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PubMed2002

Bovine retained placenta: hormonal concentrations in fetal and maternal placenta.

The aim of this study was to evaluate the relationship between the occurrence of retention of the fetal membranes (RFM) and the hormonal concentrations of progesterone, estradiol-17beta, prostaglandin E(2) (PGE(2)), prostaglandin F(2alpha) (PGF(2alpha)), oxytocin (OT), oxytocin receptor (OT-R), endothelin-1 and angiotensin II (Ang II) in the placental tissues of cattle. Parturition was induced in nine Holstein cows by a single injection of PGF(2alpha) on Day 274 of gestation. Six out of nine cows in the induced group did not release the fetal membranes within 12 h after parturition and served as the RFM group, and the remaining three cows in that group, which released their fetal membranes within 12 h, served as the non-RFM group. Five other cows calved spontaneously and served as controls. The placental tissues were collected immediately (0 h) and at 6 h after parturition. The hormonal concentrations were measured by enzyme immunoassay in maternal and fetal placental tissues from RFM, non-RFM and control cows. There were no differences in P4 and E2 concentrations among the RFM, non-RFM and control groups. The mean PGF(2alpha) concentration of the RFM group was lower than those of the non-RFM and control groups in the maternal part of the placenta. In maternal tissues, the OT and OT-R concentrations in the RFM group were lower than those at 0 and 6 h after parturition in the non-RFM group. Additionally, the Ang II concentration of the RFM group in both the maternal and fetal parts of placental tissues tended to be higher than those of the other groups. In conclusion, the present results suggest that ET-1 and Ang II may play differential tissue-specific roles in the placental unit that may amplify the local endocrinological cascade involving OT, OT-R and PGF(2alpha) interactions which are necessary for normal placental separation in the cow.

Animals↗
PubMed1998

Intra-umbilical vein injection and retained placenta: evidence from a collaborative large randomised controlled trial. Grupo Argentino de Estudio de Placenta Retenida.

OBJECTIVE: To determine whether intra-umbilical vein injection with saline solution, with or without oxytocin, reduces the need for manual removal of placenta compared with expectant management. DESIGN: Multicenter, randomised controlled trial. SETTING: Eleven hospitals in four cities of Argentina: Buenos Aires, Corrientes, Rosario, and Salta. PARTICIPANTS: Two hundred and ninety-one women showing no evidence of placental separation thirty minutes after vaginal delivery. INTERVENTIONS: Three different management strategies: 1. intra-umbilical vein injection of saline solution plus oxytocin; 2. intra-umbilical vein injection of saline solution alone; and 3. expectant management. MAIN OUTCOME MEASURES: Primary: manual removal of the placenta. Secondary: blood loss after trial entry, haemoglobin level at 24 to 48 hours and at 40 to 45 days after delivery, blood transfusion, curettage, infection, and days of hospital stay. RESULTS: Rates of subsequent manual removal were similar: intra-umbilical vein injection of saline solution plus oxytocin (58%; RR 0.92; 95% CI 0.73-1.15), or saline alone (63%; RR 1.00; 95% CI 0.80-1.24), compared with expectant management (63%). There were also no detectable effects of the active managements on any of the secondary measures of outcome. CONCLUSIONS: Based on evidence available from randomised controlled trials, including this trial, it is unlikely that intra-umbilical injection with or without oxytocin, is clinically useful. We recommend that this intervention should not be used in third stage management of labour.

Female↗
PubMed2002

Decreased neutrophil function as a cause of retained placenta in dairy cattle.

It is unclear why some cows fail to expel the placenta following calving. One theory suggests the fetal placenta must be recognized as "foreign" tissue and rejected by the immune system after parturition to cause expulsion of the placenta. We hypothesized that impaired neutrophil function causes retained placenta (RP). We examined the ability of neutrophils to recognize fetal cotyledon tissue as assessed by a chemotaxis assay, which utilized a placental homogenate obtained from a spontaneously expelled placenta as the chemoattractant. Neutrophil killing ability was also estimated by determining myeloperoxidase activity in isolated neutrophils. Blood samples were obtained from 142 periparturient dairy cattle in two herds. Twenty cattle developed RP (14.1%). Neutrophils isolated from blood of cows with RP had significantly lower neutrophil function in both assays before calving, and this impaired function lasted for 1 to 2 wk after parturition. The addition of antibody directed against interleukin-8 (IL-8) to the cotyledon preparation used as a chemoattractant inhibited chemotaxis by 41%, suggesting that one of the chemoattractants present in the cotyledon at parturition is IL-8. At calving, plasma IL-8 concentration was lower in RP cows (51 +/- 12 pg/ml) than in cows expelling the placenta normally (134 +/- 11 pg/ml). From these data, we suggest that neutrophil function is a determining factor for the development of RP in dairy cattle. Also, depressed production of IL-8 may be a factor affecting neutrophil function in cows developing RP.

Animals↗
PubMed2002

Obstetric performance of a patient with multiple uterine and cervical fibroids and expectant management of retained placenta.

The aim of this case report is to describe the obstetric performance of a patient with multiple uterine and supravaginal cervical fibroids. A 36-year-old, gravida 3 para 0+2 with multiple uterine and cervical fibroids presented with inevitable abortion at 17 weeks gestation. She had a spontaneous rupture of membranes followed by expulsion of fetus as breech with entrapment of aftercoming head by a cervical fibroid. Oxytocin infusion and digital traction were able to deliver the fetus. The placenta, however, was trapped in the fundal area and could not be delivered under general anesthesia because of mechanical obstruction by the fibroid. Expectant management was successful in expulsion of the placenta within 7 days without complication.

Abortion, Spontaneous↗
PubMed1995

[Metabolic profile in cows in the peripartum period with and without retained placenta].

Blood samples were taken and subjected to biochemical analysis in the crossbred cows of the Red-Pied, Black-Pied or Holstein-Friesian breed raised on a large farm under standard conditions, with the average annual milk yield of 4,300 kg milk, and divided into two groups--cows with afterbirth retention and without it; the samples were taken in the last period of pregnancy (since day 245), during parturition, and within the first 50 days post partum. In both groups, the values of acid-base balance and metabolic profile mostly ranged within the interval of reference values, nevertheless there were certain trends and differences in absolute values as well as in the dynamics of changes, but they did not always show a doubtless character and the same significance. The cows with afterbirth retention exhibited a trend of a more expressive decrease in partial pressure CO2, actual acid output and phosphorus level. Glucose level at the end of pregnancy was statistically significantly lower (P < 0.01), cholesterol level also decreased (P < 0.05). On the other hand, the cows with afterbirth retention had, at the end of pregnancy, statistically significantly higher concentrations of urea and creatinine (P < 0.05-0.01), a higher bilirubin level and enzyme activities of acid phosphatase, and particularly of aspartate aminotransferase and lactate dehydrogenase (P < 0.05-0.01). There were insignificant differences in the concentrations of total protein, calcium, magnesium and enzyme activity of alkaline phosphatase and gammaglutamyl transferase.

Animals↗
PubMed2002

15-Ketodihydro-PGF(2 alpha), progesterone and uterine involution in primiparous cows with induced retained placenta and post-partal endometritis treated with oxytetracycline and flunixin.

Retention of the foetal membranes (RFM) and post-partal endometritis are common problems in dairy cows. Among other things, the disease is characterized by a bacterial endometritis with aerobic as well as anaerobic bacteria. From an endocrine perspective, cows with RFM have high levels of 15-ketodihydro-PGF(2 alpha) (PG-metabolite) immediately after parturition but these levels fall rapidly within 2 weeks post-partum (early PG-metabolite elevation). After this decline, the PG-metabolite levels increase again and the levels (at this time of a lower magnitude) remain elevated during the period of uterine infection (late PG-metabolite elevation). The aim of this study was to investigate the PG-metabolite profiles in cows with retained placenta and post-partal endometritis treated with the prostaglandin synthesis inhibitor flunixin (F), either alone or in combination with oxytetracycline (T). The study was accomplished over 2 years with 12 primiparous cows in each experiment. As a model for RFM, preterm parturition was induced in late-pregnant heifers by injecting PGF(2 alpha) (25 mg i.m) twice with a 24 h interval. In each experiment, the cows were divided into four groups and treated with either T (10 mg/kg b.w. i.m. once daily), F (2.2 mg/kg b.w. p.o. twice per day), a combination of T and F (dosage, as above), or conservatively (0). The treatment periods lasted from day 11 to day 14 post-partum (pp) in experiment 1 (after placental shedding, groups T1, F1, TF1 and 0) and from day 3 to day 6 pp in experiment 2 (before placental shedding, groups T2, F2, TF2 and 0). Jugular vein blood samples were collected for analyses of PG-metabolite and flunixin. Uterine biopsies were collected twice weekly for investigation of endometrial microbiology. Rectal palpation and ultrasonographic examinations were performed three times per week for investigations of uterine and cervical involution and ovarian activity. No attempts were made to remove the placentas manually. The experiment lasted until day 56 pp. The induction of parturition was successful in all heifers and 22 of 24 animals had RFM. All RFM cows had bacterial endometritis, based on bacteriological examinations. Flunixin treatment (F1, TF1, F2 and TF2) suppressed PG-metabolite levels significantly (p=0.006) during the period of treatment in both experiments. However, the early flunixin treatment only suppressed PG synthesis partially. Late oxytetracycline treatment (T1) did not influence the PG-metabolite levels but oxytetracycline treatment (T2 and TF2) before placental shedding significantly altered the kinetics of the early PG-metabolite elevation compared with other treatments. Late PG-metabolite elevation was significantly correlated to duration of uterine infection and cervical involution. In conclusion, flunixin treatment of cows with retained placenta either before or after placental shedding suppresses prostaglandin synthesis. However, early treatment, when the release of prostaglandins is high, might need more intensive treatment in order to prevent the PG synthesis effectively. Oxytetracycline treatment during the period immediately after parturition before placental shedding might influence the PG-metabolite profile and suggests a bacteriological contribution to the high levels of PG-metabolite seen during the first 2 weeks pp in cows with retained placenta. In this study, a correlation between prostaglandin release, the final cervical involution and the end of infection was found. This suggests a link between uterine endocrinology, bacteriology and involution in cows with retained placenta.

Animals↗
PubMed1990

Preterm delivery: a risk factor for retained placenta.

The purpose of this study was to determine whether preterm delivery, with and without intraamniotic infection, is a risk factor for retained placenta. This complication occurred more frequently in women with preterm vaginal delivery than in women with term vaginal delivery (9.1% [21/231] vs 1.1% [6/561]; p less than 0.00001; odds ratio = 9.25). There was no significant difference in the prevalence of retained placenta between women with preterm labor and intact membranes and those with preterm premature rupture of membranes (8% [10/125] vs 10.4% [11/106]; p greater than or equal to 0.05). A positive amniotic fluid culture or clinical chorioamnionitis was not associated with a higher incidence of retained placenta. This study indicates that preterm delivery is associated with an increased risk of complications of the third stage of labor.

Adult↗
PubMed1997

Postpartum plasma PGF metabolite profile in cows with dystocia and/or retained placenta, and effect of fenprostalene on uterine involution and reproductive performance.

Objectives of this study were to show postpartum plasma PGF2 alpha metabolite (PGFM) profile, to clarify whether endogenous PGF2 alpha plays a certain role in the uterine involution in cows with dystocia and/or retained placenta, and to examine the effects of fenprostalene, a long-acting PGF2 alpha analog, on the uterine involution and reproductive performance of the cows with abnormal puerperium. A group of 27 cows with dystocia and/or retained placenta showed a massive release of PGF2 alpha after parturition as indicated by a rise of plasma concentrations of PGFM, significantly higher than 33 cows with normal puerperium. The duration of the elevated plasma PGFM concentrations in the cows with abnormal puerperium was shorter than that of the normal cows. In cows with normal puerperium, those showing relatively longer duration of elevated plasma PGFM levels needed a shorter period for postpartum uterine involution than the cows showing a shorter duration of the PGFM elevation (P < 0.01), while no such relationship was observed in cows with abnormal puerperium. In field trials, an administration of an exogenous PGF2 alpha, fenprostalene, at 7 to 10 days (78 cows) or 14 to 28 days postpartum (74 cows) was found to be effective in facilitating uterine involution and resumption of ovarian cyclicity, and improved reproductive performance. It may be concluded that a large amount of PGF2 alpha is released for a relatively shorter period in cows after dystocia and/or retained placenta and the elevation of PGFM is not responsible for the uterine involution. The administration of the exogenous PGF2 alpha was shown to be effective at improving the postpartum reproductive performance of cows with abnormal puerperium.

Abortifacient Agents, Nonsteroidal↗
PubMed1990

Comparison between the influence of methylergometrine and oxytocin on the incidence of retained placenta in the third stage of labour.

Twenty randomly selected birth centres were questioned about their oxytocic use in the third stage of labour and incidence of retained placenta in relation to the number of vaginal deliveries during 1987. Ten centres used either methylergometrine or oxytocin routinely. Of 6,906 vaginal deliveries treated with 0.2 mg methylergometrine immediately after birth, 187 (2.7%) were complicated by retained placenta. Significantly fewer (p less than 0.001) of the 10,680 vaginal deliveries treated with 5-10 IU oxytocin were complicated by retained placenta (n = 192; 1.8%).

Cesarean Section↗
PubMed1998

Pregnancies complicated by retained placenta: sex ratio and relation to pre-eclampsia.

Pre-eclampsia and placenta accreta have opposite histological features of placentation. This study set out to test the hypotheses that the sex ratios in these two pregnancy complications are opposite and that these conditions are mutually exclusive. A population-based database covering all deliveries in South Australia between 1986 and 1995 and the hospital-based obstetric database of the Adelaide Women's and Children's Hospital, covering 8549 births between 1993 and 1995, were used to ascertain the sex ratios in singleton pregnancies and the sex ratios in those pregnancies in which there was retained placenta, hypertension in pregnancy, or pre-eclampsia. The likelihood of independence of occurrence or mutual exclusivity of retained placenta and hypertension in pregnancy or pre-eclampsia were also examined. The male:female sex ratio in the South Australian population was 1.077. In pregnancies with hypertension in pregnancy it was 1.165 (P<0.001) and in pregnancies with retained placenta it was 0.883 (P<0.0001). There was a trend to an increased sex ratio in pre-eclamptic pregnancy (1.248 in primigravid and 1.092 in multigravid women) but there was insufficient power to detect significance (P=0.207 and 0.470, respectively). Neither hypertension in pregnancy nor pre-eclampsia were mutually exclusive of placenta accreta: hypertensive disorders of pregnancy and placenta accreta occurred independently of each other. Our findings suggest that sex-linked antigens are unlikely to influence maternofetal interactions consistently to give rise to one but not the other pregnancy complication.

Adult↗
PubMed2004

Major histocompatibility antigen expression on the bovine placenta: its relationship to abnormal pregnancies and retained placenta.

In viviparous animals, regulation of expression of major histocompatibility complex (MHC) class I antigens by the trophoblast cells, which constitute the outermost layer of the placenta, seems to be critical for maternal immunological acceptance of an allogeneic fetus. Cattle are unusual in this regard, since the bovine trophoblast cells, in specific regions of the uterine/placental interface, normally express MHC class I antigens during the third trimester of gestation. This expression appears to be biologically relevant as MHC class I compatibility between a cow and her fetus has been associated with an increased incidence of placental retention. We have found significant differences in lymphocyte populations, cytokine production, and trophoblast cell apoptosis in the placentomes of MHC-compatible and -incompatible pregnancies at parturition. This suggests that maternal immunological recognition of fetal MHC class I proteins triggers an immune/inflammatory response that contributes to placental separation at parturition in cattle. Early in pregnancy, a complete shutdown of MHC class I expression by trophoblast cells appears to be critical for normal placental development and fetal survival. In bovine somatic cell nuclear transfer (SCNT) pregnancies, there is an extremely high rate of fetal loss between days 30 and 90 of pregnancy. We have shown that in bovine SCNT pregnancies, between days 34 and 63 of gestation, there is both abnormal expression of MHC class I antigens by trophoblast cells and an abnormal accumulation of lymphocytes within the uterine stroma. Consequently, it is likely that activation of the maternal mucosal immune system, within the uterus at the same time when placentomes are being established, interferes with the process of placentome development and leads to immune-mediated abortion. Our data suggest that bovine MHC-compatible pregnancies provide a unique model for studying regulation of the uterine immune system, as well as immune-mediated placental rejection.

Abortion, Veterinary↗
PubMed1992

Reduced incidence of retained placenta with induction of parturition in the cow.

Two experiments were designed to determine whether pretreatment with Opticortenol (OPT), a long-acting corticosteroid, prior to induction of parturition with 25 mg of dexamethasone (DEX) alone or in combination with 500 mug cloprostenol (CLO) would result in a reduced incidence of retained placenta. In Experiment 1, 70% of the cows pretreated with 25 mg OPT on Day 270 of gestation calved before or within 24 hours of the scheduled induction treatment on Day 277. Cows induced to calve with DEX plus CLO without OPT pretreatment had an increased rate of placental retention (P<0.05), whereas, cows that received OPT were not different from the controls. In Experiment 2, cows received either 1 mg/25 kg OPT (high dosage) or 1 mg/50 kg OPT (low dosage) on Day 270 of gestation and were induced with DEX plus CLO on either Day 274 (4 days) or Day 276 (6 days). Cows claved 29.0 to 31.8 hours after induction treatment with 95% beginning to calve between 0700 and 1900 hours. The interval from calving to placental release and the incidence of retained placenta was not different between the high dosage 6-day group (29.4+/-8.2 hours, 29%) and the non-induced control cows (16.1+/-10.7 hours, 5%). When three cows in the high dosage 6-day group that retained their placentas for 30 to 36 hours were considered as not retained, the incidence of placental retention for that group was reduced still further to 17%. First service conception rates and pregnancy rates were lower in cows with retained placentas. Differences were significant (P<0.01) in Experiment 1 but not in Experiment 2. It was concluded that pretreatment with 1 mg/25 kg OPT 6 days prior to induction of parturition with DEX plus CLO in combination results in a predictable calving time, high calf viability, and a low incidence of placental retention.

Journal Article↗