Principles of Post Partum Conditions Flashcards
Take a moment to brainstorm what conditions can occur immediately postpartum. Consider all species and list 3 conditions (7)
· Haemorrhage (vaginal/uterine artery) - common - pale mucous membranes
· Nerve damage (obturator, gluteal/sciatic nerve) - -common - recumbency
· Fracture (pelvis / femur / vertebral column)-rare - recumbency
· Rupture (vagina, uterus, gastrocnemius muscle)
· Toxaemia (puerperal metritis, retained fetal membranes) - common - recumbency
· Hypocalcaemia - common- recumbency
· Prolapse (uterus/cervix/vagina/bladder) - common - may be recumbent
What can haemohorrhage be due to post partum? (4)
· Blood leaking from the maternal surface may occur in carnivores because of the endothelio-chorial placenta
In other species profuse bleeding can be due to:
· Breakage of the umbilicus and blood leaking from the placenta
· Uterine artery rupture (bleeding from uterine artery into the broad ligament may occur, in those cases external blood loss is not noted, rather collapse and death)
· Vaginal artery haemorrhage in heifer after forced extraction
How would you diagnose a vaginal artery laceration in a heifer after a forced extraction?
As with a uterine artery rupture, due to gravity, you will not see blood leaking from the vulva, unless the animal is recumbent. The animal will eventually become pale, but you hope to diagnose a vaginal rupture before that occurs.
You will be able to palpate the artery, review anatomy using the image below.
Blood will flow rapidly into the uterine cavity, if no action is taken the heifer will bleed to death.
How do you manage a vaginal artery laceration?
: place a hemostat on the artery to stop the bleeding, place 1 suture to keep the hemostat in place and return the next day to remove the clamp, blood flow in the vaginal region is then reduced and no ligature needs to be placed. Placing a ligature is a possibility too but often not as easy as placing the hemostat.
Vaginal artery rupture is mostly due to forced extra
What is the aetiology of a uterine rupture?
May be by extremities perforating the uterus during repositioning and traction (particularly fetal monsters)
May be due to excessive vigorous retropulsion
May be by forceful movements due to asphyxia fetus
May be spontaneous with uterine torsion (friable uterus)
May be secondary to instrument perforation (fetotomy)
What is the prognosis of a ewe with a uterine rupture?
Poor, it is very difficult to suture a perforating lesion in the uterus
The prognosis of a uterine rupture (as well as uterine artery rupture) is generally very poor. Peritonitis and sepsis occurs if a perforating lesion exists. Closing the lesion intra abdominally is difficult, as is everting the uterus to suture the lesion outside the animal. For those reasons treatment is generally not attempted.
What can happen through the vaginal ruture?
Sometimes small intestines, bladder or uterus can prolapse through a fully perforating vaginal tear, so make sure you check the vaginal cavity carefully after each assisted delivery.
Where is vaginal rupture often seen?
obese heifers with assisted calvings, usually there is only prolapse of peri-vaginal fat into the vaginal cavity. The vagina often heals satisfactorily on its own.
What can happen secondary to a vaginal rupture and how can we prevent this?
Secondary infection, necrotic vaginitis (F. necrophorum & Clostridia) is a complication that can be life threatening; advice Clostridial vaccination preventatively and clean calving procedures.
What can you advice to prevent vaginal ruptures?
Take the time and work with the abdominal contractions when the animal is in parturition to give the soft tissue in the vaginal cavity sufficient time to relax
Often the parturition process has not progressed sufficiently; reducing stress, manual stretching of the soft tissue and providing enough time for the animal to progress is often sufficient.
Fetomaternal oversize is determined by bony aspects, not so much tby the soft tissue, although it may play a role.
At this stage no pharmaceutical intervention will be effective
What is a perineal injury common as a result of?
Perineal injuries of the 3rd degree are most common in the mare as the result of a foal’s foot forceful perforating the roof of the vagina leading to a rectovaginal fistula (RVF).
How can we repair a rectovaginal fistula?
Repair of RVF can be carried out at various times relative to the time of injury. A period of at least 1 month is considered necessary for initial inflammation to subside, leaving healed and healthy mucosal edges and a fibrous scar capable of holding of sutures under tension during the repair.
Historically, fistulas are repaired at a time suitable to the surgeon (after the breeding season and/or after the foal was weaned).
Why is an RVF a more common postpartum condition in mares compared to other species?
The parturition process in the mare is forceful compared to other species, combined with the long extremities of the foal this can lead to RVF during dystocia
The parturition process in the mare is rapid and forceful; if there is a dystocia issue, you have to be there really quick but are often too late.
How common is a bladder prolapse?
A prolapse of the bladder is uncommon; sometimes in the mare the bladder everts through the fairly wide urethra; the internal [mucosal] surface of the bladder is visible.
In some cases (ewe or cow) the bladder prolapses through a tear in the vagina; the external [serosal] surface of the bladder is visible.
What are the 3 stages of a vaginal or cervix prolapse?
Stage 1: Mucosa protrudes when female recumbent but disappears when she stands
Stage 2: Mucosa protrudes when dam stands
Stage 3: All vagina protrudes and cervix is visible
What does this show?
Gerlach needle
How can we use a harness in a vaginal prolapse?
How can you use a vaginal spoon in a prolapse?
Which peripheral nerves are easily damaged during a forced extraction?
Gluteal and obturator nerve
The calf presses with its head dorsally against the gluteal nerve, the hip joints and shoulders often press on the obturator nerve when stuck in the birth canal
What nerves are there of the pelvic limb? (5)
What is this?
Obturator Nerve Paresis
What is this?
Femoral Nerve Paresis
What is this?
Gluteal Nerve Paresis
