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
Metritis tx
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
Endometritis definition
= infection of the endometrium only
27
Clinical endometritis
* 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
Subclinical endometritis
* >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
Endometritis risk factors
▪Trauma ▪ Hygiene -- Calving environment -- Post partum housing -- Personnel ▪ Metabolism -- NEB ▪Herd size -- Larger herds
30
Clinical endometritis diagnosis
▪ Transrectal palpation +/- ultrasonography (may see purulent content in uterus on US) ▪ Vaginal examination (inc. cervix) -- Manual -- Metricheck
31
Subclinical endometritis diagnosis
▪ Cytology on cervical swabs or lumen flush ▪ Uterine biopsy
32
Endometritis diagnosis – transrectal palpation
▪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
Endometritis diagnosis - Metricheck
▪Rubber diaphragm on steel rod ▪Inserted into vagina ▪Diaphragm collects fluid from vaginal floor
34
Endometritis diagnosis - Cytobrush
▪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
Endometritis diagnosis - endometrial biopsy: pros
* Predictive for subsequent fertility
36
Endometritis diagnosis - endometrial biopsy: cons
* Costly * Time consuming * Not often clinically accessible * May depress fertility
37
Endometritis diagnosis - cytology: pros
* More practical * Can diagnose subclinical endometritis
38
Endometritis diagnosis - cytology: cons
* Does not produce a rapid diagnosis
39
Endometritis diagnosis - CE: pros
* Rapid and not time consuming * No specialist equipment required * Minimal risk of further contamination
40
Endometritis diagnosis - CE: cons
* Cannot differentiate vaginitis/cervicitis * Cannot detect subclinical endometritis * Palpation for tone and size is subjective
41
Endometritis grading - vaginal mucus score, grade 0
Clear or translucent mucus
42
Endometritis grading - vaginal mucus score, grade 1
Mucus containing flecks of white or off-white pus
43
Endometritis grading - vaginal mucus score, grade 2
Discharge containing ≤ 50% white or off-white mucopurulent material
44
Endometritis grading - vaginal mucus score, grade 3
Discharge containing ≥ 50% purulent material, usually white or yellow, but occasionally sanguineous
45
Endometritis - Pathogens most commonly identified
▪E. coli ▪T. pyogenes ▪F. necrophorum (Opportunistic bacteria)
46
Endometritis tx - 2 problems
- 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
Endometritis treatment
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
Endometritis - impact on production
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
Endometritis - target % within a herd
- <10%
50
Pyometra definition
= Purulent or mucopurulent material within uterine lumen, causing uterine distension, in the presence of a closed cervix and functional corpus luteum
51
Is pyometra common in cows and small ruminants
- it is uncommon
52
Pyometra diagnosis
- Transrectal palpation and ultrasonography; history of anoestrus
53
Pyometra tx
PGF2α→luteolytic→expulsion of exudate and bacterial clearance; needs repeating in ~20% of cases
54
Intrauterine infusions of AB must work:
- 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
For uterine infection in a cow within 21d of parturition will it be endometritis or metritis?
- metritis
56
When is endometrial biopsy used?
- only really for research purposes
57
Which ABs are justified/used for these conditions?
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