Understanding Retention of Fetal Membranes in Veterinary Obstetrics

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Dr. Bhavna
Asstt. Prof.
Deptt. Of VGO
 
Introduction
 
 
The fetal membranes are normally
expelled during the third stage of labor.
 
The membranes are said to be retained
whenever the 
third stage of labor is
prolonged
 beyond its normal duration.
 
 
Occurs in all species, particularly
common in the dairy cow 
but its
consequences may be 
most serious in
the mare
.
 
In 
polytocous species
 (sow, bitch &
queen), may be associated with
retention of one or more fetuses
.
 
Causes
 
Three main factors:
1.
Insufficient expulsive efforts by the
myometrium.
2.
Failure of placenta to separate from
the endometrium (may be due to
inflammatory changes, placental
immaturity, hormonal imbalance,
immune deficiencies).
3.
Mechanical obstruction (including
partial closure of the cervix).
 
Cattle
 
Mostly cattle shed placenta within 6
hours after parturition.
Said to be retained if not shed even at
12-24 hours.
RFM is a recurrent theme in
considerations of the metritis-
endometritis-pyometra complex of
diseases.
An important contributor to bovine
infertility due to its role in
predisposition to uterine infections.
 
Incidence
 
Overall incidence is 6 – 8%.
 
25 – 50% associated with dystocia.
 
30 – 50% of twin births are associated
with RFM.
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Structure of the cotyledonary placenta
undefined
 
Physiologic processes leading to the detachment of the placenta in cattle.
 
Beagley et al. 2010
 
Factors which predispose to retained
fetal membranes
 
Abortion, especially associated with placentitis.
Abnormal (prolonged or shortened) gestation
length.
Dystocia, primary uterine inertia, delivery by
caesarean section
Fatty liver (predisposes to uterine atony)
Deficiencies of selenium/vitamin E /vitamin A
Failure of placental maturation - Twin births
and induced calvings
Heat stress
Abnormalities of oestrogen: progesterone ratio
in late gestation
 
Clinical Features
 
Membranes (normally visible hanging
from vulva) become progressively more
decomposed, have 
fetid odour
,
contaminated with faeces and soil.
Reduced appetite and milk yield
.
Retention followed by extensive
obstetric interference may be
supervened by 
severe metritis and
toxaemia
 within 2-3 days which can be
fatal, if not treated timely.
 
Effects on subsequent fertility
 
Increased incidence of 
endometritis
.
 
Once metritis is developed, leads to
economic losses 
due to increase in days
open, services per conception, calving to
first estrus interval and days from
calving to first service and reduced
conception rates to first service.
 
Treatment
 
Manual removal
, though commonly
practised but is contraindicated as it is
detrimental to the cow.
 
Can result in damage of endometrium,
leading to haemorrhage and infection.
 
If the animal has fever, uterine damage
increases the risk of septicaemia and
perimetritis.
 
 
Ecbolic agents
 
Oxytocin 
@ 40-60 IU intramuscularly,
if used immediately after calving.
 
PGF
α
 
and its analogues have direct
effect on the placentomes.
 
Antibiotics
 
 
Rationale behind using antibiotics is to
prevent or treat metritis.
 
Systemic antibiotics
 can be used.
 
Ceftiofur @2.2mg/kg intramuscularly
for 5 days.
 
Local/intrauterine antibiotics reduce
odour but reduce the rate of
putrifaction of membranes and level of
intrauterine phagocytosis thus,
prolonging retention.
 
Tetracyclines cause irritation and pH
damage to endometrium.
 
Intrauterine pessaries are inactivated
in the presence of debris present in the
uterus.
 
Collagenase
 
 
Infusion of collagenase into the stumps
of the umbilical arteries for correcting
the lack of cotyledon proteolysis.
 
Bacterial collagenase (200,000 IU)
from 
Clostridium histolyticum 
dissolved
in 1 L of saline is infused.
 
Prevention
 
Providing cow comfort.
 
Reducing stress around parturition.
 
Careful nutritional management
including supplementation of cows with
Vitamin E and selenium during transition
period in the deficient areas.
 
Mare
 
One of the most common peripartum
problems in mare.
 
Average time taken ̴ 1 hour
 
Should not exceed ˃ 2 hours
 
Should be treated as an emergency.
 
Incidence
 
 
Usually 2 - 10.6%
 
28% after fetotomy
 
50% after caesarean section
 
Clinical signs
 
 
Presence of a variable portion of tissue
protruding from the vulva.
 
Complications include -
acute metritis,
septicaemia,
laminitis and
even death.
 
Treatment
 
 
Oxytocin
 @ 20 – 40 IU intramuscularly,
can be repeated after 1 hour if
membranes are not expelled.
 
Alternatively, slow intravenous infusion
of 50 IU oxytocin in 1 L of physiological
saline over 1 hour.
 
Manual removal
 
Can be tried but very carefully.
The hanging part is grasped and twisted
into a rope.
The gloved hand anointed with lubricant
is gently introduced along the 'rope' to
the area of circumferential attachment
in the uterus.
As the 'rope' is gently pulled and
twisted, the tips of the fingers are
pressed between the endometrium and
the chorion.
 
Unwanted side-effects of this manual
removal may be serious haemorrhage,
invagination of one of the horns and a
higher chance of retention of microvilli
in the endometrium.
 
The consequences of difficult removal
are increased puerperal exudate,
containing much tissue debris;
endometritis and laminitis; uterine
spasm and delayed involution of the
uterus.
 
Another treatment is placement of 
10 L
of warm saline
 inside chorioallantoic
membrane.
Stretching of uterine wall stimulates
uterine contraction leading to
separation of placenta.
Should be used in combination with
exogenous oxytocin administration.
 
Collagenase 
@ 200,000 IU in 1 L saline
can be infused into umbilical arteries.
 
After care
 
Flushing and siphoning the uterus once
or twice daily for a few days using
warm, sterile physiological saline should
be used in 2-4 litre flushes (until the
recovered fluid is clear).
NSAIDS for treating laminitis, if any.
Systemic antibiotics in case of toxic
metritis.
COX inhibitors like flunixin meglumine
can be given to treat endotoxaemia.
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Retention of fetal membranes, a common issue during the third stage of labor, has significant consequences for animals, especially cattle. Causes include insufficient expulsive efforts and placental issues. The incidence ranges from 6.8% to 50%, often associated with dystocia and twin births. Factors predisposing to this condition include abortion, gestational abnormalities, and uterine inertia. Recognizing and managing these factors are crucial in veterinary obstetrics.


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  1. RETENTION OF FETAL MEMBRANES Dr. Bhavna Asstt. Prof. Deptt. Of VGO

  2. Introduction The expelled during the third stage of labor. fetal membranes are normally The membranes are said to be retained whenever the third stage of labor is prolonged beyond its normal duration.

  3. Occurs common consequences may be most serious in the mare. in in all the species, dairy particularly cow but its In polytocous species (sow, bitch & queen), may be retention of one or more fetuses. associated with

  4. Causes Three main factors: 1. Insufficient expulsive efforts by the myometrium. 2. Failure of placenta to separate from the endometrium inflammatory changes, immaturity, hormonal immune deficiencies). 3. Mechanical obstruction partial closure of the cervix). (may be due placental imbalance, to (including

  5. Cattle Mostly cattle shed placenta within 6 hours after parturition. Said to be retained if not shed even at 12-24 hours. RFM is a recurrent considerations of endometritis-pyometra diseases. An important contributor infertility due predisposition to uterine infections. theme metritis- complex in the of to bovine role to its in

  6. Incidence Overall incidence is 6 8%. 25 50% associated with dystocia. 30 50% of twin births are associated with RFM.

  7. Structure of the cotyledonary placenta

  8. Physiologic processes leading to the detachment of the placenta in cattle. Beagley et al. 2010

  9. Factors which predispose to retained fetal membranes Abortion, especially associated with placentitis. Abnormal (prolonged or shortened) gestation length. Dystocia, primary uterine inertia, delivery by caesarean section Fatty liver (predisposes to uterine atony) Deficiencies of selenium/vitamin E /vitamin A Failure of placental maturation - Twin births and induced calvings Heat stress Abnormalities of oestrogen: progesterone ratio in late gestation

  10. Clinical Features Membranes (normally visible hanging from vulva) become progressively more decomposed, have contaminated with faeces and soil. Reduced appetite and milk yield. Retention followed obstetric interference supervened by severe metritis and toxaemia within 2-3 days which can be fatal, if not treated timely. fetid odour, by extensive may be

  11. Effects on subsequent fertility Increased incidence of endometritis. Once metritis is developed, leads to economic losses due to increase in days open, services per conception, calving to first estrus interval and days from calving to first service and reduced conception rates to first service.

  12. Treatment Manual practised but is contraindicated as it is detrimental to the cow. removal, though commonly Can result in damage of endometrium, leading to haemorrhage and infection. If the animal has fever, uterine damage increases the risk of septicaemia and perimetritis.

  13. Ecbolic agents Oxytocin @ 40-60 IU intramuscularly, if used immediately after calving. PGF and its analogues have direct effect on the placentomes.

  14. Antibiotics Rationale behind using antibiotics is to prevent or treat metritis. Systemic antibiotics can be used. Ceftiofur @2.2mg/kg intramuscularly for 5 days.

  15. Local/intrauterine antibiotics reduce odour but reduce putrifaction of membranes and level of intrauterine phagocytosis prolonging retention. the rate of thus, Tetracyclines cause irritation and pH damage to endometrium. Intrauterine pessaries are inactivated in the presence of debris present in the uterus.

  16. Collagenase Infusion of collagenase into the stumps of the umbilical arteries for correcting the lack of cotyledon proteolysis. Bacterial collagenase (200,000 IU) from Clostridium histolyticum dissolved in 1 L of saline is infused.

  17. Prevention Providing cow comfort. Reducing stress around parturition. Careful including supplementation of cows with Vitamin E and selenium during transition period in the deficient areas. nutritional management

  18. Mare One of the most common peripartum problems in mare. Average time taken 1 hour Should not exceed 2 hours Should be treated as an emergency.

  19. Incidence Usually 2 - 10.6% 28% after fetotomy 50% after caesarean section

  20. Clinical signs Presence of a variable portion of tissue protruding from the vulva. Complications include - acute metritis, septicaemia, laminitis and even death.

  21. Treatment Oxytocin @ 20 40 IU intramuscularly, can be repeated after 1 hour if membranes are not expelled. Alternatively, slow intravenous infusion of 50 IU oxytocin in 1 L of physiological saline over 1 hour.

  22. Manual removal Can be tried but very carefully. The hanging part is grasped and twisted into a rope. The gloved hand anointed with lubricant is gently introduced along the 'rope' to the area of circumferential attachment in the uterus. As the 'rope' is gently pulled and twisted, the tips of the fingers are pressed between the endometrium and the chorion.

  23. Unwanted side-effects of this manual removal may be serious haemorrhage, invagination of one of the horns and a higher chance of retention of microvilli in the endometrium. The consequences of difficult removal are increased puerperal containing much endometritis and spasm and delayed involution of the uterus. exudate, debris; uterine tissue laminitis;

  24. Another treatment is placement of 10 L of warm saline inside chorioallantoic membrane. Stretching of uterine wall stimulates uterine contraction separation of placenta. Should be used in combination with exogenous oxytocin administration. leading to Collagenase @ 200,000 IU in 1 L saline can be infused into umbilical arteries.

  25. After care Flushing and siphoning the uterus once or twice daily for a few days using warm, sterile physiological saline should be used in 2-4 litre flushes (until the recovered fluid is clear). NSAIDS for treating laminitis, if any. Systemic antibiotics in case of toxic metritis. COX inhibitors like flunixin meglumine can be given to treat endotoxaemia.

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