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Theriogenology > Periparturient period > Flashcards

Periparturient period Flashcards

1
Q

What species get vaginal prolapses most commonly?

A

Bovine!

  • See in Herefords and Shorthorns most commonly –> must cull because it is heritable!!!!!
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2
Q

When does vaginal prolapse occur?

A
  • Usually pre-partum but can be post-partum
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3
Q

What is a grade 1 vaginal prolapse?

A

Floor of the vagina protrudes intermittently –> usually when laying down, goes in when standing

  • Will usually progress to worse situation
  • Starts off mucousy but then dries and becomes uncomfortable
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4
Q

What is a grade 2 vaginal prolapse?

A
  • Floor of vagina protrudes permanently
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5
Q

What is a grade 3 vaginal prolapse?

A
  • Part of cervix and vagina protrude permanently
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6
Q

What is a grade 4 vaginal prolapse?

A
  • 2nd or 3rd degree that has been exposed

long enough to cause necrosis/fibrosis

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7
Q

How do you treat vaginal prolapse in the cow?

A
  • Reduction!!!!!
  • Give an epidural and clean with mild antiseptic
  • May also need to clean and debride
  • Sugar
  • Manually reduce with oven mitts –> less traumatic
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8
Q

Why do you want to use sugar to treat vaginal prolapse?

A
  • Causes osmosis

- Useful for reducing osmosis alongside manual edema reduction

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9
Q

What are some vaginal prolapse treatment options that prevent reoccurence?

A
  • Buhner technique - place needle through vulva, wind in and around through vulva, basically a purse string suture that allows the cow to urinate
    ▪ Halstead technique/Horizontal mattress
    ▪ Bootlace
    ▪ Jorvet prolapse kit
  • Minchev technique - send a suture dorsally from caudal vagina to lower back and securing in place
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10
Q

T/F

Uterine and vaginal prolapses are occur together

A

False –> no relationship between the two

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11
Q

How do you diagnose uterine prolapse?

A
  • Must look for descriptors to differentiate between placenta and uterine prolapse

** a true food animal emergency**

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12
Q

How do you treat uterine prolapse in the cow?

A
  • Epidural
  • Clean and debride –> elevate uterus with tarp, towel, tray when standing
  • When animal sternal, extend hindlimbs caudally (frog legs –> tilts pelvis forward)
  • Punch the uterine horns back in place
  • Reduce the uterus with a large bottle (wine bottle, etc.) and place vulvar retention sutures
  • ABs, calcium therapy
  • LAST RESORT –> Uterine amputation cranial to cervix
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13
Q

What are the follow-up pathologies that can occur from a uterine prolapse?

A

▪ Uterine artery rupture –> Hypovolemic shock, DEATH
▪ Septicemia –> Devitalized tissue
▪ Hypothermia –> Due to exposed tissue
▪ Strangulation of other abdominal viscera
within prolapse
▪ Reperfusion injury

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14
Q

What is the prognosis of uterine prolapse?

A

▪ Depends upon initial state (calcium status, shock,
dehydration, length of time prolapse)
▪ Recurrence is NO more likely in these animals than
animals that have never prolapsed.
▪ Long-term: potential for metritis and subfertility
▪ Radical: amputation of uterus cranial to cervix may
be used as last resort procedure.

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15
Q

What are the most common causes of perineal lacerations?

A
  • Iatrogenic from dystocia
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16
Q

What is a first degree perineal laceration?

A

▪ Only mucosa of vulva or vestibule
▪ May involve perivaginal fat- excise
▪ Spontaneously heal

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17
Q

What is a second degree perineal laceration?

A

▪ Entire wall of vulva/vestibule and portion of perineal body but not
the anus or rectum
▪ Tissues contaminated wait 6-8 wks before sx

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18
Q

What is a third degree perineal laceration?

A

▪ Entire wall of vagina, perineal body, rectum and anus leaves cow
with common opening for vagina/rectum
▪ Wait 6-8 wks before sx

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19
Q

What are some other perineal lacerations that occur alongside recto-vaginal tears?

A

▪ Vulva or vestibule- covered under RV tears
▪ Caudal uterus or cervix –> fix by Blind stitch
▪ repair of a rent in a uterine horn may be attempted:
▪ via laparotomy
▪ In the cow by prolapsing the uterus after 10ml epinephrine
(1:1000) IV slug/push, repair, replace
▪ Bleeding from vagina
▪ Check for tears, may be torn caruncle
▪ Administer oxytocin
▪ Uterine artery rupture
▪ Usually associated with uterine prolapse
▪ Usually fatal
▪ Could attempt transfusion, laparotomy, oxytocin

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20
Q

What are some examples of periparturient diseases?

A

▪ Metabolic and Nutritional Diseases –> Ketosis, Hypocalcemia, LDA +/-
▪ Mastitis
▪ Uterine infections–> Metritis, endometritis, pyometra
▪ Retained Placenta

21
Q

How long does uterine involution take? What anatomic and physiologic processes take place during that time?

A 
▪ Usually takes 25-50
days
▪ Lochia is expelled
▪ Blood-tinged fluid,
tissue, debris
▪ Blood vessels to
caruncles undergo
vasoconstriction and
slough after necrosis
▪ Endometrial
epithelium repairs
22
Q

What are some factors that can affect involution?

A

▪ Systemic Factors
▪ Retained fetal membranes (have foul odor and don’t look good)
▪ Negative energy balance
▪ Local Factors
▪ Hormone factors –> Presence of progesterone, Oxytocin (Suckling response, Milking)
▪ Inflammation
▪ Presence of leukocytes

23
Q

How do you treat retained fetal membranes?

A

▪ Historically –> “Clean her out” = manual removal, Infusions (Antibiotics, antiseptics)
▪ Hormones- ecbolics –> PGF2a- questionable value but many vets use, Oxytocin – causes uterine contractions in early post-partum
▪ Antibiotics
▪ Collagenases- most promising therapy (sloughs caruncle to release fetal membrane) –> Injected into umbilical artery, Not approved in USA

24
Q

What is metritis?

A

▪ Severe inflammation involving all layers of the uterus –> Endometrial mucosa and submucosa, Muscularis, Serosa
▪ Occurs within 21 days post calving

25
Q

What is endometritis?

A

▪ Inflammation of the endometrium extending no deeper than the stratum spongiosum
▪ Occurs at least 21 days after calving
▪ Uterus is normally protected from bacterial contamination by the vulva, vestibular
sphincter, and cervix –> During parturition, mechanical barriers are breached

26
Q

What is pyometra?

A 
▪ Collection of purulent exudate of variable amount within the endometrial cavity
▪ Persistence of a corpus luteum
▪ Suspension of the estrous cycle
▪ Purulent exudate in uterus
▪ Presence of a CL
▪ No estrus
27
Q

What are the clinical signs of metritis?

A

▪ Fetid red-brown watery uterine discharge

▪ Within 21 days post calving

28
Q

What is puerperal metritis?

A 
▪ Usually within 10 days after parturition
▪ Pyrexia* (Sheldon, et. al., 2006)
▪ Reduced milk yield
▪ Dullness
▪ Inappetance or anorexia
▪ Elevated heart rate
▪ Dehydration
29
Q

How do you diagnose metritis?

A

▪ Abnormally large uterus post calving –> Within 21 days (usually a week post calving, rare >2 weeks)
▪ Presence of purulent discharge
▪ +/- Pyrexia

30
Q

How do you treat metritis?

A

▪ Systemic antibiotics –> Ceftiofur, Penicillin, Oxytetracycline
▪ Anti-inflammatory
▪ +/- Uterine lavage

31
Q

What are some risk factors for endometritis?

A

Retained fetal membranes (big one!!!!), stillbirth, twins, assisted calving, primiparity

32
Q

What are the clinical signs of clinical endometritis?

A

Purulent discharge detectable in the vagina days or more after calving

33
Q

How do you diagnose clinical endometritis?

A

▪ Rectal palpation
▪ Transrectal ultrasound
▪ Examining contents of vagina –> Gloved hand, Speculum, Metricheck device
▪ Presence of >50% purulent material (score 3) in uterine discharge detectable in
vagina 21 days or more after parturition
▪ Presence of mucopurulent material (score 2) in vagina after 26 days postpartum

34
Q

What are some treatment options for clinical endometritis?

A

▪ Penicillin* –> 21,000 IU/kg Procaine Penicillin G IM SID 3-5 days, Milk: 96 hours (TEST); Meat: 10 days
▪ Ceftiofur Sodium* –> 1 mg/kg IM or SQ 3-5 days
▪ Ceftiofur Crystalline Free Acid –> 6.6 mg/kg SQ SID; 72 hours second dose, Meat: 13 days
▪ Oxytetracycline* –> 11 mg/kg IV BID – Not effective
▪ Hormone Therapy –> Prostaglandin F2a, Mechanism unknown
▪ Oxytocin –> Increase uterine tone
▪ Estrogen –> Increase oxytocin receptors, Not proven effective
▪ Supportive Care

35
Q

What is the etiology of pyometra?

A

▪ Occurs when metritis, endometritis, lochia, or other
contents are present and ovulation occurs resulting in CL
formation
▪ 1
st post-partum ovulation in dairy cow is ~18d
▪ Normal gross uterine involution complete 30d
▪ Uterine contents inhibit PGF2a release, and the CL is
maintained
▪ Pyometra discovered after natural breeding may be more
likely to be due to tritrichomoniasis

36
Q

How do you diagnose pyometra? What are the clinical signs?

A

▪ routine reproductive herd health visit (fresh cow checks)
▪ history or compliant of unobserved estrus
▪ no observed estrus after the voluntary waiting period (VWP)
▪ rectal exam:
▪ thin walled, fluid filled uterus,
▪ must be differentiated from pregnancy:
▪ all of the indications (secondary signs) of pregnancy may be present, but there will be no cardinal signs

37
Q

How do you treat pyometra?

A

▪ Remove the CL
▪ PGF2a
▪ Prognosis is fair to good, but do not breed on the first heat after CL removal

38
Q

What are some causes of prepubertal anestrus?

A

▪ Poor nutrition
▪ Too young
▪ Breed variations: zebu puberty later. Dairy earlier
▪ Genetic components: larger scrotal circumference= earlier
▪ Intersex states
▪ freemartinism
▪ Ovarian aplasia/hypoplasia

39
Q

What is the pathophysiology of Freemartinism?

A

▪ Shared chorioallantoic membranes
▪ Testicles of male twin develop prior to female
▪ Leads to production of AMH
▪ Goes to female tract inhibits development of duct
systems of female

40
Q

What is the clinical appearance of Freemartinism?

A

▪ Broad variation
▪ Most common apparently normal
▪ Can have small vulva, enlarged clitoris, tuft of
hair on ventral vulva
▪ Internal repro organs are abnormal
▪ Vestigial ovaries
▪ Reduced devlpt of paramesomephric duct system
▪ Some devlpt of male duct system
▪ Most common= small genital tract, hypoplastic ovaries,
short vagina, and absent cervix

41
Q

How can you diagnose Freemartinism?

A 
▪ Hx of twin birth
▪ Probe vagina
▪ Vagina is 1/3 length of normal vagina
▪ This test finds 80% of affected animals
▪ Lab tests
▪ Look for presence of Y chromosome
▪ PCR
▪ karyotyping
42
Q

What are some predisposing factors for postpartum anestrus?

A 
▪ Normal 3-5 wks
▪ Metritis
▪ Poor nutrition
▪ High producing dairy cows
▪ Lactational anestrus
43
Q

What is an ovarian follicular cyst?

A

▪ Thin walled fluid filled follicular structure >25mm (KNOW THIS)
▪ Can be present on both ovaries
▪ Absence of luteal tissue
▪ Persist for a minimum of 10 days (KNOW THIS)
▪ Interferes with normal ovarian cyclicity

44
Q

What are the characteristics and signs of ovarian follicular cysts?

A 
▪ Anestrus –> primary sign
▪ Some show nymphomania
▪ Irregular estrus intervals
▪ May have “ Bull like “ appearance
▪ Incidence affects ~ 10% annually
▪ Increases calving interval by ~50 days
▪ Self recovery in early cyst ~ 50%
45
Q

What is the etiology for ovarian follicular cysts?

A

▪ GnRH surge center appears to be refractory to estradiol stimulation
therefore no LH surge for ovulation or luteinization

46
Q

How do ovarian follicular cysts develop?

A 
• COF’s are similar to follicular waves
▪ Recruitment Selection Dominance
▪ The dominant follicle reaches ovulatory size but fails to ovulate
▪ Growth continues until cystic
▪ Cyst produces Estradiol and Inhibin A
47
Q

How do you diagnose ovarian follicular cysts?

A

▪ > 80% cows show anestrus
▪ At least 2.5cm diameter large fluid filled in
absence of a CL
▪ Palpation Per Rectum
▪ Ultrasound
▪ May require serial examination as cyst grows in
size

48
Q

How do you treat ovarian follicular cysts?

A 
▪ Spontaneous recovery
▪ ~ 50% before 1st postpartum ovulation
▪ ~ 20% after 1st postpartum ovulation
▪ Manual rupture- not recommended anymore
▪ Lutenize it/ lyse it
▪ GnRH / PGF2a
▪ hCG / PGF2a
▪ Aspiration
▪ Progesterone (CIDR) for 7 days then lyse

Theriogenology (19 decks)

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