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Problems of Bovine pregnancy Dr.SAMIR MUDULI ORISSA VETERINARY COLLEGE BHUBANESWAR ORISSA
Problems of pregnancy • Dropsy conditions include hydrallantois and hydramnios • Uterine torsion • Uterine Prolapse • Vaginal prolapse • Fetal mummification • Fetal Maceration • Calving Injuries
Hydroallantois • Hydroallantois, or hydrops of the allantois, is due to a defective placenta (the chorio-allantois). • The fetus is normal. • The condition is characterized by a rapid accumulation of watery, clear fluid, usually in the last trimester. • The cow is rounded in the caudal view, and you normally can't palpate the fetus or placentomes. • Usually the condition results in a sick cow with anorexia, decreased rumen motility, dehydration and weakness.
The cow may be down. • The placenta is thick. • If the cow survives, postpartum metritis is common. • The condition usually ends in death or intervention. • The prognosis is guarded to poor for life and fertility. • Treatment consists of Caesarian section with a slow drainage of fluid and perioperative support. • Dexamethasone can be used if the cow is not down.
Hydramnios • Hydramnios, or hydrops amnios, is due to a defective calf, usually attributed at least partly to a defect in swallowing. • The placenta is normal. • The condition is characterized by a gradual accumulation of thick, viscid fluid during the last half of gestation. • The cow has a pear shaped caudal view. • Usually you can palpate the fetus and placentomes. • The cow is clinically otherwise unaffected. • The pregnancy usually goes to term, and frequently a small, deformed fetus is delivered. • Postpartum metritis is uncommon. • The prognosis is good for life and fertility. • No treatment is required. • The cow may be allowed to go to term or induced to calve.
Uterine torsion • Uterine torsion usually occurs near term and is usually found at parturition because of the subsequent dystocia. • The attachments of uterus and manner in which cows rise are assumed to play a role in the development of this condition. • Diagnosis can be made by a number of ways. • By manual vaginal exam, the vaginal wall can be felt to be twisted or spiraled. This can be visualized with the aid of a speculum. • By rectal exam, the broad ligaments can be felt to be crossed and the uterus twisted. The vulva can often be seen to have a slight twist of the dorsal portion. • It is important to determine the direction of the torsion during the examination.
Uterine torsion(contd.) • When correcting a dystocia, if the calf is found upside down (dorso-pubic), consider the possibility of a uterine torsion. • Before and during correction, insure that things are going in the proper direction. • If the cervix is open, a detorsion rod may be used. • Alternatively, the torsion may be corrected manually by rocking the fetus until enough momentum is achieved to flip the uterus. • If the cervix is closed other methods must be employed such as the "Plank in flank" method or surgical (C-section) correction.
Uterine Prolapse • Lay terms for this condition include "cast her wethers" and "lost her calf bed". This is a true emergency. This is an acute condition that is often associated with hypocalcemia and may also follow use of great force in fetal extraction. It is not hereditary. • Diagnosis is fairly obvious, caruncles can be observed on the uterus which is prolapsed through the vulva. The prolapse can involve other organs such as the bladder or intestines. In some cases, the uterine artery may rupture with fatal consequences.
The prognosis is relatively good if the uterus does not suffer too much trauma and is replaced properly. The chance of recurrence not great. If properly corrected, there are no serious long term effects, although there may be a slight increase in days open during that lactation. • Correction isaccomplishedbyfirstcleaning the uterus to remove dirt and accumulated debris. • Proper restraint is essential. • Epidural anesthesia is helpful to prevent straining. • To aid in replacing the uterus, tip the pelvis cranially by placing the cow in a "frog leg" position and elevate the uterus (either by elevating the hind quarters of the cow or having assistants hold the uterus up). • It may help to empty the bladder if it is trapped.
Uterine Prolapse (contd.) • Generally the placenta is removed only if loose. • More trauma is caused to the endometrium by manually removing the placenta than by leaving some attached to the uterus. • Sugar or other such substances are sometimes used in an attempt to reduce the edema in the uterus and shrink it down. However, the effect is not remarkable. • Oxytetracycline powder or other broad spectrum antibiotics are sprinkled on the uterus before replacement or placed in the uterus after replacement. • Completereplacement is essential to prevent continued straining and reoccurrence.
Some recommend suturing the vulva after replacement with heavy suture material in something like a large horizontal pattern. Although this is often done, it is considered a placebo procedure if the uterus has been properly replaced. • Oxytocin should be given after replacement. If given before replacement, the uterus will contract down and make the job more difficult. • It is important to treat milk fever first before replacement because that is a more life threatening condition. • Hysterectomy is considered a salvage procedure.
Vaginal prolapse • This is often a chronic condition and is hereditary. • There is a breed predisposition with Hereford, Santa Gertrudis being predisposed. • Vaginal prolapses often recur. For this reason, it is recommended to cull cattle with a vaginal prolapse. • They usually occur prepartum, in late gestation, when the cow is under the influence of rising estrogen and experiencing relaxation of the tissues. • They may occur postpartum or may be associated with follicular cysts. • Upon presentation, the vagina, with or without the cervix, is seen protruding from the vulva.
The tissue is often dry and necrotic. • Tenesmus is common. • When considering the prognosis, although rarely life threatening, consider the chance of recurrence and inheritance and recommend culling. • These are much easier to replace but harder to maintain in the correct position. • Correction is aided and tenesmus reduced with an epidural. • The tissue is cleaned,, lubricated and replaced. • After replacing the prolapse, the cow may be maintained so that her hind quarters are elevated (dairy cow) • These need to be sutured to help reduce the risk of reoccurrence. • There are numerous methods of fixation. 1)Buchner tape 2)Minchev`s technique 3)Boot lace
Probably one of the most effective is the Bühner stitch. • This requires a Bühner needle and Bühner tape. If other material such as umbilical tape is used, results are unsatisfactory. Umbilical tape, for example, will break and also wicks bacteria. • The Bühner stitch must be removed prior to parturition.
Minchev's technique is useful prepartum, especially in cattle that cannot be watched closely because they are able to calve with the Minchev buttons in place. • Tissue trauma, swelling and inflammation may be a problem.
Other techniques commonly used include: The "boot-lace", where eyelets are made from hog rings or sutures. This can be removed temporarily and replaced by lay help, for example in prepartum cases. • Modified Caslick's are also used occasionally with varying degrees of success. • Pessaries are also used occasionally with varying degrees of success. • Trusses, etc. are also used occasionally with varying degrees of success.
Fetal mummification • This occurs in cases of fetal death without involution of the corpus luteum and fetal expulsion, followed by autolytic changes, absorption of the fetal fluids and involution of the placenta. • In cows the maternal caruncle involutes and hemorrhage occurs between the placenta and the endometrium, leaving a reddish-brown, gummy mass that imparts a reddish brown color to the mummified fetus. • The etiology is varied and ranges from infectious causes such as BVD, leptospirosis, etc. to non-infectious causes such as genetic, compressed umbilical cord, etc. • Diagnosis is based on the presence of a CL, the lack of fremitus in the uterine artery and lack of fetal fluid in the uterus. The fetus feels dry and mummy-like on palpation. Oftentimes the head, ribs, etc. can be felt. • Prognosis is good if the fetus is removed. After the fetus is removed, conception usually occurs 1-3 mo. later. • Treatment is accomplished by administering PGF2a (with or without estrogen) to lyse the CL. Steroids are ineffective with dead fetus and non-functioning placenta. After treatment, check the vagina because sometimes the mummy may be lodged in the vagina when expelled.
Fetal Maceration • Fetal maceration results from death of the fetus followed by dilation of the cervix and incomplete abortion or dystocia, usually during the last half of gestation. This condition can be due to a variety of miscellaneous organisms. Diagnosis • On palpation per rectum, the uterine wall is thick, little or no fluid is present in the uterus and you may be able to palpate fetal bones and pus, or bones crepitating against each other in the uterus.
Prognosis • The prognosis is poor for cows with this condition. This is not a "retained CL" problem so lysis of the Cl is not helpful. Endometrial damage is present even if all fetal parts are removed. Treatment • Treatment is very difficult. The cervix cannot usually be dilated sufficiently to remove all the fetal parts and any remaining fetal parts act as an IUD. Surgery has been performed in valuable individuals but is very difficult.
Calving Injuries • Postpartum hemorrhage: This can be due to a variety of causes. When observed, the origin of the blood should first be determined. • Lacerations or tears are usually due to mishandling during OB procedures. • Tears in the uterus are usually located in dorsally, near the cervix. They can be diagnosed by palpation or visually. • (Sideline: Schistosomus reflexus should be included in the differential diagnosis when viscera are observed protruding from the vulva or palpable during an obstetrical procedure. • This is a congenital defect where the spine is bent back on itself in a hairpin turn and the ventral body wall is not closed. • This defect is incompatible with life although the calf may be alive at the time of attempted delivery. • Delivery requires a fetotomy or cesarian section.)
The prognosis in the case of lacerations of the reproductive tract varies with the location and extent of the tear. • Peritonitis is a possible sequela. • Small tears may heal without treatment. • Larger ones should be sutured, either via laparotomy (difficult) or by intentionally prolapsing the uterus. This can reportedly be achieved by administering 10 cc epinephrine i.v., but is not effective after oxytocin administration.
Cervical tearscan result in profuse bleeding. Not as critical to future fertility as in the mare but may reduce fertility depending on the extent. No real treatment, rather try to prevent. • Vaginal tearsare not uncommon. They may go unnoticed unless they result in hemorrhage. • There are large arteries at the 1:00-2:00 and 10:00-11:00 positions. • Otherwise, a vaginal tear may be noticed because of masses of fat protruding from the vulva after calving or during a vaginal exam. • During the postpartum period they may be suspected during a rectal exam when hard masses are palpated in the vaginal area. • Again, the prognosis varies, depending on the location and extent. • If significant hemorrhage is occurring, place a pair of hemostats on the artery for 24 h. • Attempting to suture the artery is difficult. • After 24 h, the hemostats may be removed and the hemorrhage will have stopped.
Vulvar or perineal lacerationscan be sutured immediately if seen at parturition, otherwise wait until all the swelling, inflammation, etc. is gone. • A laceration in the vaginal or vestibular areas may sometimes become an abcess. They should be allowed to heal. Many times no treatment is needed, especially if the dam is not systemically ill. Caution should be exercised to not transport infective material into uterus during anytreatments. (For example - a cow is found to have a foul smelling vaginal discharge but the uterus is normal on rectal palpation. A vaginal exam should be performed because if the source is a vaginal tear or abcess, treating the uterus would drag the infective material into the uterus.) Caruncles,if torn during obstetrical procedures can be the cause of observed hemorrhage. Usually no treatment is needed. • The umbilical cord will result in bleeding after it ruptures. This is normal but if significant hemmorhage is observed, you should verify that the ruptured cord is the source and there are no tears.
