Postpartum complications in buffaloes--a review.
The postpartum period is often related with complications, disease and disorders as majority of buffaloes are sold near term. It is possible to control postpartum complications with prompt veterinary aid and treatment but it is most appropriate to effect preventive measures during pre-partum period at stage of advance pregnancy for avoiding post partum problems. Following are some important measures which can be implemented under all circumstances in buffaloes on generalized basis to avoid and avert post partum complications.
1. Drying off: Majority buffaloes are not in milk during advance pregnancy. High yielder buffaloes can be dried off with simple management practices viz. incomplete milking, withholding of water, reducing quantity of concentrates, reducing number of milkings. On drying, it is necessary to administer intramammary preparations for keratinization of teat canal and sphincter as well as to control udder health.
2. Monitoring appetite: Advance pregnancy leads to increased abdominal load, discomfort and restlessness, thus reduced appetite. Dietary requirements need to be fulfilled through feeding management even against will of animal. It is possible to provide fresh chaffed fodder with inclusion of different varieties for increasing curiosity of animal to manger. Buffaloes will refuse to intake fodder but will prefer concentrates. The ratio of fodder to concentrates as 60:40 towards lowered milk production needs to be slowly turned to 40:60 near term for avoiding acute change in feeding pattern after parturition.
3. Immunity improvement: Since buffaloes are under severe stress during advance pregnancy, it is important to strengthen their immunity through immune modulator drugs. Vitamin A, D and E along with Selenium is necessary and additional requirement before term. Improved immunity will avoid peripartum and postpartum infections, in particular. Buffaloes supplemented with antioxidants and ecbolics had lower oxidative stress as indicated by various enzymes and exhibition of early postpartum estrus.
4. Placental maturation: Prompt expulsion of placenta is dire necessity after parturition and placenta must mature and degenerate before separation and expulsion.
5. Metabolic prophylaxis: Ketosis and milk fever are two most important production related disorders of postpartum period and with new approaches can be restricted by following prophylactic treatments before term. The hypocalcaemia and energy deficit can be monitored to avoid the production diseases through preventive therapies which are to be administered approximately ten days before term.
6. Energy supplementation: It is well known fact that parturient buffaloes suffer from negative energy balance and stage proceed for next two-three months. Elevated non-esterified fatty acids in blood indicate alternate body mechanism to compensate blood glucose through utilization of body fat depot. It is possible to use glucose therapy orally before and after parturition and to avoid speedy recovery from negative energy balance in buffaloes.
Post partum reproductive challenges
Buffalo rearing units have to face following reproductive challenges at each calving to optimize productivity
i) Prompt expulsion of placenta
ii) No metabolic disorder
iii) Speedy uterine involution
iv) No adverse effect of negative energy balance
v) Constant increment in milk production
vi) Early attainment of peak milk yield
vii) Early resumption of oestrus cyclicity
To deal with all these reproductive challenges, immediately after safe foetal delivery, antibiotic coverage, energy supplementation, fluid therapy, intrauterine therapy and high calorie diets are necessary and are to be given as per case merits.
Post partum problems can be classified into four broad categories like reproductive, traumatic, infective/ inflammatory and metabolic complications. All complications are acute and possibly fetal in neglected cases or atleast they lead to immediate productivity and future fertility losses in buffaloes. Similarly, these complications also increase risk of death of new born due to incomplete nutrition.
Postpartum complications are the biggest bottlenecks in achieving desired calving to conception interval. Identification of prepartum biomarkers that could predict risk of developing post partum complications and development of (on-spot) diagnostic kits based on identified markers could help in reducing losses associated with post partum problems (Bujarbaruah, 2012).
Delay in placental expulsion beyond six hours of foetal birth is considered as retention of placenta. Mature degenerated placenta is functionless after foetal birth and hence needs to be expelled out by uterus. Placenta plays vital role during pregnancy and its process of seperation starts many days before parturition and depends on dilatation of maternal caruncular crypts and shrinking of foetal chorionic villi.
Approximately 16 million bovines are affected by placental retention in a year in India and keeping in view loss in milk production (10%) in affected animals, it can be estimated that 2.5 million tons of milk is lost which tantamount to loss of 50000 million INR indicating seriousness of the condition (Kumaresan et al., 2014).
The incidence of retention of placenta is 80 per cent due to failure of fetomaternal junctions and 20 percent due to lack of strength of myometrial contractions to expel the same. A farm having incidence of retention of placenta cases more than 7 percent should investigate the cause. Incidence of retention of placenta in different breeds of cattle and buffaloes reported recently indicates 7.6 and 2.73 percent cases in Surti buffaloes by Murugeppa and Dubey (1997) and Murugeppa (1998), whereas in Murrah buffaloes the same is reported to be 4.01, 8.63, 6.01-14.0, 46.37 and 13.08 by Prasad and Prasad (1998), Taraphder (2002), Thavani et al. (2011) and Kumari (2013), respectively.
Many factors attribute to the causes of retention of placenta in buffaloes. Lack of dehiscence of placental membranes is because of extended duration of gestation period, cooler season (spring), dairy type breed, male calf, twins, abortion, dystocia, still birth, primiparaous animals, lack of exercise, low level of progesterone, low level of Vitamin A, disturbance in mineral metabolism, deficiency of Vitamin E and Se, deficiency of iodine, lack of uterine contractions, infections and transport.
Predisposing factors for placental retention depends on degree of placental degeneration before calving, decrease in uterine blood flow after fetal expulsion and decrease in speed of uterine ovulation due to deficient levels of glucose and minerals.
Mandali et al. (2002) observed significantly lower mean glucose and serum calcium levels in buffaloes with retention of fetal membranes. Studies on blood biochemical parameters in Surti buffaloes by Pathak et al. (2006) indicated disturbed calcium phosphorus ratio because of significantly lower level of phosphorus, may be the factor in delayed placental expulsion in buffaloes. Higher levels of protein in retained placenta may be due to its bio-synthesis which could be the reason for its delay. Higher levels of progesterone and protein in circulations are responsible for delay in placental expulsion. Total and free cholesterol levels on higher side in placental retention have also been estimated. High cholesterol may be supporting for higher steroid production which is known for delay in placental expulsion. Serum GOT and LDH activities are significantly higher in retention of placenta cases.
Ray et al. (2004) reported that total leukocyte count, eosinophil and monocyte percentage do not vary significantly but neutrophil count is significantly lower and lymphocyte percent is significantly higher in retained placenta cases.
Serum calcium, in-organic phosphorus, Alanine amino transferase and Asparate amino transferase concentrations in placental retention did not differ significantly but Alkaline phosphatase activities were significantly higher (Ray et al., 2004). Higher Alanine amino transferase is related to development of necrosis of cotyledons and some part of caruncle during separation. Serum Alanine amino transferase activities enhance due to leakage from placenta after tissue damage.
Cortisol levels are greater in placental retention conditions and associated with oxidative stress. There is evidence that immune system has great relevance as it should recognize placenta as a foreign body to expel. In fact, white blood cells and specifically neutrophils are involved in recognition of fetal cotyledonary tissue as foreign for expulsion. Lower levels of neutrophils with retained placenta suggested lower ability of cells to recognize placental issue as foreign and thus fails to expel the same.
Sero-monitoring prepartum levels of serum cytokines (IL-10, TNF[alpha] and IL-6) can predict retention of placenta in cows. T-lymphocytes are considered as predictive markers of retention of placenta in buffaloes (Singh et al., 2003). Retention of placenta is associated with abnormally low levels of peripheral blood thymus dependent T-lymphocyte at calving and prepartum lower levels can be considered as predictive marker. It was observed that better the initial state of health of buffaloes, in terms of their peripheral blood thymus dependent lymphocytes--sheep red blood cell--rosettes status, better the pregnancy outcome and also for Vitamin A values during the third trimester and at calving.
Pre-partum supplementation of Vitamin E and Selenium reduces levels of lipid peroxide and there by incidence of retention of placenta. Injection of Vitamin E and Selenium increases levels of [alpha]-tocopheral in RBC, neutrophil and plasma and also increases the biochemical activity of glutathione peroxidase (GSH-Px). Vitamin E is considered to be an antioxidant, preventing oxidative damage to sensitive membrane lipids by destroying hydroperoxide formation, acting in conjunction with Selenium which is a part of GSH-Px, protects cellular membrane and lipid containing organelles from peroxidative damage by inhibition and destruction of endogenous peroxides, thus maintains integrity of membrane and reduce oxidative stress (Gupta et al., 2004).
Post-partum uterine soundness is most essential for re-establishment of reproductive activity in dairy animals. Delayed in uterine involution, chronic metritis and poor conception rate are common sequelae to retention of foetal membranes (Roberts, 1971).
Treatment for expulsion of placenta is possible at three levels
1. Preventive approach-before term
2. Preventive approach--after term
3. Curative approach after placental retention
Pre-partum herbal ecbolic administration is possible way to effect prompt placental expulsion after parturition. There are no side effects of pre partum treatment and chances of retention are drastically reduced. However no herbaceuticals are proposed for such preventive approach.
After parturition, suitable approach is proposed to administer oxytocin for three days followed by prostaglandins for three days for better expulsion of placenta and its shreds with speedy and early uterine involution. Oxytocin @ 30-50 IU and prostaglandin @ 25 mg can be used. Prostaglandins causes myometrial contraction, placental separation and expulsion with infiltration of neutrophils, thus also clears infections through phygocytosis.
Sinha (2002) used prostaglandins 6 hrs of parturition in crossbred cows and noted no significant difference with respect to reduction in diameter of cervix and uterine cornua in treatment and control group.
Manual removal of placenta is controversial and arguments are based on experiences. Manual removal is only attempted after 18-24 hours of calving under aseptic condition, not exceeding 10 minutes, without injury to maternal caruncles. On attempt, gently squeeze base of maternal caruncle so as to open crypts on its convexity, the thumb is lightly passed over periphery of caruncle in order to complete the separation of released villi. Continuous steady traction and rotational force are applied with other hand carrying placental mass.
Gaundi et al., (2004) cited six arguments of Boyd (1992) for manual removal of placenta.
* Avoids putrefied smell.
* Ensure hygiene.
* Early ovarian rebound and increment in future fertility.
* Avoid symmetric illness.
* Maintains high milk production.
* Small number of conservatively treated cows requires life saving treatment.
Overdosing of antibiotic in cases of retention of placenta leads to delayed uterine involution and delay in post partum oestrus with chances of metritis or pyometra. In fact, some bacteria actually aid uncoupling of placenta, which are eliminated by antibiotic. Anti-microbial drugs like oxytetracycline and nitrofurazones are used with urea in intra uterine therapy. Penicillins are used only parentally. Kulasekar et al. (2004) suggested parental antibiotic therapy without manual removal for retention of fetal membranes in cattle. It is suggested to use antibiotics, if cow is expected to suffer from puerperal metritis.
Oral or injectable ecbolics and uterine tonics are most safe in retention of placenta cases. Supportive fluid therapy and anti inflammatory, anti-histaminic treatment are useful. Gautam et al. (2003) conducted three experiments in buffaloes and concluded that no ecbolic herbal preparation or uterine tonic is effective in treating established cases of retained fetal membranes. However, Markendeya et al. (2012) observed that herbal uterine cleanser can provide best alternatives to strong irritant chemicals and antibiotic molecules for placental expulsion and further reported that polyherbal uterine cleanser and restorative treatment in buffaloes helps to treat delayed involution of uterus and subsequent fertility.
Khan et al. (2009) suggested therapy of ergot alkaloids and intra uterine antiseptics with use of calcium and glucose during pre pregnancy stage for prevention. Dutt et al. (2009) reported new concepts in treatment of retained fetal membranes like use of collagenase enzyme which causes collagenolysis and loosening of cotyledon from caruncle. Umbilical cord infusion with 200,000 units of bacterial collagenase in 1 L of saline is safe and potentially effective treatment for retained placenta.
Satapathy et al. (2012) reported combination treatment of ecbolics, calcium and prostaglandin has got highest efficacy (1.05%) for inducing normal uterine involution and prevention of retention of foetal membrane and uterine infection than ecbolics alone (4.55%), ecbolics with calcium (2.35%), injectable ecbolic (1.26%), or injectable prostaglandin (4.62%) therapy.
Prolapse of genitalia
Although pelvic cavity carry and sustain reproductive organs in empty animals, holding capability of pelvic ligaments is questionable during uterine contractibility and hence atonic reproductive tract and uterus can be forced out through birth canal with uterine contractions before and after parturition. Initially vagina, cervix and then uterus, rectum and even bladder, intestines may follow eversion and prolapse.
In majority cases, prolapse of vagina and cervix is evident. Pluriparous buffaloes often suffer from cervico-vaginal prolapse. However, excessive expulsive force of uterus can push uterus through birth canal immediately after foetal birth. Complete eversion of uterus after foetal expulsion is amply reported in literature as post partum emergency condition. Open cervix and lack of tone of uterus predisposes prolapse.
There are strong indications that prolapse of genitalia is a heritable trait in buffaloes (Nanda and Mishra, 2004) and repeatability is reported on basis of incidence by Tomar and Tripathi (1992) as 0.424.
In complicated cases of prolapse involving multiple organs, intra-abdominal haemorrhage with shock due to exposure of visceral organs might be responsible for death of animals. Severe bleeding or uterine infection occurring after delivery is a serious, potentially fatal situation. Hypocalcaemia is usually thought to predispose genital organ prolapse.
Mishra et al. (1997) reported prolapse of genitalia in buffaloes in 98.40 percent pluriparous and 82.50 percent stall fed buffaloes with remark that negligence in treatment of prolapse may result in permanent damage to reproductive organs followed by their dysfunction. Prolapse of genitalia has been observed in all domestic animals but the incidence of prepartum vaginal prolapse has been reported to be higher than any other type of prolapse in buffaloes (Pandit et al., 1982).
Mandali et al. (2002) estimated blood biochemical profile in buffaloes suffered from postpartum prolapse and reported serum calcium level was lower, Inorganic phosphorus level was significantly lower and magnesium levels did not differ for normal buffaloes.
The condition is noticeable in buffaloes and according to symptoms, severity, stage and mass size the disorder is generally classified into four categories.
i) Grade I prolapse: Part of vaginal mucus membrane is protruded when animal is in recumbent position and retracted back as soon as the animal stands up.
ii) Grade II prolapse: Prolapsed part of vagina and cervix will be evident even though animal is in standing position and on recumbency. The condition leads to lacerations, injuries, bleeding and bites by external agents. Mild uterine contractions are noticeable with animal discomfort.
iii) Grade III prolapse: Complete eversion of vaginal mucosa, cervix and part of uterus with strong strainings, regular forceful contractions, injuries and lacerations to exposed part, devitalization, bleeding and animal suffers from pain and agony due to distention of bladder. Animal attempts to urinate but fails.
iv) Grade IV prolapse: Involves prolapse of reproductive organs and part of rectum with severe discomfort, strong forceful strainings, profuse bleeding and devitalization of prolapse part.
The treatment of prolapse depends on time lapse, size of prolapse, injuries to prolapse mass and entry of infection. It is possible to treat fresh case of prolapse mass with favorable but prognosis for delayed cases is unfavorable and fetal at times. Skill, patience, experience and scientific approach are essential for treatment.
Relieving of bladder, epidural anesthesia, sedation, cleaning with dressing of prolapsed part are most important prerequisites in prolapsed cases.
On attending a case of prolapse, relieve bladder at first. This will impose ample comfort and siege of relief to animal. It is necessary to administer epidural anesthesia to facilitate handling of prolapsed part. Posterior epidural anesthesia retaining for 20-30 minutes is necessary. Always check reactivity or aggressiveness of animal and as per need, use tranquilizers or sedatives.
Cleaning of prolapsed part with lukewarm antiseptic for removal of dust, dung, dirt, debris, broken membranes, inanimate objects, adhered items is most essential to revitalize prolapsed part. Thorough cleaning of all prolapsed parts with mild warm antiseptics is necessary and then dressing of injuries, ligation of bleeding vessels, applications of anesthetic ointments should be followed.
Treatment of prolapse consists of three steps like reduction, reposition and retention.
1. Reduction: The prolapse mass needs to be reduced in size with all efforts to reduce emphysema. It is possible to use ice cubes, application for reduction of mass size. Herbal spray for reduction in mass size is recent clinical approach in prolapse cases. (cold water, hypertonic sugar solution) Local administration of oxytocin and adrenaline in uterine musculature can reduce size of prolapsed mass. Application of magnesium sulphate and glycerin paste is also helpful. Edema of prolapsed mass can be minimized by using hygroscopic solution like cold alum or sugar.
2. Reposition: Reposition necessitates applications of force on centre of prolapsed mass. It is necessary to lubricate prolapsed mass for facilitating reposition. Boiled common oil is regularly used on field level but market available lubricants are most suitable for effective reposition. Once centre of prolapsed mass is reposed, its possible to push the reminder peripheral part of prolapsed mass at site. The reposition must be confirmed and on proper reposition, no care should be left for recurrence of prolapse. As uterine contractions are going on continuously, many reposed parts prolapse within no time after reposition and hence care is necessary. While reposing the mass, no pressure should be applied with finger tips. Palm pressure is most suitable to repose prolapse mass starting from lateral walls, middle portion and roof of vagina.
3. Retention: Once prolapsed mass is properly reposed, it is possible to retain the same at appropriate site by reducing luminal diameter of birth canal. The best approach is to applying rope truss. It is recommended to prepare loose loop of only cotton rope to reduce vulval opening. Many farmer breeders can themselves apply rope truss but it is pertinent to note that rope truss should be moved sideways after to avoid skin irritation and injuries. Also, it is mandatory to closely observe that animal can urinate comfortably.
Vulval opening is closed partially can be applied sutures after reposing of prolapsed mass. Use of vulval suture and negligence towards reproductive infection lead to forceful and violent contraction leading to rupture of suture and severe damages to vulvar portions. Hence, antibiotic, anti-inflammatory, analgesic, supportive and pain relevant treatment is highly essential.
Naidu et al. (2009) reported buffaloes in which Buhner's suture was applied showed early recovery and less post operative stress with minimal cicatrisation and no deformity of vulval lips but use of rope truss and shoe lace pattern of vulval sutures to retain prolapsed mass resulted in severe post operative test, longer time of recovery, deformity to vulval lips with reduction in aesthetic and market value of animals.
Prolapsed cases generally carry infections and contractions are difficult to be handled for retention of prolapsed mass as continuous vaginal irritation, pain, odema and inflammation at level of birth canal leads to discomfort. It is necessary to check straining in case of prolapse and generally Isoxuspurine HCl is used to prevent uterine contractions.
Singhal et al. (2011) reported postpartum uterine prolapse in Murrah buffaloes where clinical management failed to save life of animals and observed that stall fed pluriparous buffaloes are prone for prolapse and old age, off feed state, anaemic condition leading to hypocalcaemia and further uterine inertia results in total uterine prolapse. Trauma, injury, necrosis of prolapsed uterus might result in exaggerated release of inflammatory mediators and toxins which may direct animal towards shock. Sachan et al. (2012) reported post-partum uterine prolapse with vulvovaginitis in Murrah buffalo and treated successfully. Suresh Kumar (2013) reported complete uterine prolapse in a buffalo after assisted delivery due to tenesmus.
All prolapse cases in buffaloes needs appropriate managemental approaches after treatment for next ten days which includes
i) Provide laxative feed and fodder.
ii) Reduce abdominal load by over feeding.
iii) Supply fodder in divided parts.
iv) Use stanchions in cow sheds.
v) Continue antibiotic and uterine tonic therapy.
Now a day, many hospitals have facilities of hind quarter elevator to treat prolapse and the same can be used for 3-4 days for support. Delay in handling prolapsed mass outweighs and may result into rupture of mesovarium and ovarian artery leading to internal haemorrahages and finally death due to shock (Noakes et al., 2001).
Delayed uterine involution
Uterine involution is dependent upon concentration of prostagladin metabolites at parturition (Lindell et al, 1980), status of microflora present (Deka et al., 1985) and is generally delayed with increased parity (Peter et al., 1987) and during colder season (Etherington et al., 1985).
Handling, assisted delivery or obstetrical maneuvers attempted to relieve dystocia may lead to severe injuries, lacerations/istalation, tearing of external genitalia. These cases are prone for ascending infections, uterine infections, delayed involutions and post partum infertility problems. Neglected cases lead to prolapse, bleeding or permanent damage to genitalia.
Lacerations: Perineal lacerations are injuries to vulva and adjoining skin due to sharp objects while handling of dystocia or assisted delivery. Dilation of birth canal is necessary in case of relative oversized fetus. Forceful dilation of vaginal passage and vulva in particular leads to injuries. Surgical dilation of birth canal in stenosed vulva is affected by episiotomy. On removal of fetus, the surgical incision is closed with sutures. All lacerations are increasing chances of infections and also ascending infections.
Perineal lacerations are classified as first, second and third degree lacerations. First degree lacerations occur when only mucosa of vulva/ vestibule/vagina is involved. Second degree laceration occur when full thickness of vulva/ vestibule/vagina wall is involved but not the rectal wall/anus. Third degree laceration when full depth of vulva/vestibule/vagina wall as well as recto-vaginal tear, including and sphincter or recto-vaginal fistula is involved. Repairing of peroneal laceration, particularly in third degree laceration involving rectal wall, there is considerable risk of intra operative and postoperative bacterial contamination, mechanical abrasion of wound and sutures or contamination by faeces and this may limit successful outcome. To minimize this problem, complete fast the animal for 48 hours preoperatively to 24 hours post-operatively should be done. Surgical repair is performed either within 12 hours of injury or after edema and inflammation have subsided usually after 6-8 weeks. If the condition is not corrected, future breeding life of animal become poor.
Bleeding and Haematoma: Postpartum bleeding occur due to trauma, lacerations or tearing of tissues. Hemorrhages are possible on injury to caruncles at time of forceful handling of placenta or intra uterine manipulations.
Cervical bleeding is expected in cases of failure of cervical dilation and large blood vessels of birth canal may rupture due to forced traction. Cervical tear and bleeding can be prevented by local pressure, cold fomentation and ligation. It is possible to induce cervical prolapse by ligation of large blood vessels.
It is possible to administer oxytocin 30-50 IU and injection Calcium borogluconate with injections of hemostats based on extent of bleeding. Oxytocin prevents hemorrhages at dose rate of 20-50 units. Treatment of hemorrhages involves supportive treatment and fluid therapy. Injection saline with 10 cc of formalin helps for cloating of blood. Calcium gluconate is advisable in cases of bleeding. Blood transfusion is rarely attempted.
Postpartum haematoma are left untreated with overall supplementation of anti-inflammatory and analgesic drugs. These local injuries are absorbed generally within 5-10 days. However, site incision with evacuation of clout and suturing site is possible. If contusions are observed, edema can be treated with cold and hot applications.
Profuse blood loss due to uterine bleeding within 24-36 hrs of foetal birth is a serious condition, which is usually not attended by animal owners. Bleeding needs to be controlled by blind legation and involves skill of obstetrician. Uterine bleeding necessitates laparotomy to ligate blood vessels.
Profuse bleeding in uterus or birth canal with continuous flow of blood, if unattended, aggravates toward critical situation and leads to hypovolumic shock, loss of cellular and plasma elements and death. Singh (1994) defined shock as a critical and continuous decrease in tissue perfusion, leading to oxygen deficiency in cell probably secondary necrosis in certain organs.
Animals under state of shock may not have decreased blood and cardiac output esp in cases with massive infections. A patient in shock state has fast but weak pulse, dilated pupils, pale and cyanotic mucous membranes, cold extremities, low urine output and increased capillary refill time with hypo-volumic patient having increased respiratory rate.
Significantly high cost is debited due to negligence towards haemorrhage in recently parturated cases. Such cases need plasma expanders, infusion of fluid therapy and even blood transfusions as per the need. 'Veterinary control of parturitions' is highly essential in farm animals under scientific managemental practices, but unfortunately, the same is not practiced at field level by Vets nor it is strongly proposed by animal owners.
Rupture of pelvic organs: Part of vulva, vagina, cervix, uterus, bladder, perineum, sacro-sciatic ligament or pre pubic tendon may rupture during normal or assisted delivery in buffaloes and surgical affection necessitates immediate attention. Recto vaginal fistula, uterine tear, vaginal tear, vaginal rupture and perineal lacerations are some types of injuries to female reproductive tract after parturition and their extent is classified as first degree, second degree and third degree injuries.
Rupture of vagina is not much serious and even can be left unsutured with regular dressing and antibiotic coverage.
Rupture of cervix is common in buffaloes suffering from maternal dystocia and failure of cervical dilatation. It is possible to suture the cervical wall but scar tissue formation at level of cervix leads to kinked position and reduces future fertility.
Uterine tear and rupture occurs due to forceful contraction, incomplete cervical dilation, traction on malpositioned fetus or due to oversized fetus. The excess uterine load and increased intra uterine pressure like dropsy, macerations and torsion may lead to uterine injury. Physical injury to expected mother by accidental slipping or falling on ground may lead to uterine rupture.
Uterine rupture or tear is possible during obsterical improper manipulations. If site of injury is dorsal and small, it is recoverable. Large and lateral or ventral injuries always need blind suturing. Ruptures in old and infected cases leads to severe peritonitis and is generally fetal.
Selvaraju et al. (2009) reported uterus should be taken outside of vulva through tear and eversion of uterus followed by repair of rupture site and then replacement may help to save life of buffalo in uterine rupture cases. Continuous mattress suture are to be applied at level of rupture uterine lines. Laparotomy can help to attempt, correct and appropriate sutures for longitudinal uterine tears and blind palpation and appropriate repositioning is necessary.
For all tissue ruptures and organ injuries, it is necessary to stop bleeding by using blood clotting agents, cotton mobs application and antibiotic. Rupture of pre pubic tendon after parturition is rare in buffaloes but post partum laminitis occurs.
Fistulation: Recto vaginal fistula denotes rupture of dorsal wall of vagina and ventral wall of rectum. The opening thus created between rectum and vagina needs to be closed immediately.
The suturing pattern involves tight transfers sutures to rectal wall but vaginal rupture is left as it is. (Recto-vaginal fistula correction requires freshening of wounds, removal of debris from fistulous tract). Double row of lock stitch sutures with silk No. 1 providing proper security to fistulous tract and avoids linkages of faeces into vagina.
Dhaliwal et al. (1991) reported spontaneous rupture of vagina in heifers and concluded that vaginal wall can rupture while handling dystocia due to faulty obstetrical technique. Phogat et al. (1992) reported recto-uteral fistula due to violent uterine and abdominal muscle contractions with insufficiently dilated cervix and delivery of fetus through rectum in Murrah buffalo. Shrivastava et al. (1990) reported utero-rectal fistula in buffalo due to pressure of pointed bones of macerated foetus. Kasrija et al. (2009) reported a complete postpartum uterine eversion through vaginal fistula in a buffalo.
Paralysis: Postpartum injuries to reproductive tract include peripheral nerve damages. Obturator nerve paralysis is always bilateral and animal may find difficulty to get up The limbs are abducted while standing or walking and there is potential danger of slipping and limbs fractures. Peroneal paralysis due to prolonged lateral recumbency is possible in long standing case of dystocia. Similarly, gluteal nerve paralysis is possible in maternity cows. Delay in treatment of paralytic cases extends recovery period.
Trauma or associated inflammation to obturator and peroneal nerves leads to paralysis. Buffaloes in recumbent positions with spraddle legged and inability to rise indicates obturator nerve injury. Prolonged recumbency after paralysis leads to crush syndrome due to loss of strength to standup. Mechanically, applications of hobbling may help to keep animal on support standing.
Gluteal nerve paralysis is possible due to pressure of bony prominence of fetus at level of lambosacral articulation. Obturator paralysis is possible in hip lock conditions. The paralysis leads to abduction of legs and affected side of limb is placed too lateral while walking. Peroneal paralysis occurs with dystocia in milk fever and results in knuckling of fetlock and dropping of hocks. Nervine tonics, soft bedding, assistance to standup and physiotherapy is recommended.
Milk fever/Parturient paresis/hypocalcaemia/ puerperal apoplexy
Hypocalcemia is a common metabolic disorder of animals after parturition where blood calcium level reduces less than 6 mg/dl due to drainage of body calcium towards milk production through can be treated successfully with calcium preparations providing readily ionizable calcium. Parturient paresis indicate critical decline in levels of ionized calcium of tissue fluids. Hypocalcaemia can further result in major postpartum complication like Downer's cow syndrome, ketosis, placental retention, metritis etc. The condition needs preventive approach through anionic feed supplement (DCAD) during pre-parturient stage for enhancing of calcium absorption from intestine, mobilization of calcium from bone and minimal calcium loss in urine.
Jadhav et al. (2000) suggested detailed preventive strategies against post parturient hypocalcaemia as dietary management with feeding grains @1 percent of body weight, oral calcium propionate paste, calcium chloride gel, use of hydrochloric acid, feeding of Ammonium chloride and injections of parathyroid hormones with administration of interleukin 1p or Inj. Vitamin D and their metabolites.
Mandali et al. (2002) estimated blood biochemical profile in milk fever cases of buffaloes and noted that serum calcium level was lower, inorganic phosphorus level was significantly lower but magnesium levels did not differ for normal buffaloes and serum GOT and LDH activities were significantly higher in milk fever cases.
Normal values of calcium, phosphorus and magnesium are expected to be 8-12, 4-8 and 2-3, mg % in healthy animals. The condition is classified into two categories like parturient coma and recumbency. Parturient coma category consists of three stages on the basis of serum calcium level ranging from 8-6.5, 6-4 and less than 4 mgm %respectively.
Stage--I: Animal stands with alert expression but reluctant to move, stiffness of hind limbs, staggering gait, protrusion of tongue, may act constipated, fine muscle tremors, diminished appetite and may have slight elevated temperature.
Stage--II: Animal lying in sternal recumbency with lateral kink, drowsy/dry muzzle, may be titanic in early stages, then usually becomes flaccid later, cold skin and extremities, sluggish to absent eye response, weak pulse, slightly high rate, less than 90 subnormal temperature, G.I. tract and uterine stasis, decreased rumen motility.
Stage--III: Animal lying in lateral recumbency, coma progressing rapidly, weak pulse (more than 110), bloat, lack of papillary light reflex, cannot hear heart sound by phenodoscope but can hear directly by keeping ear in cardiac area.
In recumbency (paresis) serum Ca, P, Mg levels will be reduced but ratio not affected. However, calcium level does not fall below 7 mg%. Animal will show acute development of signs like inability to stand and pain in bones. Hind quarters are affected more than fore quarters.
Downer syndrome or Creeper cows is the condition occurring after parturient paresis and is characterized clinically be prolonged recumbency even after two successive infusions with calcium. Downer syndrome is characterized by inability to stand voluntary, recumbancy and is generally associated with hypocalcaemia, hypomagnaesamia, hypo-phosphataemia, hypokalaemia, toxaemia, septicaemia, muscle and nerve injuries. Massive fluid (DNS) and electrolyte (RL) therapy with calcium, magnesium borogluconate administratiion is necessary. Support of steroids and physiotherapy helps in early recovery of the cases.
Ketosis: Mandali et al. (2002) estimated blood biochemical profile in clinical ketosis of buffaloes and recorded significantly lower mean glucose level but magnesium levels in milk fever did not differ for normal buffaloes.
Gauswami et al. (2014) reported that Surti buffaloes with increasing blood plasma, glucose, total protein, total cholesterol, calcium and phosphorus had higher conception rate and further reported that feeding of bypass fat, carbohydrates and chelated minerals with vitamins during postpartum period decreased interval from calving to first postpartum estrus and also calving to conception.
All parturated animals undergo hypoglycaemia and negative energy balance. The condition is severe in high yielders as energy intake remains far less than energy requirements. Animal collapse immediately after delivery as energy levels is lowest in blood. These animals can be saved by oral feeding of crushed maize, propylene glycol (gluconeogenic precursor), oral supplementation of glucose and dextrose fluid therapy. Negative energy balance is most critical with regards to nutritional and particularly energy demands in recently calved animals. Negative energy balance can be associated with health problems.
Negative nitrogen balance
Injectable Nandrolone lourate for maintaining Nitrogen balance in negative nitrogen balance is indicated after parturition as is a long acting steroid with very potent anabolic with weak androgenic properties, improves red cells formation, promotes retention of calcium and phosphorus.
Haemoglobinuria is common in high yielding buffaloes within a week of parturition or in last trimester of pregnancy. This metabolic melody is more commonly seen when blood phosphorus level goes less than 2 mg/dl leading to increased fragility of RBC cell wall.
Injectable inorganic phosphorous 3-4 days or till reduction of coffee coloured urine is the required therapy and cases can be treated with oral feeding of 60-80 grams of sodium acid phosphate. Vitamin C can be the part of therapy to reduce oxidative stress. Nagpal et al. (1968) reported in buffaloes in India for the first time.
Predisposing are thought to be advanced pregnancy, recent parturition, high milk yield, presence of oxidants in feed and other stress factors. Deficiency of inorganic phosphorus in blood is a constant finding and cases responded to various degrees to phosphorous therapy. A part from phosphorus deficiency, oxidative stress is also responsible for red blood cell membrane alternations and subsequent to haemolysis.
Post parturient haemoglobinuria (PPH) is an acute disease of cows and buffloes characterized by severe intravascular haemolysis, haemoglobinaemia, haemoglobinuria, anaemia and death due to anaemic anoxia. Singh et al. (2006) studied post parturient haemoglobinuric buffaloes which were treated before one year clinically and observed chronic hypophosphataemia, decreased milk yield, lameness anoestrus and change in body color ranging from brown to light grey.
Acidosis is quiet common in expected mothers due to excessive feeding of carbohydrates, jaggery or easily fermentable products. Oral and systemic alkalizer are essential with proper nutritive recommendations. Condition can be treated with sodium bicarbonate hypertonic fluid therapy (7.5%) or oral powder followed by isotonic sodium bicarbonate in fluid or oral administration. Lactoacidosis is consequence of extra feeding of concentrate after having smooth parturitions. Blood pH severely alters in acidosis from normal range of 7.35-7.55 and buffering capacity is collapsed with subsequent alterations in enzyme system. All metabolic pathways are deranged and animal suffers from pain, discomfort and life risk factors.
Infectious and or Inflammatory conditions
Although parturition is a physiological process, many non specific infections of reproductive tract and unhygienic care amplifies the incidence of post partum uterine infections. Patient genital tract under immune suppression effect of parturition is facilitated by bacterial multiplication and clinical incidence of infections. Blood, cellular debris and parts of placenta provide favorable environment and ideal medium for infective agents. Usmani et al. (2001) reported incidence of post partum uterine infections in buffaloes as 20-75 percent indicating very high a range.
Sheldon et al. (2006) has defined the conditions encountered after uterine infections as under.
Puerperal metritis has been defined as condition when animal has an abnormally enlarged uterus and fetid watery red brown uterine discharge associated with signs of systemic illness (decreased milk yield, dullness or other signs of toxemia) and fever >39.5[degrees]C, within 21 days after parturition.
Clinical metritis has been defined as condition seen in animals those are not systemically ill but have an abnormally enlarged uterus and purulent uterine discharge detectable from vagina, within 21 days after calving. Sclerotic metritis is caused by severe chronic metritis that has caused by complete destruction of endometrium and fibrolytic changes in uterine wall.
Clinical endometritis has been defined as a condition with presence of purulent (>50% pus) uterine discharge detectable from vagina 21 days or more after parturition, or muco-purulent (approximately 50% pus, 50% mucus) discharge detectable in vagina after 26 days.
Metritis: Puerperal metritis is an acute systemic illness due to infection of uterus with bacteria, usually within 10 days after parturition and characterized by reduced milk yield, illness, anorexia, elevated heart rate, fetid red-brown watery uterine discharge and usually pyrexia in severe cases with dehydration. The term metritis should be used in delayed involution and fetid discharge in absence of detected fever. Puerperal metritis is often occurs toward the end of first week post partum, being rare after second week post partum.
The incidence of metritis range in buffaloes range between 7-17 percent and average incidence of metritis is more in buffaloes than cows. Rao and Murthi (1977) attributed this to peculiarity of buffaloes in which vulval lips are not closely opposed to each other. Samad et al. (1984) reported more incidence of metritis in buffaloes due to their wallowing habits. Dobran and Kamonpatana (1986), Bassiony (1988) reported the frequent human interference at calving coupled with unhygienic conditions increasing percentage of incidence in buffaloes. Eljakee (1985) and Shalaby (1986) reported that specific infection of reproductive tract in buffaloes is quite low as buffaloes appear to be more resistant to Brucellosis and Tuberculosis than cow.
Puerperium period of reproductive life influences subsequent fertility. The uterine diseases are most difficult to control as they belong to complex multifactorial causes of gram positive, gram negative aerobes and anaerobes which increases during first four weeks of calving and secure is evident due to uterine defense mechanism within six weeks.
Production of excessive corticosteroids along with negative energy balance during early postpartum period makes dam susceptible to infections. Immediately after calving, negative pressure created in uterus along with open cervix facilitates entry of microorganisms into uterus. In Immunosuppressed dam for next several weeks, there is cycle of contamination and recombination of uterus. The microorganisms pattern isolated also go on changing in first few days. During first two weeks after calving, 25-40 percent of dairy cattle develop metritis and persists in about 20 percent animals as clinical endometritis, 40 percent of animals have uterine infections till 3 weeks after parturition.
Emphasis is now being given on dry matter intake, non esterified fatty acids (NEFA) and calcium for early identification of animals susceptible for uterine diseases (Martinez-Patino et al., 2011). Dry matter intake has been recognized as an important risk factor for development of uterine diseases as accompanied by increase in levels of non esterified fatty acids and beta hydroxy butarate (BHBA) in blood which also signifies negative energy balance and immune suppression (Galvao et al., 2010). Decrease in dry matter intake upto 2 weeks before calving has higher risk factor for development of uterine infections (Huzzey et al., 2007).
The type of bacteria isolated from uterus are Streptococci, Staphylococcus, A pyogenes, Proteus, Bacillus, Pseudomonas, Klebsiella, Listeria, Micrococcus, E. coli, Corynaebacterium spp. Pseudomonas aeruginosa with anaerobic agents as Fusobacterium, Bacterioides, Clostridium and Porphyromonas.
Patbandha et al. (2012) reported that non esterified fatty acids on 1st and 7th day postpartum can accurately predict possibility of metritis in dairy cows as elevated NEFA impairs neutrophil function and prolongs bacterial clearance of uterus thus increases chances of post partum infection.
Sharma and Mehta (1982) reported significantly higher values of serum glycoprotein and increased ratio of sialic acid to fructose in metritis cases.
Islam et al. (2012) concluded that increase serum concentration of anti-inflammatory cytokine IL10 at 15th day prepartum in cows developed retention of placenta and clinical metritis with higher levels of indicator till 15th day postpartum.
Exogenous prostaglandin F2[alpha] increases uterine secretion of prostaglandin F2[alpha] and luteal production of leukotriene [B.sub.4] (Wade and Lewis, 1996). Prostaglandin F2[alpha], a proinflammatory molecule enhances neutrophil chemotaxis, ability of neutrophils to engulf bacteria, leukotriene [B.sub.4] stimulated chemotaxis and antibody independent cell mediated cytotoxicity (Hoedemaker et al., 1992). Leukotriene [B.sub.4] promotes uterine involution and reduced risk of infection in cows (Slama, 1993).
Lipopolysachharide leads to increase in phagocytic activity and antigen processing with be antilymphocyte increase and production of inflammatory cells. Lipopolysachharide stimulate interferones production which inter enhance natural killer activity. But immune suppression activity mediated by T cells is a major limitation.
The sequelae of treating puerperal metritis without recovery of relapse may lead to septic metritis which is difficult to treat. Postpartum uterine affections were treated in buffaloes by intra urine Levofloxacin-Ornidizole combination with Alpha tocopherol and uterine involution was noted to be 26 days in buffaloes as against 32.66 in non treated group. (Markandeya et al., 2014).
Pyometra is characterized by accumulation of purulent or mucopurulent material within uterine lumen and distension of uterus, in presence of an active corpus luteum. Although there is functional closure of cervix, lumen is not always completely occluded and some pus may discharge through cervix into vaginal lumen. Pyometra is sonographically characterized by a corpus luteum in an ovary, accumulation of mixed echo density fluid in uterine lumen and distension of uterus.
The extent of negative energy balance, circulatory concentrations of non esterified fatty acids and immune status of animal are the primary determinants of clearance of uterine infections in postpartum animals. The persistence of infection in uterus damages endometrium, affects production of hormones prostaglandins, gonadotrophin releasing hormone (GnRH) and Luteinizing hormone (LH) and hence days open. In sub-clinically infected cows, early onset of ovarian cyclicity may lead to closure of cervix and development of pyometra.
Alanine amino transferase activity is increased during uterine infection specifically in pyometra as a result of tissue damage. Higher concentration of Asparate amino transferase is indicator of puerperal disease.
The treatment as should be aggressive as bacterial agents releasing endotoxins which make complicate anti microbial selection (Johnson, 1995) supportive fluid theory for rehydration is recommended to avoid endotoxic shock. cephalosporins, amino glycosides, fluoroquinolones with preference to lactam associated with endotoxin release can be used effectively.
Rao and Murthy (1977) classified endometritis in three stages depending upon discharges viz. First degree endometritis is characterized by intermittent or no discharge, Second degree endometritis is characterized by continuous mucopurulent discharge and third degree endometritis is characterized by purulent discharge with tendency to accumulate.
Zheg et al. (1986) estimated serum protein of 33 cows suffering from endometritis and affected cows showed decrease in alpha 2 globulin and increase in gamma globulin as against healthy 15 cows. Baglalia and Sharma (1988) estimated glycogen, protein, DNA, RNA, acid phosphatase, Alkaline phosphatase from uterine biopsy of fertile cows and cows with endometritis and found that the values were significantly higher in fertilize cows. Patra et al. (2012) reported that upregulations of cytokines gene expression might represent as potential marker for detection of endometritis and monitoring of new therapy of approaches.
Parturated animals are also prone for acute bacterial mastitis due to environmental infection, particularly E. coli. Animal suffers from high temperature, severe effects of bacterial toxins on mammary gland and also on systemic toxemic condition. Mastitis prevention is possible through treatment of buffer, antioxidant and immunopotentiator treatment. Tri sodium citrate acts as a milk pH (6.5 and reduced alkalinity of milk. Antioxidant like Vitamin E, Selenium, Manganese detoxifies free hydroxyl radicals to prevent damage of mammary epithelium and subsequent leakage of blood bicarbonates. Vitamin A and D plus copper and zinc acts as immunopotentiator to improve cell immunity.
Bhulla et al. (2006) reported that N-acetyl-p-D Glucosaminidase (NAG-ase) activity can be used as a preferred laboratory method for screening of sub clinical mastitis over somatic cell count and bacteriological examination for detection of subclinical mastitis. The lysosomal enzyme (NAGase) is lysosomal enzyme originating from epithelial and inflammatory cells, therefore, increased level or activity of NAG-ase can provide a convenient measure of mammary gland damage and can also be used as an excellent marker for detection of sub clinical mastitis in buffaloes.
Phosphorus deficiency and oxidative injury may be related to altered red cell structure and functions. Red cell membrane skeletal composed of spectrin, actin and several other proteins is essential for maintenance of erythrocyte shape, reversible deformability and membrane structural integrity. Tehlan et al. (2007) reported a review on different diagnostic test for diagnosis for mastitis in buffaloes.
Awasthi and Upadhyay (2006) reported four basic principles of mastitis control as post milking teat disinfection, universal dry cow antibiotic therapy, appropriate treatment of clinical cases and regular milking maintenance. The therapeutic efficacy of antimicrobial depends mainly on its ability to penetrate udder tissue. Following intra mammary infusion, lipid solubility, tissue protein binding of drug, pH of milk and inflammatory exudates affects efficacy. Sometimes, influsion may cause additional infection and stress to udder tissue therefore parenteral administrations are gaining significant importance in antimicrobial therapy. The efficacy of antibiotics like Benzyl Penicillin-G, Ampicllin, Cloxacillin, Tetracyclines, Cephalosporins, Chloramphenicol, Aminoglycoside, Macrolides, Polymyxin-B and Fluroquinolones in mastitis is questionable and some alternative should be explored to provide holistic approach to disease management.
Tetanus: Tetanus should always be considered in differential diagnosis in sick post parturient cows and active immunization with adsorbed tetanus toxoid should be used in animals nearing parturition. Bhadwal et al. (2004) reported tetanus in post parturient cows with clinical signs such as lock jaw, stiffness and erect ears the probable source of infection with uterus, which had been handled in five out of six cases.
Postpartum tetanus is noticed in many long standing cases of metritis and hence it is recommended to administer 40,000 units of tetanus toxoids with or without antibiotics whenever there is much handling of genitalia.
Toxaemia: The periparturient toxaemia is possible in acetonemia, ketosis, fat cow syndrome, mastitis, peritonitis, septic metritis and pregnancy toxemic conditions. Toxins produced by bacteria lead to toxemic conditions in post partum animals. The most common form of toxemia in large animals is endotoxemia caused by gram negative bacterial organism in blood. Lipopolysaccharide is released by gram negative bacteria, which is circulated in blood as a toxin which leads to dysfunction in cardio pulmonary unit. Haemostatic and thermo regulatory metabolic pathway are disturbed. There is depressed functional activity of most of the body tissues and death is possible due to shock arising from cardio-renal failure.
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N. M. Markandeya (1)
Department of Animal Reproduction, Gynaecology and Obstetrics College of Veterinary and Animal Sciences Maharashtra Animal Fishery Sciences University (MAFSU) Parbhani--431402 (Maharashtra)
(1.) Professor/Head and Corresponding author. E-mail: email@example.com
Table 1: Post partum complications Reproductive problems Placental retention, Prolapse of vagina /+cervix /+ uterus /+ rectum (post parturient atony), Extended labour (post parturient straining), Delayed uterine involution, Post partum infertility Traumatic complications Rupture of vulva/vagina/cervix/uterus/ bladder/perineum/sacro-sciatic ligament, Bleeding, Haematoma, Lacerations, Paralysis, Fistulation Metabolic disorders Hypocalcaemia/Parturient paresis/puerperal apoplexy/Milk fever, Ketosis, Hypophospetimia/Haemoglobinourea, Hypomagnesimia/Parturient eclampsia/Tetany, Acidosis Infectious and/or Metritis, Pyometra, Mastitis, Laminitis, inflammatory conditions Toxaemia
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