Post partum period

Question 1

What are the transition period and the post-partum period?

Answer 1

Transition period:
* 3 weeks pre- to 3 weeks post- calving
* should this be extended?
* 60 days either side of calving?

Post-partum period
* Post-calving
* Lactation, uterine involution, return to cyclicity, regeneration of endometrium, efficient control of uterine bacteria

Question 2

Describe the post-partum pathophysiology?

Answer 2

• uterine involution 3-6 weeks
• lochia - normal for 23 days (red brown - white discharge, lacks odour)
• late gestation immunosuppression continues in early post-partum
• around calving physical barriers to infection are compromised

Question 3

What are retained foetal membranes? What physiology is involved in the placental expulsion?

Answer 3

• non-expulsion of foetal membranes beyond 24 hours post calving
• normal placental expulsion = within 6 hours of calving

Placental expulsion - Cotyledonary placenta
* 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

Question 4

What are risk factors for retained foetal membranes?

Answer 4

• induced parturition
• shortened gestation
• infectious disease (BVD)
• uterine trauma
  
  • caesarean section
  • dystocia
  • fetotomy
• twinning
• nutritional deficiency (vitamin E, selenium deficiency)
• abortion
• immunosuppresion (failure to switch off immuno-protective mechanisms from pregnancy)
• flunixin, meglumin

Question 5

How are retained foetal membranes diagnosed? How are they treated? What is the impact on production?

Answer 5

Diagnosis
- History and clinical signs!
- Vaginal examination

Treatment
* No consensus
* Manual removal
* 5-7 days
* Risks: haemorrhage, tearing
* No benefit on repro performance or milk yield
* Systemic antibiotic therapy
* Systemic signs of illness
* Amoxicillin 3-5days
* NSAID?
* Benign neglect!
* Usually expelled 2-11 days

Impact
* Production losses
* 753kg milk/lactation
* 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…

Question 6

How is RFM different in sheep?

Answer 6

• Placenta usually expelled within 6 hours
• Retained if >18 hours
• Relatively uncommon
  
  • Post c-section or dystocia
  • Selenium or vit A deficiency
  • Infectious abortion
  • Obesity of dam
  • Hypocalcaemia

Question 7

What is the difference between clinical and puerperal metritis?

Answer 7

Metritis = infection of all layers of uterus

Clinical metritis:
* Not systemically ill
* Abnormally enlarged uterus
* Purulent uterine discharge
* Within 21 days post-partum

Puerperal metritis:
* 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

Question 8

What are the risk factors for metritis? How is it diagnosed and graded? How is it treated?

Answer 8

Risk factors
* Following abnormal stage 1 or 2 of labour
* Severe dystocia
* Prolonged traction
* Damage to birth canal
* Uterine inertia
* Premature calving and abortion
* Induced calving
* Twins
* RFM
* Dairy > beef
In sheep often associated with:
* Dead foetus
* Assisted delivery of multiple lambs without proper hygiene
* Uterine prolapse

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

Grading
Graded based on clinical signs in cow
Grade 1
* Abnormally enlarged uterus purulent uterine discharge
* without any systemic signs of ill health
Grade 2
* Abnormally enlarged uterus
* purulent uterine discharge
* with additional signs of systemic illness such as decreased milk yield, dullness, and fever
Grade 3
* 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.

Treatment
* Dependent on clinical signs and severity of disease
* Do not treat grade 1
* Systemic antimicrobials
* Intrauterine alone insufficient
* Penicillin (amoxicillin)
* 3-5 days
* Supportive therapy not to be underestimated
* TLC
* NSAIDs
* Fluid therapy
* Calcium borogluconate
* Uterine lavage?
* Saline only
* Peritonitis and toxaemia risk
Grade 3 = high risk of sepsis, peritonitis, UTI and reproductive adhesions.
Other complications include endocarditis, pneumonia, polyarthritis etc.

Question 9

What is the difference between clinical and subclinical endometritis?

Answer 9

Clinical endometritis
- purulent uterine discharge (>50% pus) >21 days after parturition
OR
- mucopurulent uterine discharge (~50% pus 50% mucus) >26 days after parturition
- whites

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

Question 10

What are risk factors for endometritis? How is it diagnosed?

Answer 10

Risk factors
* Trauma
* Hygiene
* Calving environment
* Post partum housing
* Personnel
* Metabolism
* NEB
* Herd size
* Larger herds

Diagnosis
* No practical gold standard
* Transrectal palpation +/- ultrasonography
* 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
* Vaginal examination (inc. cervix)
* Manual
* Metricheck
* Rubber diaphragm on steel rod
* Inserted into vagina
* Diaphragm collects fluid from vaginal floor
* Cytology on cervical swabs or lumen flush
* Uterine biopsy
* History?
* (Vaginoscope)

Question 11

How is endometritis graded? What pathogens are most commonly identified? How is it treated?

Answer 11

Pathogens
* E. coli
* T. pyogenes
* F. necrophorum
* Opportunistic bacteria

Treatment
* Intrauterine infusion of antiseptics = limited value
* Risk of injury, peritonitis, septicaemia etc
* Treat only >3weeks calved
* PGF2a - cloprostenol
* Intrauterine antibiotics - cefapirin (metricure) no withdrawal on milk

Question 12

What is the impact of endometritis on production?

Answer 12

• 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
• Target <10%
• Reduced fertility:
  
  • Reduced chance of conception
  • Increased risk of cull

Question 13

What is pyometra? How is it diagnosed? How is it treated?

Answer 13

Definition
* Purulent or mucopurulent material within uterine lumen, causing uterine distension, in the presence of a closed cervix and functional corpus luteum
* Uncommon
* In cattle and small ruminants
Diagnosis
Transrectal palpation and ultrasonography; history of anoestrus
Treatment
PGF2a -> luteolytic -> expulsion of exudate and bacterial clearance; needs repeating in ~20% of cases