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Postpartum Complications

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Title: Postpartum Complications


1
Postpartum Complications
Ahmed Ali
MS, PhD
Dept. Theriogenology, Assiut Univ., Assiut, Egypt
2
Postpartum period (Puerperium)
AI
Birth
AI
Birth
Pregnancy
Pregnancy
Postpartum period
12 m
3
Changes occur during the Puerperium
  • Return of normal ovarian activity (3-4 weeks)
  • 2. Shrinkage of the uterus (25-35 d)
  • 3. Regeneration of the endometrium (50-60 d)
  • 4. Elimination of bacterial contamination (4-5
    weeks)

4
Most important postpartum complications
1. Perineal rupture 2. Retained placenta 3.
Uterine prolapse 4. Uterine and vaginal
rupture 5. Postparturient paraplegia 6.
Postparturient uterine atony 7. Postparturient
straining 8. Bacterial puerperal diseases 9.
Puerperal intoxication 10. Puerperal
infection 11. Septic metritis 12. Puerperal
tetani 13. Puerperal vaginitis and vulvaitis
5
Perineal Rupture
Causes 1. Spontaneous, during the second stage
of labor (vigorous straining) 2. Extreme traction
of an oversized foetus 3. Predisposition include
a hypoplastic vulva 4. Mares with Caslick
operation
6
Symptoms 1. In cow, the tearing begins at the
dorsal commissure, as the head of the fetus
approaches the vulvar cleft, and extended
dorsally and cranial. 2. In mare, the initial
injury in perforation of the vaginal roof by the
fetal forelimb, the limb then perforate the
rectum to tear the anal sphincter. 3. Such
lesion destroy the sphincter effect of the vulva,
lead to aspiration of air into the vagina. 4.
laceration may extend and destroy the anal
sphincter, thus creating a cloaca through which
faces fall into the terminal vagina. Complication
Pneumovagina Bacterial contamination of the
genital tract. Infertility
7
Surgical correction 1. The patient is confined
in stanchion in the standing position 2.
Cleaning the perineal region 3. Light epidural
anesthesia 4. The tail is tied to one side 5.
Tampon placed in the rectum 6. Exposure the
operative area by placing tension suture in the
perineal skin 7. The free edge of the
shelf is incised to a depth of 3 cm and extended
laterally and caudally on each side 8.
Synthetic non-absorbable suture and a No. 2 or 3
half circle cutting edge needle are used
in the modified vertical suture pattern after the
method of Goetze, starting at the deepest
part. 9. The two ends of each suture are left
long (8 cm) and are tied together at their
ends to aid in identification of each knot during
removal. 10. The suture must not penetrate the
rectal mucosa. 11. The perineal skin is closed
with vertical mattress suture.
8
Retained Placenta
Definition In cattle the fetal membrane are
expelled within 12h after parturition. Retention
of the placenta for longer period must be
considered pathological.
9
The Loosing Process in Placentomes 1. In the
last month of pregnancy The connective
tissue of the placentomes become progressively
collagenized up to the time of birth. The
maternal epith. Of the crypts become flattened.
Many phagocytic cells are manifested. 2. With
the onset of parturition and following hormonally
induced imbibition, the tissue of the
placentome become loose. 3. During uterine
contraction, the attachment of the villi in the
crypts becomes impaired. 4. During fetal
expulsion, caruncles are pressed against the
fetus 5. After fetal expulsion and rupture of the
umbilical cord no blood is pumped in the
fetal villi and they shrink in size due to a
reduced blood supply, and the maternal
crypts dilate. 6.The postpartum uterine
contraction complete the process of
detachment of the membrane.
10
Etiology It is basically due to failure of the
villi of the fetal cotyledon to detach
themselves from the maternal crypts of the
caruncle. Basic Causes 1. Immature Placentomes.
2. In non-infectious abortion and premature
birth. 3. Edema of the chorionic villi. 4.
Following cesarean section and uterine
torsion. 5. Necrotic areas between chorionic
villi and the cryptal wall 6. In allergic
cases. 7. Advanced involution of the
placentomes. 8. Hyperemia of the placentomes. 9.
Placentitis and cotyledonitis.
11
Direct causes 1. Infection of the uterus during
gestation 2. Brucella abortus, tuberculosis,
Vibrio fetus, mold infection 3. Infection of the
uterus immediately after partuition Strept.,
E. Coli, Staph., Cory. pyogenes. 4. Abortion and
premature birth 5. Uterine inertia (primary or
secondary) 6. Endocrine disorder 7. Mechanical
prevention
12
Indirect causes 1. Stress 2. Transportation,
short dry period, change of locality, management
problem 4. Deficiency of vitamins and
minerals, Carotene, vitamin A, iodine,
selenium and vitamin E, imbalance in calcium and
phosphorus 5. Hereditary factors
13
Incidence More common in dairy than in beef
cattle The average incidence for all calving
11 The incidence after normal calving 8 The
incidence after dystocia 25-50 Retention
increase with parity
14
Clinical feature 1. A portion of fetal membranes
hang from the vulva 12h or more after
calving. Occasionally the FM may be not hang but
entirely within the vulva and uterus. 2.
About 80 of cases show no marked illness 3.
About 20 may exhibit moderate to sever symptoms
of metritis and septic metritis 4. In
severely affected animals RFM may be associated
with mastitis, perimetritis or peritonitis,
sever straining, necrotic vaginitis,
parturient paresis and acetonemia. 5. A fetid
odor is usually produced. 6. Mortality 2 and
morbidity 55 7. Delay uterine involution 8.
Increase day open
15
Treatment Manual treatment 1. One day after
parturition under aseptic condition without
injury to the maternal caruncle. The trial
should not exceed 10 minutes/day. 2. The
veterinarian twist the postcervical part into a
bulky rope, which he hold in one hand at the
vulva. With the other hand he gently follows
the rope through the cervix to the cotyledonary
attachment of the uterus. He squeezes gently
the base of the maternal caruncle so as to
open the crypts on its convexity, the thumb is
lightly passed over the periphery of the
caruncle in order complete the separation of
the released villi. 3. Succeeding cotyledons are
approached in a circumferential order. 4.
Continuos steady traction and rotational force
are applied with the other hand.
16
5. Regardless of the outcome, 2-4 gm terramycine
is deposited in the uterus. 6. This
treatment should be repeated on days 3, 6 and 9
postpartum, when necessary, in addition to
manual trial of loosening the afterbirth. 7. In
all cases as much as possible of the uterine
exudate should be removed by siphonge.
17
Therapeutic treatment without manual
removal Oxytocin 20-50 I.U., within 24h after
birth Estrogenic substances 5-20 mg
stilboesterol Ergot preparation 1-3 mg of
ergonovine Calcium gluconate Broad acting
antibiotic 2-4 gm terramycine   No
treatment Uncomplicated cases required no
treatment
18
Prophylaxis Balanced nutrition for pregnant
animal Large animal boxes Daily outlet Avoidance
of transport Sufficiently extended dry
period Avoidance of bacterial infections and
parturition hygiene. Injection of 2 million IU of
vitamin A 4-8w antepartum Injection of 50-100 IU
oxytocin immediately after parturition
19
Postpartum Paraplegia
The animal fail to raise after parturition  Cause
s Metabolic and nutritional disturbances 1.
Hpocalcemia 2. Grass tetany 3. Ketosis 4.
Debility 5. Vitamin E and Selenium
deficiency   Traumatic injuries 1. Paralyses of
the obturator, perineal, gluteal femoral or
brachial nerves 2. Dislocation of the hip
joint. 3. Fracture of the leg and pelvis 4.
Exhaustion after dystocia 5. Hemorrhage, anemia,
or shock due to rupture of uterine or pelvic
vessels
20
Infectious diseases 1. Septi metritis 2. Septic
mastitis 3. Peritonitis 4. Acute laminitis 5.
Septic Arthritis   Diagnosis 1. Examining the
locomotor system, especially the hind limbs 2. In
cases of recumbency due to physical inability to
rise, the affected animal usually has good
appetite, its temperature and pulse are
unaffected. 3. Examining the uterus and udder 4.
Infectious cases usually accompanied with fever
21
Treatment 1. Each case must be treated on its
merits 2. Tray to rise the animal with a brief
application of electric goad 3. Place the
recumbent animal on ample, soft, clean and dry
bedding
22
Uterine and vaginal Rupture
Causes 1. Prolonged dystocia with fetal
emphysema 2. Uterine torsion 3. Improper
manipulation and traction of the foetus 4. Forced
traction of the fetus in abnormal p.p.p. 5.
Fatigue of the operator 6. An accident in
foetotomy operations 7. In mare with the foetus
of long extremities (spontaneous) 8. Poorly
dilated cervix 9. Administration of oxytocin
while the cervix is closed
23
Symptoms and prognosis Depend on 1. Animal
art 2. Portion of the genital tract 3. Size of
the rupture 4. character of rupture while regular
or irregular, vertical or horizontal 5. Nature of
the uterine contents In mare fatal peritonitis
usually develops rapidly In cow rupture due to
emphysema rapidly produce peritonitis Anorexia,
lack of rumination and rumen contraction,
restlessness Cold extremities Normal or subnormal
body temperature
24
In infected material released into the abdominal
cavity, acute, sever septicemic symptoms develop
rapidly. Shock, prostration and death usually
occur in 1-2 days. In small rupture of the
uterus, when no infection is present and the rent
is in the dorsal half some cattle have
survived. In sever cases, the prognosis is poor
and slaughter is advised. Even if recovery take
place, future breeding life is questionable.
Rupture of the vagina is not serious as uterine
rupture and the prognosis is much better.
25
Treatment In small uterine rupture Repeated
doses of oxytocin Parental and
intrauterine Antibiotic Fluid
therapy Close observation of the
animal   In large uterine rupture
Suturing the uterus through the birth way
Prolapsing the ruptured uterus and suturing
it Suturing the uterus through
laparotomy  
26
Under no circumstances should fluids be injected
into the ruptured uteri, nor should manipulations
of retained placentas take place. Rupture of
the cervix Cervical forceps can be used to draw
it to the cervix to the vagina and vulva and
suture Oxytocin Rupture of the vagina Simple
rupture in the lateral or dorsal wall need not to
be sutured Recto-vaginal fistulas should be
changed into cloaca and repaired after
granulation.
27
Postparturient Uterine Atony
The uterus is abnormally large, roomy, flabby and
without contraction directly after
birth   Causes Uterine inertia (primary and
secondary) Over-thinning of the uterus (twins,
hydropsy) Rupture of the uterus or
cervix Hypocalcemia  
28
Clinical findings In rectal examination, the
uterus found descended in the abdominal cavity,
the uterus lack any contraction and filled with
lochia The cervix is dilated with small amount of
lochia discharged from the vulva. Secondary
retention of placenta   Treatment Oxytocin
50-100 IU, within 24h after birth Methergin 5-10
mg i.m. Siphonage of the uterine content Calcium
gluconate Local and systemic antibiotic
29
Postparturient Straining
There is a persistent strong uterine birth pains
for one or more day after birth   Causes There
is irritant to the vagina or vulva Long standing
dystocia Pneumometra Bleeding from the genital
tract Phlegmone of vaginal tissue
30
Symptoms The pains may persist for 4-7 days after
birth Continuos or intermittent straining, arched
back, sunken eyes and depression Frequent
defection, diarrhea There is great tendency for
prolapse of the vagina or rectum Uterine
contractions are stronger   Treatment General
sedative Epidural anesthesia Local antibiotic
within the uterus Treat the original cause
31
Bacterial puerperal Infection
Disease Puerperal bacterial intoxication Cause
Saprophytic bacteria Pathogenesis Putrefaction
of the uterine contents produce toxins which
absorbed through the uterine endometrium to
circulate in the blood with general
intoxication. Symptom Fever, indigestion,
exhaustion, little edema in the genital tract,
abnormal lochia Treatment Local
antibiotic,Oxytocin, Siphoning the uterus,
Supportive treatment, Antihistaminic, Calcium
gluconate, Good green pasture, Systemic
antibiotic, Epidural Anesthesia, Ice packs in
case of laminitis in mare
32
Disease Puerperal bacterial infection Cause
Saprophytic bacteria Pathogenesis Bacterial
activities are intensive. Bacteria tend to act
locally in the uterus Symptom Fever,
Depression, edema of the soft birth way, abdomen
is tense Treatment see before
33
Disease Septi metritis Cause Coliform,C.
Pigeons, Streptcoccen and Micrococcen
Pathogenesis The difficult form of the
non-specific Puerperal infection Symptom Fever,
reddish watery fetid vulvar discharge,
peritonitis, arthritis, laminitis Treatment see
before
34
Disease Puerperal necrosis Cause F.
nechrophorum Pathogenesis Necrotic bacteria get
entrance to the uterus from the claws Symptom
General health disturbances, liver painful in
palpation, the mucus membrane yellowish. Treatment
Local and systemic Antibiotic, supportive
treatment
35
Disease Puerperal tetanus Cause Cl. tetani
Pathogenesis m.o. enter the uterus through
injury in the endometrium. Symptom Muscular
cramps and stiffness. Treatment Anti-tetanic
serum, supportive treatment.
36
Disease vaginitis and vulvitis Cause
Saprophytic Bacteria, F. nechrophorum
Pathogenesis Narrow birth way result in trauma
and laceration m.o. Symptom Swollen vulva and
vagina, fetid odor, diaphteretic
inflammation. Treatment Oily bland antiseptic
Antibiotic, Epidural Anesthesia.
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