Principles of the post-partum period Flashcards
Post-partum Haemorrhage
Simply meaning blood passage after parturition – can have many causes:
Profuse bleeding can be due to:
Breakage of the umbilicus and blood leaking from the placenta
Uterine or vaginal laceration - i.e. vaginal artery haemorrhage in heifer after forced extraction
Minor seepage can occur from where placenta attached
Trauma/ laceration/ contrusion post partum
Result of bruising of the wall of the vestibule or vulva during delivery
Perineal laceration: most commonly seen in cow and mare, often at first parturition, and most commonly when there has been forced traction
1st/2nd/3rd degree perineal tear
First degree
Skin and mucosa (usually of dorsal commissure)
Second degree
Deeper laceration involving muscle of perineal body
Third degree
Torn vagina and rectal wall (creating a cloaca)
Retro-vaginal fistula
Penetration from the vaginal cavity into the rectum but not continuous distally
Post partum Bladder Prolapse
In some cases (ewe or cow) the bladder prolapses through a tear in the vagina (external [serosal] surface of the bladder is visible)
In other cases (mare) the bladder everts through the large urethra (internal [mucosal] surface of the bladder is visible)
When is a vaginal (&cervix) prolapse most commonly seen
Late pregnancy- not post partum
Which species is a uterus prolapse most commonly seen in
Cow and ewe
Common post-partum
Usually complete eversion of previously pregnant horn
Sow
Infrequent
Eversion of one horn
Mare
Rare
Eversion of the whole of the uterus
Bitch and Queen
Rare
Eversion of one horn
Aetiology of uterus prolapse
In cows more common in multiparous cow (hypocalcaemia=risk factor)
Usually seen soon after calving
Associated with uterine inertia or poor involution of a portion of uterus which predisposes to protrusion when there is protracted abdominal straining
May be associated with traction of retained placenta (mare)
Treatment of uterus prolapse
Epidural, establish ‘frog-leg’ position in cow
Push components close to vulval lips first and gradually replace
Ensure complete inversion
Post replacement: oxytocin, calcium, parenteral antibiotic, NSAIDs
Prognosis: good if treated soon after prolapse occurred
In which species is retained foetal membranes most common
Cow
Common: incidence 6-8% overall (25-50% of dystocias)
Important in metritis-endometritis-pyometra complex
Mare
Less common: incidence 1-10%
Consequences (metritis -> laminitis) can be very severe
Ewe
Uncommon
Consequences metritis but often limited treatment required
Bitch and Queen
Uncommon
Consequence is metritis
Aetiology of retained fetal membranes
Failure of normal process of dehiscence and expulsion
Cow
Associated with abortion, dystocia, inertia, hypocalcaemia, caesarean, twins, some mineral/vitamin deficiencies
Mare
Associated with breed, dystocia, uterine inertia, hypocalcaemia
Treatment of retained fetal membrane in cow and effect of ecbolics (Pg and oxytocin)
Gentle removal (triple glove!!)
Parenteral antibiotics if clinically ill
Ecbolic have little (PG) or no (oxytocin) effect
Treatment of retained fetal membrane in mare and effect of ecbolics
Treatment is urgent
Can be removed by careful traction
Sometimes ecbolic agents used (oxytocin in different regimes)
Remember careful examination of membranes (fragments remaining = metritis
Treatment of retained fetal membrane in bitch and queen and effect of ecbolics
The condition is less common than the concern about it
Dams often eat the placentae and this is not noted by the owner
Persistence of green-coloured discharge is suitable confirmation
Diagnosis/treatment is often undertaken from day 2
Ecbolic agents; oxytocin, prostaglandin, ergometrine
Critical other treatments: NSAIDs, parenteral antibiotic, fluid therapy
Post-partum Metritis
Associated with dystocia, assisted parturition, placental retention
Affects most species:
May be severe and be associated with odorous discharge and acute toxaemia with dehydration, pyrexia and collapse
May be chronic and be mainly a pooling of fluid in the uterus
In per-acute cases the prognosis is guarded
Treatments:
Fluid therapy, NSAIDs, intra-uterine(?) and/or parenteral antibiotics, drainage of fluids by oxytocin or PG administration (remember no CL), calcium administration, uterine lavage
