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PubMed1990

Does cord drainage of placental blood facilitate delivery of the placenta?

A series of 1,908 women delivering vaginally, and actively managed in stage 3 of labour, were randomly assigned to 2 groups to study if cord drainage of placental blood facilitated delivery of the placenta. Prophylactic oxytocics were given with the birth of the anterior shoulder. In both groups, early cord clamping was practised, timing being at the midwives' discretion. In the control group the cord remained clamped; in the drainage group the cord was unclamped and the volume of placental blood measured. Controlled cord traction completed active management at evidence of separation/descent of the placenta. Rates for retained placenta, postpartum haemorrhage and transfusion were similar. It was concluded that when the third stage of labour is actively managed, placental drainage of cord blood confers no extra benefits. Pre- and post-delivery Kleihauer tests were performed on blood from 20 women in each group. All tests were negative. Contrary to previous work, this does not suggest that cord drainage reduces the fetomaternal transfusion rate. The well known association of prolonged duration of stage 3 of labour and the risk of haemorrhage was strongly confirmed.

Drainage↗

PubMedDate not supplied

Abdominal massage: another cause of maternal mortality.

BACKGROUND: Abdominal massage is an age long practice among obstetric and non obstetric patients in different parts of the riverine areas of Southern Nigeria. AIM: To highlight the consequences associated with this practice in pregnancy and labour even among literate clients. METHODS: Two hundred and eighty four pregnant women who presented as obstetric emergencies in pregnancy and labour at the University of Port Harcourt Teaching Hospital from 1st May 1988 to 31st July 1998 were studied. RESULTS: Forty two (14.79%) of the 284 patients had abdominal massage. Maternal mortality rate was 4.76% while the perinatal mortality rate was 14.29%. Twenty four of the patients were literate though 15 of them only had primary education. Most of the patients were unbooked (76.19%). The complication of pregnancy noted were cephalo pelvic disproportion /obstructed labour (28. 57%) and abruption placenta (23.80%); placenta previa (9.52%); retained placenta (4.76%) abortion / preterm labour (19.04%); genital injuries and tears (7.14%); perinatal death (14.28%); uterine rupture (9.52%); maternal mortality (4.76%). CONCLUSION: Abdominal massage is a silent killer, which has added to matemal and perinatal mortality and morbidity in this region. Ignorance, illiteracy and poverty have sustained this practice, while underdevelopment, inaccessibility and ill-equipped medical facilities have kept this traditional practice flourishing even amongst the educated group. The time to stop this form of avoidable losses is now. This can be achieved through public health approach, mass literacy, even distribution of affordable healthcare services, improved social services and transportation, robust economy and a grass root involvement of rural programmes aimed at eradicating harmful traditional practice.

Abdomen↗

PubMed1991

Ultrasound of the postpartum uterus. Prediction of retained placental tissue.

We reviewed ultrasound images an 53 postpartum patients referred for possible retained products of conception and correlated specific ultrasound patterns with clinical and pathologic follow-up. The most common finding in patients with retained placental tissue was an echogenic mass in the uterine cavity, seen in 9 of 11 patients with pathologically proven retained placental tissue. In the remaining 2 patients with pathologically confirmed retained placenta, a heterogeneous mass was seen in the uterine cavity at some point during the course of serial sonography. Retained placental tissue was unlikely when ultrasound demonstrated a normal uterine stripe (n = 18), endometrial fluid (n = 6), or hyperechoic foci in the uterine cavity without an associated mass (n = 17). The latter finding was often associated with recent uterine instrumentation. The sonographic appearance of retained placental tissue is variable, but detection of an echogenic mass in the uterus strongly supports the diagnosis. A heterogeneous mass is sometimes caused by retained placenta, but can also be secondary to blood clots or infected or necrotic material in the absence of placental tissue. Sonographic evaluation for retained products of conception is best done before uterine instrumentation to avoid confusion with iatrogenically introduced air.

Abortion, Incomplete↗

PubMed1982

Response of cows consuming adequate selenium to vitamin E and selenium supplementation prepartum.

A 2-yr study of 195 parturitions was to evaluate the prepartum need for supplemental vitamin E and selenium by cows consuming diets that contained ample amounts of selenium (.1 to 2.0 ppm selenium). One-half of the cows were injected with 68 IU vitamin E and 5 mg selenium per 45.4 kg body weight approximately 21 days prepartum. Incidences of retained placenta and calving difficulty were similar for treated and control cows. There was a lower incidence of retained placenta (7.5%) for cows that calved during fall, whereas incidence was greater than 20% in cows that calved during the rest of the year. Serum vitamin E and selenium concentrations in treated cows doubled within a day after injection, then declined to concentrations typical of untreated cows within 8 and 3 days postinjection, respectively. Serum carotene, vitamin A, and vitamin E concentrations were similar for treated and control cows and were elevated in cows that calved during the summer and fall, possibly because cows dry during the grazing season were pastured. However, discriminant analysis of 21-day prepartum serum data indicated that serum concentrations of carotene, vitamins A or E, or selenium would not predict accurately the retention of the placenta. Colostrum and 4-day milk from treated and control cows contained similar amounts of vitamin E and selenium.

Animals↗

PubMed1979

The association between disease, production and culling in a university dairy herd.

The impact of ten diseases of dairy cattle on milk production, calving interval and culling were studied in a university operated dairy herd. Cows with clinical mastitis, ketosis or displaced abomasum had lowered milk production. Cows with metritis, retained placenta, cystic graafian follicles or ovarian hypofunction had longer calving intervals. Cows with clinical mastitis, metritis, pneumonia or retained placenta had increased risks of culling. The relationship between disease and culling was based on the medical history of culled and nonculled cows using a case control approach. Therefore, it is likely that in many cases, the association between disease and culling is due to the impact of that disease on productivity.

Animals↗

PubMed2005

Blood selenium associated with health and fertility in Norwegian dairy herds.

A survey of blood selenium (Se) concentrations in Norwegian Red heifers and dry period cows was conducted to reveal possible association to management, feeding, health and fertility. Selenium contents were determined in 254 herd blood samples consisting of pooled samples from individual non-lactating animals from herds in 5 counties. The Se concentrations showed a normal distribution with mean 0.09 microg Se/g blood, with a standard deviation (SD) of 0.05, and ranged from 0.02 to 0.23 microg/g, with 50 % of the samples being between 0.06 and 0.11 microg/g. The herds with Se concentrations below 0.06 microg/g were smaller (21.4 +/- 8.7 cow-years) than those with Se levels above 0.11 microg/g (27.5 +/- 14.1 cow-years) (P<0.01), but there were no differences in milk yield, incidence of replacement, proportion of animal culling, amount of concentrate or grass silage as percentage of energy consumption between the groups. Treatment registration records showed a tendency that more animals in the low Se herds were treated for all the diseases included in this investigation (64.8 animals per 100 cow-years) than those in the high Se herds (57.5 per 100 cow-years), while no such differences were revealed for individual disorders. There was, however, a significant difference in bulk milk somatic cell counts (BMSCC) between low and high Se herds, their values being 137 000 and 155 000 cells/ml, respectively. This difference was significantly influenced by herd size. Furthermore, a total of 4916 lactations were analyzed from individual health and fertility recordings, including 2 934 first lactations and 1 982 later lactations. The present study revealed a reduced incidence of disease treatment with increased Se concentrations from 0.02 to 0.23 microg Se/g blood. In this regard, there seemed to be an optimum of 0.10 to 0.15 microg Se/g for all types of mastitis treatments summarized, and for treatment of retained placenta. Thus, herd Se concentrations below and above these values was connected with increased probability for sum mastitis and retained placenta, reflecting the effect of the quadratic term of Se. The cow (composite) milk somatic cell count (SCC) was lower in lactations from low Se herds than in high Se herds with a marked SCC increase in the Se concentration interval from 0.11-0.13 microg/g blood. In conclusion, heifers and dry period cows in Norway are low in blood Se content and there seems to be a positive association between increased blood Se concentration pre partum and decreased incidence of mastitis, ovarian cysts and anoestrus/silent oestrus post partum.

Animal Feed↗

PubMed2002

Placenta accreta postpartum.

BACKGROUND: Placenta accreta is the abnormal attachment of the placenta to the uterus. It occurs when the decidua basalis is either absent or incomplete. It is uncommon and most often presents with a retained placenta and hemorrhage. CASE: A 29-year-old gravida 1 had an uncomplicated antenatal course and delivery. The third stage of labor was complicated by a retained placenta necessitating manual removal. Her postpartum course was complicated by a persistent endometritis. The diagnosis of placenta accreta was made with the help of sonohysterography. CONCLUSION: Sonohysterography is a useful tool in discriminating a solid intracavitary mass from a placenta accreta postpartum.

Adult↗

PubMed1984

Influence of dilution on the chemotactic properties of cotyledon suspensions.

In this study the influence of dilution of cotyledon suspensions on the chemotactic stimulus was investigated. When the concentration of the chemotactic stimulus is reduced, the activity of the leucocytes is reduced as well. Dilutions of retained placenta cotyledon suspensions showed an increase in leucocyte activity. This may indicate the existence of a leucocyte inhibition factor in the retained placenta cotyledon.

Animals↗

PubMed1985

Concomitant and repeated happenings of complications of the third stage of labour.

Complications of the third stage of vaginal delivery have been studied among 36 312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless, only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.

Abortion, Spontaneous↗

PubMed1997

Use of oral misoprostol in the prevention of postpartum haemorrhage.

OBJECTIVE: To investigate the use of the oral prostaglandin E1 analogue, misoprostol in the prevention of postpartum haemorrhage. DESIGN: A prospective observational study. SETTING: A university teaching hospital. PARTICIPANTS: Two hundred and thirty-seven consecutive women undergoing vaginal delivery. METHODS: All the women were given 600 micrograms oral misoprostol just after delivery. MAIN OUTCOME MEASURES: Rates of postpartum haemorrhage; need for therapeutic oxytocic drugs; retained placenta and length of the third stage of labour. RESULTS: Postpartum haemorrhage occurred in 6% of the women; the need for therapeutic oxytocics in 5%, retained placenta in 2% and the median length of the third stage was 5 min. Vomiting and diarrhoea in the first hour after delivery occurred in 8% and 3% respectively and shivering in 60%. CONCLUSIONS: Misoprostol may be effective in the prevention of postpartum haemorrhage, and has few side effects. A double blind randomised trial is required.

Administration, Oral↗

PubMed1997

Body condition score, health, yield and fertility in diary cows.

The effects of body condition score at drying off and after calving and the rate of loss of body condition score during the dry period on the performance of 2162 cows in eight commercial Israeli Holstein herds were evaluated. The relationships between health, fertility and yield and body condition score were examined by using multiple logistic regressions for measurements with only two outcomes and general linear models for the continuous variables. Herds, parity, season, length of dry period, postparturient diseases, twinning, stillbirth, induction of calving and high somatic cell counts were used as confounding and other exposure variables. Multiparous cows that were underconditioned at calving were culled and exhibited more postparturient uterine diseases. The risk of retained placenta was greater for cows that were underconditioned at drying off, whereas cows that lost more body condition during the dry period suffered more from both retained placenta and metritis; the two effects being independent of each other. An apparent increase in the risk of ketosis associated with over-conditioning at calving could be partly attributed to long dry periods. Cows with a higher condition score at calving were less prone to anoestrus but did not conceive more successfully to first service. A reduction of six open days in primiparous cows was estimated for each additional unit of body condition score at calving. Multiparous cows that lost more body condition during the dry period suffered more from inactive ovaries and were more likely to be open 150 days after calving in the next lactation. Cows calving in a higher body condition score produced more milk, fat and protein in the first 90 days of lactation, the effect being most pronounced on milk fat content.

Animal Husbandry↗

PubMed2001

Pathology of brucellosis in bison from Yellowstone National Park.

Between February 1995 and June 1999, specimens from seven aborted bison (Bison bison) fetuses or stillborn calves and their placentas, two additional placentas, three dead neonates, one 2-wk-old calf, and 35 juvenile and adult female bison from Yellowstone National Park (USA) were submitted for bacteriologic and histopathologic examination. One adult animal with a retained placenta had recently aborted. Serum samples from the 35 juvenile and adult bison were tested for Brucella spp. antibodies. Twenty-six bison, including the cow with the retained placenta, were seropositive, one was suspect, and eight were seronegative. Brucella abortus biovar 1 was isolated from three aborted fetuses and associated placentas, an additional placenta, the 2-wk-old calf, and 11 of the seropositive female bison including the animal that had recently aborted. Brucella abortus biovar 2 was isolated from one additional seropositive adult female bison. Brucella abortus was recovered from numerous tissue sites from the aborted fetuses, placentas and 2-wk-old calf. In the juvenile and adult bison, the organism was more frequently isolated from supramammary (83%), retropharyngeal (67%), and iliac (58%) lymph nodes than from other tissues cultured. Cultures from the seronegative and suspect bison were negative for B. abortus. Lesions in the B. abortus-infected, aborted placentas and fetuses consisted of necropurulent placentitis and mild bronchointerstitial pneumonia. The infected 2-wk-old calf had bronchointerstitial pneumonia, focal splenic infarction, and purulent nephritis. The recently-aborting bison cow had purulent endometritis and necropurulent placentitis. Immunohistochemical staining of tissues from the culture-positive aborted fetuses, placentas, 2-wk-old calf, and recently-aborting cow disclosed large numbers of B. abortus in placental trophoblasts and exudate, and fetal and calf lung. A similar study with the same tissue collection and culture protocol was done using six seropositive cattle from a B. abortus-infected herd in July and August, 1997. Results of the bison and cattle studies were similar.

Abortion, Veterinary↗

PubMed1996

Effect of reproductive disorders previous to conception on pregnancy attrition in dairy cows.

This study was undertaken to determine whether reproductive disorders previous to conception influence pregnancy attrition in dairy cows. Reproductive disorders were registered and pregnancy diagnoses were performed as a part of a reproductive health program at 9 commercial dairy herds in northeastern Spain. Data from 3022 diagnosed pregnant lactating cows were used. Pregnancy diagnosis by palpation per rectum was performed from 33 to 70 d post insemination. Pregnancy attrition was registered when the pregnancy diagnosis was negative at the second palpation carried out between 120 and 150 d following insemination. Data analysis was performed by multiple logistic regression methods. Pregnancy attrition rates were 2.6 and 1.8 times higher in cows with previous pyometra and retained placenta, respectively, than in cows without these disorders. No effect of endometritis, ovarian cysts and repeat breeding was shown on pregnancy attrition. Our results suggest that additional efforts to reduce the risk of retained placenta and pyometra should decrease the incidence of pregnancy attrition in dairy cows.

Journal Article↗

PubMed2006

Women's groups' perceptions of maternal health issues in rural Malawi.

BACKGROUND: Improvements in preventive and care-seeking behaviours to reduce maternal mortality in rural Africa depend on the knowledge and attitudes of women and communities. Surveys have indicated a poor awareness of maternal health problems by individual women. We report the perceptions of women's groups to such issues in the rural Mchinji district of Malawi. METHODS: Participatory women's groups in the Mchinji district identified maternal health problems (172 groups, 3171 women) and prioritised problems they considered most important (171 groups, 2833 women). In-depth qualitative data was obtained through six focus-group discussions with the women's groups, three with women's group facilitators, and four interviews with facilitator supervisors. FINDINGS: The maternal health problems most commonly identified by more than half the groups were anaemia (87%), malaria (80%), retained placenta (77%), obstructed labour (76%), malpresentation (71%), antepartum and postpartum haemorrhage (70% each), and pre-eclampsia (56%). The five problems prioritised as most important were anaemia (sum of rank score 304), malpresentation (295), retained placenta (277), obstructed labour (276). and postpartum haemorrhage (275). HIV/AIDS and sepsis were identified or prioritised much less because complexity and contextual factors hindered their consideration. INTERPRETATION: Rural Malawian women meeting in participatory groups showed a developed awareness of maternal health problems and the concern and motivation to address them. Community mobilisation strategies, such as women's groups, might be effective at reducing maternal mortality because they can draw on the collective capacity in communities to solve problems and make women's voices heard by decision-makers.

Adolescent↗

PubMed1993

Abnormalities of the tubular genital organs.

Abnormalities of the tubular reproductive tract are responsible for decreased fertility in the cow. Typically, these are related to congenital defects such as segmental aplasia or to acquired conditions resulting from infections or trauma caused during breeding or parturition. Infection of the tubular tract may result in vaginitis, cervicitis, metritis, endometritis, pyometra, or salpingitis. Trauma to the tract may result in urovagina, pneumovagina, or prolapse of the vagina or uterus. Retained placenta may result in metritis. Potentially, all of these conditions, unless properly treated, may result in reduced fertility or, in the extreme, sterility. Judicial and properly timed use of antibiotics and ecbolic agents should return the tract to proper function with little or no reduction in fertility. Some conditions, such as prolapse, retained placenta, and pneumovagina, may call for manual or surgical intervention for successful resolution.

Animals↗

PubMed1986

[Continuing eco-pathological survey: 10. Variation of pathological frequency in dairy cow stock as a function of season, year and number of lactations].

The distribution of main herd diseases in course of time is studied with the season, the year and number of lactation. There is a seasonal effect for retained placenta, spring and summer being a favorable time for the increase of their frequency. Milk fever is also more frequent during summer. Out-calving pathologies are more frequent during housing time, but we do not observe any monthly variation for ovarian pathology. The age is a risk factor for milk fever and retained placenta. On the contrary, dystocia and stillbirth are more common on heifers. All the metabolic disorders and infectious diseases (mastitis-metritis) seem to be more frequent on old cows. The variations between years are interpretable with difficulty because they depend on the regularity in the quality of collected data. More, the necessity for the breeders to observe conscientiously their animals is a favouring factor for the improvement of the health status of the herd.

Age Factors↗

PubMed2002

Post-term pregnancy: should induction of labor be considered before 42 weeks?

OBJECTIVE: To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor. STUDY DESIGN: A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves. RESULTS: The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section. CONCLUSIONS: The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.

Amniotic Fluid↗

PubMedDate not supplied

Induction of parturition in dairy cows with dexamethasone.

Sixty Holstein cows were paired by parity and sire, and one of each pair was allocated at random to treatment or control; 17 cows were injected with 7.5 mg/100 kg dexamethasone trioxa undecanoate 14 days before the predicted date of calving, 13 cows received the same dose five days before term and 30 cows were left untreated. The treatment significantly advanced parturition and 29 of the 30 induced cows calved within 72 hours of the injection. Induction at day 14 before term was safe for calf and dam, the calves were 3.2 kg lighter than control calves and there was a high incidence of retained placenta. Treatment for this condition resulted in increased veterinary costs of 14.50 pounds per cow exclusive of dexamethasone treatment. Treatment at this stage was also associated with low pregnancy rates in the next breeding season. Calves born after induction at five days before term were not significantly lighter than calves from control cows, the problem of retained placenta was less marked and there were no subsequent effects on fertility. There were no significant effects of induction on milk yield or milk quality up to 200 days of lactation.

Animals↗