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PubMedDate not supplied

Progressive systemic sclerosis and postpartum renal failure complicated by peripheral gangrene.

A patient with progressive systemic sclerosis (PSS) complicated by accelerated hypertension, postpartum renal failure and gangrene in all 4 extremities is presented. Pregnancy seldom has a significant effect upon the course of PSS unless there is renal involvement. Four previously reported cases of PSS with postpartum renal failure are reviewed. In our case, sepsis, shock, retained placenta, propranolol therapy and disseminated intravascular coagulation may have contributed to the development of renal failure and symmetrical peripheral gangrene.

Adult↗

PubMed1981

Angular intrauterine pregnancy.

Implantation of the embryo in the uterine angle, medial to the uterotubal junction, may lead to several complications, both during pregnancy (persisting uterine pain and bleeding, spontaneous abortion, ruptured uterus) and in the puerperium (retained placenta). Nevertheless this entity is still rarely discussed in textbooks or in the literature. Its differential diagnosis from interstitial tubal pregnancy and cornual pregnancy is often confused. Four new cases of angular pregnancy with varied outcomes are described and 35 cases from the literature of the past 50 years are reviewed. Uterine anomalies, myomas, and uterotubal implantation may be predisposing conditions in a minority of cases. The differential diagnosis of angular intrauterine pregnancy from interstitial pregnancy, based on the position of the gestational enlargement in relation to the round ligament, is considered and the management discussed.

Adult↗

PubMedDate not supplied

[Uterine inversion: a cause of obstetric hemorrhage not to be missed. Discussion].

Severe obstetric bleeding is the primary cause of maternal morbidity and mortality. While classical causes such as uterine inertia or retained placenta are well known, inversion of the uterus is a rare cause which should not be missed. Only very rapid diagnosis and management can avoid serious and irreversible consequences. A case of inversion of the uterus is reported. The circumstances of onset and treatment possibilities are also discussed.

Adult↗

PubMed1995

[Fertility in mares after disturbed or undisturbed puerperium; evidence from clinical, microbiologic and hormone analysis].

Because of the mare's ability to conceive very soon post partum a thoroughly performed control of the puerperal period is of particular importance. In addition to cytological and histological examinations of the uterus, rectal palpation and vaginoscopic inspection as well as microbiological examinations of uterine swabs and the evaluation of the mare's hormonal status during the puerperal period provide useful information which can be used either prognostically or to initiate a specific therapy. 55 mares were examined on days 3, 6 and 9 post partum. Rectal palpation, vaginoscopic inspection, microbiological examination of uterine swabs and determination of progesterone-(P4)- and estradiol-(E2)-levels in the peripheral blood were performed on all the three days. On day 18 after the last breeding the mares were checked for pregnancy by ultrasonic echography. We observed many cases of heavy bacterial contamination of the uterine contents during the puerperal period up to the foal heat. Especially coliforms and beta-hemolytic streptococci were often found. However, these contaminations could not be proven to interfere with fertility rates during the first post partum estrus periods. Dystocia and retained placenta had a strong influence on the hormonal situation of mares during the puerperal period. In addition to this we found disturbed involution of the genital system in these mares. Much higher pregnancy rates at foal heat were detected after a rapid onset of ovarian activity post partum especially during May, June and July, compared to mares with delayed onset of ovarian activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

[Uterine rupture: 50 cases].

The author reports 50 cases of rupture of the uterus among 11,060 labors i.e. one rupture per 220 labors. This study shows that rupture of the uterus occurs in women in poor socio-economic circumstances. Uterine scarring seems to be a more important factor than age and multiparity. Traumatic rupture is also common, resulting from obstetric procedures but above all from abdominal expression, most often performed outside hospital. Rupture of the uterus may present in many different ways. It was diagnosed in 32 cases before delivery while in 18 cases it was discovered during cesarean section or extraction of retained placenta. The lower segment was the elective site of rupture. With regard to treatment, suture was possible in 42 cases while hysterectomy proved necessary in the other 8 cases in view of the poor local tissue state. The prognosis remains gloomy, with a high risk of maternal death and, above all, a 58% fetal death rate.

Adolescent↗

PubMed1994

A comparison between health centre deliveries and deliveries born before arrival in the Aitape district.

In this survey the obstetric and neonatal data of the admissions to the Obstetric Ward in Raihu Health Centre during 1990, 1991 and the first half of 1992 were analyzed. The emphasis of the survey was on the difference between deliveries born before arrival (BBA) (24%) and health centre (HC) deliveries (76%). The survey shows that there were differences in postnatal complications, postpartum haemorrhage (16% vs 4.3%), retained placenta (21% vs 1.3%) and puerperal sepsis (18% vs 4.3%), and in antenatal attendance (52% vs 90%), average bedstay (6.5 days vs 5.4 days), mean haemoglobin level (7.78 vs 8.77 g/dl) and gonorrhoea (17% vs 8%). For the neonatal data the survey shows differences in stillbirth rate (10.5% vs 2.3%), perinatal death in the first week (4.0% vs 2.5%) and mean birthweight (for male infants 2.75 kg vs 2.88 kg and female infants 2.60 kg vs 2.73 kg).

Birth Weight↗

PubMed1994

Mid-trimester abortion using hypertonic saline or prostaglandin E2 gel: an analysis of efficacy and complications.

A total of 149 mid-trimester termination of pregnancies using hypertonic saline infusion (125) or prostaglandin E2 gel (24) have been analyzed for efficacy and complications. The mean induction to abortion time (I-A) was 31.7 +/- 9.2 hours in hypertonic saline (HSI) group and 28.4 +/- 27.7 hours in prostaglandin (PGE2) group. Retained placenta occurred in 76 (63.3%) in HSI group and 6 (25%) in PGE2 group. Four (3.3%) in HSI group had pyrexia over 38.5 degrees C and the only one case with proven sepsis developed disseminated intravascular coagulation defect (DIC) which accounted for one case (0.8%) of blood loss of more than 500 ml. There was also one case of mildly disturbed electrolytes in HSI group occurring during the instillation. Minor side-effects of nausea and vomiting occurred in 4 (16.7%) in the PGE2 group only.

Abortion, Induced↗

PubMed1994

[Nursing study on the occurrence of unplanned home births in Tygerberg Hospital].

A retrospective, descriptive study was conducted from March to May 1992 to investigate the incidence, factors associated with, and neonatal and maternal complications of babies born before arrival (BBA) at the Tygerberg Hospital and its peripheral clinics. This was done by means of a personal interview with 30 of the mothers within 6 hours after the birth of their babies, representing 44% of the study population during the period the study was undertaken. The incidence of BBA over the period was 5.3%. The typical patient who presented with BBA, was found to have little education, no or small income, gravida 2 and between the ages of 20 and 25 years. As much as 47% of patients did not have transport available. Only 53% of patients received specific guidance as to when to come to the hospital or clinic. The majority of these "informed" respondents, did not fully understand the information given to them. Maternal complications included vaginal and perineal lacerations, retained placenta and abruptio placentae. 47% of babies developed complications. Neonatal death, breech presentation, prematurity and umbilical cord around the neck, featured prominently. The lack of transport and inadequate or ineffective prenatal guidance and information as well as relative illiteracy were identified as the most important causative factors. The solution to the problem lies at least partially in better prenatal guidance, which includes specific reference to the symptoms of the onset of labour and the timely arranging of transport.

Adult↗

PubMed1994

[The ecopathologic approach to the study of the relationship between nutrition and health in the dairy cow].

An ecopathological approach for examining nutrition-induced health disorders in dairy herds in France is described. Bovine dairy herds were surveyed for 4 yr to detect nutritional risk factors that discriminated between high and low disease incidence rates for retained placenta, milk fever, calf perimortality, metritis, liver disorders and infertility. In the cow, preventive feeding helps avoid nitrogen overnutrition, and reduces the requirements of Ca in the late gestation period, gives a satisfactory balance in polyunsaturated fatty acids before calving. The absence of feedstuffs including toxic components and a feeding system with few feedstuffs and few diet changes are also beneficial factors.

Animal Nutritional Physiological Phenomena↗

PubMed1994

Epidemiological study of metritis in Michigan dairy cattle.

A prospective study using the Michigan National Animal Health Monitoring System was conducted to determine factors that affect the incidence of metritis in Michigan dairy herds. Data on herd management, disease, and environmental risk factors were collected from a stratified random sample of 97 herds with 7,835 cows for 12 months. Linear and logistic regression models were developed to assess the association between metritis and factors at the herd and cow level. Significant factors included retained placenta, dystocia, routine post partum examinations, herd size, and parity. Implications on the interpretation and use of results from herd- and cow-based analyses are discussed.

Animals↗

PubMed1994

[The therapy of postpartum secretion retention (lochiometra) in high-yielding cows].

In 11 specialised dairy farms belonging to the herd book and cattle health service of the Bureau of animal health in Hannover 1134 gynaecological examinations had been accomplished during a two and a half years period every four weeks. 120 cows (approximately 10%) showed an ichorous vaginal secretion between the second and third week post partum. The treatment was conducted beginning from ten days post partum with a high antibiotical dosage (4 g Tetracycline) in shape of small-sized pessaries (UT-forte, MSD) and additionally the cows received 20 micrograms GnRH (Receptal, Hoechst) by intramuscular injection. 3-4 weeks later the cows were reexamined, 36 cows did not reveal any abnormal signs, the remainder had to be treated in accordance with the diagnosis in the sexual tract (on average 1.16 times). After a mean interval calving to first service of 93 days 85% of the cows with lochiometra needed some more than two A. l's with a six weeks' delay to get pregnant. The reasons for the differences between the results of this study and those of other investigations are explained. It requires a great deal of veterinary labor to prevent the inflammatory processes in the genital tract from getting chronic, that is why lochiometra must be looked upon as one of the most aggravating puerperal disease. The medical care of the uterus with high doses of antibiotics combined with the application of GnRH must be recognized as a good supplement to the therapy of retained placenta favoured by Götze or other puerperal disorders such as lochiometra especially in regard to compatibility and high pregnancy rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

Use of prostaglandin products by dairy cattle owners, beef cattle owners, and veterinarians.

Questionnaires regarding the use of prostaglandin F2 alpha and its analogues (hereafter referred to as PG) were sent to 332 Alabama beef cattle owners and to 279 Alabama dairy cattle owners after attempting to contact them by telephone to request their participation in the survey. Questionnaires concerning the use of PG in their clients' herds were likewise sent to 147 food animal and mixed animal practitioners in Alabama after attempting telephone contact. Response among beef cattle owners, dairy cattle owners, and veterinarians to whom questionnaires were mailed was 64.5, 61.6, and 75.5%, respectively. Only 7.4% (13 of 175) of respondent beef cattle owners reported use of PG in their herds, and this use was predominantly for artificial insemination and embryo transfer. In contrast, 66.5% (109 of 164) of respondent dairy cattle owners reported use of PG, generally with satisfactory results, for some of the following conditions: unobserved estrus (n = 77), uterine infections (n = 74), retained placenta (n = 65), cystic ovaries (n = 56), estrus synchronization (n = 45), and induction of parturition (n = 13). Although 94.9% of respondent veterinarians treated cattle with PG, those attending beef herds thought that more important strategies were available for improvement of beef cattle productivity than increased use of PG. Among these strategies were shorter calving seasons, improved nutrition, better record keeping, more frequent herd health visits, improved animal identification, and increased use of bull breeding soundness examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Agriculture↗

PubMed1977

[Studies on cattle in anoestrus (author's transl)].

One of the items of a herd management programme concerned with reproduction consists in a study of those animals which have not yet come into oestrus within fifty to sixty days after parturition. On twenty farms, an inventory was made of the causes of anoestrus in these animals and the effects of anoestrus on fertility were studied. In addition, studies were done to determine whether there was a possible relationship between the causes of anoestrus and the age of the animals, the season, type of housing and the course of the last parturition and puerperium. Of the total number of 2,720 animals which had calved, 438 (16 per cent) had not yet come into oestrus within fifty to sixty days after parturition. This proportion varied markedly from one herd to another (8-24 per cent). The following causes of failure to come into oestrus were diagnosed: suboestrus (76 per cent), genuine anoestrus (9 per cent), ovarian cysts (2 per cent), pyometra (6 per cent) and gestation (1 per cent). All these changes obviously had an effect on the fertility of the herds (Table 1). Genuine anoestrus was found to occur particularly in primparous cows, whereas ovarian cysts and pyometra were diagnosed in the older cows (Table 2). It also became apparent that suboestrus and genuine anoestrus mainly are problems in tying stalls during the winter season (Table 3). There was not found to be any relationship between the presence of suboestrus or genuine anoestrus and the course of parturition and the puerperium. Fifty-two per cent of those animals in which a diagnosis of pyometra was established, had shown retained placentas (Table 4). In view of the fact that a diagnosis of suboestrus was so frequently established, particular attention should be paid to the detection of oestrus.

Age Factors↗

PubMed1996

Accounting for the peripartum loss of granulated metrial gland cells, a natural killer cell population, from the pregnant mouse uterus.

Natural killer (NK) cells become a prominent cell population in the rodent uterus during pregnancy. The mature, heavily granulated form of these cells is rare in virgin or postpartum uteri. Death, migration, or dedifferentiation could account for the disappearance of these cells from late gestation uteri. We asked whether uterine NK cells, also known as granulated metrial gland (GMG) cells, die in situ and if expression of Fas antigen is essential for their death. Late in gestation, fragmentation of nuclear DNA was detected histologically by OH-end labeling, as were ultrastructural changes suggesting cell death. NK cells developed in and were lost from the uteri of pregnant Fas antigen-deficient lpr/lpr mice. Postpartum samples of retained placentas contained some residual NK cells that had moved from regions of uterine musculature toward the uterine lumen and were being expelled with the placenta. Thus, both cell death and placental separation remove NK cells from the peripartum uterus.

Animals↗

PubMed1996

Use of corticosteroids alone or combined with glucose to treat ketosis in dairy cows.

OBJECTIVE: To compare relative efficacy of dexamethasone and flumethasone alone or in combination with rapid IV infusion of glucose for treatment of ketosis in cattle. DESIGN: Clinical trial. ANIMALS: 127 cows with urine acetoacetate concentration > or = 60 mg/dl. PROCEDURE: Cows were treated with 500 ml of 50% glucose solution. IV, and 40 mg of dexamethasone, IM (group 1), 40 mg of dexamethasone, IM (group 2), 5 mg of flumethasone (group 3), or 500 ml of 50% glucose solution, IV, and 5 mg of flumethasone (group 4). Treatment success was defined as recovery after a single treatment without relapse during the same lactation. Uterine disease (retained placenta or metritis), parity, and pretreatment plasma glucose, serum beta-hydroxybutyric acid, and urine acetoacetate concentrations were evaluated as possible confounding factors affecting recovery. RESULTS: Only uterine disease was found to have a significant effect on recovery. Treatments 1 and 4 were significantly more efficacious than was treatment 2, but efficacy of treatment 2 was not significantly different from that of treatment 3. Regardless of treatment, cows with uterine disease were less likely to have a successful outcome than were cows without uterine disease. In all treatment groups, plasma glucose concentration increased and serum beta-hydroxybutyric acid and urine acetoacetate concentrations decreased following treatment. CLINICAL IMPLICATIONS: In this study, treatment of ketosis in dairy cattle with a corticosteriod alone was less efficacious than treatment with glucose and a corticosteroid.

3-Hydroxybutyric Acid↗

PubMedDate not supplied

Maternal mortality following post-partum haemorrhage in Calabar a 6-year review.

During the 6-year period (January 1987 to December 1992) a maternal mortality rate of 16.2 per 1,000 deliveries and a post-partum haemorrhage case fatality rate of 2.2 percent were recorded at the University of Calabar Teaching Hospital. Sixteen of the 62 unbooked patients with primary post-partum haemorrhage died giving a case fatality rate of 25.8% as compared with a case fatality rate of 0.8% for booked patients with primary post-partum haemorrhage. A case fatality of 5.4% from induced labour compared with 1.8% from spontaneous labour was recorded, while assisted vaginal delivery had a case fatality rate of 4.7%. Uterine atony, retained placenta and coagulation defect in that order were the main causes of maternal death from primary post-partum haemorrhage. The case fatality rate amongst primigravidas now seems to be the same as that of grandmultipararas traditionally classified as high risk. Lack of adequate supervision of junior residents formed the major defect in the management of patients in this study.

Causality↗

PubMed1976

Induced parturition in cattle. 1. Clinical studies.

Parturition was induced in 17 Friesland heifers to decrease the possible occurrence of dystocia. The heifers were given 39 mg dexamethasone intra-muscularly on the 267th day of pregnancy and were observed for signs of impending parturition. The time of foetal membrane expulsion was noted. Parturition occurred on an average of 57 hours after corticosteroid administration. Three heifers required assistance during parturition. In one case a second injection of dexamethazone had to be given. The incidence of retained placenta was 68,8%. Rectal examination five to seven months after induction revealed that 76,5% of all animals were again pregnant. Of the four non-pregnant animals three had received assistance during parturition.

Animals↗

PubMed1998

Common peripartum emergencies.

Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic clues. Repetitive late decelerations may signify uteroplacental insufficiency, and a sinusoidal pattern may indicate severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardless of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for delivery are considered. Massive obstetric hemorrhage requires prompt action. Clinical signs, such as painless bleeding, uterine tenderness and nonreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean delivery. The causes of postpartum hemorrhage include uterine atony, vaginal or cervical laceration, and retained placenta. The challenge of managing shoulder dystocia is to effect a rapid delivery while avoiding neonatal and maternal morbidity. The McRoberts maneuver has been shown to be the safest and most successful technique for relieving shoulder dystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypertension.

Algorithms↗