Post-Partum Disorders LA and SA Flashcards
How many weeks post-partum is it NORMAL for a bitch to have vulvar discharge?
3-4 weeks
initially, its green and watery, then it turns reddish/brown and mucoid, then it decreases over time. It should NEVER have odor!
A client presents to you because her dog gave birth 2 weeks ago and she is concerned that she still has discharge coming from the vulva. The discharge is red/brown and does not smell. To confirm that this is a normal finding, you do cytology. What do you find on cytology of this ‘normal’ sample?
some neutrophils
RBCs
bacteria
when is peak lactation in bitches?
3-4 weeks post partum
what is the normal appearance of the mammary glands post partum in bitches?
engorged, not hard, swollen, red
A queen presents to your clinic because the owner is concerned about reddish, mucoid non-odorous discharge coming from the vulva. You looked on cytology and saw RBCs and <20% of PMNs, so now you know this is a normal post-partum finding. How many days ago did she give birth?
up to 4 days ago
when should nutrition be highest in small animals?
a. gestation
b. whelping
c. lactation
d. weaning
c. lactation
A bitch presents to your clinic after having 12 puppies yesterday. She has green vulvar discharge and has been restless, but is otherwise normal. You do an ultrasound and diagnose retained placenta. What is your treatment protocol?
spontaneous breakdown and passage
monitor dam for development of metritis
and let the puppies nurse so that itll increase oxytocin release
T/F: you should provide antibiotics to cases of retained placenta in small animals because these animals are at risk for developing metritis
false! prophylactic antibiotics are not indicated
An owner shows up to your clinic with a dog that had puppies about 8 days ago. The owner states that her litter was large and she had dystocia that the vet down the street helped with. Now, this dog is presenting to you because of stinky, reddish brown vulvar discharge, not eating, vomiting, and isnt letting her puppies nurse. You suspect acute metritis. What diagnostics would you like to run and what are the findings consistent with your presumptive dg?
- vaginal cytology – in this case, you’d see high #s of degenerate PMNs and bacteria + non-cornified vaginal epithelial cells (parabasal)
- ultrasound – intraluminal fluid, uterine wall thickening, and hyperechogenic/heterogenous endometrium
- CBC: leukocytosis with LS (inflammatory)
How would you treat acute metritis in small animals?
goal: evacuate the infected material from the uterus
1. medically: PGF2a (dinoprost or cloprostenol)
Oxytocin: only in first 24 hr
2. surgical: OHE
3. antibiotics: based on guarded deep cra. vaginal swab (make sure they are safe for neonates)
4. NSAIDs
5. supportive care (fluids, antiemetics, etc.)
What antibiotics are commonly used to treat acute metritis in small animals?
beta lactams (ex. amoxicillin-clavulanic acid)
A 2 year old bitch presents to your clinic because she has had serosanguinous vulvar discharge for 3 months since she had her last litter. What is most likely the diagnosis given the signalment and history?
subinvolution of placental sites (SIPS)
How do you treat subinvolution of placental sites in small animals?
spontaneous remission
if severe hemorrhage is occuring, then OHE.
why does subinvolution of placental sites develop?
trophoblast-like cells keep invading deeper endometrium and myometrium which causes damage to the blood vessels and subsequent hemorrhage
A cat presents to your clinic 36 hr after giving birth to her 4 kittens. She has a large red mass hanging from the back end of her, which prompts you to give a presumptive dg of uterine prolapse. What is your treatment protocol?
- stabilize her
- control the hemorrhage
- clean and apply a cold, hyperosmotic solution + lubrication
- sedate her and attempt manual reduction (unless it needs amputated)
- then spay her
- antibiotics
- supportive care – fluids, etc.
What is the term for accumulation of milk within the mammary glands without infection?
galactostasis
name 3 risk factors for galactostasis in small animals
- heavy lactation
- poor teat conformation (inverted nipples)
- lack of adequate suckling
T/F: galactostasis predisposes to mastitis
true because the teat canal will be open and bacteria can ascend
A patient with galactostasis will present with swollen, edematous, firm, painful mammary glands that produce normal milk and she will not have systemic illness. What is the treatment?
alternating cool/warm compress
and ensure puppies nurse glands – massage and strip the milk if needed
A bitch presents to your clinic. The owner states that she had 13 puppies and stopped allowing her puppies to nurse, so they just weaned all of them. Her mammary glands are swollen, red, hot, and painful. The milk is thick and purulent. She has a fever and the owner stated that she hasnt eaten in 2 days. Your presumptive dg is acute mastitis, what diagnostics do you need to run to confirm and what are the findings consistent with this diagnosis?
- milk c/s +/- cytology: aseptically collected into red top tube
- ultrasound: to confirm no concurrent abscesses
- CBC: leukocytosis with LS
How do you treat acute mastitis in small animals?
antibiotics based on c/s
NSAIDs
cool every 3-6 hr for 10-15 min and strip affected glands to allow puppies to nurse.
give prolactin inhibitor (cabergoline) to decrease milk production (esp if weaning)
supportive care – fluids, antiemetics, opioid analgesia, etc.
If the mammary gland is abscessed or necrotic, how should you treat it?
if small – warm/cold compress
if larger – open, drain, and sx debridement if necrotic tissue present
T/F: you want the puppies to nurse on abscesses/gangrenous teats in order to stimulate milk let down and clearance of the infection
false – do not allow the puppies to nurse on these type of glands. only if there is no abscess or necrotic tissue present and you must strip the gland first.
An owner brings her dog and her 8 puppies to your clinic. She is a committed, responsible breeder who weighs her puppies 2x/day and noticed that her puppies have not been gaining the amount of weight they should be. On exam, you notice that her mammary glands are pretty underdeveloped, especially given that she has had 8 puppies recently. What could be a maternal issue that would cause this?
agalactia / hypogalactia
What are the secondary causes to agalactia in small animals?
mastitis
metritis
systemic illness
hypocalcemia
stress
premature delivery
inadequate nutrition
How do you treat agalactia?
First, correct the underlying cause
Then, provide a dopamine receptor antagonist (metoclopramide or domperidone) this will increase prolactin and increase milk prod.
Can give oxytocin if production isnt the issue, but let-down is.
Always supplemental feed and provide passive immune transfer to the babies until milk comes in.
A maltese presents to your clinic after having 7 puppies 3 weeks ago. The owner reports she has lost interest in her puppies, has been panting, and her legs keep twitching. On exam, she has a fever, is tachycardic, is restless, and you confirm the stiffness and muscle fasciculations. You presumptively diagnose this patient with hypocalcemia (eclampsia). What diagnostic test should you run to confirm?
blood ionized calcium
if less than 0.80-1.00 mmol/L, then dg is hypocalcemia
what are the common causes of eclampsia in small animals?
- small breed, large litters
- Ca supplementation during pregnancy (suppression of PTH, hypocalcemia)
- inadequate nutrition
How are the clinical signs different in cats with hypocalcemia?
anorexia, excitable, flaccid paralysis
what is the treatment for eclampsia in small animals?
- wean the puppies
- emergency – IV 10% Ca-gluconate slowly until effect + ECG monitoring (stop if bradycardic, arrhythmia, vomiting)
- short-term treatment with SQ 10% Ca-gluconate diluted with saline (once stable, start PO suppl)
- long-term treatment with PO calcium tablets through lactation
regular rechecks, correct dams nutrition, reintro. pups/kittens if necessary
when does the first ovulation occur post-partum in cows?
3-4 weeks post partum
when does uterine involution complete by post partum in cows?
45 days post partum
what is the voluntary waiting period for cows?
60 days
when has all lochia passed in the cow post partum?
by 1-2 weeks
when does the small ruminant begin to cycle again after parturition?
next breeding season for seasonal breeders
but they are able to be bred 3 months post-partum (1 month post weaning)
how long until all lochia are passed in small ruminants?
4 weeks post partum
when does ovarian activity resume in pigs post partum?
estrus will resume in 4-7 days post-weaning
what factors lead to pathological post-partum anestrus (extended anestrus period in non-suckled dairy cattle).
- physiological (suckling, parity, milk yield, genetics)
- nutritional management
- environmental
- pathological – infection
how to you treat prolonged post-partum anestrus?
- correct the underlying cause
- give progesterone based synchronization drugs (CIDR)
Involution of the uterus and breakdown of cotyledons from caruncles is accompanied by a massive breakdown of what?
collagen and other proteins
what is the main consequence of retained placenta?
low fertility of cow
and the retained placenta is a good environment for bacterial growth
What are predisposing factors of retained placenta in cows?
twinning
dystocia
induced parturition
abortion
vitamin E or Se deficiency
infections (ex. placentitis)
what is the treatment for a retained placenta in cows?
if the cow is normal – none, itll expel within 5-7 days when the caruncles slough; can give Ca, oxytocin, and PGF
if cow has metritis – systemic antibiotics (ceftiofur, penicillin), oral or IV fluids, NSAIDs, +/- uterine lavage
Metritis typically occurs _____ weeks post calving.
2
what are the clinical signs of metritis in cows?
fetid, watery brown uterine discharge
febrile
fluid-filled uterus on palpation
what are predisposing factors of metritis in cows?
retained placenta
obstetrical intervention – dystocia, twins
abortion
dirty calving environment
what pathogen is most commonly involved in metritis of cows post-partum?
trueperella pyogenes
what is the treatment protocol for cows with post-partum metritis?
- NSAIDs
- Antimicrobials – systemic
- uterine lavage
- IV fluids
- oxytocin (only if calved 24 hr ago)
what is the prognosis for post partum metritis in cows?
good if treated early, but can be guarded
signs of recovery should occur in 3-5 days
what are common sequela of metritis?
salpingitis, ovarian adhesions, peritonitis, endometritis, reduced fertility
You visit a farm to see a cow that gave birth 19 days ago. You palpated her uterus and felt asymmetrical enlargement of uterine horns and ultrasound showed thickness of the endometrium. Otherwise she is normal. You diagnose her with endometritis. What is the treatment?
systemic ceftiofur
if CL is present (probably not) give prostaglandin
You take a uterine sample from a cow you suspect has metritis and you give it a grade 3. Describe what this sample would look like.
exudate containing >50% purulent material.
could be white, yellow, or sanguineous.
how do you definitively diagnose subclinical endometritis in post-partum cows?
- endometrial cytology
- endometrial biopsy
looking for neutrophils
______ is the accumulation of pus in the uterus with a persistent CL and closed cervix.
pyometra
pyometra typically occurs postpartum, specifically …
after the 1st ovulation
what is the treatment for pyometra in post partum cows?
prostaglandin (PGF2a) repeat in 14d
uterine lavage
describe the protocol for prolapsed uterus in cows?
its an emergency and you should NOT transport this cow. keep her contained
give caudal epidural
clean prolapsed tissue and apply hypertonic saline or dextrose to reduce edema
lift the prolapsed mass to relieve any urine
replace the prolapsed tissue
antibiotics, NSAIDs, Ca, and oxytocin
if salvage – amputation
If a cow is down after calving and her legs are splayed out, what likely has occurred?
obturator nerve paralysis caused by nerve damage when delivering calf
what is the treatment for calving paralysis?
steroids
frequent lifting
hobbles
time
___________ is associated with high milk production usually within 48 hrs of calving. clinical signs are progressive muscular weakness to complete recumbency, muscle twitching, anorexia, cold extremities, and rapid pulse.
milk fever / hypocalcemia
What is the treatment for hypocalcemia in post-partum cattle?
IV and oral calcium
A cow presents to you 17 days after calving because farmer reports that her milk production has decreased and she has not been eating as well. She is down when you arrive. You use urine ketone strips and diagnose her with ketosis (increased ketones in the blood, milk, or urine d/t high milk production). What is the treatment protocol?
oral propylene glycol
IV hypertonic saline +/- dextrose and oral electrolytes
vitamin B12
When do milk fever and pregnancy toxemia occur in small ruminants?
pre-partum
What are the most common causes of MMA complex in sows?
mastitis/metritis: coliforms, staph aureus, trueperella pyogenes
agalactia: can be infectious or non infectious (heritable, nutritional, environmental)
what is the treatment for MMA complex in sows?
IV antibiotics
oxytocin, adjust nutrition, +/- cull
