Lesson 9 - Gestational and Post-Partum Problems I (bovine)

A 6-year-old cow was confirmed pregnant approximately 7 months ago. She has not shown signs of calving. On rectal examination, the uterus contains a firm, dry, shrunken fetal mass. The cervix is closed, and there is no vaginal discharge. What is the most likely diagnosis?

fetal mummification

How does fetal maceration differ from fetal mummification?

a macerated fetus is liquified and fetid with just bones left

How is fetal mummification diagnosed?

1. transrectal examination

2. accidental finding in routine preg check

3. cow where the pregnancy failed to progress

4. cow overdue for calving

How does a mummified fetus feel on rectal palpation?

"rock in utero", persistent CL, no fetal fluids, no palpable placentomes

What is the treatment for a mummified fetus?

PGF2α (e.g., Lutalyse® or Estrumate ®) and expulsion of the fetus within 24-72 hours

What happens if treatment of a mummified fetus with PGF2α (e.g., Lutalyse® or Estrumate ®) is unsuccessful because the fetus is lodged in the vagina?

requires lubrication and manual removal

What is the prognosis for fetal mummification?

good, no uterine pathology and breeding potential is not impaired

How is fetal maceration diagnosed?

1. Transrectal examination

2. Crepitus on palpation (due to bones in the uterus)

3. Open cervix

4. Fetid, purulent discharge

What is the recommended treatment for fetal maceration?

1. Medical treatment unrewarding due to chronic damage to the uterus

2. Slaughter is recommended for economic reasons

3. Possible manual removal of fetal bones from the uterus if the cervix is open

Why is surgery not recommended for fetal maceration?

post op complications of peritonitis and/or septicemia

What is the prognosis of fetal maceration?

poor prognosis for return to fertility

What is the most recommended treatment for fetal maceration in a cow?

slaughter for salvage value

Which form of hydrops is caused by the cow and not the fetus?

hydroallantois

In what timeframe does hydroallantois develop?

quickly over 4-5 days

How is hydroallantois diagnosed?

highly distended uterus filled with fluids and no placentomes or fetus can be palpated on transrectal examination

What is the prognosis of hydroallantois?

guarded to poor for both life and fertility

What are the potential complications of hydroallantois?

1. Retained fetal membranes and metritis

2. Ventral abdominal rupture and herniation

3. Prepubic tendon rupture

What does the treatment plan for hydroallantois depend on?

severity

What is the likelihood of recurrence of hydroallantois?

high

What are the treatment options for hydroallantois if the cow is not going to be salvage slaughtered?

1. induce parturition with PGF2α alone or in combination with corticosteroids

2. cow will need assistance with calving because of uterine atony due to excessive distention

3. monitor after induction of parturition

4. may need supportive therapy (intravenous fluids) to prevent hypovolemic shock

In what timeframe does hydroamnion develop?

weeks to months

Which form of hydrops is caused by the fetus?

hydroamnion

How is hydroamnion diagnosed?

excessive fetal fluid with fetus and placentomes palpable on transrectal palpation

What is the prognosis of hydroamnion for the cow?

fair to good for life and fertility

What is the prognosis of hydroamnion for the fetus?

poor

What is the treatment for hydroamnion?

induction of parturition/abortion

What is important to know regarding future breeding of a cow who has experienced hydroamnion in the past?

might be genetic, so choose different sire

A farmer calls you about a 6-month pregnant cow that seems to have doubled the size of her abdomen over the last 4-5 days. On transrectal examination, the uterus feels extremely distended with fluid. Neither the fetus nor the placentomes are palpable. What is the most likely diagnosis?

hydroallantois

How is vaginal prolapse different from uterine prolapse?

no visible caruncles and typically happens prepartum

What is the cause of vaginal prolapse?

decreased uterine tone (potentially from hypocalcemia) can make the vagina easier to push out

How is vaginal prolapse diagnosed?

obvious on visual inspection

What is the treatment for vaginal prolapse?

1. Reduction, replacement, and retention

2. Caudal epidural anaesthesia to abolish straining and abdominal contractions

3. Prolapsed mass is cleaned with non-irritant fluid & lubricated

4. Prolapsed mass gently replaced and retained

5. Sugar or syrup draws out fluid to shrink mass and allow it to be pushed back in

What techniques are commonly used to secure a vaginal prolapse and prevent it from recurring?

1. Bühner stitch

2. Prolapse pins

3. Michev's Technique

How far should a Bühner stitch be tightened?

until only 2-3 fingers can fit in (just enough room to pee)

What is important to note about the use of a Bühner stitch to treat vaginal prolapse?

must be removed before parturition

How are prolapse pins used to treat vaginal prolapse?

placed across vulvar lips to close vulva

What is Michev's Technique most beneficial for?

chronic vaginal prolapses

What is an important benefit of using Michev's Technique to treat vaginal prolapse?

allows cow to calve without removal of device

How does Michev's Technique work?

prolapse replaced and prolapse pin passed through vaginal wall outwards through sacrosciatic ligament and secured in gluteal region with "buttons" causing adhesion of the vaginal wall to the body

How is uterine torsion diagnosed?

1. twisting of cranial vagina felt during vaginal exam

2. broad ligament dorsal and lying over the rotated uterus on opposite side of torsion on rectal exam

If a uterine has a torsion to the left, what side will the broad ligament feel taught on?

right

What side is this torsion on?

left

What side is this torsion on?

right

Why are cows predisposed to uterine torsion?

they get up with their hindlimbs first making room in the abdomen for the uterus to twist

What are the treatment options for uterine torsion?

1. Manual detorsion per vaginum at parturition if

What is the process of manual detorsion per vaginum

1. If the cervix is open enough to allow passage of hand and fetal limbs can be grasped

2. Epidural + tocolytic (clenbuterol) to relax uterus

3. Only in standing animal

4. Operator grasps fetus and attempts to swing away from side of torsion

5. Needs a strong operator

What is the process of detorsion by rolling the cow?

1. Cow is placed in lateral recumbency on the side to which the uterus is rotated

2. Both hindlegs and forelegs are tied

3. A plank is placed across the cow's abdomen and a person stands on the plank to try and fix the uterus in place while the cow is turned

4. Cow rolled towards the other side while trying to keep the uterus in place

What side is the uterine torsion on?

right

What are the dropsical conditions that can cause complications of pregnancy?

1. Fetal ascites (Infectious and non-infectious causes)

2. Edema of chorioallantois (Brucella)

3. Fetal anasarca

A cow is presented with 180°uterine torsion towards the right (clockwise from the back). For correction using the rolling method, which side will you cast her on?

right side

A cow is presented with 180°uterine torsion towards the right (clockwise from the back). For correction using the rolling method, which side will you cast her on?

clockwise

What is the puerperium/postpartum period?

the period from the end of 2nd stage of calving until the reproductive tract returns to its non-pregnant state ("ready to get pregnant again")

What is significant about the puerperium/postpartum period, especially in Dairy cows?

high-risk period in the production cycle

What are the consequences of a prolonged puerperium?

negative impact on reproductive efficiency and profitability

What are the postpartum events?

1. Uterine involution

2. Regeneration of the endometrium

3. Elimination of bacterial contamination of the uterus

4. Resumption of ovarian cyclical activity

What are the components of a postpartum exam?

1. History and general physical examination

2. Rectal palpation

3. Vaginal examination

4. ± Ultrasound

What history and clinical signs are important to gather in a postpartum exam?

1. History of dystocia, retained fetal membranes, metabolic diseases etc.

2. Temperature, appetite, mentation and production

What is the appetite level and production of a cow undergoing normal involution?

normal appetite and production

Are most postpartum conditions associated with signs of systemic disease?

no

Which postpartum condition IS associated with signs of systemic disease?

metritis

What are the characteristics of normal lochia?

pale brown to red in color, mucoid, no smell and decreases in volume, may contain some pus

When does normal lochia disappear by?

about 3 weeks postpartum

What are the characteristics of abnormal lochia?

1. Malodorous/fetid

2. Dark red to black in color

3. Watery consistency (versus mucoid)

4. Purely purulent discharge

5. Persisting beyond 3 weeks post partum

6. Progressively increasing in volume

What is the purpose of postpartum rectal palpation?

assess uterine size, tone, presence of uterine content, thickness of uterine wal

How will the uterus feel during rectal palpation during the first week postpartum?

thick walled (rubbery consistency) and too large to palpate fully

How will the uterine horns feel in early postpartum?

marked asymmetry between pregnant and nonpregnant horns

When should the cervix and uterine horns return to normal size?

21 days postpartum

What is the normal size for the cervix and uterine horns?

between 3 to 5 cm with

What will uterine tone depend on?

stage of estrus cycle

What can be used for a postpartum vaginal exam?

speculum and digital examination (gloved hand)/Metricheck device

What should be assessed during a postpartum vaginal exam?

1. Presence of trauma and/or adhesions, fibrosis, strictures

2. Appearance of vaginal mucosa

3. Presence and nature of discharge

4. Presence of air or urine indicating disruption of normal barriers

5. Integrity and appearance of cervix

What are the three barriers of the vagina?

1. Vulvar lips

2. Vestibulo-vaginal junction

3. Cervix

When can ultrasound be beneficial for postpartum examination?

can provide more accurate assessment of the uterus and the ovaries and the presence or absence of fluid

What is the best treatment for retained fetal membranes in cows?

no treatment, just monitor clinical signs until the membranes are expelled

When are fetal membranes considered retained in cows?

after 24 hours

What are the characteristics of acute puerperal metritis?

1. Abnormally enlarged, fluid-filled uterus

2. Fetid, watery, red-brown lochia

3. Signs of systemic illness like fever (>39.5°C/103.1 °F), reduced milk production, dullness, reduced appetite etc.

4. Within 21 days postpartum (most commonly seen within the first 5 days post-partum)

What are the characteristics of subacute metritis?

1. Abnormally enlarged, fluidfilled uterus

2. Purulent lochia

3. Cow not systemically ill

4. Within 21 days postpartum (most commonly seen at 2 weeks postpartum)

What is the main difference between acute and subacute metritis?

cow is not systemically ill with subacute metritis

What are the predisposing factors of metritis?

1. Retained fetal membranes (RFM)

2. Poor hygiene at calving

3. Dystocia

4. Poor uterine contractions due to metabolic diseases

5. Concurrent systemic disease

What bacteria are most commonly associated with metritis?

1. Trueperella pyogenes

2. E. coli

3. Fusobacterium necrophorum

4. Prevotella spp.

What are the clinical signs of metritis?

1. Inappetence

2. Dehydration

3. Decreased production

4. Increased temperature

5. Lochia

What are the differences in the appearance of lochia in acute vs subacute metritis?

acute cases appear red-brown, watery, foul smelling while subacute cases appear purulent

What are the differences in rectal palpation of the uterus in acute vs subacute metritis?

acute cases have a large, flaccid, fluid filled uterus while the uterus feels more firm and "doughy" in subacute cases

What type of antibiotic therapy seems more likely be effective in cases of metritis in cows?

systemic antibiotic therapy

What systemic antibiotics are approved for metritis treatment in cows?

1. Ceftiofur hydrochloride (Excenel®)

2. Ceftiofur crystalline-free acid (Excede®)

What is a benefit of using Ceftiofur crystalline-free acid (Excede®) to treat metritis?

no milk withdrawal time

Why is the use of intrauterine antibiotic therapy to treat metritis not recommended?

antibiotic won't be able to reach MIC (too much pus)

What are the consequences of metritis?

1. Delayed involution

2. Endometritis

3. Metabolic disorders

4. May lead to septicemia, toxemia, and death if untreated

What is the most appropriate treatment for acute puerperal metritis in cattle?

systemic administration of Ceftiofur

What is the difference between metritis and endometritis?

inflammation is limited to the superficial layers of the uterus in endometritis

When does endometritis usually occur?

3 weeks after parturition

What are the causes of endometritis?

1. Failure to eliminate infection during involution

2. Unhygienic AI or specific venereal pathogens

What are the clinical signs of endometritis?

1. often subclinical, and the cow is not systemically ill or showing signs of disease

2. Purulent vaginal discharge that may not appear at vulva

3. Irregular cycles

What are the consequences of endometritis?

1. Significant negative impact on reproductive efficiency

2. Increased inter-calving interval

3. Increased services per conception

4. Increased culling rates

What are the main pathogens that cause endometritis?

T. pyogenes often in combination with F. necrophorum

How is endometritis diagnosed?

1. Vaginal exam with a speculum

2. Collection of vaginal discharge using a gloved hand or Metricheck device

3. Endometrial cytology for subclinical endometritis

What is the treatment for endometritis?

1. May resolve spontaneously

2. Intrauterine antibiotics like Cephapirin (Metricure®)

3. Endometrial culture and sensitivity if nonresponsive to antibiotics (guarded swab)

4. PGF2α used by some but efficacy is questionable based on results of various research studies

What are the regulations on the intrauterine use of Cephapirin (Metricure®) to treat endometritis in cows?

1. not approved in the US

2. approved in Canada

When does uterine prolapse usually happen?

within 12 hours of parturition

What are the consequences of uterine prolapse?

1. Rupture of major blood vessels leading to hypovolemic shock

2. Absorption of toxins, especially when prolapse is replaced, leading to endotoxic shock

3. Thromboembolism

4. Trauma and necrosis of prolapsed tissue

5. Sudden death