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Y4 Farm Reproduction > Post partum period > Flashcards

Post partum period Flashcards

1
Q

Transition period definition

A

= 3 weeks pre- to 3 weeks post- calving

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2
Q

Postpartum period definition

A
  • Post-calving
  • Lactation, uterine involution, return to cyclicity, regeneration of endometrium, efficient control of uterine bacteria
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3
Q

Post-partum pathophysiology

A
  • Late gestation immunosuppression continues in early post-partum
  • Around calving physical barriers to infection are compromised (uterus becomes open allowing bacteria in) (change in pH during calving compromises barriers)
  • Lochia
  • Uterine involution
  • Closed cervix is a great barrier for ascending infection
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4
Q

How long does uterine involution post-partum take?

A
  • 3-6wks
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5
Q

What is lochia and how long is it normal for postpartum?

A
  • normal for ~23 days
  • Red brown – White discharge, lacks odour
  • Brown as blood becomes oxidised - don’t mistake for metritis
  • white - not pus, usually inflammatory material, esp WBCs
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6
Q

Retained foetal membranes definition

A
  • “The non-expulsion of foetal membranes beyond 24 hours post calving”
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7
Q

When is normal placental expulsion?

A
  • within 6h of calving
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8
Q

Cotyledonary placenta physiology

A
  • Foetal cotelydon + maternal
    caruncle = placentome
  • Collagen links interface together
  • Breakdown of theses links= factor in placental separation
  • Facilitated by relaxin secretion and decline of progesterone
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9
Q

Risk factors of FRM

A
  • induced parturition
  • shortened gestation
  • infectious dz e.g. BVDV
  • uterine trauma (c-section, dystocia, fetotomy)
  • twinning
  • nutritional deficiency (e.g. vitamin E/selenium deficiency, NEB)
  • abortion
  • immunosuppression (failure to switch off immuno-protective mechanisms from pregnancy)
  • flunixin meglumine
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10
Q

RFM tx

A

▪No consensus

▪Manual removal
– 5-7 days after calving
– Risks: haemorrhage, tearing
– No benefit on repro performance or milk yield

▪Systemic antibiotic therapy
–Systemic signs of illness
– Amoxicillin 3-5days
– Routine parental antimicrobial treatment not supported by research (i.e. when no evidence of infection present)

▪Benign neglect
– Usually expelled 2-11 days

Future developments?
▪Collagenase into umbilical arteries
▪Ozone treatment

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11
Q

RFM - impact on production

A
  • Production losses
    – 753kg milk/lactation lost
  • Reproductive disorders
    – delayed uterine involution and cyclicity
    – longer time to 1st service
    – increased service/conception
    – lower pregnancy rates
  • Increased culling risk
  • Increased likelihood to develop secondary health problems
    – metritis, endometritis, ketosis, displaced abomasum, mastitis, etc
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12
Q

RFM target

A
  • <5%
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13
Q

RFM in sheep

A
  • retained if >18h
  • relatively uncommon
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14
Q

Normal placental expulsion in sheep

A
  • within 6h
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15
Q

Causes/risk factors for RFM in sheep

A

▪Post c-section or dystocia
▪Selenium or vit A deficiency
▪Infectious abortion ▪Obesity of dam
▪ Hypocalcaemia

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16
Q

Metritis definition

A

= infection of all layers of the uterus

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17
Q

Clinical metritis

A
  • Not systemically ill
  • Abnormally enlarged uterus
  • Purulent uterine discharge
  • Within 21 days post-partum
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18
Q

Puerperal metritis

A
  • Systemic signs of illness
    – Decreased milk yield, dullness, inappetence, signs of toxaemia
  • Fever >39.5oC
  • Abnormally enlarged uterus
  • Fetid watery red-brown discharge
  • Within 21 days post-partum
    – Usually <10days
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19
Q

Metritis risk factors

A

▪Following abnormal stage 1 or 2 of labour
–Severe dystocia
–Prolonged traction
–Damage to birth canal
▪Uterine inertia
▪Uterine prolapse
▪Premature calving and abortion
▪Induced calving
▪ Twins
▪ RFM
▪Dairy > beef

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20
Q

What is metritis often associated with in sheep

A

▪Dead foetus
▪Assisted delivery of multiple lambs without proper hygiene
▪Uterine prolapse

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21
Q

Metritis diagnosis

A

▪ Clinical signs of illness and straining
▪ Foetid uterine discharge detectable on clinical exam

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22
Q

Metritis grade 1

A
  • Abnormally enlarged uterus
  • purulent uterine discharge
  • without any systemic signs of ill health
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23
Q

Metritis grade 2

A
  • Abnormally enlarged uterus
  • purulent uterine discharge
  • with additional signs of systemic illness such as decreased milk yield, dullness, and fever
24
Q

Metritis grade 3

A
  • Sometimes called puerperal metritis, or toxic metritis
  • abnormally enlarged uterus
  • purulent uterine discharge, with signs of toxaemia such as inappetence, cold extremities, depression, and/or collapse
  • high risk of sepsis, peritonitis, UTI and reproductive adhesions.
  • Other complications include endocarditis, pneumonia, polyarthritis etc.
25
Q

Metritis tx

A

Dependent on clinical signs and severity of disease
* Do not treat grade 1

Systemic antimicrobials
* Intrauterine (e.g. Metricure) alone insufficient
* Penicillin (amoxicillin)
* 3-5 days

Supportive therapy (if systemically unwell)
* NSAIDs**
* Fluid therapy
* Calcium borogluconate (often sub clinically hypocalcaemic)

Uterine lavage?
* Saline only
* Peritonitis and toxaemia risk if tear the uterine wall

26
Q

Endometritis definition

A

= infection of the endometrium only

27
Q

Clinical endometritis

A
  • Purulent uterine discharge (>50% pus) ≥21 days after parturition
    OR
  • Mucopurulent uterine discharge (~50% pus. 50% mucus) >26 days after parturition
  • “Whites” (as purulent white discharge)
28
Q

Subclinical endometritis

A
  • > 18% neutrophils in uterine cytology sample collected 21-33 days after parturition
    OR
  • > 10% neutrophils in uterine cytology sample collected 34-47 days after parturition
  • Uterine discharge not yet seen
29
Q

Endometritis risk factors

A

▪Trauma
▪ Hygiene
– Calving environment
– Post partum housing
– Personnel
▪ Metabolism
– NEB
▪Herd size
– Larger herds

30
Q

Clinical endometritis diagnosis

A

▪ Transrectal palpation +/- ultrasonography (may see purulent content in uterus on US)
▪ Vaginal examination (inc. cervix)
– Manual
– Metricheck

31
Q

Subclinical endometritis diagnosis

A

▪ Cytology on cervical swabs or lumen flush
▪ Uterine biopsy

32
Q

Endometritis diagnosis – transrectal palpation

A

▪Delayed uterine involution
▪“doughy” feeling uterus
▪Palpation alone not particularly sensitive or specific
▪Combination of transrectal ultrasound
– + vaginal examination most commonly performed on routine fertility visit

care not to cause discomfort to the cow

33
Q

Endometritis diagnosis - Metricheck

A

▪Rubber diaphragm on steel rod
▪Inserted into vagina
▪Diaphragm collects fluid from vaginal floor

34
Q

Endometritis diagnosis - Cytobrush

A

▪For subclinical endometritis diagnosis ▪Same as human cervix analysis
▪Brush inserted through the cervix into uterus
▪Looking for proportion of polymorphic neutrophils (PMNs)
– >5% abnormal?
– >50 days post partum should be none

35
Q

Endometritis diagnosis - endometrial biopsy: pros

A
  • Predictive for subsequent fertility
36
Q

Endometritis diagnosis - endometrial biopsy: cons

A
  • Costly
  • Time consuming
  • Not often clinically
    accessible
  • May depress fertility
37
Q

Endometritis diagnosis - cytology: pros

A
  • More practical
  • Can diagnose subclinical endometritis
38
Q

Endometritis diagnosis - cytology: cons

A
  • Does not produce a rapid diagnosis
39
Q

Endometritis diagnosis - CE: pros

A
  • Rapid and not time consuming
  • No specialist equipment required
  • Minimal risk of further contamination
40
Q

Endometritis diagnosis - CE: cons

A
  • Cannot differentiate vaginitis/cervicitis
  • Cannot detect subclinical endometritis
  • Palpation for tone and size is subjective
41
Q

Endometritis grading - vaginal mucus score, grade 0

A

Clear or translucent mucus

42
Q

Endometritis grading - vaginal mucus score, grade 1

A

Mucus containing flecks of white or off-white pus

43
Q

Endometritis grading - vaginal mucus score, grade 2

A

Discharge containing ≤ 50% white or off-white mucopurulent material

44
Q

Endometritis grading - vaginal mucus score, grade 3

A

Discharge containing ≥ 50% purulent material, usually white or yellow, but occasionally sanguineous

45
Q

Endometritis - Pathogens most commonly identified

A

▪E. coli
▪T. pyogenes
▪F. necrophorum
(Opportunistic bacteria)

46
Q

Endometritis tx - 2 problems

A
  • spontaneous self cute (33-46%)
  • imperfect diagnostics
  • little merit to C&ST
  • intrauterine infusion of antiseptics = limited value, risk of injury, peritonitis, septicaemia, etc
  • treat only >3w calved

Commercial sheep:
- AM diagnosis rare
- tx generally impractical

47
Q

Endometritis treatment

A

PGF2α:
▪500mcg Cloprostenol ▪Stimulate uterine defences
▪Luteolysis of CL→reduced progesterone→ return to oestrus
▪Increased uterine tone + open cervix
▪Withdrawal – 0 hours milk, 1 day meat

Intrauterine antibiotics:
▪500mg Cefaprin (Metricure)
▪Withdrawal – 0 hours milk, 1 day meat

48
Q

Endometritis - impact on production

A

Reduced fertility:
* Reduced chance of conception
* Increased risk of cull

Clinical endometritis:
▪ Increases the interval to first insemination by 11
days
▪ Delays conception by 32 days

Cows with clinical endometritis between 20 and 33 days post partum:
▪ 1.7 times more likely to be culled for reproductive failure (cf. cows without clinical endometritis

49
Q

Endometritis - target % within a herd

A
  • <10%
50
Q

Pyometra definition

A

= Purulent or mucopurulent material within uterine lumen, causing uterine distension, in the presence of a closed cervix and functional corpus luteum

51
Q

Is pyometra common in cows and small ruminants

A
  • it is uncommon
52
Q

Pyometra diagnosis

A
  • Transrectal palpation and ultrasonography; history of anoestrus
53
Q

Pyometra tx

A

PGF2α→luteolytic→expulsion of exudate and bacterial clearance; needs repeating in ~20% of cases

54
Q

Intrauterine infusions of AB must work:

A
  • Against gram +ve and gram –ve, aerobic and anaerobic bacteria
  • In microaerophilic uterine environment
  • In an evenly distributed fashion across uterine lumen, with good penetration in endometrial layers
  • Without inhibiting uterine defence mechanisms
  • Without traumatising endometrium (e.g. not cause irritation)
  • Without reducing infertility by producing irreversible changes
  • In a cost-effective manner
  • With a known excretion pattern so appropriate withdrawal times can be applied
55
Q

For uterine infection in a cow within 21d of parturition will it be endometritis or metritis?

A
  • metritis
56
Q

When is endometrial biopsy used?

A
  • only really for research purposes
57
Q

Which ABs are justified/used for these conditions?

A

Amoxicillin
– Cat D
– Ceftiofur is not warranted in these cases as amoxicillin is adequate to tx the type of bacteria likely to be present and penetrates the inflamed uterus well

Cefapirin
– Category C
– good for endometritis
– localised use justified for endometritis, but not for other conditions

Y4 Farm Reproduction (11 decks)

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