Obstetrical emergencies

This article discusses different techniques that can be used in the diagnosis and treatment of obstetrical emergencies. Female reproductive emergencies commonly encountered by small animal practitioners include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine torsion, and uterine prolapse. A thorough knowledge of normal and abnormal reproductive behavior will aid the emergency veterinarian in successfully managing such cases. Timely diagnosis and treatment of these emergencies will often give a good outcome.     

Defining and Dealin with Emergencies

Over the years the meaning and definition of what constitutes an emergency have evolved but still an emergency is very much in the eye of the beholder. Certainly, clients view clinical emergencies in various ways and their expectation of care for their pets has risen with advancements in emergency and critical care medicine. The emergency clinic practitioner has the challenge of satisfying their customers, both client and referring veterinarian while striving to provide the appropriate care to their ultimate customer, the patient.     

Emergency treatment of limb fractures in large and small ruminants

Limb fractures in cattle have to be treated as emergencies. The success or failure of treatment depends on a careful examination and adequate emergency treatment by the veterinarian. The most important rules in an emergency treatment are the evaluation of the general systemic conditions and the initiation of whatever supportive care is required. Further attention should be paid to thoroughly rinsing and disinfecting open wounds and to immobilizing fractures for transport purposes. In 39 cases the localisation and the type of fracture were determined and the clinical relevance of a careful examination and emergency treatment was evaluated. Metacarpal fractures were the most common type of fracture. Open fractures were more likely to occur in cases of insufficient immobilisation than with properly attended patients (p less than 0,01). Open fractures have a poorer prognosis than closed fractures (p less than 0.002).     

Emergency care for potbellied pigs.

Because of the limited number of veterinarians treating potbellied pigs, many pet pigs do not receive proper preventative health care. The potbellied pig's continued popularity among urban dwellers ensures that veterinarians who treat small and exotic animals will be contacted by owners of pet pigs with real or perceived emergencies. Regardless of their knowledge of swine, the information contained in this article should enable any veterinarian to provide basic emergency care for pet pigs.     

Endocrine changes in late bovine pregnancy with special emphasis on fetal well-being

During late bovine pregnancy, several hormones are involved to maintain and develop a successful result with a live calf. These hormones are e.g., progesterone, high levels during the whole pregnancy period, originating from the corpus luteum, maternal adrenals and placenta. Oestrone sulphate, oestrone in its conjugated form, shows elevated levels from about mid-pregnancy until the third stage of parturition (expelling of the fetal membranes). For the onset of normal parturition and the parturition process as such, a change from progesterone to oestrone synthesis is crucial. The increasing levels of oestrone are time-related to an increased synthesis of prostaglandin F(2alpha) (reflected as elevated levels of 15-ketodihydro-PGF(2alpha)) causing prepartal luteolysis and several hormones are then involved in the labour process such as prostaglandin F(2alpha), cortisol and oxytocin. Cortisol might also be an indicator of stressful events for the dam. Levels of pregnancy associated glycoproteins (PAGs), originating from the trophoblastic binucleate cells, are increasing during the last 10 days prior to parturition. All the mentioned hormones have certain functions during pregnancy, more or less understood. However, could deviations from the expected profiles during late bovine pregnancy indicate impaired fetal well-being or be of importance for reproductive performance during the postpartum period? Abortions, stillbirths or dystocia are situations where endocrine profiles might predict the status of the calf. There are two possible approaches to study the endocrine changes in late pregnancy-to follow spontaneous cases of normal or impaired pregnancies or to experimentally disturb the gestation or induce parturition. We have in one study followed pregnant animals to depict reproductive disturbances, both animals with expected normal parturitions and animals where the sire of the calf has given rise to a high incidence of stillborn calves. The number of stillborn calves or dystocia has been small and so far it has not been possible to obtain a clear picture of the usefulness of endocrine parameters to follow fetal well being, but some of the hormonal parameters show a deviating profile. In a small group of animals with induced parturition (PGF(2alpha)), two out of three had parturition problems and one of these animals had a stillborn calf. All three animals had retained fetal membranes. It was possible to demonstrate a deviating endocrine profile in the cow having the stillborn calf in the sense of higher levels of progesterone, cortisol and 15-ketodihydro-PGF(2alpha) at the time of parturition. In both animals with dystocia the levels of oestrone sulphate after parturition were more sustained. Increasing and high levels of PAGs were only demonstrated in the animal with a normal parturition. These studies are ongoing, aiming at finding changes in endocrine profiles related to impaired pregnancies.     

Motility of the equine gastrointestinal tract: Physiology and pharmacotherapy

Normal gastrointestinal (GI) motility patterns are necessary to maintain transit of ingesta and to facilitate digestion and absorption of nutrients. Disorders of the equine GI tract are frequently encountered by the equine practitioner and these disorders are often associated with an interruption in normal intestinal motility patterns, thus complicating treatment of the primary disease. Consequently, numerous treatments have been investigated in horses to facilitate the return of normal intestinal motility. The purpose of this article is to provide a brief review of the anatomy and physiology of the GI tract in the horse and review medications available to the equine veterinarian that may potentially promote intestinal motility.     

Uterine torsion in cattle - frequency, clinical symptoms and theories about the pathogenesis

Aim of the present study was to summarize the available literature about the incidence, frequency, clinical symptoms and ideas as to the pathogenesis of uterine torsion in the cow. MATERIALS AND METHODS: Analysis of the literature using electronic libraries (Pub Med, Medline), German veterinary medicine journals and obstetrical textbooks. RESULTS: Uterine torsion is a very important maternal reason for dystocia as most cases occur during parturition. The post-cervical torsion (combined uterine and vaginal torsion, Torsio uteri and vaginae) is more commonly diagnosed than an intra-cervical or pre-cervical torsion. Torsions to the left occur more frequently than to the right. Clinical symptoms clearly vary depending on the degree of torsion. The frequency in relation to all parturitions is described as between 0.5 and 1%, whereas the percentage of uterine torsions presented to the veterinarian as a reason for dystocia varies between 2.7 and 65%. The pathogenesis of uterine torsion remains unclear; however, general agreement exists that the cow is predisposed to uterine torsion due to its anatomy. It appears that the Brown Swiss is more often affected than other cattle breeds.     

新疾病：母羊生殖应激及其综合征

母羊的生殖应激主要包括母羊主动应激、母羊被动应激以及胎羊宫内应激。适当的生殖应激是正常发情、维持妊娠、发动分娩、顺利哺乳的重要生理基础。但长期或过度的生殖应激，将引起母羊代谢紊乱、免疫功能损害、生殖障碍以及胎羊或羔羊发育受阻等，这一系列能造成母体健康损害的疾病和临床表现，被定义为“母羊生殖应激综合征”。本文对母羊生殖应激及母羊生殖应激综合征进行了定义，并对生殖应激理论的综合临床应用进行了探讨，为预防和治疗生殖疾病(如妊娠期毒血症、产后乏力、子宫内膜炎等)提供了理论依据。     

Physiology and Treatment of Retained Fetal Membranes in Cattle

Retained fetal membranes (RFM) in cattle have adverse effects on fertility and production. Understanding the pathophysiology and causes of RFM is important for managing this disease. The hormonal processes that lead to normal placental separation are multifactorial and begin before parturition. A variety of risk factors, including early or induced parturition, dystocia, hormonal imbalances, and immunosuppression, can interrupt these normal processes and result in retention of the placenta. Current research does not support the efficacy of many commonly practiced treatments for RFM. Systemic administration of antibiotics can be beneficial for treating metritis after RFM, but antibiotic administration has not been shown to significantly improve future reproduction in cows with RFM. Collagenase injected into the umbilical arteries of retained placentas specifically targets the lack of placentome proteolysis and might enhance placental release. However, such therapy is costly and its benefits in terms of improving subsequent reproductive function have not been evaluated.     

Incidence and Prevention of Early Parturition in Sows

A retrospective study, based on 60 990 farrowing records from 35 commercial herds, was performed to determine the incidence of early parturition (<114d) and to investigate the relationship between early parturition and total number of piglets born, number of piglets born alive and percentage of stillborn piglets per litter. The mean gestation length was 115.4 ± 1.62d, and early parturition occurred in 10% of all farrowing records. Sows with early parturition had significantly more stillborn piglets and a larger litter size compared to sows with a normal gestation length (114–117d). Sows with a gestation length <114d were 1.2 times (95% CI: 1.19–1.21; p < 0.001) more likely to have an early parturition at the subsequent parity. A second study was performed in four herds (n = 329) to investigate the efficacy of altrenogest administration on 110–112d (T112) or 111–113d (T113) of gestation for preventing early parturition and to investigate the effect of this treatment on the reproductive performance of sows. The interval between the last altrenogest treatment and the onset of parturition was 3.3 ± 1.32 (T112) or 2.0 ± 0.89 (T113) days. The gestation length of sows of the altrenogest group (T112 + T113) (115.3 ± 1.23d) was significantly longer compared to gestation length of the non‐treated sows (114.7 ± 1.69d) (p < 0.01). Altrenogest treatment had no negative effect on the reproductive performances of the sows. In conclusion, the administration of altrenogest in late gestation is an effective and safe method to prevent early parturition and can counteract the reproductive losses because of premature farrowing, which may occur in a substantial part of the farrowing events.     

Mares admitted to a referral hospital for postpartum emergencies: 163 cases (1992–2002)

Objective: To identify and describe the physical, historical, and clinicopathologic characteristics of diseases requiring emergency treatment in postpartum mares, and to evaluate the utility of these characteristics in making an accurate diagnosis in these mares. Design: Retrospective study. Setting: University large animal hospital. Animals: One hundred and sixty‐three mares admitted for emergency treatment within 30 days following parturition between the years 1992 and 2002. Interventions: None. Measurements and main results: Information obtained from the medical records included age, breed, date of admission, sex of the foal from this parturition, time from parturition to admission, duration of clinical signs prior to admission, and any report of dystocia or normal attended delivery, physical examination and clinicopathologic findings and diagnosis. Urogenital hemorrhage and large colon volvulus were the most common diagnoses, comprising 16.6% and 15.9% of total cases, respectively. Older mares were more likely to have a diagnosis of urogenital hemorrhage than younger mares. Mares with urogenital hemorrhage had a median age of 13 years and were admitted to the hospital significantly closer to parturition than mares with other diagnoses. Anemia, hypoproteinemia, and hypofibrinogenemia were significantly associated with a diagnosis of urogenital hemorrhage and occurred in 32%, 36%, and 26% of the mares with urogenital hemorrhage, respectively. Dystocia was more commonly reported (70%) in mares with metritis. Leukopenia was more common (88%) in mares with uterine tears. Conclusions: Careful evaluation of clinicopathologic data can aid the emergency clinician in making a correct diagnosis in postpartum mares with emergent problems.     

Ferret urogenital diseases.

Improved nutrition and client education have decreased the incidence of certain urinary tract diseases in ferrets. Early neutering programs at commercial breeding farms in the United States have also led to a marked decrease in the incidence of reproductive tract disease, especially estrogen-induced bone marrow suppression. However, the increased incidence of adrenal disease and its secondary effects on reproductive and associated urinary tract tissue presents an ongoing challenge for the clinician working with pet ferrets. Acute and chronic renal failure remain important, though less common, disease entities. It is imperative that the veterinarian working with pet ferrets be aware of the clinical presentation and clinicopathologic abnormalities associated with these syndromes.     

An overview of canine reproduction services. Getting started.

A veterinarian desiring to increase his or her proficiency in canine reproduction needs to become competent in a variety of reproductive procedures. This article describes commonly performed procedures and gives an overview of how to develop a practice in canine reproduction. Once a veterinarian develops expertise in this area, the base of breeder clients in the practice should rapidly increase.     

青海八眉猪及其杂交组合不同胎次的繁殖性能研究

通过青海八眉猪(本)以及与长白猪,大约克夏猪杂交组合不同胎次的繁殖性能的研究,结果表明:青海八眉猪纯繁时,它的产仔数,产活仔数,初生重、初生窝重,断奶仔数,断奶重,断奶窝重七项繁殖性能指标均以3-6胎较高,长×本组合的7项繁殖性能指标均以3-6胎较高。约×本组合的7项繁殖性能指标均以4-6胎较高。     

Oncologic emergencies

Cancer can lead to emergencies either due to the primary disease, or as a result of therapy. Appropriate diagnosis and rapid treatment of these conditions can result in survival of the patient. Whether chemotherapy is implemented or not, the clinician may be presented with a patient in need of emergency stabilization. Common occurring emergencies are related to effects of the cancer, ranging from immune dysfunction due to marrow infiltration to brain herniation due to increased intracranial pressure from neoplasia. Often adverse effects secondary to chemotherapy can cause emergency situations such as sepsis. Prompt diagnosis and treatment may result in a favorable outcome. Addressed in this chapter are commonly occurring emergencies and specific stabilizing treatments.     

Emergency treatments for police dogs used for illicit drug detection

The key to saving police dogs that have been exposed to large quantities of illicit substances is rapid action. Removal from the gastrointestinal tract, adsorption, and catharsis are the first steps. Some of these measures can be instituted on site by the attending officer. In case of accidental drug exposures of a dog during a search, police officers should have on hand apomorphine, syringes for administration of the drug and rinsing of the conjunctival sac, activated charcoal, a saline cathartic such as sodium sulfate (not needed if the activated charcoal product contains sorbitol), a resuscitator bag, and a well-fitting canine face mask. If bags of drugs are ingested intact, immediate surgery by a veterinarian may be required to remove the bag and prevent an obstruction or rapid absorption of a lethal dose. Injectible medications to antagonize the effects of the drugs should be reserved for administration by a readily available veterinarian upon arrival of the dog at the veterinary hospital. Pharmacologic antagonistic agents may have adverse side effects, especially if used in the treatment of a drug exposure against which they are not specifically indicated. Proper dosage and route of administration are additional important factors with such treatment. The veterinarian must instruct the police officers on the proper use, dosages, and methods of administration of the detoxifying agents as well as the proper procedures for using the face mask and resuscitator bag before an emergency arises. The officer should also be aware of the clinical signs likely to be produced following exposure to the agents for which these dogs search.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ophthalmic emergencies.

Ophthalmic emergencies are common presenting complaints in an emergency room. Most ophthalmic emergencies can be treated and stabilized until an ophthalmologist can be consulted. Most ocular emergencies involve loss of vision, compromised globe integrity, or severe ocular pain. Delay in treating true emergencies may result ina blind eye or loss of an eye. This article discusses the clinical signs,diagnosis, and treatment as well as the prognosis of some of the more common ophthalmic emergencies.     

Reproductive effects of estradiol cypionate in postparturient dairy cows

OBJECTIVE: To determine the effects of estradiol cypionate (ECP) on measures of reproductive efficiency in postparturient dairy cows. DESIGN: Randomized clinical trial. ANIMALS: 273 cows in a single herd in California. PROCEDURE: Twenty-four hours after parturition, 122 cows were treated with ECP (4 mg, IM); the remaining 151 cows were untreated controls. Percentages of cattle with abnormal findings during uterine palpation 27 to 40 days after parturition were compared between groups, along with days to first artificial insemination (AI), percentages of cows that were not pregnant after the first AI, and days to pregnancy. RESULTS: Treatment with ECP did not have a significant effect on whether results of uterine palpation 27 to 40 days after parturition were abnormal, days to first AI, or odds that a cow would be pregnant after the first AI. Treatment with ECP appeared to have a negative effect on days to pregnancy (hazard ratio, 0.72) CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prophylactic administration of ECP during the early postparturient period in dairy cows did not have measurable beneficial effects on reproductive efficiency.     

The management of bovine reproduction in elite herds

The management of bovine reproduction is the cornerstone of health provision in elite herds. Aims and objectives for reproductive performance should be herd specific and data to monitor progress should not only be frequently collected, but also analysed and reported. Strategic monitoring of animals should include a vaginal examination for evidence of uterine disease, as well as transrectal ultrasonography of the genital tract. There has been considerable advancement in our ability to intervene in the reproduction of cattle during the last 50 years. However, it is salutary to note that during this time fertility has consistently declined, despite increasing veterinary intervention. Most elite herds use artificial insemination and success depends on accurate detection of oestrus expression, but this appears to be less overt than 25 years ago. In addition, half the cattle have abnormal oestrous cycles after parturition and conception rates are decreasing by 1% per year. Risk factors for abnormal oestrous cycles include puerperal problems, negative energy balance, which can be evaluated by body condition scoring, and uterine disease. Bacterial contamination of the uterus is ubiquitous after parturition in cattle and disease disrupts ovarian follicle growth and function. Reproduction is also disrupted by stress associated with clinical disease, pain or a sub-optimal environment. The challenge for veterinarians providing reproduction control programmes to elite herds is to transfer our knowledge of the problems underlying subfertility to the farm, in order to provide effective solutions.