A review of retained placenta in bovines - risks, diagnosis, treatment, and control

Retained placenta (RP) adversely affects postpartum productivity and reproduction in dairy cattle. Thus, methods to predict the occurrence of RP before calving would be desirable. Herein,we assessed whether vaginal temperature measurements (which have already been applied to detect calving) could be used to predict the occurrence of RP in cattle. A vaginal temperaturerecording device was inserted into the vagina of 49 pregnant Holstein-Friesian heifers (n = 16) and cows (n = 33); this device recorded the vaginal temperature every 5 min until the devicedropped out at calving. Serum was collected 10 days before the expected calving date. The time points of calving and placental expulsion were identified via video recordings. We furthercalculated calving duration (temperature decrease to calving) and placenta expulsion time (PE time = calving to placenta expulsion). The PE times were divided into four categories (0–4 h,4–8 h, 8–12 h, and RP at >12 h), while subsequent analysis revealed that an extension of the PE time dependent on the shortening of the calving duration (P < 0.05). The vaginaltemperature patterns also differed in a PE time-dependent manner, and cows with RP did not show any re-elevation of vaginal temperature. Serum analyses indicated an energy deficiency in RPcattle. These results suggest that RP may be detected early as a specific change in the vaginal temperature associated with reproductive hormone secretion.

Vitamin E supplementation has been reported to decrease the incidence of cystic ovarian disease (COD) and retained placenta (RP) in cattle however the mechanism of action is not known. In humans, vitamin E supplementation twofold the daily requirements decreases plasma plasminogen activator inhibitor-1 (PAI-1) activity. As proteolysis may be involved in both COD and RP, vitamin E may be reducing these disorders in cattle through its effects on PAI-1. To evaluate the effects of vitamin E on plasma PAI-1 activity in cattle, six non-lactating beef cows (n = 3 per treatment) were injected with 0 (Control) or 2750 IU of vitamin E (Vitamin E) IM once every four days for 24 days (Day 0 = first day of treatment). Blood samples were collected every two days for 28 days starting on Day 0 and plasma PAI-1 and tissue-type plasminogen activator (tPA) concentrations and activities were determined. No differences (P > 0.05) were observed due to vitamin E supplementation in plasma PAI-1 and tPA concentrations and activities or concentrations and activities adjusted relative to the Day 0 value for each cow. Day of treatment was a significant effect in all tPA measurements. The ratio of adjusted PAI-1 to tPA concentrations did not differ (P > 0.05) due to vitamin E supplementation however the ratio of PAI-1 to tPA activity tended to be greater (P = 0.097) in Control compared to Vitamin E cows (1.0 ± 0.1 and 0.7 ± 0.1, respectively). These data suggest vitamin E supplementation may contribute to the reduced incidence of COD and RP in cattle by shifting the ratio of plasma PAI-1 to tPA activity to a state favoring proteolysis.

Retained placenta (RP) is a condition in which foetal membranes are seen at vulva or are present in uterus even after more than 24 hours post-partum. The cases present with symptoms like pyrexia, inappetence, sudden weight loss and udder inflammation with reduced milk yield few days post-partum. Treatment included uterine lavage, antibiotic therapy, and supportive care. It is a significant reproductive disorder in dairy cattle, associated with substantial economic losses. This review study discusses current understanding of RP aetiology, diagnosis, treatment, and its complications including metritis, mastitis, and tetanus. This article highlights the complexity of RP and the importance of prompt, comprehensive treatment strategies. It also discusses recent advances in understanding RP pathophysiology, and emphasizes the need for improved prevention and management protocols.

Retained placenta, common in postpartum dairy cows, involves those animals not releasing their placenta within 8-24 hours after parturition. Cows with retained placenta (RP) are more prone to metritis and cystic ovarian disease than healthy ones. On the other hand, metritis complex, in the presence and/or the absence of retained placenta, has a detrimental effect on reproductive performance. Although retained placenta can be minimized by application of preventive and control measures in the herd, removing the placenta by manual, hormonal, antibacterial and antiseptic ways are other suggested methods. The aim of the present study was to compare manual removal, conservative treatment and control (non-retained healthy cows) based on uterine bacteriological and cytological state and reproductive performance.

Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta (RP). The general accepted treatment of RP is manual removal of the placenta (MRP), but medical intervention protocols were suggested. We evaluate a protocol of using intra-umbilical vein injection of misoprostol followed, if necessary, by intravenous sulprostone. A reduction in the need for MRP and less blood loss was expected. Cohort A (1 January 2007 to 31 September 2008), managed by an expectative protocol including active management of the third stage of labor and if necessary MRP performed 60 min after birth of the baby, was compared with cohort B (1 April 2009 to 31 December 2010) managed by medical intervention protocol. This protocol consisted of intra-umbilical vein injection of misoprostol and if not successful, 250 μg of sulprostone was given intravenously in 30 min. All vaginal deliveries after 24 weeks of gestation, with RP after 20 min and blood loss <500 mL were included. An intention to treat analysis was performed, with the need for MRP as the primary outcome. Baseline characteristics were similar. In cohort A, 275 women met the inclusion criteria and 57 (20.7%) women needed MRP. In cohort B, 219 women were included and 35 (16%) women needed MRP. There was no significant difference in number of MRP, the amount of blood loss and other secondary outcomes. We conclude that the use of intra-umbilical vein injection of misoprostol and intravenous sulprostone consecutively, does not reduce the number of MRPs as well as the total amount of blood loss in women with RP after 20 min. The study shows that changing obstetric management by extrapolating results from specific study groups to a general population may lead to other results.

Retained placenta (RP) is the absence of placental expulsion within 30 min of neonatal delivery. It is an obstetric complication affecting 0.5-4.8% of all vaginal deliveries. We report two cases in which the patients were primiparous. Patients were initially kept at the hospital under close observation. The lack of spontaneous detachment and the absence of bleeding prompted us to resort to an expectant approach approved by both patients. A decrease in B-hCG levels was followed by a steady decrease in placental size and the resumption of regular menses. The management of RP should be individualized according to hospital resources, patient fertility desire, sonographic characteristics, the presence of hemorrhage, and hemodynamic stability. RP should prompt the mobilization of resources needed for managing postpartum hemorrhage (PPH), which might ensue without notice. Manual removal of the placenta (MROP) has been recommended for managing RP regardless of hemorrhage or retention etiology. MROP, however, might initiate massive bleeding, infections, prolonged hospitalization, the need for curettage and hysterectomy. Moreover, if MROP is attempted in an unidentified placenta accreta spectrum (PAS), it might initiate life-threatening hemorrhage, necessitating the performance of hemostatic interventions, including emergent hysterectomy. Serious considerations should be given to mitigate the indiscriminate use of MROP in the era of the "PAS epidemic."

The objective of this study was to examine women with retained placenta (RP) and the risk of postpartum haemorrhage (PPH) in relation to prolonged duration of third stage of labour>30min vs.≤30min, nighttime childbirth vs. daytime, and manual removal of placenta in regional vs. general anaesthesia. Additionally, determine if there were any differences in amount of bleeding until or after placental detachment, or number of blood transfusions. This was a single-centre retrospective cohort study including women with a diagnosis of RP at Sahlgrenska University Hospital, Sweden, between January 2014 and December 2020. Data were collected from the Swedish Pregnancy Register and the Hospital Discharge Register. 746 women were included. A total of 84 women (84/746, 11.3%) experienced PPH. There was no significant correlation between the duration of the third stage of labour and the amount of bleeding postpartum (p-value 0.57). A prolonged third stage of labour was not associated with an increased risk of PPH (duration>30min vs.≤30min: aOR 1.12, 95% CI 0.65-1.93). Giving birth during nighttime vs. daytime was not associated with an increased risk of PPH (aOR 1.27, 95% CI 0.68-2.37). Manual removal of the RP under regional anaesthesia vs. under general anaesthesia was not associated with an increased risk of PPH (aOR 1.12, 95% CI 0.65-1.93); however, the number of blood transfusions was significantly lower (p-value<0.001) under regional anaesthesia. Prolonged third stage of labour, childbirth during nighttime, and regional anaesthesia were not associated with an increased risk of PPH in women diagnosed with RP.

The study aimed to evaluate the effect of α-chymotrypsin on placental separation as a treatment protocol for retained placenta (RP) in dairy cows and its effect on reproductive performance after placental shedding. The study was conducted on 64 crossbred cows that suffered from retained placenta. Cows were divided into four equal groups: group I (n = 16) treated with prostaglandin F2α (PGF2α); group II (n = 16) treated with PGF2α in combination with α-chemotrypsin; group III (n = 16) treated with α-chemotrypsin only and group IV (n = 16) treated by manual removal of the RP. Cows were under observation after treatment till placental shedding. Placental samples were taken from the non-responsive cows after the course of treatment and examined to observe the histopathological changes in each group. Results revealed that the time of placental dropping showed a significant decrease in group II compared to other groups. Histopathological examination of group II shows that collagen was found as fewer fibres in scattered areas and necrosis appeared as numerous areas widespread in the foetal villi. A few inflammatory cells were infiltrated in the placental tissue and the vascular changes appear as mild vasculitis and mild oedema. Cows in group II have rapid uterine involution, decreased risk of post-partum metritis and improved reproductive performance. It is concluded that PGF2α in combination with α- chemotrypsin is the recommended treatment for RP in dairy cows. This recommendation is warranted, as this treatment was successful in achieving rapid placental shedding, rapid uterine involution, a decreased risk of post-partum metritis and improved reproductive performance.

288: Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta: a retrospective cohort study

Summary Fetal membranes usually are released from the uterus between 2 and 6 postpartum hours. However, in a substantial percentage of cows (11%), fetal membranes are retained for several days. In part, failure of collagen breakdown seems to be related to retention of fetal membranes. Injections of 200,000 U of bacterial collagenase in 1,000 ml of physiologic saline solution via umbilical arteries (1 or 2) between 24 and 72 hours of retention caused release of retained fetal membranes in 23 of 27 cows (85%) with noninduced retained fetal membranes and in 10 of 14 cows (71%) with experimentally induced retained fetal membranes, within 36 hours after injection. Controls (n = 36) did not release retained fetal membranes within this time. Injections of collagenase via a jugular vein (2.2 × 106 U in 1,000 ml of physiologic saline solution), administered over a 30-minute period, caused release of retained fetal membranes within 36 hours in 3 of 6 cows with experimentally induced retained fetal membranes. Clinical complications did not follow treatments with collagenase. Umbilical injections of bacterial collagenase were highly effective in the treatment of retained fetal membranes in cows. The procedure is simple, safe, affordable, and can be completed in 25 minutes.

Prevention of retained placenta by injection of collagenase into umbilical arteries of calves delivered by cesarean section: A tolerance study

The objective of this study was to improve the reproductive efficiency of dairy cows with puerperal metritis (PM) subsequent to retained placenta (RP) using a two-step treatment strategy. A total of 188 postpartum cows, aged from 2 to 8 years, were utilised for 2 experiments. In Experiment 1, cows affected with RP/PM were randomly assigned to two treatment groups. Cows in Group A (n = 17) were treated with 600 mg of ceftiofur intramuscularly for 3 days followed by intrauterine lavage with 0.1% chlorhexidine and infusion with 0.5% povidoneiodine, while cows in Group B (n = 16) received two intrauterine infusions, first with 5 g of oxytetracycline and then with 0.5% povidone-iodine. Cows with normal postpartum findings were regarded as the healthy control group (n = 26). Ultrasonographic examination revealed that the ovarian activities including the appearance of a dominant follicle and days to first ovulation of the cows in Group A during the early postpartum period differed from those of Group B (P < 0.05), which coincided with the results of uterine swabbing for bacteriology. In Experiment 2, cows with normal postpartum findings were allocated to Group D (n = 78), which received an ovulation protocol (GnRH - 7 d PGF2α - 48 h hCG - 24 h AI) on day 50 ± 2 postpartum. Cows affected with PM were randomly divided into two groups, Group E (n = 25) combined the treatments applied in Groups A and D, while Group F (n = 26) repeated the treatment administered in Group E except for uterine lavage. The results indicated that the pregnancy rate within 150 days postpartum and the mean days open in Group E (76.0% and 106.3 ± 4.6 days, respectively) were significantly different from those in Group F (38.5% and 137.9 ± 10.9 days, respectively) (P < 0.05). This study suggests that reproductive efficiency could be improved by using the two-step treatment to regulate uterine involution and an early resumption of ovarian function in cows with RP/PM.

The retained placenta

Asthma is one of the most frequent chronic diseases of childhood. Its etiology is not fully understood and risk factors for its development are numerous. The aim of this study was to determine the incidence of prenatal and postnatal risk factors in children suffering from asthma. The study was conducted on a sample of 100 patients with a diagnosis of asthma according to Global Initiative for Asthma guidelines. The data was collected using a questionnaire. We have considered prenatal (smoking during pregnancy, hormone and antibiotic therapy, the use of acetaminophen and dietary supplements, maternal blood sugar level, the term of delivery and the method of childbirth) and postnatal risk factors (oxygen and antibiotic therapy during the first year of life, immunization status during the first 6 months of life and presence of the older sibling in the family). In our study group, the most common prenatal risk factors related to asthma were: smoking during pregnancy, hormone therapy, the use of the dietary supplements and delivery via Caesarean section, while the most frequently found postnatal risk factors were: antibiotic therapy during the first year of life and the presence of older child in the family.

Background: Although acne is principally a disorder of adolescence, the prevalence of adult acne is increasing. Adult acne has been defined as presence of acne beyond the age of 25 years. Various studies have shown that a significant percentage of adult women with acne failed to respond to treatment with systemic antibiotics and isotretinoin which indicates a need for treatment alternatives with improved effectiveness and acceptable side effects for resistant acne. Aim: This study aims to study the response of oral antibiotic therapy and oral hormonal therapy in Adult Acne. Objective: The objective of the study is to examine the response of oral antibiotic and oral hormonal therapy along with their side effects in cases diagnosed with adult acne. Material and Methods: (i) Study design: Interventional study, (ii) Basis of adequate sample size: All patients diagnosed with adult acne will be considered for study. Seventy-two adult female patients presenting with acne fulfilling the inclusion and exclusion criterias were enrolled for the study. (iii) Sampling frame and method: Written informed consent will be obtained and identity of the participants will be kept confidential. Sequential photographs will be taken after patient’s consent to check the response rate. Data will be analyzed using ‘Friedman test”. Result: Based on the results of our study, it can be concluded that although both antibiotics and hormonal therapy improved acne lesions, but results were statistically significant with hormonal therapy as compared to antibiotic therapy. Conclusion: Both antibiotic and hormonal therapies are safe and effective options for treating adult acne. All patients of adult acne may not have an underlying hormonal imbalance or hyperandrogenism, thus the role of oral antibiotics in the treatment should not be underestimated.