Umbilical vein injection for management of retained placenta.
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Female↗
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The retained placenta.
The retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world. It complicates 2% of all deliveries and has a case mortality rate of nearly 10% in rural areas. Ultrasound studies have provided fresh insights into the mechanism of the third stage of labour and the aetiology of the retained placenta. Following delivery of the baby, the retro-placental myometrium is initially relaxed. It is only when it contracts that the placenta shears away from the placental bed and is detached. This leads to its spontaneous expulsion. Retained placenta occurs when the retro-placental myometrium fails to contract. There is evidence that this may also occur during labour leading to dysfunctional labour. It is likely that this is caused by the persistence of one of the placental inhibitory factors that are normally reduced prior to the onset of labour, possibly progesterone or nitric oxide. Presently, the only effective treatment is manual removal of placenta (MROP) under anaesthetic. This needs to be carried out within a few hours of delivery to avoid haemorrhage. For women in rural Africa, facilities for MROP are scarce, leading to high mortality rates. Injection of oxytocin into the umbilical vein has been suggested as an alternative. This method relies on the injected oxytocin passing through the placenta to contract the retro-placental myometrium and cause its detachment. Despite several placebo controlled trials of this technique, no firm conclusion have been reached regarding its efficacy. This may be due to inadequate delivery of the oxytocin to the placenta. Further trials are in progress to assess the optimal dose of oxytocin as well as the efficacy of a new technique designed to improve delivery of the oxytocin to the placental bed.
Female↗
Reproductive performance of Friesian mares after retained placenta and manual removal of the placenta.
Because the incidence of retained placenta in Friesian mares is estimated to be high, and no reports have been published on the reproductive performance of Friesian mares after retained placenta, we studied postpartum reproductive performance in Friesian brood mares with (n = 54) and without (n = 50) retained placenta. We defined a retained placenta as the failure to expel all fetal membranes within 3 h after the delivery of a foal. We subdivided the group of mares with retained placenta into mares in which the placenta had been removed manually (n = 30) and mares in which it had not (n = 24). Within each group, we compared reproductive performance after breeding in the foal heat and breeding in a subsequent heat. We also recorded the age of the mares, number of mares treated with antibiotics after insemination, and number of mares treated with prostaglandins. The interval between delivery and conception, efficacy rate (number of served cycles divided by the number of mares that had a positive pregnancy diagnosis), seasonal pregnancy rate, pregnancy rate after first insemination, pregnancy loss rate, and foaling rate did not differ between mares with and without retained placenta or between mares with and without manual removal of the retained placenta. Within each group, the pregnancy rate after first insemination did not differ between breeding for the first time in the foal heat and breeding for the first time in a subsequent heat. We concluded that reproductive performance did not differ between (1) Friesian mares with and without retained placenta and (2) Friesian mares with and without manual removal of the placenta. With regard to reproductive performance, retained placenta and manual removal of the placenta are not valid reasons to avoid foal heat breeding in Friesian mares.
Animals↗
Rectal administration of misoprostol for the management of retained placenta--a preliminary report.
BACKGROUND: Retained placenta is one of the serious complications of childbirth, and misoprostol is known to be a potent uterotonic agent. Therefore, we proposed that rectal misoprostol also may facilitate placental separation in women with retained placenta by its ability to increase uterine contractility. METHODS: The placenta was diagnosed as retained if it was not expelled within 40 minutes after vaginal birth. Then, 800 microg of misoprostol was inserted rectally and the patient observed thereafter. RESULTS: A total of 18 parturients who had retention of the placenta were studied; all the placentas were spontaneously expelled within 35 minutes. The side effects involved included nausea 17%, vomiting 11%, diarrhea 22%, shivering 33%, and pelvic cramping pain 44%. All these discomforts resolved within 24 hours. CONCLUSIONS: Our study demonstrated that misoprostol per rectum is a safe and effective technique and may be a useful alternative to manual removal of retained placentas.
Abortifacient Agents, Nonsteroidal↗
The effect of retained placenta and metritis complex on reproductive performance in dairy cattle -- a case control study.
A study of the computer stored records of 293 dairy cows and 652 calvings reveals the effects of retained placenta and metritis complex on reproductive performance. The overall incidence rate of retained placenta was 11.2%. Retained placenta was 4.6 times more likely to occur following twin births than following single births. Most cases of retained placenta occurred during the fall. Forty-five percent of that seasonal increase was explained by an increased number of calvings. Metritis complex was diagnosed following 54.8% of retained placenta cases. Retained placenta alone did not significantly impair reproductive performance. Metritis complex, in the presence or absence of retained placenta, caused a significant (P</=0.05) increase in days open, services per conception, calving to first heat intervals and days from calving to first service. There is an indication (interaction P</=0.1) that cows with both retained placenta and metritis complex are more severely affected than cows with either retained placenta or metritis complex alone. The influence of retained placenta on fertility appears to depend on the proportion of cows with retained placenta that have metritis complex.
Animals↗
Risk of retained placenta: multivariate approach.
BACKGROUND: To identify important covariates related to retained placenta using logistic regression analysis. METHODS: The study was carried out in the King Khalid University Hospital, Saudi Arabia, and involved 114 women who had retained placenta, and 116 women with normal deliveries. Chi-square test and logistic regression analysis were used for analysis of data. Adequacy of predictor variables was examined using indices of sensitivity and specificity and plots of probability histograms for prediction of retained placenta among patients and controls. RESULTS: Logistic regression analysis highlighted multiparity, induced labor, small placenta, and large amount of blood loss to be significantly associated with retained placenta. In addition, high pregnancy number, previous injury to uterus, and pre-term labor related significantly to retained placenta. Predictor variables had sensitivity of 65.5% and 87.9% specificity and achieved 77% overall correct classification. CONCLUSIONS: These findings could be used to develop a predictive procedure for identifying high-risk cases of retained placenta.
Case-Control Studies↗
Economic and reproductive consequences of retained placenta in dairy cattle.
The financial losses due to retained placenta in Dutch dairy cattle were estimated by using two different methods of calculation. A data-set containing the birth records of 160,188 Meuse-Rhine-Yssel cows provided data on the reproductive performance of cows with and without retained placenta. The fertility of cows after retention of the placenta appeared to be affected. An economic calculation made by adding the losses due to increased calving interval, increased culling rate, loss of milk production and the costs of veterinary treatment and drugs revealed that the total loss due to retained placenta was 471 pounds per year for a 100-cow farm with an average incidence of the condition (6.6 per cent). For a 'problem' farm with a 30 per cent rate, the loss was 2139 pounds per year. A computer farm simulation model, based on a stochastic determination of events, was used to make calculations for circumstances closely resembling those on farms. A 6.6 per cent rate of retained placenta caused a small but significant decrease in net return on labour and management; however, a 30 per cent rate caused highly significant changes. The economic effects of retained placenta were similar in magnitude in herds of high or low productivity and high or low fertility. Sensitivity analysis showed that the greatest financial losses were caused by loss of milk production, followed by the number of animals suffering from complications. The financial losses in herds with an average rate of retained placenta were thus of limited economic importance and therapeutic measures alone should be adequate.(ABSTRACT TRUNCATED AT 250 WORDS)
Animal Husbandry↗
Retained placenta continues to be fatal but frequency can be reduced.
Retained placenta is potentially lift-threatening not only because of retention per se, but because of associated haemorrhage and infection as well as complications related to its removal. These risks are increased in women in poor social circumstances due to pre-existing malnutrition, anaemia and unsupervised home deliveries. The present study was undertaken to assess the situation in this rural area. A previous study at the same place suggested preventive strategies an and individualised approach. Incidence of retained placenta has been 0.23% of all births over 15 years. Of the deliveries at Kasturba Hospital, the incidence of retained placenta was 0.008% (two of 23,838 vaginal deliveries). Sixty-five women were admitted with retained placenta after home deliveries and three after delivery at other hospitals The age of most of the patients was between 20 and 29 years and most were para 2 or 3. In twenty-three (32.4%) cases, women had delivered preterm. Twelve (16.9%) women had previous uterine surgery and 10 (14.1%) had had a retained placenta in the past. Twenty-six (36.61%) women had come in a state of severe shock. Thirty-six (50.7%) women required general anaesthesia for manual removal. One woman with an adherent placenta had to undergo hysterectomy (1.40%). The maternal mortality was 5.6%. Perinatal loss was 7.04%. It is unfortunate that of the four deaths, two women had actually delivered at a near by district hospital and were referred moribund and died. A properly conducted delivery can reduce the incidence of retained placenta and if retention occurs, timely appropriate treatment can save life.
Adult↗
Reduced concentrations of apolipoproteins B-100 and A-I in serum from cows with retained placenta.
The purpose of the present study was to evaluate apolipoprotein B-100 and A-I concentrations in cows with retained placenta. Animals used were cows with retained placenta alone (n = 10), those with both retained placenta and ketosis (n = 7), and controls (n = 10). Apolipoprotein B-100 concentrations at 2 to 4 d after parturition were significantly (P < 0.01) decreased in cows with retained placenta alone (mean +/- SD, 0.084 +/- 0.029 mg/ML of serum) when compared with those in control cows (0.154 +/- 0.022 mg/mL). Apolipoprotein A-I concentrations (0.713 +/- 0.177 mg/ML) were also significantly (P < 0.05) lower than those of controls (0.895 +/- 0.159 mg/mL). These decreases were more distinct for apolipoproteins B-100 (55% of controls) than A-I concentrations (80% of controls). Concentrations of apolipoprotein B-100 (0.071 +/- 0.032 mg/mL; P < 0.01) and A-I (0.708 +/- 0.189 mg/mL; P < 0.05) in the cows with both retained placenta and ketosis were also reduced, when compared with values in controls. Other than apolipoproteins, cows with retained placenta alone had significantly (P < 0.01) higher serum nonesterified fatty acids, and lower triglyceride concentrations. Significantly (P < 0.01) higher nonesterified fatty acids and lower triglyceride concentrations were similarly observed in cows with both retained placenta and ketosis.
Analysis of Variance↗
Reduced phagocytotic activity of macrophages in the bovine retained placenta.
This study was carried out to investigate the distribution of immune cells in the bovine placenta during the postpartum period and to compare these cells between normal and retained placenta. Within 1 h after normal calving, biopsy samples of placentomes were collected from 10 cows. The occurrence of retention of fetal membranes was monitored for more than 8 h post-calving, and the samples obtained were divided into two groups: normally discharged and retained placenta (n = 5 each). Immunohistochemical procedures were utilized to detect macrophages and T lymphocytes. Numerous CD14-positive macrophages were found in the stroma of both normal placenta and retained placenta whereas only a few CD3-positive T lymphocytes were found in both cases. However, histochemical staining for acid phosphatase, a predominant lysozomal enzyme, revealed that almost all macrophages showed strong enzyme activity in the normally discharged placentas, whereas in retained placenta the activity of acid phosphatase was conspicuously decreased in intensity. These results indicate that there are functional differences in placental macrophages between normal and retained placenta.
Acid Phosphatase↗
A hospital-based study of the relationship between retained placenta and mastitis in dairy cows.
We investigated the relation between retained placenta and mastitis in Holstein dairy cows admitted to the New York State College of Veterinary Medicine. Cows with retained placenta were three times more likely to develop mastitis during hospitalization than animals without retained placenta. Since the hospital population was not representative of the general population, the possibility of a bias existed; a large bias was not likely because most distorting variables occurred equally in animals both with and without retained placenta. The literature suggests that the relationship between retained placenta and mastitis may be mediated through activity of the peripheral leukocytes. Further research is necessary to test this hypothesis.
Animals↗
Non-enzymatic antioxidative defence mechanisms against reactive oxygen species in bovine-retained and not-retained placenta: vitamin C and glutathione.
Vitamin C and glutathione (GSH) are water-soluble antioxidants which take part in defence mechanisms against reactive oxygen species (ROS). They may also be involved in processes of releasing/retaining bovine fetal membranes. Hence vitamin C, reduced (GSH) and oxidised (GSSG) glutathione levels were determined in retained and not-retained bovine fetal membranes in order to describe the non-enzymatic antioxidative status. Placental samples were collected immediately after spontaneous delivery or during caesarean section before term and at term, and 6 groups were formed as follows: (A) pre-term caesarean section without retained placenta; (B) pre-term caesarean section with retained placenta; (C) term caesarean section without retained placenta; (D) term caesarean section with retained placenta; (E) spontaneous delivery without retained placenta and (F) spontaneous delivery with retained placenta. Homogenates of maternal and fetal placental tissues were prepared, and vitamin C, GSH and GSSG were measured spectrophotometrically. Vitamin C levels were significantly higher in the maternal part than in the fetal part of the placenta in all groups examined. In retained placenta cases the levels were significantly lower than in control cows, except in pre-term groups. GSH concentrations were significantly higher in placentas without retention than with retention. GSSG levels showed the opposite relationship and were significantly higher in samples with retention of fetal membranes than in controls. Further experiments on antioxidative as well as oxidative status in bovine placenta are necessary.
Animals↗
[Effectiveness of local treatment using a PVP-iodine compound for retained placenta in cows].
106 cattle with retained placenta were treated either with Vetisept-bolus or Tetran-bolus (controls) after an attempt to remove fetal membranes. Uterine involution judged by rectal palpation on the 28th day was the same in both groups, but more treatments were necessary for cows of the experimental group. Cows treated with Vetisept came in heat nine days earlier than controls (p < 0.05). The pregnancy rate of the controls (91.6%) was better (p < 0.05) than in the experimental group (60.7%). No significant differences between the two groups were encountered for pregnancy index, total index, and service period. Of 82 cows after single calving 50 got pregnant again. In 18 of the remaining cattle another pregnancy was not attempted. The other 14 were bred but did not conceive. Treatment with tetracycline seems to be slightly superior and safer than the treatment with PVP-iodine. It is uncertain, whether the higher (p < 0.05) losses of animals in the experimental group than in the controls is due to the different treatment, for most of the cows had been slaughtered because of insufficient milk production. Therapy with iodine is a recommended alternative to the treatment with tracycline for certain indications.
Administration, Intravaginal↗
Equine retained placenta: technique for and tolerance to umbilical artery injections of collagenase.
Under laboratory conditions and in clinical experiments, bacterial collagenase has proven to be effective in hydrolyzing placenta and detaching cotyledon from caruncle in the bovine species. Laboratory studies in which placental samples were incubated with collagenase have also demonstrated that collagenase is 3.7 times more effective in hydrolyzing equine placenta than bovine placenta. This led to the hypothesis that collagenase may be a potential treatment for mares with retained placenta. However, that collagenase may hydrolyze the uterine wall and perforate the uterus was a concern. It was the purpose of this study thus to determine any adverse effects of collagenase on the equine uterus and to develop a method for intraplacental injection of collagenase. Three normally expelled intact placentas from Arabian mares, 10 cyclic mixed-breed mares, and 4 mares of various breeds with retained placenta were used. Fluoroscein dye and latex were used to study the placental vasculature and to determine a suitable dose of collagenase; placentas were hydrolyzed by collagenase solution in vitro. Bacterial collagenase solution (40,000 units, 200 ml) was infused into the uterine lumen of each cyclic mare. Uterine biopsies were obtained from the mares before collagenase infusion and again at 16 h and 26 d after infusion. In the mares with retained placenta, each placenta was infused via its umbilical cord vessels with 200,000 units of bacterial collagenase in 1 L of saline. Results showed that none of the uteri from cyclic mares were damaged by collagenase treatment. During a 4-wk period of monitoring (including endoscopy) mares with retained placenta did not show any abnormalities. Retained placentas were expelled in less than 6 h after collagenase treatment. It was concluded that intraplacental injections of collagenase are a safe and potentially effective treatment for retained placenta in mares.
Animals↗
Safety of intravenous glyceryl trinitrate in management of retained placenta.
A retrospective chart review of all anaesthesia consultations for retained placenta at 28 weeks' gestational age or more was performed to determine the safety and efficacy of intravenous glyceryl trinitrate therapy in the management of retained placenta. Of the 33 patients who received glyceryl trinitrate, 1 received a total dose of 50 micrograms and the remainder received 100 to 200 micrograms. All placentas were extracted within 4 minutes of the first bolus. The systolic and diastolic blood pressures and the haematocrit fell by a mean of 8.1 +/- 5.3 mmHg, 6.0 +/- 3.5 mmHg, and 2.6 +/- 1.7%, respectively (mean difference +/- SD, p < 0.05 for each). The pulse rose by a mean of 7.7 +/- 4.5 bpm (p < 0.001). Only 1 patient required ergometrine for continued atony. None of the patients required transfusions or operative therapy other than dilatation and curettage. The use of glyceryl trinitrate in doses of 200 micrograms or less for retained placenta appears efficacious and safe, and may obviate the need for general anaesthesia for uterine relaxation.
Adult↗
Effects of twinning on gestation length, retained placenta, and dystocia.
Constraints to maximal productivity from twinning in beef cattle include increased incidence of dystocia and retained placenta, longer postpartum interval, and lower conception rate. Incidence and cause(s) of the shorter gestation length and of the increased retained placenta and dystocia associated with twinning were evaluated for 3,370 single and 1,014 twin births produced in a population of cattle selected for natural twin births. Gestation length was shorter for twin than for single pregnancies (275.6 vs. 281.3 d, P<.01) and likely contributed to the higher incidence of retained placenta associated with twin births (27.9 vs. 1.9%; P<.01). Incidence of retained placenta was also higher in the spring (March-April) than in the fall (August-September) calving season (18.3 vs. 11.4%; P<.01). The higher incidence of dystocia with twins than with singles (46.9 vs. 20.6%, P<.01) was primarily due to abnormal presentation (37.0 vs. 4.5%, respectively) of one or both twin calves at parturition. First- (40.5%) and second- (22.7%) parity dams with a single birth had more (P<.01) dystocia than older dams (13.4%), whereas dystocia was not affected (P>.10) by parity with twin births. Because of the shorter gestation length and the increased incidence of retained placenta and(or) dystocia, achievement of increased productivity with twinning in cattle necessitates intensive management of twin-producing dams and their calves during the calving season. Management of the increased dystocia can be facilitated by preparturient diagnosis of twin pregnancies, enabling timely administration of obstetrical assistance to facilitate delivery of twin calves and to increase their neonatal survival.
Animals↗
Treatment of bovine retained placenta and its effects.
The literature on the treatment of retained placenta and its effects is reviewed. Manual removal, the oldest and commonest method of treatment, benefits parlour hygiene but may adversely affect the cow. The use of collagenase may allow manual removal without such side effects. Ecbolic drugs are often ineffective, both as prophylaxis and treatment for the condition. They are most effective within one hour of parturition, particularly after a caesarean section in which tocolytic drugs have been used. Endometritis is a very common sequel to retained placenta. Antibiotics and oestrogens have been used to treat, control or prevent the condition, but they are not routinely effective and may have deleterious side effects. Gonadotrophin releasing hormone and/or prostaglandins have been used to reduce the deleterious effect of retained placenta on fertility, but the results obtained have been inconsistent.
Animals↗
Early postpartum reproductive profiles in Holstein cows with retained placenta and uterine discharges.
Sixty Holstein cows were allocated to three groups. Twenty cows had retained placenta. The remaining cows were examined on d 14 postpartum and those with purulent discharges (n = 22) were assigned to one group and the remaining (n = 18) to a control group. Within each group, cows were given randomly either gonadotropin-releasing hormone (i.m., 200 micrograms) or saline on d 15 postpartum to evaluate the effect on changes in ovarian structures and plasma progesterone through 50 d postpartum and fertility. Corpora lutea were found in control cows by d 21, cows with uterine discharge by d 28, and cows with retained placenta by d 27. Maximum progesterone production during the first luteal phase was higher in control cows than in cows with purulent discharge or retained placenta (4.66 ng/ml compared with 3.23 and 3.34 ng/ml, respectively). Duration of the first corpus luteum was affected by clinical condition. Only 6.2% of cows with retained placenta had corpora lutea of normal duration (12 to 16 d), whereas 43.8 and 50.0% of cows with uterine discharge and control cows had normal postpartum luteal phases. Measures of fertility were not affected by gonadotropin-releasing hormone. Control cows had less days to conception (97) and fewer services per conception (1.6) than cows with retained placenta (134 and 2.5, respectively). Clinical group affected reproduction more than gonadotropin-releasing hormone did, possibly by altering ovarian function.
Animals↗