Periparturient Period

Question 1

T/F: bovine are the most common species to have vaginal prolapse and can be a heritable trait

Answer 1

True

Heritable especially in Herefords and shorthorns

Question 2

Grade this prolapse..

Floor of the vagina protrudes intermittently

Answer 2

Grade 1

Question 3

Grade this prolapse. .

Floor of vagina protrudes permanently

Answer 3

Grade 2

Question 4

Grade this prolapse ..

Cervix and most of vaginal floor protrude

Answer 4

Grade 3

Question 5

Grade this prolapse ..

Cervix and vagina protruding to a greed that there is necrosis/fibrosis

Answer 5

Grade 4

Can also see bladder and rectal prolapse

Question 6

Treatment for vaginal prolapse?

Answer 6

Reduction

• epidural
• clean with mild antiseptic
• may need to debride some necrotic tissue
• sugar=osmosis. Combined with squeezing to reduce edema

-manual reduction (use your oven mitts!)

Question 7

How can you prevent reoccurrence of vaginal prolapse ?

Answer 7

Buhner technique with umbilical tape 
Halstead technique/horizontal mattress
Bootlace
Minchev technique 
Jorvet prolapse kit 

You must watch for parturition in these cows— trauma can occur if calves through the Buhner

If there is significant fribosis/edema, a C-section may be required

Question 8

What are predisposing factors for uterine prolapse ?

Answer 8

Parturient accident
Dystocia

Hypocalcemia
Uterine inertia
Straining

Begins with inversion of one uterine horn

Question 9

How can you diagnose uterine prolapse and how do you approach a case?

Answer 9

History from owner
This is a true emergency

You must travel to the cow(reduce cows movement and risk of uterine artery rupture)
Minimize stress to animal

Question 10

Treatment of uterine prolapse?

Answer 10

Epidural
Clean and debride
-standing animal — elevate uterus with tarp, towel, or tray
-position animal in sternal and extend hindlimbs caudally AKA frog leg (tilts pelvis forward)

Reduction

• hold uterus at level of vulva, reduce gently (will be friable and edematous)
• make sure horns are everted
• once reduced give oxytocin

Vulvar retention sutures
Antibiotics
Ca therapy

Last resort — amputation

Question 11

What are possible complications due to uterine prolapse?

Answer 11

Uterine artery rupture — hypovolemic shock, death
Septicemia — devitalized tissue
Hypothermia — due to exposed tissue
Strangulation of other abdominal viscera within prolapse
Reperfusion injury

Question 12

What is the prognosis for uterine prolapse ?

Answer 12

Depends upon initial state (Ca status, shock, dehydration, time spent prolapsed)

Metritis and subfertility possible long term effects

Question 13

T/F: Cows that have had a uterine prolapse are more likely to have recurrence than those animals that have never prolapsed

Answer 13

False

Recurrence is NO more likely in animals with previous prolapse

Question 14

What is a first degree perineal laceration?

Answer 14

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

Question 15

What is a second degree perineal laceration?

Answer 15

Entire wall of vulva/vestibule and portion of perineal body but not the anus or the rectum

Question 16

What is a third degree perineal laceration?

Answer 16

Entire wall of vagina, perineal body, rectum, and anus —> leaves cow with common opening for vagina/rectum

Question 17

How long does uterine involution take?

Answer 17

25-50days

Question 18

What occurs during uterine involution?

Answer 18

Lochia is expelled — blood tinged fluid, tissue, debris

Blood vessels to caruncles undergo vasoconstriction and slough after necrosis

Endometrial epithelium repairs

Question 19

What factors can alter involution?

Answer 19

Retained fetal membranes
—delays (foul odor/unsightly)

Negative energy balance 
Local factors 
Hormone factors 
—presence of progesterone 
—oxytocin (sucking response and milking) 

Inflammation — presence of leukocytes

Question 20

What is the treatment for retained fetal membranes?

Answer 20

Clean out= manual removal
Infusions — antibiotics and antiseptics

Hormones — ecbolics (PGF2a and oxytocin)

Antibiotics

Collagenases —most promising therapy
Injected into umbilical artery