlusion of the _____.

Answer 19

Birth cannal

Question 20

How do you fix a uterine torsion via a vaginal exam/birth canal?

Answer 20

If the torsion is not as severe, you can ran the fetus with your hand and undo the torsion by twisting the fetus.

Must have access to the fetus through partially dilated and patent cervix.

Most successful in fresh cases with moderate degree of torsion.

Wrap front legs around each other and roll uterus with the fetus.

Can use a detorsion rod (but uncommon)

Question 21

You can roll a cow to try to fix uterine torsions. It is important however, to first ____ the cow to the ____ side that the torsion has occured.

Answer 21

Cast; same

Question 22

How to roll a cow to fix a uterine torsion to the left?

Answer 22

Cast animal on her LEFT side

Roll her to the LEFT

Question 23

When rolling a cow to fix a uterine torsion, sometimes the fetus and thus the uterus move with the cow, how can we prevent this?

Answer 23

Apply a plank across the side of hte animal to put pressure on the abdomen. This pins the fetus in its current location.

Question 24

It is important to re-examine the birth canal and assess proress when rolling a cow to fix a uterine torsion. What will often happen right away once you fix the torsion?

Answer 24

The water will break immediately and amnion will show at the vulva.

Question 25

T/F: Never role a cow twice with a uterine torsion without examining her inbetween.

Answer 25

True

Question 26

When rolling a hembra to fix a uterine torsion, what can you use to stabilize the fetus while rolling the dam?

Answer 26

Hands

Question 27

In a cow, examine the cervix after detorsion by rolling. If it is closed with a LIVE calf, wait up to ___ hours for the cervix to dilate. If it is closed with a dead calf, the cervix will not dilate, and we need to perform a _____.

Answer 27

6 hours; C/section

Question 28

When should you avoid rolling to fix a uterine torsion in a calf or foal?

Answer 28

When the calf/foal is dead and possibly emphysematous or the uterus is compromised. The uterus can rupture secondary to extreme fetal emphysema. Uterine contents end up in the perotneum, killing the dam.

Question 29

In alpacas, because uterine torsions are so difficult to dx and difficult to roll when fixing a uterine torsion, what is another tx option?

Answer 29

Laparotomy - can confirm diagnosis, correct torsion, and perform vaginal delivery or c-section.

Question 30

When you roll a mare to fix uterine torsion, it is improtant to ______ her first.

Answer 30

Anesthetize

Question 31

Describe using laparatomy a tx method for uterine torsion in the mare

Answer 31

• Standing
  
  • Incision on the side to which the uterus is displaced
  • Roate uterus to normal position
• Ventral midline under general anesthesia
• Leave fetus in pacle if uterus is not severely comproimsed; expect pregnancy to continue

Question 32

Vaginal prolpases occur in all species, but vary WHEN they occur.

In cattle and sheep, vaginal prolapses commonly occur during _____ due to high ____ and ____.

In dogs, vaginal prolapses commonly occur during ______.

Answer 32

Cattle, sheep - late gestation - high estrogen and relaxin

Dogs - estrus

Question 33

MC species to get vaginal prolapse

Answer 33

Cow and sheep (however sheep is caused by us)

Question 34

Why do vaginal prolapses in cows occur in late gestation most commonly?

Answer 34

The high levels of estrogen and relaxin prior to parturition leads to severe, extensive relaxation of pelvic ligaments and therefore the entire perineal architecture becomes sloppy and floppy and leads to the eversion of the vagina under increased pressure of hte abdominal site.

Question 35

Early C/S of vaginal prolpase in cow:

Answer 35

Begins with mucous memrbanes exposed in a recumebnt cow, and the tissues return to normal upon arising.

Question 36

Vaginal prolapses can include the _____ and cause secondary ____ prolapse.

Answer 36

urinary bladder; rectal

Question 37

Tx of vaginal prolpase in the cow

Answer 37

• Caudal epidural anesthesia to remove the incentive to strain
• clean and replace
  
  • Lubricate and protect tissue, hydroscopic agents
  • Suture significant lacerations
• Retain in position
  
  • Buhner suture; bootlace suture
  • Many other retaining devices and techniques
• Cull the cow after calf is weaned

Question 38

Descibre the Buhner technique in treating vaginal prolapse

Answer 38

1. Make full thickness, vertical skin incisions dorsal and ventral to the vulva.
2. Then use the buhner needle and push it through the ventral incision all along the vulva lip to exit through the dorsal incision.
3. Thread umbilical tape soaked in iodine through the eye the needle and reverse the needle.
4. Pass the needle along the opposite vulva lip and pull the end of the umbilical tape through the second side.
5. Tie the suture in show lace bow, burying the knot in the ventral incision. Leave 3-4 fingers opening.
6. Instruct the farmer on how to open and remove suture when labor starts!!

Question 39

Describe the boot lace technique to tx vaginal prolapse:

Answer 39

Use steal hooks on either side of hte vulva and lace these hoks with a suture material and tie.

This is not as sturdy as the buhner suture, and we can even use weaker suture material if the partus observation is poor, allowing it to tear by itself as cow gets into labor.

Question 40

A very common cause of vaginal prolapse in ewes is from what?

Answer 40

Excessively short tail docking in show sheep

Question 41

Someone designed a special prolapse retainer for ewes with vaginal prolapse. It can only be used in ____ sheep.

Answer 41

fleeced - with wool - wings of retainer are tied to the fleece of sheep

Question 42

Why does the prolpase retainer designed for sheep to tx vaginal prolpase often not work?

Answer 42

Because if the spoon feels uncomfortable in the ewe - the ewe will start pushing/straining, which will push out the retainer.

Question 43

What is an alternate method for tx vaginal prolapse in the ewe besides the proplase retainer?

Answer 43

Matress sutures across vulvar cleft - these need to taken out prior to delivery!!

Question 44

Benefits of amniotic fluid

Answer 44

• Protects the fetus from external shock
• Prevents adhesions between the fetal skin and amniotic membrane
• “amniotc bubble” aids in dilation of cervix
• Lubricates the birth canal

Question 45

How is the amount of amniotic fluid regulated?

Answer 45

Fetus regulates the volume by swallowing or by drawing fluid into its lungs during respriaotry movements.

Question 46

Concentration of fetal urine _____ as pregnancy advances and secretions from the respiratory tract increase.

Consistency of amniotic fluid will also change from ____ to ____ mostly so in ruminants.

Answer 46

decreases

watery to mucoid

Question 47

Allantoic fluid is composed of what?

Answer 47

Fetal urine and eretory products that cannot be transferred back to the dam.

Question 48

How is volume of allantoic fluid regulated?

Answer 48

By the placenta

Question 49

Hydrops MC occurs in the _____ and NOT in the ____.

Answer 49

allanotis; NOT in the amnion

Question 50

If a cow suffers hydroallantois, is the problem likely with the fetus or the uterus/cow?

Answer 50

The cow - becuase placenta regulates the volume int he allantoic fluid - and most likely due to an abnormal uterine lining.

So we do not want to breed the cow again if it has suffered from hydroallantois - likely to happen again.

Question 51

Hydrops of the amnion (hydramnios) is characterized by a gradual enlargement of the amniotic cavity. It really only found in _____, and is associated with an abnormal ____.

Answer 51

Cattle - RARE in other species; Fetus - unable to swallow fluid.

Question 52

C/S of hydrops of the amnion

Answer 52

• Condition develops slowly during the last half of pregnancy
• Large volume of viscid fluid released at parturition
• Cow may be unable to rise
• Uterine inertia and dystocia due to excessive stretching of the myometrium

Question 53

Tx of hydramnios

Answer 53

Extract fetus

Induce parturition

Emergency slaughter

Question 54

Prognosis of hydramnios - dam vs fetus

Answer 54

Good for dam

Fetus is frequently abnormal.

Question 55

How is hydrops of the allanotis characterized differently than hydrops of the amnion?

Answer 55

Hydroallantois is characterized by a rapid accumulation of fluid during late gestation, where hydramnios is a gradual accumulation of fluid during late gestation.

Question 56

What is more common cattle, hydroallantois or hydramnios?

Answer 56

Hydroallantois - comprises 90% of dropsical conditios inc attle.

(Hydramnios only about 10%)

Question 57

Hydroallantois is associated with defective ____ or ____.

Answer 57

Placenta or uterus

Question 58

C/S of hydroallantois

Answer 58

• Rapid enlargement of abdomen (5-20 days)
• Difficult to palpate fetus and placentomes; can palpate only fluid-filled, “doming” tense uterine wall
• GI signs - anorexia, rumen atony in cows
• Dyspnea, elevated heart rate, colic in mares
• Cows move with difficulty and eventually become recumbant

Question 59

Tx of hydroallantois

Answer 59

• Emergency slaughter if dam will pass ante-mortem inspection
• Terminate pregnancy (PGF and/or dexamethasone)
• If we want to save the cow - Drain fluid SLOWLY
  
  • C-section
  • Complicated by shock (sudden decrease in intra-abdominal pressure –> circulatory collapse)
  • Rapid fluid administration may be needed while draining allantoic fluid

Question 60

T/F: a cow can die from shock when draining fluid from a hydro-allantois.

Answer 60

FALSE - dies from circulatory collapse, not shock becuase we are not removing circulating blood from her, the only thing that happens is htat we change the intravascular pressure in her vessels to all her abodminal organs.

Question 61

In cows, _____ placentation is almost always present in hydroallantois cases.

Answer 61

Adventitious

Question 62

Prognosis of hydroallantois

Answer 62

Poor - dam is predisposed to retained fetl membranes and metritis; uterus re-fills with fluid before and/or after fetus is removed.

Fetus frequently dies

Question 63

Pregnancy toxemia most commonly occurs in what species?

Answer 63

Sheep and goats, sheep MC