Problems in Post-Partum Cattle 1

Question 1

1. Sources of haemorrhage post partum.
2. Treatments for post partum haemorrhage.

Answer 1

1. • Uterus – problematic – hard to reach.
     –> laparotomy or euthanasia.
     - Vagina.
     - Placenta – red-brown blood that comes off – normal.
2. Ligate.
   Clamp.
   Pack.
   Oxytocin.

Question 2

1. What are vaginal/uterine tears associated with?
2. Treatment of vaginal/uterine tears.
3. Prevention of vaginal/uterine tears.

Answer 2

1. Dystocia, excessive traction, large calves.
   May be associated with profuse post-calving arterial haemorrhage from vulva. But can also bleed into the uterus and go unseen externally.
2. • Identify bleeding vessel and clamp w/ artery forceps.
     - Stitch vaginal tears.
     - If large uterine tear, consider salvage slaughter or repair via laparotomy.
3. Avoid foeto-maternal disproportion, over-fat cows at calving, excessive traction.
   Consider episiotomy.

Question 3

1. What is uterine prolapse associated with?
2. Why may a cow be down w/ uterine prolapse?

Answer 3

1. • Prolonged parturition.
     - Straining.
     - Hypocalcaemia.
2. Exhaustion.
   Shock.
   - Hypovolaemia.
   - Hypothermia
   Hypocalcaemia (assume to be the case and treat w/ calcium).
   Pelvic nerve damage.

Question 4

Steps to replacing a uterine prolapse.

Answer 4

• Give calcium!
• Place cow in sternal recumbency w/ hindlegs pulled back (ropes).
• Give caudal epidural anaesthetic.
• Clean uterus (hibi, saline), remove placenta.
• Replace uterus using firm manual pressure (closed fist).
• Ensure uterus fully inverted.
• Consider ABX 3-4 days.
• Give NSAID, and oxytocin injections.
• Consider stitching vulva (Buhner’s suture). – loose enough to allow foetal membrane passage, urination.
  – Do NOT rely on this to keep the uterus in!

Question 5

1. Post partum pelvic nerve damage cause.
2. What nerve damage can occur? – How may these present?

Answer 5

1. Pressure of large calf passing through pelvic canal.
2. • Gluteal nerve paralysis – weakness in HLs or inability to stand after calving.
     - Obturator nerve paralysis – Legs tend to splay laterally when weight bearing.

Question 6

Important events in the post partum period.

Answer 6

• Uterine involution.
• Regeneration of endometrium.
• Elimination of bacterial contamination of uterus.
• Return of cyclical ovarian activity.

Question 7

Normal uterine involution.

Answer 7

• Reduction in size occurs in a decreasing log scale.
• Uterine contractions continue for a few days.
• Time for complete involution 4-6wks.
• Cervix constricts rapidly post-partum.
• Prostaglandins released from uterine caruncles have role in controlling uterine involution.

Question 8

Factors affecting normal uterine involution.

Answer 8

• Parity.
• Retained placenta.
• Uterine infection.
• Twins.
• Hypocalcaemia.
• Selenium deficiency.
• Suckling frequency.
• Dystocia.
• Climate (esp. heat stress).
• Hydrops.

Question 9

1. What is lochia?
2. Time to complete regeneration of caruncular epithelium?

Answer 9

1. Normal cows have post partum discharge for 7-10 days due to sloughing of the surface tissue from the uterine caruncles.
   Lochia is reddish brown and odourless.
2. Normally 25 days post partum.

Question 10

Bacterial contamination of uterus post partum reason and common bacteria that contaminate the uterus.

Answer 10

Reason:
- Vulva and cervix relaxed and open at and immediately after calving, allowing environmental bacteria to colonise the uterus.
Common bacteria:
- T. pyogenes.
- E. coli.
- Fusobacterium necrophorum.
- Staphs and streps.

Question 11

1. How is the bacteria normally eliminated from the uterus?
2. What may failure to to eliminate peri-parturient bacterial contamination lead to?

Answer 11

1. • Uterine contractions.
     - Sloughing of caruncular tissue.
     - Phagocytosis by leucocytes.
     - Secretory IgG in uterine secretions.
     Early resumption of post partum cyclicity aids in eliminations of any persistent bacterial contamination (enhanced oestrogens&raquo_space; increased blood flow&raquo_space; flushing effect of secretions). .
2. Development of acute metritis or chronic endometritis which may have
   serious detrimental effects upon subsequent fertility.

Question 12

How does uterine bacterial contamination interfere w/ fertility?

Answer 12

• Directly kills gametes or conceptus.
• Alters uterine ‘milk’.
• Causes endometritis (generates toxic products, inducing luteolysis).
• Causes chronic histological lesions (metritis, pyometra, salpingitis).
• Delays onset of ovarian cyclicity (w/ or w/o formation of ovarian cysts).

Question 13

Aetiology of post partum metritis.

Answer 13

Contaminant bacteria fail to be eliminated due to either:
- Overwhelming degree of bacterial contamination.
- Impaired natural uterine defence mechanisms.

Question 14

Acute post partum metritis…
1. When?
2. Associated with?
3. Clinical signs.
4. Differential diagnoses.

Answer 14

1. Normally occurs in first week post calving.
2. Often following dystocia or assisted delivery.
   Often associated w/ retained placenta.
3. • Anorexia.
     - Milk drop.
     - Pyrexia (if severe toxaemia, may be normal or subnormal temperature).
     - Foul smelling vulval discharge.
4. • Acute mastitis.
     - Vaginal / uterine tear w/ peritonitis.

Question 15

Acute post partum metritis treatment.

Answer 15

• Broad spectrum antibiotic (local and/or systemic).
• IV fluids and NSAID if toxic (Flunixin).
• Removal of retained foetal membranes w/ GREAT CARE – contraindicated here (tearing and further toxin release is a risk).

Question 16

Sequelae of acute post partum metritis.

Answer 16

Often develop secondary ketosis and/or hypocalcaemia.
May develop displaced abomasum, chronic endometritis, salpingitis or adhesions.

Question 17

Endometritis…
1. What is it?
2. Characterised by?
3. Associated with?
4. When?
5. What do farmers call it?

Answer 17

1. An inflammation of the endometrium.
2. Presence of mucopurulent vaginal discharge.
3. Delayed uterine involution.
4. 21 days or more after calving.
5. “whites”.

Question 18

1. Clinical signs of endometritis?
2. Diagnosis of endometritis?
3. Treatment of endometritis?

Answer 18

1. “The whites”.
   Cow clinically well otherwise.
2. Look for discharges.
   Vaginal exam.
   Grade 1-3 on Sheldon scale.
3. Bring cow into oestrus w/ PGF2a.

Question 19

1. How does chronic endometritis occur?
2. Incidence of chronic endometritis?
3. Predisposing factors to chronic endometritis?

Answer 19

1. Following acute metritis or on its own w/ no systemic illness.
2. 10-40%.
3. • Negative energy balance / ketosis.
     - Dystocia / assisted calving.
     - Retained foetal membranes.
     - Dirty calving equipment.
     - Premature calving – twins, induced calving.
     - Delay in return of post partum cyclicity.
     - Overfat at calving / fatty liver.
     - Nutritional deficiency e.g. selenium.

Question 20

Consequences of chronic endometritis.

Answer 20

Extended calving-conception interval due to:
- Delay in return to cyclicity.
- Hostile environment causing semen / embryo death.
May also get ascending salpingitis.

Question 21

Diagnosis of chronic endometritis.

Answer 21

• Persistent purulent vulval discharge “whites” evident at 3-4wks post calving.
• Tacky discharge stuck to tail.
• May be seen following oestrus when cervix opens.
• Vaginal exam manual or speculum.
• Rectal exam confirmed by ultrasound.
• Cytology / culture.

Question 22

1. What is pyometra in cattle?
2. What does pyometra feel like on palpation?
3. To confirm dx…

Answer 22

1. Endometritis w/ closed cervix causing uterus to fill w/ pus.
2. • Grossly distended uterine horn which must be distinguished from pregnancy, as could develop after embryonic or early foetal death.
     - Uterine wall thick but:
     – no membrane slip.
     – no placentomes.
     – no foetus palpable.
3. Ultrasound.

Question 23

Treatment for chronic endometritis and pyometra.

Answer 23

• PGF2a (as long as got CL) – can repeat in 10-14 days if “whites” persist.
• Intra-uterine ABX. – wash out w/ Metricure.
• Saline washout.
• Antiseptic washout (not licensed) – Lugol’s iodine or Chlorhexidine.
• Oestrogens (no longer licensed and illegal in EU).
• Self-cure.

Question 24

1. What does Metricure contain?
2. Advantages of Metricure?

Answer 24

1. Cephapirin (1st generation cephalosporin) – only abx licensed for intra-uterine treatment of endometritis.
2. • Broad spectrum cover and bactericidal.
     - Penicillinase resistant.
     - Indicated for sub-acute and chronic endometritis.
     - Can be used 1 day after AI.
     - Zero milk withdrawal.

Question 25

Prevention of endometritis.

Answer 25

• Minimise dystocia.
• Avoid overfat cows / fat mobilisation syndrome.
• Ensure adequate mineral / vitamin supplementation.
• Amounts to good dry cow management.

Question 26

1. Definition of retained foetal membranes.
2. Incidence of RFM.

Answer 26

1. Partial or complete retention beyond 12hrs post partum.
2. 3-10%.

Question 27

1. Aetiology of RFM.
2. What does normal separation require?

Answer 27

1. • Failure of normal separation of foetal cotyledonary villi from maternal caruncles.
     - Often associated w/ primary or secondary uterine inertia.
2. • Prepartum maturation of the placenta.
     - Intrapartum detachment by uterine contraction.
     - ‘Exsanguination’ of cotyledonary villi after foetal expulsion.
     - Reduction in size of uterine caruncles post partum.

Question 28

RFM aetiology.

Answer 28

• Failure of breakdown of acellular layer (glueline) between foetal and maternal epithelial layers.
  – Chemical change but assisted by uterine motility.
  – Local levels of prostaglandins are also important.

Question 29

RFM predisposing factors.

Answer 29

Premature parturition.
- twin births.
- late abortions.
- induced births.
Oedema of chorionic villi caused by:
- dystocia.
- caesarean.
- following uterine torsion.
Placentitis caused by abortion agents.
Uterine inertia due to:
- hypocalcaemia.
- twins.

Question 30

RFM clinical signs.

Answer 30

• Putrid placenta hanging from vulva but, may be retained in cervix / vagina and not obvious from outside.
• Cow may strain.
• Usually not ill unless acute metritis develops.

Question 31

RFM sequelae.

Answer 31

• Usually spontaneously exoelled in 5-10 days w/ no treatment.
• May develop acute metritis.
• Usually no effect on fertility following RFM unless associated w/ metritis and endometritis.

Question 32

RFM treatment.

Answer 32

• Manual removal – NOT best practice.
• Ecbolic drugs (do not work!)
  – oxytocin, PGF2a, calcium, oestrogens (not licensed, illegal).
• Intrauterine ABX / pessaries (help ctrl local infection).
• Systemic ABX +/- NSAIDs.
• Give prostaglandin injection at 3-4wks post partum to cows that have had RFM.