Pathology of Puerperium

Question 1

what are 4 factors that predispose to postpartum disease

Answer 1

1. stress of parturition
2. open cervix
3. placental sloughing (retained placenta)
4. metabolic stress

Question 2

uterine prolapse

Answer 2

muscle hypotony or dysrhythmia of contractions, hypocalcemia, or hyperestrogenism leading to uterus to prolapse out of the vagina

species: ruminants, pigs

predisposes to infection/sepsis; causes congestion, edema, hemorrhage, necrosis, sepsis

Question 3

uterine rupture

Answer 3

sequela to uterine torsion, common in assisted deliveries

causes hemorrhage and hypovolemia

Question 4

uterine involution

Answer 4

NORMAL remodeling of the pregnant uterus to resting state

occurs in all species

sloughing of attachment sites, re-epithelialization, endometrial remodeling, myometrial contraction

Question 5

retained placenta

Answer 5

placenta that does not get expelled within 12-24 hours (ruminants) or 3 hours (horses)

can become a nidus for infection; slows down involution

Question 6

postpartum endometritis

Answer 6

inflammation of the endometrium after parturition

caused by dystocia or assisted delivery

slows down involution

dogs - usually occurs during diestrus
ruminants - usually occurs during postpartum

Question 7

subinvolution of placental sites

Answer 7

delayed involution; area of placental attachment do not regress

occurs in dogs

causes prolonged vaginal bleeding (beyond the normal 1-6 weeks), hemorrhage, hypovolemia

Question 8

defense mechanisms of the mammary gland

Answer 8

1. internal sphincter and wax plaque
2. squamous lining of teat
3. milk flow
4. resident macrophages
5. antibacterial secretions

Question 9

developmental mammary defects

Answer 9

supernumerary teats, webbed/siamese teats, atresia of streak canal

only clinically significant if unable to milk/nurse

Question 10

postpartum hypocalcemia

Answer 10

occurs in cows

high Ca demand after parturition –> hypocalcemia

can be clinical or subclinical
- clinical: paresis, slow uterine involution, reduced neutrophil function

predisposes to mastitis/metritis

Question 11

eclampsia

Answer 11

hypocalcemia that occurs at peak lactation

occurs in dogs

tetany, tremors, ataxia, seizures, etc

Question 12

galactophoritis

Answer 12

inflammation the ducts and sinuses

Question 13

galactorrhea

Answer 13

inappropriate lactation

ex. pseudopregnancy, male goats

Question 14

galactostasis

Answer 14

failure of milk letdown

caused by low OT release from fear/stress or lack of mammary stimulation

Question 15

agalactia

Answer 15

failure of milk production

“hard udder” - caprine arthritis and encephalitis (CAEV) or maedi-visna virus in sheep

Question 16

mastitis

Answer 16

inflammation of the gland acini

occurs in ruminants (rare in horses and small animal)

caused by an ascending bacterial infection

inflammation does NOT cause death, cytokine storm in response will cause death

Question 17

obligatory mammary pathogens

Answer 17

staphylococcus
streptococcus agalactiae
mycoplasma

Question 18

environmental contaminant pathogens

Answer 18

E. coli
truperella

Question 19

types of mastitis

Answer 19

• severe necrotizing
• severe
• suppurative
• granulomatous
• subclinical

Question 20

severe necrotizing mastitis

Answer 20

gangrenous; caused by endotoxins (gram negative) or exotoxins (gram positive) that induce cytokine storm leading to vascular necrosis and leakage –> acute phase reaction

bacteria: E. coli, clostridium, staphylococcus, streptococcus

Question 21

severe mastitis

Answer 21

similar pathogens as necrotizing mastitis but NO clinically apparent necrosis or systemic effects

limited to mammary gland only

Question 22

suppurative mastitis

Answer 22

cause by pus-forming bacteria

truperella, mycoplasma, strep. dysgalactiae

Question 23

subclinical mastitis

Answer 23

higher than normal somatic cell count with no clinical signs

main significance is economic loss

Question 24

cystic mammary gland dilation

Answer 24

non-neoplastic enlargement

occurs from downstream atresia –> forms cysts without milk production

Question 25

mammary hyperplasia

Answer 25

non-neoplastic enlargement resulting in increased milk production

can be generalized or focal

occurs normally in lactation or pathologically in pseudopregnancy

Question 26

fibroadenomatous hyperplasia

Answer 26

generalized hyperplasia with abundant fibrosis around the glands

occurs in cats (intact females <2 years old)

spontaneous - caused by increased progesterone
- luteal phase, early pregnancy, after exogenous progestin therapy

Question 27

mammary neoplasia in dogs

Answer 27

• benign
• reduced risk with early spay (before 2nd heat)
• solid, well circumscribed, movable masses

adenomas, fibroadenomas, benign mixed tumors, ductal papillomas

Question 28

mammary neoplasia in cats

Answer 28

• malignant
• less common
• older cats

carcinomas with metastasis