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PubMed2002

Preventing postpartum hemorrhage in low-resource settings.

OBJECTIVES: To review the literature to determine the most effective methods for preventing postpartum hemorrhage (PPH), the single most important cause of maternal death worldwide. METHODS: Systematic review of published randomized controlled trials and relevant reviews. RESULTS: Review of the literature confirms that active management of the third stage of labor, especially the administration of uterotonic drugs, reduces the risk of PPH due to uterine atony without increasing the incidence of retained placenta or other serious complications. Oxytocin is the preferred uterotonic drug compared with syntometrine, but misoprostol also can be used to prevent hemorrhage in situations where parenteral medications are not available (e.g. at home births in developing countries). CONCLUSIONS: The use of active management of the third stage of labor to prevent PPH due to uterine atony should be expanded, especially in developing country settings.

Ergonovine↗

PubMed2002

Low use of medication in home deliveries in the Netherlands.

OBJECTIVES: In view of the growing concern for de-medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. METHODS: A prospective study of medication use by 68 community midwives during 716 home births in the Netherlands. RESULTS: Medication was used in 58.4% of the home deliveries, with an average of 1.4 drugs per delivery. The drugs used were mostly oxytocin (in 35.6% of all deliveries) and local anesthetics (in 32.9%). When medication was used, it was administered before cutting the umbilical cord in 16.7% of the cases. Prophylactic or routine administration of local anesthesia, postpartum hemorrhages, and retained placenta were the most frequent indications for using medication. CONCLUSIONS: The use of medication during home deliveries in the Netherlands is low and newborns are minimally exposed to medication. This illustrates the Dutch birth culture, which tends to minimize the medical aspect of childbirth.

Adult↗

PubMed1996

Utilization of intravenous nitroglycerin for obstetrical emergencies.

OBJECTIVE: The authors investigated, by reviewing publications and their personal experience, opportunities for the use of nitroglycerin to manage several obstetric emergencies. METHODS: A retrospective study of 10 observations of internal podalic versions of the second non-vertex twin, with administration of intravenous nitroglycerine, performed between August 1994 and March 1996, was undertaken. The authors compared their results with those reported elsewhere. The indications of nitroglycerin have been extended to intrapartum external version of the second twin, retained placenta, and uterine inversion. RESULTS: Only one failure of internal podalic version due to failure of uterine relaxation was observed. CONCLUSION: From both experience and published reports it was confirmed that intravenous nitroglycerin (NTG) injection induces a transient and prompt uterine relaxation without affecting maternal and fetal prognosis.

Adult↗

PubMed1979

Serum levels of progesterone, 5 alpha-dihydroprogesterone and hydroxy-5 alpha-pregnanones in the prepartum and postpartum equine.

Blood samples were collected from eight mares for ten days before and two days following parturition. Progesterone, 5 alpha-dihydroprogesterone and hydroxy-5 alpha-pregnanones were extracted from serum, separated by Sephadex LH-20 column chromatography and quantitated by radioimmunoassay. Progesterone levels ranged from 8.5 to 4.1 ng/ml among mares with normal parturition and decreased to 1.2 ng/ml after parturition. One mare with a retained placenta maintained the prepartal levels of progesterone into the postpartum period. 5 alpha-dihydroprogesterone increased to a level of 133 ng/ml at 80 hrs before parturition and began decreasing and reached a level of 9.2 ng/ml in the postpartum period. Levels of hydroxy-5 alpha-pregnanones were variable with a high of 1690 ng/ml and declined to a postpartum level of 60 ng/ml. The timing of the decline varied among the mares. The possible source and significance of these progestins remain speculative.

20-alpha-Dihydroprogesterone↗

PubMed1999

Trilostane but not prostaglandin F2alpha (PGF2alpha) or cortisol aborts 90-day-pregnant lutectomized sheep.

Ewes were lutectomized and treatments were started 72 h later. Pregnant ewes were treated with vehicle; prostaglandin F2alpha (PGF2alpha); cortisol (C); trilostane (TR), a 3beta-hydroxy-steroid dehydrogenase inhibitor; PGF2alpha + C; TR + PGF2alpha; TR + C, or TR + PGF2 + C. TR, TR + PGF2alpha, TR + C, and TR + PGF2alpha + C aborted (P < or = 0.05) all ewes receiving TR. One ewe treated with PGF2alpha aborted (P > or = 0.05). The average time to abortion of TR-treated ewes was 50.8 h (P < or = 0.05) after initiation of treatments. All aborted ewes had retained placentas (P < or = 0.05) except one ewe in the TR + PGF2alpha, treatment group. TR was given every 12 h starting at 72 h postlutectomy until 96 h postlutectomy. TR reduced (P < or = 0.05) progesterone. Estradiol-17beta was increased (P < or = 0.05) 2 h after the first two TR treatments and declined 2 h later and was followed by a sustained increase (P < or = 0.05) in estradiol-17beta, which was coincident with the onset of abortions. Estradiol-17beta was increased (P < or = 0.05) by PGF2alpha but did not decrease (P > or = 0.05) placental secretion of progesterone. It is concluded that TR but not PGF2alpha is an abortifacient in 90-day-pregnant lutectomized ewes and that abortion occurs only when there is a decrease in circulating progesterone and an increase in circulating estradiol-17beta.

3-Hydroxysteroid Dehydrogenases↗

PubMed1996

The effect of Trypanosoma vivax infection on late pregnancy and postpartum return to cyclicity in Boran cattle.

A study was designed to examine the effect of infection with Trypanosoma vivax KETRI 2501 on the maintenance of pregnancy and postpartum return to reproductive function in susceptible Galana (n = 6) and trypano-tolerant Orma Boran (n = 6) heifers during the third trimester of pregnancy. Of the 12 study animals, 3 Galana and 3 Orma Boran heifers served as controls. One of 3 Galana heifers calved prematurely with subsequent perinatal loss. Of the 2 heifers that produced live calves, 1 calf died shortly after birth, while the other survived. Two of 3 Orma heifers calved prematurely and all 3 calves died shortly after birth. The 6 control heifers produced live calves at term, all of which survived. Infection with T. vivax during the third trimester of pregnancy delayed the resumption of ovarian activity after calving, with the Ormas taking a significantly (P < 0.05) shorter time from calving to ovulation. There was no clear evidence that premature birth was associated with pathological changes in reproductive organs. Results from this study demonstrated that infection with pathogenic T. vivax during late pregnancy influenced the outcome of pregnancy in both susceptible Galana and trypano-tolerant Orma Boran heifers, resulting in premature births, perinatal loss, retained placentae, low birth weights and a prolonged period to the onset of postpartum ovarian activity.

Journal Article↗

PubMed1999

Acute-phase response in dairy cows with acute postpartum metritis.

The diagnostic value of 2 plasma acute-phase proteins, haptoglobin and alpha1-acid glycoprotein, and plasma N-acetyl-beta-D-glucosaminidase enzyme activity were studied in 29 newly calved dairy cows. Nineteen had developed acute metritis with putrid vaginal discharge within 2 wk after calving; 10 were clinically healthy controls. Plasma haptoglobin concentration remained low in most cows with acute postpartum metritis. Only the 3 most severely affected cows exhibited a strong haptoglobin response. These were later culled due to poor condition and reduced fertility. This suggests that in acute uterine infection a highly increased haptoglobin concentration indicates poor prognosis for repeat conception. Plasma alpha1-acid glycoprotein concentration increased in acute postpartum metritis, the response pattern being less prominent than that for haptoglobin. The alpha1-acid glycoprotein concentrations did not correlate with severity of disease, and, consequently, the capacity of alpha1-acid glycoprotein in differentiating genital infections was relatively poor. The highest alpha1-acid glycoprotein concentrations were detected in cows with retained placenta and/or dystocia. Plasma N-acetyl-beta-D-glucosaminidase activity levels did not differ between the cows with acute postpartum metritis and healthy control cows.

Acute Disease↗

PubMed2000

Seroepidemiology of Brucella abortus infection in bovids in Sri Lanka.

From 1992 to 1995, 0.15% (n=3916) of the bovids (cattle and buffalo) in Sri Lanka were sampled, using a multi-stage sampling procedure. Serum antibodies for Brucella abortus were detected using the indirect enzyme-linked immunosorbent assay (ELISA). The age, the agroecological zone and the management system practiced in the farms of the sampled bovids were studied as risk factors for seropositivity. The overall seroprevalence of brucellosis in cattle was 4.7% (n=3076) and 4.2% in buffaloes (n=840). Bovids that were over 3 years of age, from the dry zone (annual rainfall 20-35 in.), and reared under an extensive management system had higher odds of being seropositive. Bovids from the dry zone were at approximately six times higher odds of being seropositive even after controlling for the possible effects of age and management system. Approximately 75% of the seropositive males were from the dry zone. Most bovids (84%) from the dry zone in this study were reared under an extensive management system (free grazing) which allows unrestricted contact between animals. These factors may have contributed to the spread of brucellosis in bovids in the dry zone. This infection might be an important cause of abortion in bovids in Sri Lanka. However, there is also evidence of other causes for abortion, repeat breeding and retained placenta.

Animals↗

PubMed2000

Simulated effects on dairy cattle health of extending the voluntary waiting period with recombinant bovine somatotropin.

We simulated the effect of extending the voluntary wait period by 100 days on disorder-frequency measures that were based on cow-years (from lactations completed during the 4-year simulation horizon), metric tons of milk yield, and lactational incidence risks. A dynamic stochastic discrete-event simulation model that focuses on clinical and subclinical intramammary infections (IMI), plus clinical metabolic (left-displaced abomasum, ketosis, milk fever) and reproductive (cystic ovarian disease, dystocia, retained placenta, twinning, uterine infection) disorders in dairy herds was used. Although the voluntary wait period was increased by 100 days (50 vs. 150), the predicted difference in simulated days to conception was only 89 days for the extended voluntary wait-period group (which we attributed to higher fertility later in lactation). Herds that had a voluntary wait period of 150 days (compared to the control herds' voluntary wait period of 50 days) were predicted to have significantly lower rates of metabolic and reproductive disorders and clinical mastitis on both cow-year and milk-yield bases. Simulated control herds, on average, produced 8539 kg of milk in an average lactation of 325 days and simulated herds with a 150-day voluntary wait period 10893 kg of milk in an average lactation of 409 days. There was a significantly lower predicted rate and risk of culling for reproductive failure in the extended voluntary wait period group. The predicted lactational incidence risks for subclinical IMI were 18% higher for the extended voluntary wait period group - but extending the voluntary wait period by 100 days was predicted not to increase the risk of any of the other 10 disorders.

Algorithms↗

PubMed2003

A stochastic model simulating milk fever in a dairy herd.

A simulation model was developed to evaluate the long-term effect of control strategies against milk fever (MF); here, we present the base model and sensitivity analyses. The representation of the within-herd dynamics was based on the existing SimHerd II model. Because of the relationships between MF and other diseases, the new model (called "SimHerd III") includes diseases common in a dairy herd. The cow level risk factors modelled were: base risk in the herd, parity, milk-yield potential, lactational disease recurrence, disease interrelationships, body condition and season. The diseases include clinical cases of MF, dystocia, downer-cow syndrome, retained placenta, metritis, displaced abomasum, ketosis and mastitis. The effects of diseases were represented by daily milk yield, daily body weight, daily feed intake, risk of stillbirth, conception probability, decision on culling, death and immediate removal. Simulated technical results showed that the herd effects of reduced risk of MF differed according to the reproductive efficiency in the herd. These interactions between reproduction efficiency and the effect of reduced base risk of MF were related to differences in how the simulated herds reacted to the reduction in replacements caused by MF. In the sensitivity analysis, eight potential key parameters were changed to their lowest and highest expected values retrieved from the literature. When measuring the sensitivity on milk production in the herd (as the economically most important technical effect), the model seemed most sensitive to the uncertainty of effect of MF on death risk and MF-recurrence risk.

Animals↗

PubMed2003

Dam-related effects on heart girth at birth, morbidity and growth rate from birth to 90 days of age in Swedish dairy calves.

We investigated the effects of dam-related factors (such as calving performance, milk leakage, diseases, milk production, and somatic-cell count (SCC)) on heart girth at birth and the incidence risk of diarrhoea and respiratory disease during the first 90 days in Swedish dairy calves. The effects of these dam-related factors and environmental and management-related (but not dietary) factors on the calves' growth rate during the first 90 days of life also were analysed. The study used nearly 3,000 heifer calves born in 1998 on 122 farms in the south-west of Sweden. Individual health records were kept by the farmers and visiting project veterinarians. The calf's heart girth was measured at birth and weaning. We used generalised linear mixed models for the size of the calf at birth and growth rate. Variables associated with the heart girth at birth were breed, calving performance, mastitis in the dam in the last 49 days before calving, milk production and parity. Variables associated with the growth rate were breed, calving performance, disease in the calf during its first 90 days of life, heart girth at birth, and housing of calves. The effect of the dam on the relative risk of diarrhoea and/or respiratory disease in the calf was evaluated by a generalised linear mixed model with a logit link. Morbidity in the dam during late pregnancy, retained placenta and SCC were associated with the relative risk of respiratory disease in the calf. None of the explanatory variables (other then breed) was associated with the relative risk of diarrhoea.

Animals↗

PubMed2003

Optimizing replacement of dairy cows: modeling the effects of diseases.

We modified an existing dairy management decision model by including economically important dairy cattle diseases, and illustrated how their inclusion changed culling recommendations. Nine common diseases having treatment and veterinary costs, and affecting milk yield, fertility and survival, were considered important in the culling decision process. A sequence of stages was established during which diseases were considered significant: mastitis and lameness, any time during lactation; dystocia, milk fever and retained placenta, 0-4 days of lactation; displaced abomasum, 5-30 days; ketosis and metritis, 5-60 days; and cystic ovaries, 61-120 days. Some diseases were risk factors for others. Baseline incidences and disease effects were obtained from the literature. The effects of various disease combinations on milk yield, fertility, survival and economics were estimated. Adding diseases into the model did not increase voluntary or total culling rate. However, diseased animals were recommended for culling much more than healthy cows, regardless of parity or production level. Cows in the highest production level were not recommended for culling even if they contracted a disease. The annuity per cow decreased and herdlife increased when diseases were in the model. Higher replacement cost also increased herdlife and decreased when diseases were in the model. Higher replacement cost also increased herdlife and decreased the annuity and voluntary culling rate.

Animal Husbandry↗

PubMed1999

Culling of dairy cows. Part I. Effects of diseases on culling in Finnish Ayrshire cows.

The effects of 15 diseases on time until culling were studied in 39,727 Finnish Ayrshire cows that calved during 1993 and were followed until the next calving or culling. The diseases studied were: dystocia, milk fever, retained placenta, displacement of the abomasum, metritis, non-parturient paresis, ketosis, rumen disorders, acute mastitis, hypomagnesemia, lameness, traumatic reticuloperitonitis, anestrus, ovarian cysts, and teat injuries. Survival analysis, using the Cox proportional hazards model, was performed and diseases were modeled as time-dependent covariates. Different stages of lactation when culling can occur were also considered. Parity, calving season and herd were included as covariates in every model. Parity had a significant effect on culling, the risk of culling being four times higher for a cow in her sixth or higher parity than for a first parity cow. The effects of diseases varied according to when the diseases occurred and when culling occurred. Mastitis, teat injuries and lameness had a significant effect on culling throughout the whole lactation. Anestrus and ovarian cysts had a protective effect against culling at the time when they were diagnosed. In general, diseases affected culling decisions mostly at the time of their occurrence. The effect seemed to decrease with time from the diagnosis of the disease. However, milk fever, dystocia and metritis also had a significant effect on culling at the end of the lactation.

Animal Husbandry↗

PubMed2000

Epidemiology of reproductive performance in dairy cows.

The objectives of this presentation are to review results of our previous and on-going research with respect to the risk factors and consequences of poor reproductive performance in dairy cows, and to develop an economic framework to optimize decisions related to dairy cow reproductive performance. To make profitable breeding and replacement decisions, the farmer must account for factors including age, production level, lactation stage, pregnancy status, and disease history of the cows in the herd. Establishing the interrelationships among disease, milk yield, reproduction, and herd management is necessary for developing a decision model for disease treatment, insemination, and replacement. The data for the studies reviewed in this presentation incorporate health, production, and management components from Holsteins in the Northeast USA and Ayrshires from Finland. Data were analyzed using the Cornell Theory Center Supercomputer. The effect of risk factors on reproductive disorders was modeled with logistic regression, and on conception, insemination, and culling with survival analysis. The effect of reproductive disorders on milk yield was analyzed with mixed models. Economic optimization of reproductive performance was done with dynamic programming (DP). High milk yield, high parity, and calving in winter were risk factors for several reproductive disorders. These disorders, in turn, delayed insemination and conception in dairy cows, and some of them increased the risk of culling. Dystocia, retained placenta, and early metritis led to a short-term drop in milk production. High milk yield was not a major factor in delaying conception, except in first parity cows. However, higher yielders were more likely to be inseminated, and less likely to be culled. Non-pregnant cows had a higher risk of being culled. Reproductive performance of dairy cows influenced a herd's profitability, and good heat detection and conception rates provided opportunities for management control. It was not always economically advantageous to get cows pregnant as soon as possible, and there was no one optimal value for the calving interval length for all cows in a herd.

Animals↗

PubMed1987

Effects of nutrition on reproduction in dairy cows.

It is clear that nutrition is closely related to reproduction in the dairy cow. In addition to classic nutrient deficiency and excess, dry cow body condition and postpartum energy balance have a major impact on fertility. Dry cow rations must be designed to prevent milk fever, dystocia, retained placenta, other calving problems, and metritis. Most importantly, milk yield and reproductive performance should be regularly monitored to detect nutritionally associated health and performance changes that precede impairment of reproductive function.

Animal Nutritional Physiological Phenomena↗

PubMed2001

Fescue toxicosis.

Most of the tall fescue pastures in the United States are infected by an endophyte, N. coenophialum. The fungus derives nutrients from the plant while supplying the plant with toxins for defense. The most detrimental toxins for animals in tall fescue are ergopeptine alkaloids, especially ergovaline. Ergovaline functions as a dopamine D2 agonist and alters prolactin and several other hormones in the body. Pregnant mares are most susceptible during their last month of gestation. Clinical signs include prolonged gestation, dystocia, retained placentas, agalactia, and dysmature foals that are either stillborn or weak.

Animal Feed↗

PubMed2002

Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a big challenge for obstetricians. Fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.

Arteries↗

PubMed2002

Planned homebirths in Victoria, 1995-1998.

This paper reports and comments on quantitative aspects of 440 planned homebirths attended by registered midwives in Victoria during the three years studied, 1995-1998. The spontaneous labour rate was 96.4%, and 91.6% of women planning a home birth experienced a spontaneous cephalic birth. The overall transfer to hospital rate was 20%, the most common reason for transfer being delayed progress in labour. 64.2% of women experiencing a vaginal birth had no perineal trauma. Postpartum haemorrhage was noted in 5.5% of participants, and 1.1% had a retained placenta. Infants were an older gestation and heavier than those in the state in general, although the Apgar scores were similar. These data support the claim that planned home birth with a qualified midwife remains a demonstrably safe option for women who choose this model.

Decision Making↗