Periparturient emergencies Flashcards
when is a gynaecological prolapse an emergency?
Uterine prolase:
* Post-partum
* Emergency
* Life threatening
* Cotyledons visible
Cervicovaginal prolapse:
* Pre-partum - Occasionally seen when in oestrus
* Not emergency
* Not life threatening (usually)
* Surface is smooth
what are the risk factors for uterine prolapse?
- (sub-clinical) Hypocalcaemia - Reduced uterine tone
- Difficult calving
- Dystocia
- Calving assistance
- Calving injury
How do you replace a uterine prolapse?
- Epidural (surgery and anaesthesia classes)
- Use gravity to help
- If animal is recumbent place in sternal with hindlimbs ‘frog legged’
- If animal is standing, make sure is a flat surface or patient is pointing downhill
- Remove placenta (cut, don’t pull off) and clean prolapsed uterus
- Starting at vulva, carefully use fists to massage the uterus back into place
- Ensure uterine horns fully everted - Use wine bottle or warm water/saline (leave in place)
- Give calcium and oxytocin + pain relief and antibiotics
what are the complications of uterine prolaspe?
Haemorrhage
- Rupture of uterine artery within broad ligament
- Avoid excessive movement of animal
- Careful handling of everted uterus
Metritis (postpartum lectures)
Reduced subsequent reproductive performance
what are the risk factors of cervicovaginal prolapse?
- limited excercise
- hereditary
- hypocalcaemia
- increased abdominal pressure
what is the grading system used for cervicovaginal prolapses
- Small intermittent vaginal prolapse only present when animal lies down.
- Continuous vaginal prolapse. Can rapidly progress to grade 3. Bladder may be included.
- Vagina and cervix continuously prolapsed with exposure of mucus plug which may liquify allowing ascending infection.
- Long standing grade 3 prolapse resulting in necrosis and fibrosis of mucosa. May lead to peritonitis.
What is the treatment for cervicovaginal prolapse?
- Epidural
- Use gravity to help
- If animal is recumbent place in sternal with hindlimbs ‘frog legged’
- If animal is standing, make sure is a flat or downhill surface
- 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
what are the potential complications of a cervicovaginal prolapse?
- Ruptured bladder - Secondary to urethral occlusion - life threatening
- Ringwomb
- Failure of cervix to fully open at parturition
- May need C-sec
- Ascending infection —> placentitis and foetal death
- Grades 3 and 4
what is the history and presentation of a uterine torsion?
History consistent with prolonged 1st stage labour/failure of progression
- “thought was calving but didn’t get on with it”
Early 2nd stage or late 1st stage parturition
- Very occasionally in late gestation
Twist can range from < 90° to 720°
how do you diagnose a uterine torsion?
Vaginal exam
* Folds palpable in vagina –> in direction of the torsion
Rectal exam
* Broad ligament palpably stretched across uterus
* Dorsal aspect –> ligament stretched in direction of torsion
* Ventral aspect –> ligament stretched ventrally away from torsion
About 2/3 of cases are anti-clockwise
what are the treatment options for uterine torsion?
Manual de-rotation
* Only possible if can feel calf feet (i.e. < 360° twist)
* Grasp calf’s feet and swing calf until flips over
* Gyn-stickTM can help
* Deliver calf per vaginum
* C-sec may still be needed
Roll cow
- Deliver calf per vaginum
- C-sec may still be needed
Caesarean section
What are the indications for an episiotomy?
- Useful if foetus will not pass through vulva and careful traction does not stretch soft tissues
- Oversized foetus
- Stenotic/inadequately relaxed vulva (e.g. scarring, congenital abnormality)
- Aids foetal passage
- Prevents uncontrolled tearing
How do you perfrom and episitomy?
Make incision with scalpel at 10 o’clock or 2 o’clock position of vulva
* Epidural
* Start at mucocutaneous junction
* Dorso-lateral direction (oblique)
* Up to 10 cm length
* DO NOT make incision at 12 o’clock position
- Absorbable sutures
- Simple continuous pattern
- Skin closure pattern is surgeon choice
- Mucosal layer does not need sutures
Do minor tears of the vulva need treatment?
no - Minor vaginal tears are best left to heal by secondary intention.
Moderate tears resulting in prolapse of the bladder or peri-vaginal fat can be sutured
2nd degree tears may result in faecal contamination of vagina over time –> increase endometritis risk –> reduced fertility
Can be managed with a Caslick procedure if required
what is the treatment for 3rd perineal degree tears?
Delay surgery for 6-8 weeks
* Allows epithelialisation of defect
* Allows swelling to resolve –> can identify normal architecture
* Immediate surgery (< 4 h post calving) also possible but poorer outcomes
Advise farmer to consider whether wants to cull the animal
