Periparturient emergencies Flashcards
when do cervical/ vaginal prolapses occur
pre-partum- occasionally in oestrus
how to tell difference between uterine and cervical/vaginal prolapses
uterine- postpartumn- cotyledons visible
carvical/ vaginal- pre-partum
describe a grade 1 cervicovaginal prolapse
Small intermittent vaginal prolapse only present when animal lies down
describe a grade 2 cervicovaginal prolapse
Continuous vaginal prolapse. Can rapidly progress to grade 3. Bladder may be included
describe a grade 3 cervicovaginal prolapse
Vagina and cervix continuously prolapsed with exposure of mucus plug which may liquify allowing ascending infection.
describe a grade 4 cervicovaginal prolapse
Long standing grade 3 prolapse resulting in necrosis and fibrosis of mucosa. May lead to peritonitis
List 2 risk factors of a uterine prolapse
hypocalcaemia
difficult calving
List 4 risk factors of cervical/vaginal prolapse
limited exercise
hereditary
increased abdominal pressure
hypocalcaemia
describe how to use gravity to help replacae cervical/vaginal prolapse
If animal is recumbent place in sternal with hindlimbs ‘frog legged’
If animal is standing, make sure is a flat or downhill surface
Describe how to replace cervical/ vaginal prolapse
epidural
Clean prolapse
Apply firm cranial pressure to the prolapsed vagina (+/- cervix) with a flat hand
Prolapse will evert and replace
Perform Bühner suture
Give pain relief +/- antibiotics
List 3 potential complications of cervical/ vaginal prolapse
ruptured bladder
ringwomb
ascending infection –> placentitis and fetal death
what is ringwomb
Failure of cervix to fully open at parturition
May need C-sec
Describe how to treat uterine prolapse
epidural
use gravity
remove placenta and clean prolapsed uterus
Starting at vulva, carefully use fists to massage the uterus back into place
Ensure uterine horns fully everted
give calcium and oxytocin and pain relief and ABs
List 3 potential complications of replacing uterine prolapses
haemorrhage
metritis
reduced subsequent reproductive performance
Describe how to reduce the risk of haemorrhage when replacing uterine prolapse
Avoid excessive movement of animal
Careful handling of everted uterus
Describe the history associated with a uterine torsion
History consistent with prolonged 1st stage labour/failure of progression
“thought was calving but didn’t get on with it”
Describe what you feel on vaginal exam with uterine torsion
folds palpable in vagina –> in direction of the torsion
Describe what you can feel on rectal exam with uterine torsion
Broad ligament palpably stretched across uterus
Dorsal aspect –> ligament stretched in direction of torsion
Ventral aspect —> ligament stretched ventrally away from torsion
what direction do most uterine torsions occur
2/3 of cases are anti-clockwise
List 3 treatment options for uterine torsion
manual de-rotation
roll cow
c-section
Describe manual de-rotation of uterine torsions
only possible if can feel calf feet
Grasp calf’s feet and swing calf until flips over
Describe rolling method of treating uterine torsion
roll in same direction of twist (as viewed from behind)
e.g. Anti-clockwise (left) twist – cast onto left side and roll over in anti-clockwise direction
when is an episiotomy useful
soft tissue obstruction
describe how to perform an episiotomy
epidural
start at mucocutaneous junction
Make incision with scalpel at 10 o’clock or 2 o’clock position of vulva
up to 10cm length
DO NOT make incision at 12 o’clock position
Decsribe how to close episiotomy
epidural needed
absorbable sutures
simple continuous pattern mucosal layer does not need sutures
describe how to treat minor tears of the vulva
don’t need treatment
leave to heal by secondary intention
Describe a 1st degree perineal tear
Skin and mucosa of vagina/vestibule/vulva affected only. Rarely require surgery
Describe a 2nd degree perineal tear
full thickness tear of the vagina/ vestibule/vuvla but not the rectal wall or anus
Describe a 3rd degree perineal tear
full thickness tear of the vagina/vestibule/ vulva as well as the rectal wall +/- anus - a rectovaginal fistula may be present
Describe how to treat 1st and 2nd degree perineal tear
not emergencies
most heal by secondary intention
can be managed with caslick procedure- not done often
Describe how to treat 3rd degree perineal tear
Surgical repair - which is delayed for 6-8 weeks
Not day 1 skill
advise farmer to consider if they want to cull
Describe how to treat mild to moderate uterine bleeding
oxytocin - to stimulate myometrial contration
What first aid advice do you give in cases of arterial haemorrhage
Digital occlusion of offending artery if end can be found
Pack vagina as tightly as possible- e.g. Clean bedsheets/towels
If you can find offending artery in arterial haemorrhage what do you do
clamp with haemostats
leave in place for 3 days
if you can’t find the offending artery in cases of arterial bleeds what do you do
Pack vagina tightly
Leave in place for ~3 days
Guarded prognosis
Describe how to treat hypovolaemic shock in cow
Treat with fluids initially –> volume expansion
Blood transfusion may be required (taught elsewhere) - > 10L blood lost
