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PubMed1998

Labour outcome of low-risk multiparas of 40 years and older. A case-control study.

Between January 1, 1994 and December 31, 1997 a total of 76 low-risk multiparas of 40 years and older with spontaneous onset of labour were delivered and were compared with 152 younger (25-30 years-old) low-risk multiparas of similar parity in a case-control study. The labour and perinatal outcomes of the 2 groups were compared. The duration of the first stage of labour was longer (233 minutes versus 149 minutes, p<0.0005) in the older women. Significantly more labours of older multiparas were complicated by intrapartum fetal distress (6.6% versus 1.3%, p<0.05); received intramuscular analgesia (11.8% versus 2.6%, p<0.01); and had operative deliveries (17.1% versus 4.6%, p<0.01). The incidence of instrumental delivery (11.8% versus 3.9%, p<0.05) and Caesarean section (5.3% versus 0.7%, p<0.05) were higher among older multiparas. The incidences of Syntocinon augmentation of labour, prolonged second stage, episiotomy and third stage complications such as perineal tear, primary postpartum haemorrhage, and retained placenta were similar in both groups. Both groups had similar perinatal outcomes. These women should be treated as others with high-risk pregnancies with appropriate careful attention during labour such as continuous fetal heart rate monitoring. They should be counselled to be made aware of the increased risks during labour.

Adult↗
PubMed2006

Mifepristone- and misoprostol-induced mid-trimester termination of pregnancy: a review of 272 cases.

BACKGROUND: Mifepristone became available in New Zealand in 2001, and was first used for second trimester terminations at the Level J Unit, Wellington Hospital. The protocol is based on that published by Ashok et al. in Aberdeen. AIMS: To describe the use of mifepristone prior to misoprostol induction of labour for mid-trimester termination and to compare outcomes with the published data. METHODS: A retrospective audit of prospectively collected notes for 272 women presenting for mid-trimester termination of pregnancy in a hospital termination clinic. Data collection included age, ethnicity, previous pregnancies, gestational age, induction-to-abortion interval, analgesia, and complications. Data were entered into an Access database and imported into Excel and Epi Info for the computation of descriptive statistics. RESULTS: Data on completed abortion were available for 271 women (one chose not to continue the abortion following mifepristone). The median time to abortion was 6 h, and mean number of doses of misoprostol was three. The proportion of women who aborted within 24 h was 95.9%. Immediate surgical evacuation of retained placenta was required in 22 women (8.1%). Heavy bleeding occurred in 22 women (8.1%), and seven required a transfusion (2.6%). The proportion of women who required parenteral narcotics was 78.2%. CONCLUSIONS: Outcomes for women in the present review were comparable with those for previous publications using the same regimen, with the exception of a higher transfusion rate. Our experience supports the finding that the use of mifepristone as pretreatment to misoprostol results in a shorter induction-to-delivery interval than the use of misoprostol alone as has been reported by other groups.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

Cesarean section in 19 mares. Results and postoperative fertility.

The case records of 19 mares undergoing caudal ventral midline celiotomy for cesarean section were reviewed. Surgical exposure to the uterus was good, and the incisions healed by first intention in surviving mares. Seventeen mares (89%) survived to time of hospital discharge. Six foals (32%) were delivered alive, of which three were euthanatized because of severe deformity (1 died on day 6 and 2 survived to time of discharge). The most frequent postoperative complications were abdominal pain (13 mares), anemia (10 mares), and retained placenta (6 mares). Sixteen mares were bred during at least one season after the cesarean section and eight (50%) produced at least one foal. The collective foaling rate for these mares, bred a total of 25 seasons, was 36%. Only one mare bred during the same year as the surgery produced a live foal. The collective foaling rate for mares bred after the year of the surgery was 50%.

Animals↗
PubMed2004

Comparison of prevalence and antimicrobial susceptibilities of Campylobacter spp. isolates from organic and conventional dairy herds in Wisconsin.

The prevalence and antimicrobial susceptibilities of Campylobacter spp. isolates from bovine feces were compared between organic and conventional dairy herds. Thirty organic dairy herds, where antimicrobials are rarely used for calves and never used for cows, were compared with 30 neighboring conventional dairy farms, where antimicrobials were routinely used for animals for all ages. Fecal specimens from 10 cows and 10 calves on 120 farm visits yielded 332 Campylobacter isolates. The prevalence of Campylobacter spp. in organic and conventional farms was 26.7 and 29.1%, and the prevalence was not statistically different between the two types of farms. Campylobacter prevalence was significantly higher in March than in September, higher in calves than in cows, and higher in smaller farms than in large farms. The rates of retained placenta, pneumonia, mastitis, and abortion were associated with the proportion of Campylobacter isolation from fecal samples. The gradient disk diffusion MIC method (Etest) was used for testing susceptibility to four antimicrobial agents: ciprofloxacin, gentamicin, erythromycin, and tetracycline. Two isolates were resistant to ciprofloxacin, and none of isolates was resistant to gentamicin or erythromycin. Resistance to tetracycline was 45% (148 of 332 isolates). Tetracycline resistance was found more frequently in calves than in cows (P = 0.042), but no difference was observed between organic and conventional farms. When we used Campylobacter spp. as indicator bacteria, we saw no evidence that restriction of antimicrobial use on dairy farms was associated with prevalence of resistance to ciprofloxacin, gentamicin, erythromycin, and tetracycline.

Animals↗
PubMed1988

Plasma oxytocin during third stage of labour: comparison of natural and active management.

The incidences of postpartum haemorrhage and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction. Whether such treatment is valuable is open to question because of the lack of clinical and physiological studies. The physiological effects of synthetic oxytocin on plasma concentrations of oxytocin and events during delivery were assessed. Plasma oxytocin concentration was determined in serial samples during the late second stage and throughout the third stage of labour in 25 women. Ten women received combined ergotamine and synthetic oxytocin intramuscularly and 15 were not treated. The geometric mean plasma oxytocin concentration significantly increased in the women given oxytocin when measured before and after delivery of the fetal anterior shoulder (3.1 (SD 2.0) pmol/l before and 15.9 (2.7) pmol/l after). Six of the women who did not receive treatment showed a significant increase in geometric mean plasma oxytocin concentration before and after delivery of the fetal shoulder (3.2 (2.0) pmol/l before and 6.4 (2.0) pmol/l after) and nine did not show an increase (geometric mean 2.4 (3.1) pmol/l before and 2.2 (2.2) pmol/l after). Of these nine women, two had an abnormal third stage of delivery; one woman had a postpartum haemorrhage and one required manual removal of the placenta. As it is impossible to predict which women will show a rise in the plasma concentration of endogenous oxytocin, intramuscular oxytocin should be given routinely.

Female↗
PubMed1978

Nutritional myodegeneration in dairy cows.

A syndrome is described in which parturient dairy cows showed clinical signs consistent with milk fever but failed to respond to conventional therapy. The affected cows were reluctant to walk, moved stiffy and in severe cases became recumbent. The condition was apparently precipitated by low vitaimin E and selenium intake, stress of pregnancy and in one outbreak erratic feeding. Skeletal and cardiac myodegeneration were observed grossly and histologically but an almost full term fetus from an affected cow showed no muscle lesions. A high incidence of retained placentae was also recorded.

Animal Feed↗
PubMed1981

Study of combined injections of 1 alpha-hydroxy-cholecaldiferol and cloprostenol in the prevention of parturient paresis.

Dairy cows were injected with 1 alpha-hydroxycholecalciferol (1 alpha-HCC) and, or, cloprostenol at 275 days of gestation. Blood samples were taken daily from 270 days of gestation until seven days after parturition and analysed for calcium, inorganic phosphate, magnesium and hydroxyproline. In all treated and control cows concentrations of calcium, inorganic phosphate and magnesium decreased around the time of parturition. Concentrations of hydroxyproline increased from the second to the fourth day after parturition. This increase was slightly smaller in cows injected with cloprostenol but was unaffected by 1 alpha-HCC. There was a greater indicence of retained placenta and endometritis in cows receiving cloprostenol. The injection of cloprostenol with 1 alpha-HCC at 275 days of gestation did not prevent milk fever.

Animals↗
PubMed1982

Induction of parturition in a commercial dairy herd: clinical management and treatment.

Twenty-six dairy cattle were treated with dexamethasone during medium to late pregnancy to induce premature calving. Thirteen produced calves within an average of 5-6 days of treatment. The remainder were given a subsequent injection of cloprostenol 10 days after the steroid treatment and, with one exception, all calved within the following two days. A high incidence of retained placenta was experienced, in common with other methods of inducing parturition, but this was not generally found to be associated with detrimental effects on health or fertility.

Animals↗
PubMed1987

Inactive ovaries in high-yielding dairy cows before service: aetiology and effect on conception.

The overall rate of inactive ovaries diagnosed by two consecutive rectal examinations was 8.5 per cent for 7751 lactations. Inactive ovaries had an inverse association with increasing parity and were directly associated with twinning, retained placenta, primary metritis and high milk yield after calving in heifers. No independent associations were established with stillbirth, a low milk yield in the last 120 days before calving, a long dry period, ketonuria or a high serum glutamate oxaloacetate transaminase activity in the first week after calving. The presence of inactive ovaries in the previous lactation was a significant predictor of the trait. Cows with either metritis or inactive ovaries were at a greater independent risk of not conceiving within 150 days after calving and the combined risk associated with both factors was higher than their sum. It is concluded that while damage to the uterus repeatability and an energy shortage after calving are responsible for ovarian inactivity, this trait was not associated with fatty liver. Such an association could be due to an indirect causal relationship, the outcome of post parturient uterine diseases which are associated independently with overfeeding before calving and inactive ovaries.

Anestrus↗
PubMed1991

Bovine haptoglobin response in clinically defined field conditions.

In order to assess the usefulness of haptoglobin as a measure of the acute phase response in cattle, the concentration of serum haptoglobin was estimated in the non-infectious conditions of milk fever and ketosis, and in the infectious conditions of severe mastitis, acute severe metritis, retained placenta and chronic endometritis. Mean haptoglobin concentrations were normal in cattle with non-infectious conditions and chronic endometritis but significantly increased in cattle with infectious conditions.

Acute Disease↗
PubMed1987

Leiomyomas in pregnancy: sonographic study.

With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retained placenta. Fibroids located in the uterine corpus were more frequently associated with early abortions. Multiple fibroids were accompanied by a higher frequency of malpresentation and premature contractions compared with cases with one or two fibroids.

Adult↗
PubMedDate not supplied

Perinatal case report of unexpected thalassemia Hb Bart.

Homozygous alpha-thalassaemia Hb Bart is a very rare illness in North America and Western Europe, but is a common cause of NIHF especially in South East Asia. It causes severe hydrops fetalis with lethal outcome and maternal complications as preterm labour, pre-eclampsia and retained placenta. A case report of an immigrant from Laos with preterm labour and fetal ascites, but without signs of pre-eclampsia is demonstrated. Fetal heart rate (FHR) trace and biophysical profile were pathological, while umbilical Doppler flow was normal due to hypoxaemia, but with hypervolumina and a high cardiac output. An amniocentesis and puncture of the ascites were performed, but FBS was not successful. Before receiving the results a caesarean section had to be done for deterioration of the FHR trace. A 1,370-g female infant was born who died of cardiovascular failure due to an alpha-thalassaemia Hb Bart and respiratory distress 5 days post partum. The parents had both an alpha-zero-thalassaemia. alpha-Thalassaemia is still a very unknown illness in Germany, but with the increasing numbers of immigrants from South East Asia it should be considered at the differential diagnosis of hydrops fetalis. A prenatal diagnosis should be offered to parents with alpha-zero-thalassaemia.

Adult↗
PubMed1996

The toxic and abortifacient effects of ponderosa pine.

Ponderosa pine needles cause abortion and a poorly described toxicosis when eaten by cattle. In previous trials, the abortifacient compound of pine needles was identified as isocupressic acid. At abortifacient doses, isocupressic acid caused no other toxicosis. However, other pine needle fractions, similar in composition to several commercially available rosin products, caused no abortion but were very toxic. The purpose of this study was to describe the toxicoses of ponderosa pine, compare its toxicity with other rosin and related pine products, and identify the toxin. Four groups of three pregnant beef cows each were treated with either ponderosa pine tips, rosin gum, dehydroabietic acid, or ground alfalfa. The cows treated with pine tips aborted, had retained placentas with endometritis, and developed both renal and neurologic lesions. The cattle treated with rosin gum or dehydroabietic acid did not abort but developed similar signs and lesions of intoxication. Clinical signs of intoxication included anorexia, mild rumen acidosis, dyspnea, paresis progressing to paralysis, and death. Clinical biochemical results, suggestive of renal, hepatic, and muscular disease, included azotemia, hypercreatinemia, hyperphosphatemia, proteinuria, and marked elevations of various serum enzymes. Histologically, all poisoned animals had nephrosis, vacuolation of basal ganglia neuropil with patchy perivascular and myelinic edema, and skeletal myonecrosis. The alfalfa-treated controls were normal. These findings suggest that ponderosa pine needles and tips are both abortifacient and toxic. Because the lesions caused by pine tips, rosin gum, and dehydroabietic acid are similar, toxicosis is most likely due to the diterpene abietane acids, common in all three.

Abietanes↗
PubMed2003

Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components.

BACKGROUND: Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. METHODS: The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. RESULTS: Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common.There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. CONCLUSIONS: Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

Journal Article↗
PubMed1986

Relaxin on induction of parturition in beef heifers.

Purified porcine relaxin (3000 U/mg) was administered into the cervical os of primiparous beef heifers on day 278 of gestation (approximately 5 days before parturition normally occurs) to determine its effects on the induction of parturition, changes in progesterone, estrone (E1), 17 beta-estradiol (17 beta-E2), cervical dilation, and pelvic relaxation. Heifers were assigned randomly to 1 of 3 treatments: relaxin-double (two infusions of 3000 U, 12 h apart; n = 17), relaxin-single (3000 U; n = 14), and PBS-gel vehicle (n = 16). Relaxin induced marked earlier calving (P less than 0.002) than PBS-gel vehicle. The intervals between the administration of relaxin or the PBS-gel vehicle and calving were 2.0, 2.5, and 5.3 days for heifers given relaxin-double, relaxin-single, and PBS-gel vehicle, respectively. The duration of gestation was significantly reduced (P less than 0.002) in relaxin-treated heifers compared with that in control heifers. A precipitous decrease in progesterone (7.1 ng/ml) occurred in peripheral blood plasma within 24 h after relaxin treatment. Coincident with a decline in levels of progesterone, E1 and 17 beta-E2 increased by 1700 and 400 pg/ml, respectively, an increase of 35% compared with the 12% increase in these steroids in control heifers. Mean deviations of cervical dilation increased 643%, 526%, and 11% in heifers given relaxin-double, relaxin-single, and PBS-gel vehicle, respectively. Relaxin induced maximum pelvic opening between 12-36 h after treatment. Although relaxin induced significantly earlier calving, there was no incidence (0 of 31 heifers) of retained placenta. We conclude from this study that purified relaxin administered intracervically to primiparous beef heifers during late pregnancy induced premature parturition. Marked shifts of progesterone, E1, 17 beta-E2, pelvic canal expansion, and cervical relaxation reflect the premature parturition induced by relaxin.

Animals↗
PubMed1992

Use of a beta 2-adrenergic stimulant (clenbuterol) for eliminating night-time calving.

To determine whether beta 2-adrenergic stimulant (clenbuterol) would exhibit beneficial effects upon the elimination of night-time calving, 42 Holstein Friesian cows and heifers at the first stage of labour were injected intramuscularly twice with clenbuterol; 300 micrograms at 18:00 and 210 micrograms at 22:00. Other 26 cows and heifers of the same breed at the first stage of labour at 18:00 were not treated and served as controls. All of the treated animals, but one, calved after 5:00 in the next morning, showing a peak of parturition between 5:00 and 10:00. In contrast to this, 42% of the control animals calved at night between 22:00 and 5:00. Thus, the double administrations of clenbuterol were shown to be effective for eliminating night-time calving. The cows treated with clenbuterol tended to show lower incidences of dystocia and retained placenta and a higher first insemination conception rate than the control animals. No adverse effects of the treatment on the viability of newborn calves and milk yields were observed.

Animals↗
PubMed2001

Concentrations of apolipoprotein C-III in healthy cows during the peripartum period and cows with milk fever.

Apolipoprotein (apo) C-III is a low-molecular-mass protein mainly distributed in the high-density lipoprotein fraction in cattle serum. We have recently shown that the apoC-III concentration is decreased in cows with fatty liver, ketosis, left displacement of the abomasum, retained placenta and milk fever. The decrease was most distinct in milk fever, thereby suggesting that apoC-III is particularly relevant to the development of milk fever and also that apoC-III is a candidate diagnostic marker for this disease. The purpose of the present study was to examine whether the apoC-III concentration in healthy cows is altered during the peripartum period, to assess the usefulness of apoC-III as a marker for milk fever. ApoC-III concentrations in 17 cows were monitored during the peripartum period (-48 to +12 days from parturition). Of the 17 cows, 14 were apparently healthy during the period. The apoC-III concentrations in the 14 healthy cows were unaltered during the period from -48 to -21 days, but thereafter showed individual variations. Compared with values during the period from -48 to -21 days, the apoC-III concentration was increased (137%) in 5 cows during the period from +1 to +12 days, whereas it decreased (60.7%) in 9 cows. Three cows suffered from milk fever at -3 to +10 days. Decreased apoC-III concentrations in diseased cows (15 to 37% of controls) were more distinct than in the 9 healthy cows. The apoC-III concentration was correlated with lecithin:cholesterol acyltransferase activity in cows with milk fever, but not in healthy cows. Correlation analysis also indicated that apoC-III and apoB-100 concentrations were negatively correlated in 5 healthy cows with increased apoC-III concentrations, but positively in 9 healthy cows with decreased concentrations and cows with milk fever. Determination of the apoC-III concentration during the peripartum period is suggested to be helpful in diagnosing milk fever. The possible relevance of apoC-III and apoB-100 in the development of milk fever is also implied.

Animals↗