9. disorders of the postpartum period

normal postpartum period

• eutocia + live calf

• placenta passed within 12 hrs

• cow resumes eating normally

• rapid involution of uterus during first 15d PP

  • physically involuted by 30-40d

  • histologic involution complete by 45-50d

• lochia gone by ~14-16d

• ovarian cycles resume in 20-30d

• normal fertility returns by ~60d

lochia

normal postpartum discharge consisting of blood, mucus, and detritus. in the absence of infection, it is virtually odor-free

uterine prolapse etiology

• hypocalcemia (delaying involution of cervix)

• dystocia

• trauma

• irritation leading to prolonged straining

true emergency

uterine prolapse treatment

• minimize physical activity

• epidural (stop straining)

• clean & replace

• retention — usually not needed if cow is ambulatory

• monitor for straining

• systemic antibiotics

what are common injuries sustained during calving? (calving trauma)

• include trauma and tears of the uterus and caudal urogenital system

• can be life-threatening

calving trauma diagnosis

• history (e.g. dystocia) and PE

• vaginoscopic or manual examination

calving trauma treatment

• control hemorrhage (suture, IV formalin, oxytocin)

• surgery for lacerations into peritoneum

• monitor for pneumovagina or urine pooling

• depending on the severity, culling or immediate salvage

what are common causes of vulvar & vaginal conformation problems? what are complications / consequences?

• often the result of trauma from extraction of a large fetus or inappropriate obstetrical manipulation

• disruption may result in chronic vaginitis, endometritis, cervicitis, and subfertility

• pneumovagina and urovagina are also common complications

vestibulo-vulvar trauma treatment

• allow time for healing (up to 30d)

• Caslick’s or episioplasty

• vaginal / perineal reconstruction for 3rd degree tears

urovagina diagnosis

• palpation

• vaginoscopy

• ultrasonography

urovagina treatment

• urethral extension

  • moderately expensive and high failure rate

• vestibulo-vaginal cerclage

• tincture of time for postpartum cows

what qualifies as retained fetal membranes (retained placenta)? what conditions does RFM predispose a cow to?

• failure to expel fetal membranes within 12h after parturition

• increases the risk of metritis, endometritis, displaced abomasum, and mastitis

etiology / risk factors for retained fetal membranes

• extremely common in dairy cattle

• failure of placentome maturation / collagen breakdown

  • risk factors: abortion, twins, premature & induced calving, dystocia, intensive stress, hypocalcemia

• inflammation

• selenium / vitamin E & A / iodine deficiencies

• metabolic disease and immunosuppression

retained fetal membrane diagnosis

• visually (fetal membranes protruding from vulva >12h post-calving) and aromatically obvious (fetid odor)

• vaginal exam

• foul-smelling discharge

retained fetal membrane treatment

• none specific

• limited success due to variety of causes and mechanisms

• manual removal not recommended / potentially harmful

• antibiotics

  • systemic (ceftiofur, ampicillin, k-pen) if severe signs of illness

  • intrauterine not recommended

  • prevention of metritis

retained fetal membrane prevention

• transition cow management to decrease stress, maintain feed intake, and promote immune system function

• sanitary maternity facilities and careful, timely obstetrical interventions

• minimize abortions and calving problems (e.g. sire selection)

• examine calving cow & nutrition management

• selenium supplementation may have beneficial effect in herd with regular history of RFM

what is metritis?

• severe, usually acute inflammation of the entire uterine wall (all 3 layers: endometrium, myometrium, and serosa)

• typically problem of early postpartum period ( < 21d, mainly 3-10d); often accompanied by fetid vaginal discharge and systemic signs of illness (fever)

  • reddish-brown watery fetid discharge

metritis risk factors

• stillbirth

• abortion

• male calf (larger size)

• trauma

• twins

• dystocia

• RFM

• hypocalcemia

• BCS loss

metritis etiology / pathogenesis

• etiology

  • RFM, trauma, unsanitary calving facility or assistance

• pathogenesis

  • typically involves colonization with e. coli → endotoxin causes clinical signs and results in persistent infections (trueperella pyogenes, fusobacterium necrophorum, and bacteriodes spp.) with resulting inflammation & infertility

metritis diagnosis

• history & PE

• palpation, U/S

• metricheck device

• vaginoscopy

• culture & sensitivity

• routine, systematic screening of fresh cows

metritis treatment

• systemic antibiotics (distribution to all layers of the uterus) — penicilin G; ceftiofur; oxytetracycline

  • intrauterine not recommended

• anti-inflammatory agents

• IV fluid therapy

what is endometritis? clinical signs?

• inflammation limited to the endometrium → disruption of epithelium, increased blood flow, edema, & influx of inflammatory cells, mostly neutrophils and lymphoctyes

• comparatively mild inflammation of uterine lumen & endometrium that extends > 21d postpartum & may persist into the breeding period

• not compatible with establishing pregnancy (↓ fertility)

• no or minimal vaginal discharge

• no systemic signs of illness

endometritis etiology

• conformation / trauma

• acute bacterial or viral infections (e.g. infectious pustular vulvovaginitis)

• sequelae to RFM & postpartum metritis

endometritis diagnosis

• history

• palpation

• U/S

• vaginoscopy

• metricheck

• cytobrush

• biopsy

• culture

subclinical endometritis diagnosis

uterine lavage or cytobrush

• culture

• cytology — >10% neutrophils > 21d postpartum

endometritis treatment

• prostaglandin-F2α (1 or 2 treatments 14d apart)

• tincture of time / benign neglect — most cases do not require any treatment

pyometra etiology

• usually sequelae to postpartum metritis that continues into the ovulatory period

• rarely a post-breeding event but in those instances, trichomoniasis should be suspected

pyometra diagnosis & treatment

diagnosis

• palpation / U/S

• retained CL

treatment

• PGF2α (1 or 2 treatments 14d apart)

mechanism of postpartum anovulation

• sustained exposure to high concentration of estradiol ± progesterone inhibits hypothalamic GnRH secretion → negatively affects LH synthesis → gradual depletion of pituitary LH reserves

• restoration of pituitary function & accumulation of LH could take up to 3 weeks or longer

what are the 4 types of anovular conditions?

• type I: growth of follicles up to emergence but no deviation (no dominant follicle)

• type II: follicular deviation & growth, followed by dominant follicle atresia

• type III: dominant follicle fails to ovulate, becoming a persistent structure (anovular or cystic follicle)

• type IV: prolonged luteal phase due to absence of luteolysis

anovulation diagnosis

• history: long period of anestrus

• sequential palpation / ultrasound to detect CL

• progesterone profile (basal P4)

  • twice-weekly

  • milk or blood

anovulation treatment

• double ovsynch

• ovsynch in combination with P4 intravaginal device

anovulation prevention

reduce risk factors

• short dry period

• monitor BCS loss during transition period

• decrease incidence of postpartum diseases