Peri-Partum Disorders

Vaginal prolapse timing in ruminants

- late gestation

- shortly after calving

Common causes of vaginal prolapse

- intra abdominal pressure

- post calving

Appearance of vaginal prolapse

- peeking through

- includes cervix and may include bladder

Is vaginal prolapse an emergency?

No

Vaginal prolapse is common in...

Cattle and sheep

Sequelae to vaginal prolapse

- recurrence

- infection

- concurrent rectal prolapse

Who is genetically predisposed to vaginal prolapse?

Herefords

Vaginal prolapse grade I

Intermittent prolapse often visible only when the animal is recumbent

Vaginal tissues might appear normal

Vaginal prolapse grade II

Continuous acute prolapse of vaginal tissue, typically not damaged tissue

Vaginal prolapse grade III

Continuous acute prolapse of the vagina, bladder, and cervix

Vaginal prolapse grade IV

Chronic prolapse of either grade II or III with resultant trauma, infection, or necrosis

Appears swollen, bleeding

Uterine prolapse timing

Occurs following calving or lambing, usually within 24 hours

May also come with the fetus at parturition

Common causes of uterine prolapse

- difficult birth

- manual detachment of placentomes

Is uterine prolapse an emergency?

Yes

What should you do when owner's call with a potential uterine prolapse?

- tell them to keep the animal still or move them very carefully

- tell them to cover and protect, and keep it moist

Appearance of a uterine prolapse

- hangs below the hocks

- placentomes are visible

- placenta may be retained

Causes of bladder prolapse

Associated with vaginal/uterine prolapse

- pre or post calving

- ventral vaginal floor

What occurs after replacing a bladder prolapse?

Replacing will facilitate urination and helps them to stop pushing

Definition of retained placenta in ruminants

Failure to shed fetal membranes within 24 hours postpartum

Should drop typically in 1-12 hours

Pathogenesis of retained placenta

Impaired migration of neutrophils and decreased estradiol concentrations in late preg -> decreased placental break down

Diagnosis of retained placenta

- history/clinical signs

- protruding from vulva

- foul odor

Possible sequelae of retained placenta

- metritis

- systemic toxemia

Causes of retained fetal membranes

- abortions or placentitis

- dystocia and c sections (esp small rum)

- hypocalcemia

- selenium deficiency

- induction of parturition

- high environmental temp (cattle)

- advanced cow age

- vit A deficiency (small rum)

- obesity (small rum)

Retained placenta treatment

Manual removal is not recommended, usually self-limiting in 2 to 11 days

Only treat if the cow is sick

Why do we not want to manually remove a retained placenta?

Bacteremia is possible as the caruncles and cotyledons are separated

Possible treatment for a retained placenta

- vit E and selenium

- oxytocin

- prostaglandin

- oral calcium

Bovine clinical metritis timing

Occurs 10 to 21 days postpartum

Characteristics of metritis

- abnormal discharge present

- commonly polymicrobial

Risk factors for metritis

- dystocia

- twins

- stillbirths

- retained placenta

- primiparity

- subclinical hypocalcemia

- reduced feed intake

- high NEFAs

- poor perineal hygiene

What is puerperal metritis?

Sequelae to metritis

- enlarged uterus

- fetid odor

- watery red brown discharge

- depression

- anorexia

- decrease in milk production

- pyrexia

Vaginal discharge scores in metritis (1-5)

1 - clear

2 - cloudy

3 - purulent

4 - bloody and purulent

5 - fetid, watery, red brown

Risk of a metritis score of 5

- less likely to cycle

- lower preg rates

- higher culling rate

Metritis risk factors in small ruminants

- dystocia/trauma

- retained fetal membranes

- assisted delivery

- dead fetus

- uterine prolapse

- Clostridium tetani and perfringens

When does metritis typically occur in sows?

48 hours after farrowing

Clinical signs of metritis in sows

- white to brown discharge

- necrotic and malorodous

- remnants of fetal membranes

- +/- fever

- +/- septicemia

- +/- mastitis and agalactia

- may increase mortality rate in piglets

Risk factors for metritis in sows

- lack of washing hands/arms

- lack of sow preparation

- lack of PPE

- contaminated environment

Fatty liver is common in...

High producing dairy cows

When does fatty liver typically occur in dairy cows?

Occurs in the transition period

What causes fatty liver in dairy cows?

Excessive accumulation of triglycerides within liver cells (excessively fat animals) + negative energy balance

Fatty liver pathogenesis

Negative energy balance mobilizes body fat -> NEFAs released -> overloads hepatic oxidation and export capacity -> fat accumulates in hepatocytes -> liver function is impaired

Risk factors for fatty liver

- over conditioned cows (BCS 3.5-5) at calving

- decreased feed intake before or after parturition

- twin pregnancies

- concurrent diseases (ketosis, metritis, mastitis, DA)

- stress and poor transition management

Clinical signs of fatty liver

- reduced appetite or anorexia

- decreased milk production

- weight loss

- depression and lethargy

- ketosis often present

- increased susceptibility to other postpartum diseases

Diagnosis of fatty liver

History - recent calving, negative energy balance

Blood work - elevated liver enzymes, NEFAs, BHBA

Liver biopsy

Primary ketosis is caused by...

An energy deficit

Secondary ketosis is caused by...

Concurrent disease

Lactational ketosis is common in...

Cattle

Pregnancy toxemia is common in...

Small ruminants

What is the basis of ketosis?

Loss of maternal glucose control and adipose tissue immobilization

Pregnancy toxemia risk window in small ruminants

Last 2 to 6 weeks of pregnancy

Risk factors for pregnancy toxemia

- twins

- BCS < 2

- BCS > 5

When should we suspect pregnancy toxemia?

Any time weakness is followed by death (3-10 days)

What can be a sequelae to pregnancy toxemia?

Hypoglycemic encephalopathy and secondary polioencephalomalacia

How does ketosis occur?

Decreased insulin (preserving glucose for the fetuses) calls for more fat to be mobilized -> inadequate intake prevents liver from making sufficient glucose -> energy cycle shift to ketogenesis -> ketone production and appetite suppression

When is it okay to induce parturition in pregnancy toxemia?

Only after day 138

Risks of inducing a pregnancy toxemia parturition

- dystocia

- retained placenta

- metritis

- low survival rate

When does lactational ketosis occur in small ruminants?

First 3-4 weeks of lactation

Clinical signs of lactational ketosis in small ruminants

- anorexia

- decreased milk production

- irritability

- weight loss

When is the risk for ketosis and fatty liver the highest and why?

The period between when milk yield and feed intake peak - corresponds to negative energy balance and highest body fat mobilization

What type of disease is an LDA?

A metabolic and inflammatory disease

When do LDAs tend to occur?

First 4 weeks after calving

Why do LDAs occur post calving?

- biomechanics of space post calving

- negative energy balance

- metabolic disease in the transition period

LDAs typically occur in what cows?

Multiparous, > 5 years old

Movement of the abomasum in an LDA

Abomasum migrates cranially, to the left, and dorsally between the rumen and abdominal wall

LDA sequelae

Blocks passage of normal ingest - outflow obstruction occurs and Cl is sequestered in the abomasum

Decreased dry matter intake

Fluid accumulates in abomasum

Decreased fecal output - pasty feces

Metabolic alkalosis

Dehydration

What can be used as a prognostic indicator for LDA?

Extent of hypochloremia

LDA electrolyte abnormalities

Hypochloremic metabolic alkalosis with paradoxical aciduria

Causes of milk fever

- increased lactational demands

- elevated Ca, K, or Na in dry cow ration

- Mg deficiency (dysregulation of Ca)

Clinical signs of milk fever are seen with what blood Ca level?

5-7 mg/dL (normal 8.5-10)

Who is at higher risk of milk fever?

- older cows

- jersey cows

- high producing cows

Milk fever stage 1 clinical signs

- muscle tremors, especially in shoulders and flanks

- reduced rumen contractions

- staggering or unsteady gait

Milk fever stage 2 clinical signs

- sternal recumbency

- cold ears and cool extremities

- low body temperature

- dilated pupils

- weak, rapid pulse

Milk fever stage 3 clinical signs

Lateral recumbency, coma, and death if untreated

Typical cause and signalment of milk fever in dairy goats

Caused by hypocalcemia

Usually > 3 years

Clinical signs of milk fever in dairy goats

- stiff gait

- tremors

- ataxia

- recumbency

- coma

- death

Hypocalcemia treatment in goats

Calcium gluconate

Cause of hypomagnesemia

Grass tetany - consumption of rapidly growing grass that is high in K and N, so Mg absorption is impeded

If post calving, Ca/P/Mg are excreted in milk

Hypomagnesemia (grass tetany) pathogenesis

High potassium intake alters rumen epithelium electrical potential, impairing magnesium absorption

How does hypomagnesemia cause tetany?

Crucial for proper nerve function - deficiency causes nerves to be hyperactive

Clinical signs of grass tetany

- mild restlessness and irritability

- abnormal or stiff gait

- muscle twitching and fasciculations

- increased response to stimuli

- tetanic convulsions/seizures

When does swine mastitis and metritis occur?

12-48 hours post partum

Result of mastitis and metritis in swine

Greatly reduced milk production

High preweaning piglet mortality - decreased colostrum intake, starvation, hypothermia

Clinical signs of mastitis in sows

- fever

- anorexia

- constipation

- depression

- inflammation

- severe edema

- skin congestion

- induration

Common causative agents of mastitis in sows

Coliforms

- E. coli

- Citrobacter

- Enterobacter

- Klebsiella