Bovine Postpartum Problems

335-348


Postparturient paralysis
  • Postpartum paralysis occurs due to trauma and associated inflammation to the obturator and peroneal nerves. 
  • Damage to the obturator nerve causes the cow to be unable to rise and she will be laying spraddle-legged. 
  • Damage to the peroneal nerve causes knuckling. 
  • The prognosis for these conditions is fair to guarded and depends greatly on the quality and intensity of treatment. 
  • Treatment consists of nursing care and is aimed at preventing the "crush syndrome" where nerve damage results from the weight of the cow in prolonged recumbency. Hobbling helps cows with injury to the obturator nerve to get around.

The postpartum period
  • Immediate postpartum care (in chronological order) consists of:
    • 1)calf - check respiration, clean nostrils, rub skin; 
    • 2) cow - check for presence of another fetus and damage to the birth canal; 
    • 3) calf - disinfect the umbilical cord; 
    • 4) cow - give oxytocin, check udder; 
    • 5) calf - feed colostrum (2 L) within 6 hours, 
    • check for birth defects.
  • The postpartum period spans the time from parturition to complete involution of the uterus. It can be divided into 3 periods. 
    • The puerperal period is the period from parturition until the pituitary is responsive to GnRH (usually 7-14 days postpartum). 
    • The intermediate period begins with the increasing sensitivity of the pituitary to GnRH and lasts until the first ovulation (14-20 d pp). 
    • The post-ovulatory period is the time from the first ovulation until involution is complete.

Normal involution
  • For the first few days after parturition, it is impossible to palpate the entire uterus, but you can feel a thick uterine wall and longitudinal ruggae. A thin walled, flaccid, smooth uterus is abnormal. 
  • By approximately 2 weeks postpartum you should be able to palpate the entire uterus. A discharge (called "lochia") is normal during this time. It should be odorless, thick, reddish (tomato soup), and may have white flecks. The caruncles will slough around 7 days postpartum. The fluid should be gone by 18 days and the uterus normal size by 5 weeks. Epithelization of the caruncular sites is complete by 40-50 days.
Abnormal postpartum period
  • One of the main causes of abnormal involution is an unsuitable calving environment. 
  • The ideal environment is a sunny, grassy well drained pasture.
  •  When cows are calved repeatedly in a confined area, "Seeding" of the area with pathogens may occur, thereby increasing the incidence of postpartum metritis.
  •  Inappropriate obstetrical practices, abortion diseases and retained placenta may also contribute to the problem. 
  • An abnormal postpartum uterine involution is often associated with other primary problems, e.g. LDA, ketosis, mastitis. 
  • Dairy cattle tend to have a higher incidence of postpartum problems than do beef cows. 
  • Many problems can be prevent by hygiene.

Puerperal metritis
  • This condition occurs within the few days just after calving.
  • Clostridia is often involved but other pathogens such as coliforms, etc. may be involved as well.
  • Puerperal metritis is associated with uterine atony or inertia, with or without retained fetal membranes. 
  • Cows will be systemically ill. 
  • They will exhibit depression, anorexia, GI atony, agalactia, will be febrile, and may have peritonitis.
  • The uterine discharge will be fetid, foul-smelling, watery, and reddish-black. 
  • The uterus will be thin walled and atonic. 
  • This disease can be life threatening. 
  • Treatment should include both systemic plus intrauterine antibiotics. 
    • Systemically, penicillin is a good choice, while tetracycline is best intrauterine. 
    • The uterus will be friable so care must be taken with intrauterine treatments. 
    • Uterine lavage, consisting of draining off the fluid and flush the uterus atraumatically, helps to reduce the amount of debris and bacteria within the uterus. 
    • Uterine ecbolics, such as oxytocin or ergonovine maleate may help to stimulate uterine contractions and prevent buildup of more fluid.

Postpartum metritis
  • The key differentiating feature between common postpartum metritis and puerperal metritis is that cows with common postpartum metritis are not clinically ill. 
  • In most cases, the following bacteria which have a somewhat synergistic relationship are found in the uterus. 
    • Fusobacterium necrophorum produces a leucotoxin,
    • Bacteroides melaninogenicus and fragillus produce and release a substance which prevents phagocytosis.
    • Actinomyces pyogenes produces a growth factor for Fusobacterium. 
    • Other bacteria can cause a postpartum metritis but rarely persistin the uterus, cause permanent damage or infertility. 
    • Incidental bacteria are usually gone from the uterus by 3 weeks. 
    • A. pyogenes causes extensive damage if present for greater than1 week. After clearing the uterus of A. pyogenes it takes at least 1 mo. to resolve the damage and restore fertility.
  • The problem of delayed involution or metritis is usually detected on rectal palpation. 
    • Often no systemic signs are seen. 
    • A purulent discharge may be observed. 
    • Upon vaginal speculum exam a discharge from the cervix, along with inflammation of the cervix and vaginal wil lbe seen. 
    • In a California study they concluded that a speculum exam was better than palpation for the diagnosis of metritis.
Treatment
  • Treatment will vary depending on the particular situation (cow, client, etc.). 
    • One alternative is to do nothing, just monitor the cow and intervene only if she shows systemic signs or the condition persists at the end of the Voluntary Waiting Period. 
    • Cows seem to do as well with non-intervention as with aggressive treatment and the problem of withholding milk because of residues is avoided.
  • Another treatment alternative which does not involve dumping milk is ProstaglandinF2alpha.
    •  Studies have shown that treatment with Prostaglandin gave equal or greater fertility than that obtained after intrauterine therapy, regardless of the drug used IU. 
    • In addition to causing luteolysis, Prostaglandin may stimulate myometrial contractions, may stimulate phagocytosis by uterine leucocytes and decreases progesterone inhibition of uterine defense mechanisms.
  • Other hormones which have been used include:
    • Estrogens, are sometimes used because they stimulate uterine defense mechanisms, however there is concern that they also open the utero-tubal junction.
    • Long acting forms (such as ECP) may result in salpingitis, myometrial infection, and subsequent decrease in fertility. It has been reported that 5 mg estradiol benzoate given after 5 d postpartum increases uterine phagocytosis without undesirable side effects.
    • The potential benefits of GnRH are related to the involution of the uterus and the level of management. Use of GnRH during the postpartum period may result in an increase in pyometras.
  • Intrauterine antibiotics:
    • Oxytetracycline intrauterine is effective, but there is some concern that it may decrease uterine defense mechanisms. 
    • Although it is slightly compromised by organic debris, you can achieve MIC in the uterus with intrauterine administration, but not with systemic administration without nephrotoxicity.
    • Not shown to improve reproductive efficiency
    • None aproved
  • Other antimicrobials are generally not as effective as tetracycline. 
    • The aminoglycosides are not recommended. They require an aerobic environment, but the uterus is anaerobic. The presence of organic debris inhibits their efficacy. Importantly, their use in food animals is prohibited. 
    • The sulfonamides are ineffective in the presence of organic debris, of which there is usually copious amounts. 
    • Penicillins are usually ineffective by the intrauterine route because penicillinase producing organisms are present early on (during the first 3 weeks). 
    • In the past, nitrofurantoins (nitrofurazone) has been widely used as an intrauterine infusion, however it is ineffective in the presence of organic debris and you cannot achieve the MIC in the uterus. Moreover, it is labelled as "Not for use in food producing animals".
    • Exenel (ceftiofur) -
      •  2.2 mg/kg SID 5days efective
      • Approved for metritis 

      Excenel

      • No withdrawl
      • Cure rate for the 1.0 mg ceftiofur equivalents/lb (2.2 mg/kg) BW dose group was significantly improved relative to cure rate of the negative control on day 9. 
      • Ceftiofur hydrochloride administered daily for five consecutive days at a dose of 1.0 mg ceftiofur equivalents/lb (2.2 mg/kg) BW is an effective treatment for acute post-partum metritis.

Retained Fetal Membranes
  • This is usually defined as failure of placenta to be released by 12 hours postpartum, although some use 24 hours as the cutoff. 

  • The incidence generally ranges from 5-10% in dairy cattle to 1% in beef. In cases of induced parturition the incidence increases to 30-100%. 
  • The detrimental effects come about primarily as a result of the metritis caused by the retained placenta. 
    • This is manifested by an increase in the days to first service (4 days), an increase in days open (19-35 days), and an increase in services/conception (0.2). 
  • There are multiple etiologies which may be involved. 
    • Basically they relate to a disturbance in the loosening mechanism in the placentomes or uterine inertia. 
    • Separation of placenta requires a series of events beginning with prepartum maturation of the placenta. During parturition, there is mechanical detachment of the cotyledon by uterine pressure, followed by anemia of the fetal villi after fetal expulsion and a reduction of the size of the caruncles during postpartum uterine contractions. Myometrial activity decreases by 24 hours after parturition and almost ceases by 48 h, so if expulsion has not occured by 24 hours, it is unlikely to occur until progressive liquefaction and expulsion 6-10 days later.
    • There are some specific causes of retained placenta, including premature delivery, infectious diseases, metabolic/nutritional causes, hormonal causes and uterine inertia.
  • Diagnosis is usually obvious. Retained placenta may cause decreased appetite and decreased milk yield resulting from acute metritis.
  • Treatment decisions, although maybe considered somewhat controversial, should be based on "do no harm". 
    • If left alone, the placenta will usually drop approximately 5 days postpartum.
    • If treated, they often take longer to be released because of reduced autolysis. 
    • Conservative treatment consists of trimming the membranes off at the vulva and monitoring TPR, appetite, milk production, attitude, etc. 
    • Antibiotics should be given if the cow is sick (see puerperal metritis). 
    • Oxytocin is often recommended, especially in the first 24 hours, although it may be beneficial for 4-7 days. It has been shown to increase phagocytosis by uterine neutrophils for up to 8 days but has not been shown to hasten release of a retained placenta.
    • Manual removal is not advised. 
      • Manual removal is associated with decreased fertility. 
      • Numerous studies have looked at manual removal vs. other treatments or no treatment at all and in every case manual removal had a negative effect on future reproductive parameters. 
      • The use of chemotherapeutic agents may actually prolong the condition by interfering with uterine defense mechanisms or inhibiting the lysis of villi. 
      • Antibiotics, hormones, including estrogens (see above), prostaglandins and oxytocin have all been used in various dosages and treatment schedules all without significant effect on releasing retained placentas. 
      • Basically, if the cow isn't sick, leave her alone, if she is clinically ill, treat the illness.
  • Prevention is recommended. 
    • Try to have dietary calcium <100 g/d for the last few wks of the dry period. 
    • Vitamin E at a level of 0.74 g/d per os during dry period
    • Se at 0.1 mg/kg i.m., 21 days prepartum will lower the incidence of retained placentas.
  • A good review of this subject is: Paisley LG, Mickelson WD, Anderson PB; Mechanisms and Therapy for Retained Fetal Membranes and Uterine Infections in Cows: A Review. Theriogenology 25 (March 1986):353-381
Pyometra
  • Accumulation of pus in the uterus
  • Retained CL
  • Anestrus is the primary clinical sign. There is no vaginal discharge
  • Etiology
  • Postpartum - fluid or infection in the uterus when ovulation and CL forms.
    • Early ovulation or delayed fluid clearance may increase the problems
  • Postcoital - almost pathognomonic for Trichomoniasis
  • Diagnosis
    • Rectal palpation
    • Fluid filled uterus, fluid flows from horn to horn
    • CL present
    • Absence of positive signs of pregnancy (diff dx)
  • Vaginal exam (cervix usually closed)
  • No systemic signs
  • Treatment
    • Estogens 50-65% effective
    • PGF2a 85-90% effective - increase efficacy if treat 2 days in a row
    • Intrauterine infusions

contributed by Bruce E Eilts  and modified on 23 September 2009

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contributed by Bruce E Eilts on 25 September 2012




 

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