Postpartum Complications

Ahmed Ali
MS, PhD

Dept. Theriogenology, Assiut Univ., Assiut, Egypt

 Postpartum period (Puerperium)

AI Birth AI Birth

Pregnancy Postpartum Pregnancy

period

12 m
 Changes occur during the Puerperium
1. 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)

 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
 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
ymptoms:
In cow, the tearing begins at the dorsal commissure, as the head of
e fetus approaches the vulvar cleft, and extended dorsally and cranial.
In mare, the initial injury in perforation of the vaginal roof
y the fetal forelimb, the limb then perforate the rectum to tear
e anal sphincter.
Such lesion destroy the sphincter effect of the vulva, lead to
piration of air into the vagina.
laceration may extend and destroy the anal sphincter,
us creating a cloaca through which faces fall into the terminal vagina.

omplication:
neumovagina
acterial contamination of the genital tract.
fertility
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.
 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.
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.
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.
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
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
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
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
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.
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.
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
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
 Postpartum Paraplegia
The animal fail to raise after parturition

Causes:
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
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
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
 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
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
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.
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
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.
 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
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
 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
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
 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
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
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
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
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.
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.