Primary postpartum hemorrhage

Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal failure. The clinical situations in which hemorrhage is liable to occur must be better known, so that anticipatory and preventive measures can be taken. Recent knowledge about defibrinated blood in women with degenerative changes at the placental site must be incorporated in the thinking and practice of physicians dealing with obstetrical cases. The indications, limitations, and hazards of the various anesthetic methods available for parturient women should be carefully considered in the circumstances of each case.     

Defining postpartum uterine disease in cattle

Uterine function is often compromised in cattle by bacterial contamination of the uterine lumen after parturition, and pathogenic bacteria often persist, causing uterine disease, a key cause of infertility in cattle. However, the definition or characterization of uterine disease frequently lacks precision or varies among research groups. The aim of the present paper was to provide clear clinical definitions of uterine disease that researchers could adopt. Puerperal metritis should be defined as an animal with an abnormally enlarged uterus and a 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. Animals that are not systemically ill, but have an abnormally enlarged uterus and a purulent uterine discharge detectable in the vagina, within 21 days post partum, may be classified as having clinical metritis. Clinical endometritis is characterised by the presence of purulent (> 50% pus) uterine discharge detectable in the vagina 21 days or more after parturition, or mucuopurulent (approximately 50% pus, 50% mucus) discharge detectable in the vagina after 26 days post partum. In the absence of clinical endometritis, a cow with subclinical endometritis is defined by > 18% neutrophils in uterine cytology samples collected 21-33 days post partum, or > 10% neutrophils at 34-47 days. Pyometra is defined as the accumulation of purulent material within the uterine lumen in the presence of a persistent corpus luteum and a closed cervix. In conclusion, we have suggested definitions for common postpartum uterine diseases, which can be readily adopted by researchers and veterinarians.     

Body temperature in early postpartum dairy cows

A strategy widely adopted in the modern dairy industry is the introduction of postpartum health monitoring programs by trained farm personnel. Within these fresh cow protocols, various parameters (e.g., rectal temperature, attitude, milk production, uterine discharge, ketones) are evaluated during the first 5 to 14 days in milk (DIMs) to diagnose relevant diseases. It is well documented that 14% to 66% of healthy cows exhibit at least one temperature of 39.5 °C or greater within the first 10 DIM. Although widely adopted, data on diagnostic performance of body temperature (BT) measurement to diagnose infectious diseases (e.g., metritis, mastitis) are lacking. Therefore, the objective of this study was to identify possible factors associated with BT in postpartum dairy cows. A study was conducted on a commercial dairy farm including 251 cows. In a total of 217 cows, a vaginal temperature logger was inserted from DIM 2 to 10, whereas 34 cows did not receive a temperature logger as control. Temperature loggers measured vaginal temperature every 10 minutes. Rectal temperature was measured twice daily in all cows. On DIM 2, 5, and 10, cows underwent a clinical examination. Body temperature was influenced by various parameters. Primiparous cows had 0.2 °C higher BT than multiparous cows. Multiparous cows that calved during June and July had higher BT than those that calved in May. In primiparous cows, this effect was only evident from DIM 7 to 10. Furthermore, abnormal calving conditions (i.e., assisted calving, dead calf, retained placenta, twins) affected BT in cows. This effect was more pronounced in multiparous cows. Abnormal vaginal discharge did increase BT in primiparous and multiparous cows. Primiparous cows suffering from hyperketonemia (beta-hydroxybutyrat ≥ 1.4 mmol/L) had higher BT than those not affected. In multiparous cows, there was no association between hyperketonemia and BT. The results of this study clearly demonstrate that BT is influenced by various parameters in dairy cows. Therefore, these parameters have to be considered when interpreting measurements of BT in dairy cows. This information helps to explain the high incidence of type I and II errors when measuring BT and clearly illustrates that measures of BT should not be used as a single criterion to decide whether or not to provide antibiotic treatment to dairy cows. However, research-based test characteristics of other parameters (e.g., vaginal discharge) alone or in combination with BT are still lacking.     

Effect of days postpartum and exogenous GnRH on reproductive hormone and ovarian changes in postpartum suckled beef cows

Two experiments were conducted to determine the effect of days postpartum and exogenous gonadotropin releasing hormone (GnRH) on reproductive hormone and ovarian changes in postpartum suckled beef cows. In experiment 1, eight suckled cows were bled at .5 hour intervals for 4 hours on days 7, 14, 21 and 28 postpartum. Although mean concentrations of plasma luteinizing hormone (LH) were positively correlated with days postpartum, mean concentrations did not differ. The mean maximum change and the variance of plasma LH were low on days 7, 14, 21 and 28 postpartum. Although the number of cows with an ovarian follicle and follicular size increased with days postpartum, mean concentrations of estradiol-17beta did not change. The interval from parturition to the first detected ovarian follicle and the first postpartum estrus was 17.5 +/- 2.6 days and 36.0 +/- 2.2 days, respectively. An elevation in plasma progesterone was detected about one week prior to the first postpartum estrus in 6 of the eight cows in the absence of corpora lutea. In experiment 2, gonadotropin releasing hormone (GnRH) induced ovulation in 4 of the 8 cows treated on day 27, 28 or 29 postpartum whereas none of the 8 saline treated cows ovulated to treatment. The interval from parturition to first estrus and conception were similar for both groups (P >.10).     

The effect of days postpartum, indomethacin and oxytocin on prostaglandin metabolite concentrations in postpartum suckled beef cows

In Experiment 1, blood samples were collected on days 1, 4, 7, 10, 13, 16, 19, 22, and 25 postpartum from the jugular veins of 10 suckled beef cows to determine 13, 14-dihydro-15-keto prostaglandin F(2)alpha (PGFM) concentrations during the early postpartum period. PGFM concentrations on days 1 and 4 were 207.8 +/- 33.9 and 283.6 +/- 45.6 pg/ml and then declined linearly (r = -0.71; P < 0.05) to 44.1 +/- 5.7 and 44.0 +/- 5.3 pg/ml on days 22 and 25 postpartum. Two groups of postpartum (25.3 +/- 0.5 and 37.7 +/- 1.1 days) suckled beef cows (10 cows/group) were used in the second experiment. Five cows of each group received intrauterine infusions of indomethacin for 5.5 days while the other five cows of each group served as controls. All cows had calves removed at the time of the last indomethacin infusion and were subcutaneously administered oxytocin six hours later. During the infusion period, PGFM concentrations decreased (P < 0.01) across time for both groups of indomethacin-treated cows. Concentrations of PGFM increased (P < 0.05) after oxytocin treatment for both groups of control and indomethacin-treated cows, but concentrations were higher for the control cows than for the indomethacin-treated cows.     

Cytologic findings in postpartum and postabortal smears

A study was undertaken to evaluate the cytologic features of pregnancy-induced cell patterns (PIP) observed in postpartum and postabortal cervicovaginal smears. A total of 3,000 PIP were evaluated and studied by an indirect immunofluorescent technique using human chorionic gonadotropin (HCG). Three characteristic types of PIP were demonstrated. In type I PIP, the cells had a sheetlike arrangement with a fine chromatin pattern and were thought to be of decidual origin. Type II PIP were shed in clumps and had round nuclei, cytoplasmic vacuoles and coarse chromatin. They were thought to originate in the endometrium with the Arias-Stella reaction. Type III PIP were large and had large nuclei with marked atypism. They were thought to be cytotrophoblasts. Almost all of the type III PIP were positive with the anti-HCG stain. It is concluded that this classification and analysis is significant and could reduce the number of false-positive cytology reports on postpartum and postabortal smears.     

Urinary cadmium levels during pregnancy and postpartum

It is well established that pregnancy induces physiological, metabolical and hormonal changes. As a consequence, trace metal metabolism can be affected. The aim of the present study was to assess the urinary cadmium levels in women during gestation and postpartum. The survey was conducted in a group of nonoccupationally cadmium-exposed women from Southern Catalonia (NE, Spain). Urine samples were obtained before pregnancy, during the 6th, 10th, 26th, and 30th wk of gestation, as well as during the 5th and 24th wk after delivery. Urinary cadmium levels were determined by graphite furnace atomic absorption spectrophotometry. The concentrations of zinc and copper in plasma were also measured. Moreover, to assess the effect of the diet during pregnancy, dietary ingestions of zinc, iron, and calcium were also determined. A significant decrease of plasma zinc levels could be observed during the last two trimesters of pregnancy, while plasma copper concentrations significantly increased during the same period. Urinary cadmium concentrations ranged from 0.05 to 3.79 μg/g creatinine (geometric mean 0.49±2.26 μg/g creatinine). No significant changes in urinary cadmium concentrations during pregnancy and postpartum could be observed.     

Paravaginal hematomas; their recognition and management postpartum

Paravaginal hematoma is an unavoidable obstetrical complication, usually due to the traction and rupture of paravaginal veins by the oncoming presenting part. Pain, swelling, ecchymosis and urinary retention are the usual symptoms if the hematoma is located below the levator plate, while supralevator hematomas give no external manifestations. Early diagnosis could be made more often if digital examination of the pelvis were done routinely after the third stage of labor and before dismissal of the patient from the hospital, and done more frequently in postpartum patients with pelvic complaints. Active surgical intervention is advocated to avert needless destruction of tissue, prolonged morbidity, and delayed recovery.     

产后42天产妇阴道感染发生情况调查

目的调查产后42天产妇阴道感染发生情况。方法选取2013年1月至2013年3月期间大兴区医院产后42天复检产妇188例,采用白带常规镜检方法对产后42天复检产妇进行常规筛查。结果检出：需氧菌阴道炎患者21例（占受检人数的11.17%）,细菌性阴道病患者29例（占受检人数的15.43%）,滴虫性阴道炎患者7例（占受检人数的3.72%）,外阴阴道假丝酵母菌病患者5例（占受检人数的2.67%）,共计62例（占受检人数的32.98%）。结论产后42天产妇阴道感染以细菌性阴道感染为主。     

Distribution of postpartum amenorrhea in rural Bangladeshi women

Previous studies of postpartum amenorrhea (PPA) demonstrated distinct subgroups of women with short and long durations of amenorrhea. This phenomenon was attributed to cases where breastfeeding is absent because of pregnancy loss or infant death, or confusion of postpartum bleeding with resumption of menses. We explored these ideas using data from an 11-month prospective study in Bangladesh in which 858 women provided twice-weekly interviews and urine specimens for up to 9 months; 300 women were observed while experiencing PPA. The resulting exact, interval-censored, or right-censored durations were used to estimate parameters of two-component mixture models. A mixture of two Weibull distributions provided the best fit to the observations. The long-duration subgroup made up 84% (+/- 4% SE) of the population, with a mean duration of 457 (+/- 31) days. The short-duration subgroup had a mean duration of 94 (+/- 17) days. Three covariates were associated with the duration of PPA: women whose husbands had high-wage employment had a greater probability of falling in the short-duration subgroup; women in the long-duration subgroup whose husbands seasonally migrated had shorter periods of PPA within the subgroup; and mothers in the short-duration subgroup who gave birth during the monsoon season experienced a shortened duration of PPA within the subgroup. We conclude that the bimodal distribution of PPA reflects biological or behavioral heterogeneity rather than shortcomings of data collection.     

Compliance with postpartum Rh isoimmunization prophylaxis in Alberta

A retrospective review of obstetric records for 1979 in two major Calgary hospitals was undertaken to determine the rate of compliance with postpartum Rh isoimmunization prophylaxis in Alberta. The charts of 4528 women ranging in age from 13 to 46 years were reviewed. The prevalence rate of Rh negativity was found to be 16%. Of the 710 Rh-negative women 490 (69%) were eligible to receive Rh immune globulin (RhIG); that is, they had no anti-D antibodies, and the baby/fetus was Rh-positive or Rh-unknown. RhIG had been administered to 93.6% of the eligible women; the compliance rate ranged from 66.7% for obstetric emergencies (i.e., spontaneous abortion, antepartum or early-pregnancy hemorrhage, or ectopic pregnancy) to 98.2% for postpartum diagnoses. In more than half (54.7%) of the women who underwent amniocentesis Rh type was not determined; the implications of this finding are discussed. Although poor compliance with postpartum RhIG administration is not a reason for withholding antepartum administration of RhIG, maximum compliance with the more cost-effective programs should be attained before antepartum programs are fully implemented.     

Uterovaginal packing with rolled gauze in postpartum hemorrhage

Management options for postpartum hemorrhage (PPH) include oxytocics, prostaglandins, genital tract exploration, ligation or angiographic embolization of uterine/internal iliac arteries, and hysterectomy. After excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and oxytocics. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged. Uterovaginal packing may sometimes obviate the need for surgery altogether. Two cases, a primary and a secondary PPH, managed recently with uterovaginal packing are reported. Despite concerns about concealed hemorrhage or the development of infection with this intervention, none of these problems were encountered, and uterine packing was successful even in the case of secondary PPH with documented infection.