Postpartum Period in the Cow 2024 PDF

The Post Partum Period in the Cow Roberto Palomares DVM, MS, PhD, Dip ACT  Learning Objectives 1. Describe the physiologic events occurring in the bovine reproductive system during the postpartum period. 2. Discuss the predisposing factors, causes and...

The Post Partum Period in the Cow Roberto Palomares DVM, MS, PhD, Dip ACT  Learning Objectives 1. Describe the physiologic events occurring in the bovine reproductive system during the postpartum period. 2. Discuss the predisposing factors, causes and pathogenesis of retained fetal membranes in the cow. 3. Differentiate the main postpartum uterine pathologies in cows. Explain the risk factors, pathogenesis, clinical signs, diagnosis, and treatment of puerperal metritis, endometritis and pyometra in the cow. 4. Define clinical and subclinical endometritis. Compare purulent vaginal discharge Vs. cytological endometritis. 5. Discuss the impact of uterine disease on cattle reproductive performance and describe some preventative measures to minimize the occurrence of postpartum uterine inflammation in cattle.  Post Partum Period Period after calving (uterine involution & resumption of cyclicity). Lochia normally expelled during the first few weeks pp. Lactation starts (increased metabolic rate & calcium mobilization).  Post Partum Period If uterine involution is delayed, discharge may persist for 30 days. Normal discharges range from dark brown to red to white. Discharge considered normal unless fluid is fetid or systemic signs present. Plahotnik A (2007)  Uterine Involution 1. Decrease in uterine size. 2. Increase in uterine tone (feel lines or strips). 3. Absence of fluid in the uterus (14 days even in dairy cows). Dairy Cows: 30 days gross involution / 45 days histologic involution   Retained Fetal Membranes Most cows expel the placenta by 6 hours. Considered retained >24 hpp. Detrimental effects Reproductive performance, milk production, health & culling rate. Primary Retention: Lack of detachment. Secondary Retention: Difficulty in expelling already detached FM.   Retained Fetal Membranes Spontaneous expulsion of RFM @ 5-7 dpp. Cotyledon proteolysis & Caruncle necrosis.  Etiology Placenta-anchoring systems not enzymatically degraded. Lack of cotyledon proteolysis (collagenolysis). 1. Deficiency of collagenase 2. Hypocalcaemia required MIC. It reaches all the layers of the uterus, without residues in milk. Demonstrated efficacy (clinical and reproductive parameters). Currently some strains of E. coli and T. pyogenes have resistance  Metritis. Treatment Systemic Antibiotics  Excenel: Ceftiofur (Hydrochloride) 1.1-2.2 mg/kg once daily x 5 d  Excede: (Crystalline free acid) 6.6 mg/kg two doses (72 h) in the ear  Penicillin (22,000 IU/kg, IM once daily for 5 days; extra-label),  Ampicillin (11 mg/kg, I.M. once daily for 5 days; extra-label),  Oxytetracycline LA 200 mg/mL, (20 mg/kg SC or IM) Studies have not shown its efficacy. Does not reach MICs in utero (~30%) to eliminate uterine pathogens. high resistance  Metritis. Treatment Hormonal Therapy  Oxytocin: Contraction of the myometrium first 48-72 h after delivery.  Dose of 20-40 U every 3-6 hours (not practical).  PGF2α during the early PP period does not affect uterine involution.  Research has shown no benefit of Oxytocin or PGF2α as a preventive or curative measure for metritis.  Metritis. Treatment Dehydration: Provide adequate fluid therapy. NSAD (Flunixin meglumine) Toxemia, fever, inflammation and improve appetite. Efficacy in healing and performance not proven Supplementation with Ca, dextrose and polyethylene glycol (ketosis) www.elftown.com http://www.rwn.org.uk/rwn  Endometritis Inflammation of endometrium no deeper than stratum spongiosum. After RFM, metritis, mating, artificial insemination, infusion of irritants.  Endometritis. There may be purulent exudate on visual inspection of the vulva (>21 dpi). On palpation, the uterus may be normal or with secretions in the lumen. There is no systemic disease. It may be accompanied by cervicitis and vaginitis. Clinical versus Subclinical Endometritis  Clinical Endometritis  Presence of purulent vaginal discharge (PVD) >21dpp.  Discharge in the cranial vagina or in the ventral commissure of the vulva.  PVD not in all cases of endometritis. 38% of cases PVD Dubuc 2010  Many cows with PVD do not have  % PMN or pus in the endometrium.  PVD: cervicitis, vaginitis, or endometritis, or both.  Affects pregnancy rate, PCI http://www.nadis.org.uk  Subclinical Endometritis “Cytological Endometritis” % PMN in uterine cytology relative to DPP. Immunosuppression %PMN & monocytes in peripheral blood. Prevalence of Subclínica Endometritis 40-60 dpp: 26%, Prevalence of herds with Subclinical Endometritis (5% - 50%)  pregnancy rate,  S/C, RBC, post calving intervals. Dubuc et al., 2010; Cheong et al., 2011  Endometritis. Diagnosis  Discrepancy in clinical Dx criteria: Subjective,  Low sensitivity and specificity (e.g. TRP, TRUS and vaginoscopy). Metricheck™ Purulent discharge at the ventral commissure of the vulva or vagina  Endometritis. Diagnosis Transrectal Palpación (TRP). Asymmetry of the uterine horns. Increased thickness of the uterine walls / presence of fluid. Cervix >7.5 cm in diameter. It is not accurate to detect cows with clinical endometritis.  Endometritis. Diagnosis. Ultrasound Thickness and echogenicity of the uterine mucosa. Volume and texture of uterine fluid in cows with clinical E. In some cows with subclinical Endometritis (SCE), USG could help identify small amounts of fluid in the uterine horns. Low predictive value on SCE compared to cytology Wagener et al., 2017; Kasimanikam et al., 2005  Endometritis. Diagnosis Endometrial Cytology PMN response against pathogenic bacteria of the postpartum uterus. Increases PMN cells within the uterine lumen. PMN count successful in identifying cows with endometritis. Cytobrush para citologia endometrial Santos J (2009)  Endometritis. Diagnosis Endometrial Cytology Subclínical Endometritis : > 18% PMN @ 21-35 dpp (4-5 weeks pp). > 10% PMN @ 35-45 dpp. (5-7 weeks pp) > 5% PMN > 45 dpp (> 7 weeks pp) Endometrial cytology associated with fertility in current lactation. Santos J (2009)  Endometritis. Diagnosis Endometrial Biopsy  More information on the level of inflammation than cytology.  Epithelial damage, edema, PMN and lymphocyte infiltration, and fibrosis.  Disadvantages (instrument, skills, time, and costs).  Genetically and phenotypically superior sub-fertile cows (Madoz et al., 2014).  Endometritis. Treatment  Antibiotics + administration of PGF2α.  PGF2α (two doses, 14 days apart)  Luteolysis and estrus induction  Contraction of the myometrium.  P4 E2.   Immune response of the uterus.  Leukotriene B4.  Stimulates chemotaxis, cell-mediated cytotoxicity, phagocytosis, and lymphocyte function  Scientific evidence is limited but is the Tx choice in the field. Healy et al., 2014  Endometritis. Treatment IU infusions with Oxytetracycline are not recommended: Low IU absorption Risk of residues in meat and milk Irritation and necrosis of the endometrium Decreased fertility of the cow   Pyometra Purulent exudate in the uterine lumen. Persistence of a Corpus Luteum & suspension of the estrous cycle. 1st ovulation pp before cleaning uterine bacterial contamination. Progesterone: Closed Cervix & immune suppression  Pyometra. Diagnosis Transrectal palpation is an effective method for diagnosis. In cows with pyometra the wall of the uterus is thicker (early). Ultrasound confirms purulent fluid with variable echogenicity, A corpus luteum in one of the ovaries and the absence of pregnancy. Pyometra  Pyometra. Treatment  2 doses of PGF2α 14 days apart. Luteolysis & Estrus  After PGF2α 65-80% get pregnant (≥30% 1st AI) 2.2 S/C (2-4 AI).  15-20% of cows might need extra treatment  Minimizing the impact of Uterine Inflammation Identify risk factors and critical points for each herd (breeding & calving) Management of sanitation, nutrition, population density, & stress. nhanusjr200.wordpress.com Questions?