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PubMed2000

Transvaginal sonohysterography for the evaluation and treatment of retained products of conception.

Diagnosing retained products of conception in a woman presenting with postpartum or postabortion bleeding presents a clinical challenge. Although ultrasonographic examination may be potentially useful in detecting retained products of conception, its accuracy has not yet been established. Saline infusion sonohysterography is a simple ultrasonographic technique for enhanced transvaginal sonographic imaging of the endometrial cavity by the instillation of saline into the uterine cavity during ultrasonographic evaluation. This technique enhanced our ability to diagnose retained products of conception, and we describe our experience in evacuating them under sonographic guidance while performing saline infusion sonohysterography.

Dilatation and Curettage↗

PubMed2007

The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage.

OBJECTIVE: To identify ultrasound measurements that are the best predictors of the presence of retained products of conception (RPOC) within the uterine cavity in women with clinical diagnosis of incomplete miscarriage. METHODS: This was a prospective observational study, set in a dedicated early pregnancy assessment unit in a London teaching hospital. Endometrial thickness and the volume of suspected retained products of conception were measured by transvaginal ultrasound scan preoperatively. Indications for surgical intervention were heavy vaginal bleeding or continuous bleeding lasting > 7 days. The main outcome measure was histological evidence of chorionic villi in surgical specimens. RESULTS: Among the patients, 109 (85%) had evidence of chorionic villi on histology, whilst decidua was only found in the remaining 19 (15%). There was no identifiable cut-off for endometrial thickness or volume that could be used to differentiate between retained products of conception and decidua. CONCLUSION: Measurements of endometrial thickness or volume on ultrasound scan are not good tests for diagnosing an incomplete miscarriage.

Abortion, Incomplete↗

PubMed2001

15-ketodihydro-PGF2 alpha, progesterone and cortisol profiles in heifers after induction of parturition by injection of dexamethasone.

In order to study rapid changes in 15-ketodihydro-PGF2 alpha, cortisol and progesterone in the period preceding parturition in cattle, pre-term parturition was induced in 4 late pregnant heifers. Parturitions were induced by 2 intramuscular injections of 20 mg dexamethasone with a 24-h interval. The first injection was made on days 254, 258, 264 and 265 in gestation, respectively. Twenty-four h before the first injection an intravenous polyurethane cannula was inserted. Blood samples were collected at least every hour until 12 h after parturition and during the second stage of labour at least 6 times per hour. Plasma was analysed for 15-ketodihydro-PGF2 alpha and progesterone by radioimmunoassays, and for cortisol by an ELISA. The average time from injection to parturition was 7.7 (6.6-8.9) days (mean (range)). Two of the heifers had retained foetal membranes (RFM). At the start of the experiment the levels of PGF2 alpha metabolite were low (< 300 pmol/L) and increased slowly to levels between 1000 and 2000 pmol/L at one day before parturition. During the last day, however, the levels increased rapidly and the highest levels (> 10,000 pmol/L) were reached at the time of delivery. No pulsatile release was seen. Immediately after foetal expulsion the PG-metabolite levels decreased rapidly in all animals. In the 2 animals with RFM, however, this decline ceased within a few h. The PG-metabolite levels in these animals then started to increase and reached levels as high as during parturition. Luteolysis occurred between 1.6 and 0.4 days before parturition in all animals. The cortisol profile showed a distinct peak at the time of parturition in the RFM heifers. This peak was absent in the non-RFM heifers. This study shows that the PGF2 alpha release at prepartal luteolysis and parturition is not pulsatile in cattle and that cortisol profiles in heifers with retained foetal membranes might differ from the profiles in non-RFM heifers at the time of parturition.

Animals↗

PubMed2003

Comparison of two protocols for the treatment of retained fetal membranes in dairy cattle.

Two protocols for the treatment of retained fetal membranes in dairy cattle were evaluated in a field trial. Cows that retained the fetal membranes for more than 12h were assigned to two treatment groups in an alternating order. In both groups rectal temperature was measured daily for 10 days after enrollment. In Group 1 (n=35) cows with a rectal temperature >or=39.5 degrees C received a systemic antibiotic treatment with 600mg ceftiofur intramuscularly on three consecutive days. No manual removal of the fetal membranes or intrauterine treatment was conducted. In case of elevated temperature of >or=39.5 degrees C on Day 3 treatment was conducted for another 2 days. In Group 2 (n=35) cows received a local antibiotic treatment (2500 mg ampicillin, 2500 mg cloxacillin) and an attempt was made to remove the fetal membranes manually. In case of a rectal temperature >or=39.5 degrees C 6000 mg of ampicillin were administered intramuscularly. Treatment was repeated on three consecutive days. If temperature did not decrease below 39.5 degrees C systemic treatment was extended for another 2 days. During 10 days of observation 33 and 34 cows showed fever, i.e. a body temperature >or=39.5 degrees C in Groups 1 and 2, respectively (94.3 versus 97.1%). The proportion of cows considered as cured (temperature <39.5 degrees C on Day 10 after enrollment) was 65.7 and 68.6% in Groups 1 and 2, respectively. All cows showed signs of chronic inflammation of the genital tract on Day 14 after calving. Within 4 weeks postpartum three (8.6%) and four (11.4%) cows were culled in Groups 1 and 2, respectively. Days to first service and days open did not differ significantly between the groups. Proportion of cows pregnant on Day 200 postpartum was 71.4 and 54.3% for Groups 1 and 2, respectively (P>0.05). Results indicate that treatment of retained fetal membranes without intrauterine manipulation and treatment can be as effective as conventional treatment including detachment and local antibiotic treatment.

Ampicillin↗

PubMed2004

Effect of injecting collagenase into the uterine artery during a caesarean section on the placental separation of cows induced to calve with dexamethasone.

A caesarean section was performed on 30 cows before normal term and 16 to 20 hours after the induction of parturition with dexamethasone. During the surgical procedure, 20,000 U of bacterial collagenase was injected into the uterine artery of 15 of the cows. The average periods of retention of the fetal membranes were 40 hours in the treated cows and 114 hours in the control cows (P<0.001). At 36 hours after the surgery six of the treated cows (40 per cent) but all 15 of the control cows had retained fetal membranes. The collagenase-treated cows showed no abnormal clinical signs during the 10 days after the operation.

Animals↗

PubMed1996

Oxytetracycline residues in milk after intrauterine treatment of cows with retained fetal membranes.

OBJECTIVE: To establish the maximum concentration and duration of oxytetracycline residues in milk from cows with retained fetal membranes given the antimicrobial via intrauterine infusion, and to investigate whether the number of infusions or the presence of fever (> 39.7 C) affected the duration of residues. DESIGN: Prospective study. ANIMALS: 54 Holstein cows with retained fetal membranes on a single 1,400-cow commercial dairy. PROCEDURE: Cows were treated once a day with 5 g of oxytetracycline (50 ml of 100 mg/ml solution in a povidone base) by intrauterine infusion for at least 2 days, or until the membranes were expelled. Cows that became febrile (rectal temperature > or = 39.7 C) were also given 20,000 IU of procaine penicillin G/kg of body weight, i.m., for 2 to 4 days. Milk samples were collected at 24-hour intervals during treatment. and at 12-hour intervals after the last treatment. All samples were frozen and submitted every 2 weeks for high performance liquid chromatography analysis for oxytetracycline. RESULTS: Oxytetracycline was detected in milk of all cows during treatment, at a maximum concentration ranging from 47.2 to 1,804.6 micrograms/kg (mean, 316.9 micrograms/kg). Duration of oxytetracycline residues after the last infusion ranged from 0 to 144 hours (mean, 52.3 hours). Neither the number of infusions received, nor development of rectal temperature > 39.7 C, affected the maximum concentration or the duration of oxytetracycline residues in milk. CLINICAL IMPLICATIONS: Milk obtained from cows that had been treated for retained fetal membranes by intrauterine infusion of oxytetracycline should be discarded to avoid illegal residues.

Animals↗

PubMed1999

Risk factors for Neospora caninum-associated abortion storms in dairy herds in The Netherlands (1995 to 1997).

A 2 to 1 matched case control study design was used to analyze herd level risk factors for Neospora caninum-associated abortion storms in 47 dairy herds. Data were obtained using a questionnaire regarding the state of affairs at the farms over the 2 years prior to the abortion storm. The questionnaire included 120 variables considered to be potential risk factors for either introduction of infection or recrudescence of chronic infection. The relationship between risk factors and case control pairs was analyzed by conditional logistic regression using a three-steps procedure. In addition, cross sectional serology was used to assess the possible role of concomitant infections. The main factors that were significant in the analysis and that were considered to have potential biological relevance were the presence of dogs, the presence of poultry, and the feeding of moldy maize-silage during summer. For both the presence of dogs and the presence of poultry on the farms, a linear relationship was found between the number of animals and the assessed risk for an abortion storm. These findings suggest a possible role of these species in the transmission of N. caninum. Further evidence for such a role of dogs was the significant association between the presence of dogs and the presence of seropositive cattle in the control herds. The feeding of moldy fodder is considered to be a factor which may induce recrudescence of a latent N. caninum-infection by mycotoxins causing immune suppression. We also found some evidence for a possible influence of management practices around calving and a high prevalence of retained afterbirths. No significant association was found for herd level prevalence of antibodies to bovine viral diarrhea virus, bovine herpesvirus 1, Leptospira hardjo or Salmonella dublin.

Abortion, Veterinary↗

PubMed1991

Lambing and placental expulsion time after dexamethasone-induced parturition in Corriedale and Polwarth ewes.

To study breed differences in ewes induced to parturition with dexamethasone (DXM), 15 Corriedale and 16 Polwarth ewes were injected with 15 mg of DXM four days before the expected lambing date (Days 144 and 145, respectively) in Experiment 1. Interval from treatment to parturition was twice as long for the Polwarth than for the Corriedale breed (57.9 vs 28.8 hours, P </= 0.001). In Experiment 2, the effect of DXM on the interval from parturition to expulsion of the placenta and on biological parameters of the lambs (birth weight, ability to stand after birth and daily weight gain during the first week of life) was studied in 30 Corriedale ewes. On Day 144 of gestation, ewes were given 15 mg of DXM (n= 22) or 15 ml of saline (controls, n= 8). The DXM group lambed 33.8 +/- 2.7 hours after injection. Treatment caused an increase in the time of placental expulsion (4.3 vs 3.4 hours, P>/= 0.05) and on the percentage of ewes retaining the placenta beyond 6 hours (18% vs 0%, P>/= 0.05). Birth weight of lambs was lower in the induced group (3.9 vs 4.5 kg, P</= 0.03), but this did not affect the other parameters of the lambs studied.

Journal Article↗

PubMed2006

Major advances in our understanding of nutritional influences on bovine health.

The Journal of Dairy Science has increasingly become a primary outlet for scientific research concerning the health of the dairy cow and her calf. This paper attempts to highlight Journal of Dairy Science articles that have linked nutrition and nutritional strategies to reduce disease incidence on the dairy farm. Disorders associated with an animal's inability to cope with the demands of high production include diseases such as milk fever and ketosis, which clearly are related to the cow's inability to maintain bodily functions in the face of negative calcium or energy balance. Improved nutrition of the late gestation cow can reduce the incidence of some of these disorders. Susceptibility to infectious disease is dependent on the integrity of the immune system, and recent studies have shed light on nutritional factors that affect leukocyte function. Other disorders, such as retained fetal membranes, udder edema, and displacement of the abomasum are not easily categorized as to their cause, but nutritional strategies have been developed to help prevent these disorders as well.

Acidosis↗

PubMed1999

Methotrexate treatment for retained placental tissue.

Three cases of placental polyps not responding to conventional medical and surgical treatment are presented. In all three cases, hCG in serum was negative but despite this a single injection of methotrexate successfully treated the condition. It is suggested that methotrexate acts not only on dividing trophoblastic cells but also has other effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2003

Collagen types I, III and IV in the placentome and interplacentomal maternal and fetal tissues in normal cows and in cattle with retention of fetal membranes.

The increase in uterine mass during pregnancy requires the establishment of sufficient blood supply to and strong supportive elements within the uterus. These needs are correlated with the remodelling and production of ECM materials. Therefore, placentomes and interplacentomal parts of the uterine walls and adherent allantochorion were collected from 45 cows at slaughter. Additional placentomes were obtained from 5 cows at premature cesarean section and at term in 5 cows releasing their fetal membranes in time or in 5 animals with retention of the fetal membranes, i.e. in total 60 pregnancies. Unfixed cryostat sections from 4 animals per month of pregnancy and 5 animals per peripartal group (in total 51 pregnancies) were used to immunolocalize collagen types I, III, and IV by an indirect FITC method. Collagen types I and III co-localize within the uterus. The tensile strength of the pregnant uterus is mainly represented by high contents of collagen type I within the allantochorion and subepithelial endometrial and subserosal meshes. Chorionic villi are fixed within caruncular crypts by two mechanisms: crypt openings are narrow and supplied with thick edges containing collagen types I and III. Collagen type IV contributes to all basement membranes and encloses connective tissue cells within the maternal crypt stroma, the stratum compactum and the perimetrial connective tissue. At term, fetal membranes and placentomes are edematous and at the light-microscopic level no distinct differences are visible between connective tissue fibers of placentomes from animals retaining the fetal membranes and those releasing them in time. In conclusion, collagen types I, III and IV exhibit type- and location-specific distribution patterns within the uterus of the pregnant cow. These may additionally be influenced by the stage of pregnancy, thus reflecting the dynamic processes at the stromal level.

Animals↗

PubMed1999

Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage.

BACKGROUND: To evaluate the efficacy and safety of selective arterial embolization in the management of intractable post-partum hemorrhage. METHODS: Thirty-five consecutive women with severe post-partum hemorrhage (primary, n=25; secondary, n=10) were treated by selective embolization of the uterine arteries. The main cause of immediate post-partum hemorrhage was atonic uterus. Retained placental fragments with endometritis was the main cause of delayed hemorrhage. In all cases, hemostatic embolization was performed because of intractable hemorrhage. Hysterectomy had been performed in two cases before embolization but it had also failed to stop the bleeding. RESULTS: Angiography revealed extravasation in ten cases, spasm of the internal iliac artery in four cases, false aneurysm in two cases and arteriovenous fistula in one case. After embolization, immediate cessation or dramatic diminution of bleeding was observed in all cases. Two patients required repeated embolization the following day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women but two who had hysterectomy. One woman became pregnant after embolization. CONCLUSION: Selective emergency arterial embolization is an effective means of controlling severe post-partum hemorrhage. This procedure avoids high risk surgery and maintains reproductive ability.

Adult↗

PubMed2003

[Retrospective study of the fertility outlook in cows after caesarean section].

Evaluating the possibility of performing a caesarean section on a cow with dystocia, the economic value of the animal usually plays a central role. The aim of this retrospective study was to analyse and to determine possible factors influencing the fertility. In 1998, 1999 and the first half-year of 2000 a total of 207 cows had a caesarean section. 68% of the inseminated cows which gave birth to a living calf became pregnant again, whereas only 46% of the cows with a dead calf were successfully reinseminated. Thus, 59% of all inseminated cows became pregnant, 2.5% of them had an abortion. The occurrence of retained fetal membranes or of endometritis has been shown to have negative effects on fertility. Only 30% of subsequent inseminations were successful in cows which had suffered from endometritis. The probability of being affected by endometritis was twice as high after birth of a dead calf than after a living calf.

Animals↗

PubMed2004

Postpartum uterine arteriovenous fistula.

BACKGROUND: Uterine arteriovenous communications are uncommon lesions that may be associated with life-threatening postpartum and postinstrumentation hemorrhage. CASE: A primigravida presented with infected retained products of conception. Excessive hemorrhage of unclear etiology occurred at dilation and curettage. After a second episode of bleeding, the patient received a diagnosis of uterine arteriovenous fistula. CONCLUSION: Uterine arteriovenous communications should be included in the differential diagnosis in patients with excessive postpartum or postinstrumentation bleeding. Color and spectral flow Doppler can aid diagnosis and clinical management.

Adult↗

PubMed2003

Effect of calcium-energy supplements on calving-related disorders, fertility and milk yield during the transition period in cows fed anionic diets.

The objective of this study was to determine the effect of a calcium-energy supplement at calving on the incidence of calving-related disorders (CRD), fertility, BCS and milk yield in cows fed anionic diets and to establish any associations among outcome variables. In Florida, from October to December 1997, 479 cows were assigned to three groups and treated at calving as follows: Group 1: 160 nontreated cows; Group 2: 158 cows, treated orally with 60g Ca as CaCl2; Group 3: 161 cows, treated orally with 110g Ca as calcium propionate (510g) plus propylene glycol (400g). No treatment effect was detected for any of the outcome variables. An association was found between dystocia and age and retained fetal membranes (RFM). Age and RFM were associated with metritis. RFM and displacement of the abomasum were associated with ketosis. Ketosis and age were related to displacement of the abomasum. Parity, BCS, ovarian cysts, RFM and metritis were associated with fertility.

Aging↗

PubMed2006

Comparison of two strategies for systemic antibiotic treatment of dairy cows with retained fetal membranes: preventive vs. selective treatment.

The objective of this study was to evaluate the efficacy of a blanket systemic preventive treatment (PT) of cows having retained fetal membranes (RFM) with 1 mg/kg of ceftiofur administered the first day after calving regardless of their body temperature. This strategy was compared with a selective treatment (ST) strategy in which only cows having RFM and a rectal temperature > or = 39.5 degrees C within 10 d postpartum received ceftiofur. Cows that retained their fetal membranes for at least 24 h after calving were allocated to 2 groups. Rectal temperature was measured daily for 10 d postpartum. Sixty PT cows having RFM received a daily ceftiofur (1 mg/kg of body weight) treatment, administered subcutaneously during the first 3 d after diagnosis of RFM. If rectal temperature was > or = 39.5 degrees C after 3 daily treatments, cows received ceftiofur for 2 more days. Therapy in 53 ST cows was based on selective administration of ceftiofur to cows having fever during the first 10 d postpartum. Treatment was conducted for 3 to 5 consecutive days as described for PT cows, beginning on the first day of fever. In both groups, manual removal of the placenta was not attempted and antibiotic drugs were not administered into the uterus. For every cow having RFM enrolled in PT or ST, 1 cow without RFM that had calved on the same day was enrolled in a healthy control group (n = 113). All cows received two 25-mg doses of PGF(2alpha): 1 dose between 18 and 24 d and 1 dose between 32 and 38 d postpartum. The PT did not reduce the proportion of cows experiencing fever during 10 d postpartum compared with ST cows (71.7 vs. 69.8%). Results were compared using logistic regression models and survival analyses. The artificial insemination submission rate between 42 and 62 d postpartum was greater in PT (41.2 vs. 20.8 vs. 24.5%), but total conception rate was less in ST and control cows, respectively (25.0 vs. 38.9 vs. 36.2%). In this trial, a preventive systemic antibiotic treatment of all cows having RFM was not superior to a selective antibiotic treatment of cows only in case of fever.

Animals↗

PubMed2002

Extramedullary hematopoiesis in the endometrium.

Extramedullary hematopoiesis (EMH) in the endometrium is an extremely rare occurrence. Four of the eight previously reported cases were related to an underlying hematological disorder, although the remainder had no such relationship. We describe a case of endometrial EMH associated with retained products of conception after termination of pregnancy. Routinely and immunohistochemically stained slides revealed several collections of normoblasts and granulocytic precursors in the endometrium with synchronous chronic endometritis. Retained chorionic villi were also identified. The patient had no known history of a hematological disorder or systemic disease and no such abnormality was detected after detailed hematological work-up. Local effects of growth factors on circulating stem cells may play a pathogenetic role in this process, although an association with recent pregnancy in this case suggests that implantation of fetal hematopoietic elements from the fetus or yolk sac may be more likely.

Abortion, Induced↗

PubMed1991

Characterization of receptors for insulin-like growth factors in human brain.

The structural properties of receptors for insulin-like growth factors (IGFs) in human brain were studied. Brain membranes were incubated with 125I-IGF-I or II, cross-linked with disuccinimidyl suberate and subjected to electrophoresis under reducing conditions and autoradiography. Two proteins with apparent molecular weights of 120 and 220 kD were specifically labeled. The labeled proteins were immunoprecipitated with monoclonal antibody to type IIGF receptors, indicating that they represent alpha-subunit and its dimer of type IIGF receptor. The size of brain alpha-subunit was smaller than placental alpha-subunit (130 kD). Treatment with N-glycosidase F reduced the brain alpha-subunit from 120 to 95 kD and the placental alpha-subunit from 130 to 105 kD. Neuraminidase decreased the placental alpha-subunit from 130 to 125 kD, but it had no effect on the mobility of the brain alpha-subunit. Solubilized IGF-I receptors from placenta were retained by wheat germ agglutinin and concanavalin A columns, and eluted with the specific sugars. In contrast, solubilized IGF-I receptors from brain did not bind to these columns. These results indicate that human brains have only type IIGF receptors and that the molecular size of the alpha-subunit in brain receptors is smaller than in placental receptors. The size discrepancy may result from the differences in both protein and carbohydrate moieties.

Affinity Labels↗