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PubMed1983

Interrelationships of parturition problems, production of subsequent lactation, reproduction, and age at first calving.

Data of 22,691 observations on parturition related problems (dystocia, calf mortality, milk fever, retained placenta, and mastitis) were collected from 27 cooperating California dairy herds. Age at first calving did not affect calving difficulty; thus, an optimal age for first calving was not identified. Decisions on breeding virgin heifers should be based on size of cow because of the effect of size of cow on difficulty at first parity. Small calves experienced greatest mortality at parities greater than one; however, large calves had greater mortality at first parity. Greater mortality for large calves at first parity was partially due to the increased difficulty associated with larger calves. Calving difficulty resulted in impaired reproductive performance (more days open, more services, and more days to first breeding) and decreased 30-day milk production but had no effect on 90-day milk production and 305-day mature-equivalent milk production. Dystocia, milk fever, and retained placenta occurred as a complex. Incidence of dystocia and calf mortality decreased with parity, and all other problems increased with parity.

Age Factors↗
PubMed1995

Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour.

OBJECTIVE: To compare the effect of oxytocin and Syntometrine when used as part of active management of third stage of labour on postpartum haemorrhage, hypertension, nausea/vomiting and retained placenta. STUDY DESIGN: A randomised double blind trial was conducted in the Obstetric Unit of Corniche Hospital, Abu Dhabi in the United Arab Emirates. Between 1 January 1991 and 30 June 1991, 2040 women were randomly allocated either to the oxytocin (n = 1017) or the Syntometrine (n = 1023) group. Twelve patients had to be excluded from the trial (oxytocin, 5; Syntometrine, 7) after randomisation because they no longer fulfilled the inclusion criteria. All women in the trial received either oxytocin 10 units or Syntometrine 1 ml (oxytocin 5 units+ergometrine (ergonovine) 0.5 mg) by intramuscular injection with delivery of the anterior shoulder of the baby. Relative risk with 95% confidence intervals was calculated for each variable. RESULTS: Oxytocin (10 units) alone was as effective as Syntometrine (1 ml) in preventing post-partum haemorrhage without an increase in the incidence of retained placenta. Median blood loss was similar in both groups. The incidences of nausea, vomiting and headache were significantly lower in the oxytocin group, as was the occurrence of a mean rise in diastolic and systolic blood pressures of 20 and 30 mmHg or more, respectively. CONCLUSION: Prophylactic administration of oxytocin 10 U in the third stage of labour, as part of active management, reduces the incidence of maternal nausea, vomiting, headache and rise in blood pressure than does Syntometrine 1 ml without adversely affecting the rate of post partum haemorrhage.

Adult↗
PubMed1989

Early suckling and postpartum haemorrhage: controlled trial in deliveries by traditional birth attendants.

A randomised, controlled trial was carried out to determine whether suckling immediately after birth reduces the frequency of post-partum haemorrhage (PPH), the mean blood loss, and the frequency of retained placenta. The trial subjects were attended by traditional birth attendants (TBAs), and randomisation was by TBA and not by mother. 68 TBAs attended a course on third stage management and data collection; 19 had to be excluded from the trial. 23 TBAs in the early suckling group and 26 in the control group recorded blood loss in 2104 and 2123 deliveries of liveborn singletons, respectively. The frequency of PPH (loss greater than 500 ml) was 7.9% in the suckling group and 8.4% in the control group and the mean blood loss 258 ml and 256 ml, respectively. Neither of these results differed significantly between the groups. Analysis of the results by individual TBA showed no significant difference between the groups. The frequency of PPH in women of higher parity and in those with multiple pregnancies and stillbirths was high, as expected, which seems to validate the results. The frequency of retained placenta was too low to be analysed.

Breast Feeding↗
PubMed1999

Manual removal of the placenta. Incidence and clinical significance.

OBJECTIVE: To determine the incidence and complications related to manual removal of the placenta. METHODS: Review of hospital medical records from 1990 throughout 1994. One thousand five hundred and two vaginal deliveries from 1984 1992 were used for comparisons. RESULTS: A total of 24,750 deliveries were registered during the five year study period. Placenta was removed manually in 165 women (0.6%). The use of general anesthesia for manual removal of placenta decreased from 74% in 1990 to 19% in 1994. Spinal analgesia was applied from 1993, and it was used in 42% of the women in 1994. Of 74 parous women, 12 (16%) had experienced retained placenta before. The average difference in the hemoglobin concentration between the prenatal and the postoperative values was 3.4 g/dl among the patients, and 10% required blood transfusion (1-4 units). Among the controls, there was no decrease in the average hemoglobin concentration, and only 0.5 needed blood transfusion. Endometritis following manual removal was detected in 1.8% of the patients and 1.5% among the controls. Despite manual removal, five women (3%) were considered to have retained placental fragments two days or later after delivery, which required curettage. CONCLUSIONS: Placenta needed to be removed manually in 0.60% of all deliveries in our department. It was associated with increased incidence of hemorrhage and consequently low hemoglobin values. Women with a history of retained placenta have an increased risk of recurrence of retained placenta in subsequent deliveries.

Anesthesia, Epidural↗
PubMed1998

Associations between use of electric cow-trainers and clinical diseases, reproductive performance and culling in Swedish dairy cattle.

The aims of this follow-up study were: (a) to evaluate the role of ECT technology as a risk factor for several diseases; and (b) to determine if the effects of these diseases on cows' reproductive performance and as risk factors for culling are influenced by exposure to ECTs. Diseases considered were retained placenta, metritis, ketosis, cystic ovaries, silent heat, milk fever, clinical mastitis, and foot and leg problems. We used historical and contemporary controls (with control herds selected to match the experimental herds for size and location). Data consisted of 10,264 Swedish Red and White (SRB) and 5461 Swedish Friesian (SLB) lactation records in 150 herds of which 33 used cow-trainers. Logistic regression was used to estimate the effects of parity and exposure to electric cow-trainers on the risks of diseases and the effects of diseases and exposure to electric cow-trainers on risk of culling. The least-squares procedure was used to estimate the effects of diseases on reproductive performance. The dominant effects associated with use of electric cow-trainers were an increased risk for silent heat, clinical mastitis, ketosis and culling relative to cows in herds not using cow-trainers. Diseases had negative effects on reproductive performance and the effects were larger for cows in herds using cow-trainers. In herds using electric cow-trainers, the largest increase in the interval from first service to conception (58 days) was caused by the occurrences of silent heat, cystic ovaries and the combination of two or more diseases. Retained placenta, metritis, cystic ovaries, clinical mastitis and a combination of two or more diseases increased the risk of culling about two times relative to healthy primiparous cows with the increase being greater for cows in herds using cow-trainers. Silent heat did not increase risk of culling in control groups, but was the largest risk factor for culling in the exposed group. We concluded that exposure to electric cow-trainers increased the incidence risk of silent heat, clinical mastitis, and ketosis and changed silent heat from a neutral disease with respect to culling to a major risk factor. Finally, exposure to cow-trainers increased the general negative effect of diseases on the cows' reproductive performance and risk for culling.

Animal Husbandry↗
PubMed2006

Clinical application of grey scale and colour Doppler sonography during abnormal third stage of labour.

AIM: The purpose of the study was to investigate whether colour Doppler sonography is helpful in the surveillance of abnormal third stage of labour. MATERIALS AND METHODS: 20 patients were enrolled in the prospective study. Inclusion criteria were third stage of labour > 15 min and/or clinical suspicion of retained placenta. By means of grey scale and colour Doppler sonography the length of distinct phases of third stage of labour and length of visualisation of blood flow between myometrium and placenta were measured. These data were compared with previously published normal values. RESULTS: The patients were allocated into four groups: 1. Patients with prolonged third stage of labour, but normal vaginal delivery of the placenta (Group 1, 8 cases). 2. Patients with clinically suspected retained placental parts (Group 2, 4 cases). 3. Patients with manual removal of the placenta without confirmation of placenta accreta (Group 3, 4 cases). 4. Patients with manual removal of the placenta with confirmation of placenta accreta (Group 4, 4 cases). A significant longer latent phase was responsible for the prolonged third stage of labour in Group 1 (p < 0.05). Blood flow between myometrium and placenta was significantly longer visible in Group 4 than in the normal cohort (p < 0.0001). CONCLUSION: Grey scale sonography can help to distinguish between uncomplicated and complicated prolonged third stage of labour. Colour Doppler sonography can detect persistent blood flow between myometrium and placenta during third stage of labour in cases of placenta accreta. In these instances, the patient may benefit from colour Doppler sonography-guided curettage.

Adult↗
PubMed2004

Term angular pregnancy with placenta accreta. A case report.

A 27-year-old primigravida, with two prior adnexal operations, had retained placenta with postpartum haemorrhage following an uncomplicated vaginal delivery. Laparotomic removal revealed placental accretism. Pharmacological treatment (oxytocin and sulprostone) and right cornual resection failed to control profuse bleeding. In the end, subtotal hysterectomy was unavoidable.

Adult↗
PubMed2007

Avoiding manual removal of placenta: evaluation of intra-umbilical injection of uterotonics using the Pipingas technique for management of adherent placenta.

BACKGROUND: Manual removal of placenta is performed in 1-3% of cases, and whilst a well established and relatively safe procedure, it is not without complications, which include infection, hemorrhage, uterine rupture, and occasional maternal death. METHODS: A three-arm randomized controlled trial of 50 IU Syntocinon (in 30 ml N saline) versus 800 mcg misoprostol (in 30 ml N saline) versus 30 ml N saline alone (control), injected into the placental bed via the umbilical vein using the Pipingas method. A group sequential research model (triangular test: PEST4) was adopted to minimize the sample size, as retained placenta is a relatively uncommon condition. RESULTS: No significant difference in the rate of manual removal was observed between the control and Syntocinon groups. On triggering the automatic stopping rule for this arm of the trial all subsequent cases recruited were allocated to receive either Syntocinon or misoprostol. After a total of 54 cases a significant reduction in manual removal of placenta was observed in the misoprostol group, triggering the automatic stopping rule and terminating the trial. CONCLUSION: Misoprostol (800 mcg) dissolved in 30 ml N saline and administered by intraumbilical injection using the Pipingas technique significantly reduces the need for manual removal for retained adherent placenta, whereas Syntocinon has similar effectiveness to injection of N saline alone.

Female↗
PubMed1996

Peritonitis associated with passage of the placenta into the abdominal cavity in a llama.

Following parturition, a female llama was admitted to our hospital with a tear in the dorsal area of the vagina and peritonitis. The llama was clinically normal for 7 days after which its condition started to deteriorate, and the llama died 11 days after admission. On necropsy examination, the intact placenta was found in the abdominal cavity. Therefore, we suggest that in llamas with vaginal tears after parturition, it may be useful to immediately secure the fetal membranes with umbilical tape to the outside of the llama to ensure that the placenta will pass through the vulva. Additionally, in llamas with uterine or vaginal tears in which a retained placenta is suspected but cannot be identified in the uterus, exploratory laparotomy should be performed immediately, even if the llama appears clinically normal.

Animals↗
PubMed2001

Disruption of lactogenesis by retained placental fragments.

This case report describes a situation in which lack of milk production led the mother to seek help from a lactation consultant in private practice. Despite extensive breast stimulation with the baby at breast and mechanical breast expression, no milk was produced. Retained placenta was suspected by the lactation consultant. The mother was later diagnosed with placenta increta. Only when this condition was diagnosed and resolved did milk onset occur. It is important to evaluate for retained placental fragments when lactation appears to be delayed.

Adult↗
PubMed1998

Placental copper transport in the rat. III: Interaction between copper and iron in maternal protein deficiency.

Copper (Cu) and iron (Fe) metabolism are linked in the haematopoietic process. There is also considerable evidence of a linkage between protein intake and mineral sufficiency. The present study tested the hypothesis that a low protein diet during the second half of gestation in the rat alters Cu and Fe transport across the placenta and affects the Cu and Fe status of the fetus. Pregnant rats were fed a normal commercial diet the first half of gestation, and then assigned either a 20 per cent protein (NP) or a 4 per cent protein diet (LP) during the second half of gestation. One day before delivery, rats were anaesthetized, fetuses removed and dam tissues and plasma obtained. Other pregnant rats were injected i.v. with 2.5 mg/kg Cu acetate and sequential samples of dam blood, fetal blood and placentae were taken from 0 to 60 min. The LP diet produced generalized maternal hypoproteinaemia, and although there was no difference in fetal plasma albumin, there was a generalized fetal hypoproteinaemia as well. Fetal haematocrit (Hct) of the LP litters was lower than that of the NP group, but dam Hct was unchanged. Dam plasma Fe and Cu showed no differences between diets. Dam liver Cu was unaltered but liver Fe stores were elevated significantly. Before and after a Cu bolus, the LP placentae retained Cu to a greater extent than those of the NP placentae. Fetal liver Cu and Fe were elevated in the LP litters compared to the NP group. In conclusion, the LP diet in the dam during the second half of gestation was associated with fetal anaemia, hypoproteinaemia, and increased Cu and Fe accumulation in fetal liver. The higher concentration of Cu and Fe retained in LP placentae during gestation, and confirmed in the Cu challenge, suggest that Cu and Fe delivery to the fetus is related to placental concentration and that maternal protein malnutrition is a regulatory factor in fetal mineral homeostasis.

Animals↗
PubMed1995

Alternating nitroglycerin and syntocinon to facilitate uterine exploration and removal of an adherent placenta.

Nitroglycerin (NTG) has been demonstrated to provide uterine relaxation in the management of various obstetric complications. A 32-yr-old woman presented 40 min postpartum for manual removal of a retained placenta. Repeated, alternating doses of NTG 250 micrograms and syntocinon (SYN) 10U iv were used over 15 min to produce periods of uterine relaxation and contraction respectively for uterine exploration. Multiple attempts to extract the placenta failed and a diagnosis of placenta accreta was made. There were no major side effects from this combination of drugs apart from a transient 20% decrease in blood pressure after NTG, which responded to ephedrine 10-15 mg iv. The rapid change in uterine tone was believed to be due not only to the short duration of action of NTG and SYN, but also to the possible physiological antagonism between the two drugs. The mechanism of interaction may involve calcium mobilization and myosin light chain phosphorylation. We conclude that NTG and SYN can be used to produce alternating periods of uterine relaxation and contraction rapidly and consistently with little sustained effects from either agents.

Adult↗
PubMed2001

[Pathography and biography of the Empress Maria Theresa].

The empress and queen Maria Theresa Habsburg-Lorraine (May 13th, 1917-November 29th, 1780) bore sixteen children in the marriage with the emperor Franz I Stepha and was famous as "mother-in-law of Europe". Her brother Leopold died immediately after he was born, her sister Amalia died in the cradle and Maria Ana died of perinatal complications at the birth of a dead infant in 1744. The famous hereditary facial dysmorphia of the "Hasburg jawe" wasn't noticed in Maria Theresa's surviving children. In October of 1738, after giving birth to her daughter Ana, a manual lysis of the placenta was performed due to the retained placenta and postpartal bleeding. In 1741 her daughter Carolina died, and in 1767 her daughter Josepha died of small pox. Her daughter Elizabeth remained deformed by the pock marks, and Maria Christina got a puerperal sepsis, but surprisingly, didn't die. Maria Antoinette ended under a guillotine in France, along with her husband Luis XVI. Maria Theresa's father, Karl VI died of the cholecystopankreatitis and peritonitis, and her husband and co-ruler most probably died of acute coronary incident in August 18th, 1765. After her husband's death she started suffering from depression with steady necrophile obsessions. Maria Theresa suffered from a chronical obstructional pulmonary disease (asthma), rehumatic syndromes, hypertension and anxiodepressive syndromes. In 1767 she had small pox. In November 11th 1780 she caught a cold which grew into a pneumonia with high fever. She died of cardiopulmonal dedompensation preceded by pneumonia and asthma.

Asthma↗
PubMed1951

Hemorrhage of late pregnancy.

Rupture of the uterus, cesarean section and uterine atony were the major causes of maternal death associated with hemorrhage of late pregnancy for the five years 1945 to 1949 in New York County. Shock occurred earliest in rupture of the uterus and cesarean section, while in uterine atony there was some delay before shock was evident. Placenta previa was preceded by an initial small hemorrhage, and the time interval before shock was relatively long. It appeared that in cases of retained placenta, manual removal of the organ and hysterectomy were unduly delayed. Ten per cent of the maternal deaths reviewed were associated with severe transfusion reactions. Early recognition of a serious situation, rapid blood replacement and hysterectomy might have salvaged most of the patients.

Adult↗
PubMedDate not supplied

Manual removal of the placenta--its role in intrauterine adhesion formation.

OBJECTIVE: To determine the role of postpartum intrauterine manipulation of the uterine cavity in the formation of intrauterine adhesions. PATIENTS AND METHODS: Diagnostic hysteroscopy was performed following manual removal of the placenta in 48 patients. RESULTS: Intrauterine adhesions were observed in only one case (2%), and an incomplete uterine septum was found in seven cases (15%). CONCLUSIONS: Manual removal of the placenta does not seem to predispose to the formation of uterine adhesions. Incomplete uterine septum may be involved in some of the cases of retained placenta.

Adult↗