The effect of Channa striata, Moringa oleifera, and Curcuma xanthorrhiza extract on accelerating recovery in a ventilated patient with hemorrhagic shock grade 3 due to prolonged retained placenta: a case report.

BACKGROUND: Most of critically ventilated patients with severe hemorrhagic shock experience metabolic acidosis, hypoalbuminemia, electrolyte imbalance, and increased production of free radical. Channa striata has a high content of albumin, an essential binding protein that contributes to homeostasis, and when combined with Moringa oleifera and Curcuma xanthorrhiza, they act as powerful antioxidants. Administration of C. striata, M. oleifera, and C. xanthorrhiza extract orally may benefit patient with hemodynamic issues, including significant blood loss. CASE REPORT: A 40-year-old Indonesian woman came to emergency department with decreased consciousness resulting from hemorrhagic shock grade 3 due to prolonged placenta retention for 10 days after delivery of her third child. She had an emergency hysterectomy and was sent to the intensive care unit with a hemoglobin level of 4.2 gr/dL, despite already receiving two bags of packed red blood cells during operation, and she continued with four more bags within her first day in the intensive care unit. The patient was ventilated, was supported by vasopressors, and had a low albumin level of 2.1 gr/dL. Her hemodynamic profile was difficult to stabilize, with persistent gastric residue and periodic urine output less than 1 cc/kg/hour, thereby slowing the ventilator and vasopressor weaning process. Oral supplementation of C. striata, M. oleifera, and C. xanthorrhiza was given in the second day divided in three doses every 6 hours. After the second dose, gastric residue started to subside and disappeared after the third dose. The patient's condition improved in the next 24 hours; she was extubated and discharged from the hospital in the fourth day. CONCLUSION: This is the first case report describing the effect of C. striata, M. oleifera, and C. xanthorrhiza extract in a patient with severe hemorrhagic shock due to a prolonged placenta. Accelerated recovery showed the possibility benefit of C. striata, M. oleifera, and C. xanthorrhiza extract in stabilizing oncotic pressure, neutralizing free radicals, and preventing further damage in hypoxic cells.

Management of the third stage of labour: (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gülmezoglu).

The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented.

Associations of reproductive indices with fertility outcomes, milk yield, and survival in Holstein cows.

The study is part of a research effort investigating potential associations between genomic variation and fertility of Holstein cows. The objective was to compare the reproductive performance of Holstein cows in 3 categories of 2 reproductive indices (RI) that were developed for the allocation of cows in a ranking for potential fertility, based on the predicted probability of pregnancy. The associations between categories of the developed indices and multiple fertility variables in a large multistate population of Holstein cows were tested. In addition, we analyzed associations among the RI categories with milk yield and survival. Based on phenotypic information from individual cows, 2 reproductive indices (RI1 and RI2) were developed, representing a predicted probability that a cow will become pregnant at first artificial insemination postpartum, as a function of explanatory variables used in a logistic model. Data from a total of 11,733 cows calving in 16 farms located in 4 regions of the United States (Northeast, Midwest, Southeast, and Southwest) were available. Cows were enrolled at parturition and monitored weekly for reproductive events, health status, milk yield, and survival. To develop the indices, potential significant effects were initially tested by univariate analyses. Effects with P ≤ 0.05 were offered to the multivariate analysis, and the final models were determined through backward elimination, considering potentially significant interactions. The final model for RI1 included the random effect of farm and a complement of significant fixed effects as explanatory variables influencing a pregnancy outcome: (1) incidence of retained fetal membranes; (2) metritis; (3) clinical endometritis; (4) lameness at 35 days in milk (DIM); (5) resumption of postpartum ovulation by 50 DIM; (6) season of calving; and (7) parity number. The model for RI2 included (1) parity number; (2) body condition score at 40 DIM; (3) incidence of retained fetal membranes; (4) metritis; (5) resumption of postpartum ovulation by 50 DIM; (6) region; (7) subclinical ketosis; (8) mastitis; (9) clinical endometritis; and (10) milk yield at the first milk test after calving; as well as the interaction effects of postpartum resumption of ovulation by 50 DIM × region; mastitis × region; and milk yield at the first milk test after calving × parity number. Multivariate logistic regression, ANOVA, and survival analysis were used to test the correspondence between the resulting RI and individual fertility, milk yield, and survival from the population. To facilitate the analyses, the resulting RI values were categorized as low for cows in the lowest quartile, medium for cows within the interquartile range, or high for cows in the top quartile. We found consistent agreement between categories of the predicted RI and the measures of fertility and survival collected from individual cows. We conclude that the proposed RI represent a viable approach to refine the allocation of cows into potential low- and high-fertility populations.

Effects of mineral supplementation on reproductive performance of pregnant cross-breed Bonsmara cows: An experimental study.

Minerals in animal feed occur in variable structures, most of which determine the uptake and usage in biological processes in the body. Effective chemical breakdown of minerals may ensure efficient utilization in metabolism. The aim this study was to evaluate the effects of mineral supplementation on reproduction in cows. A farm was selected for the experiment due to the fact that it previously experienced different reproductive conditions in the farm. The farm comprises cross-breed cows with Bonsmara dominating in the farm. Twelve pregnant primiparous and multiparous cows of different ages, parity and weight, that had previously experienced reproductive conditions, were randomly selected for this study. The cows were then randomly sub-divided into two groups (experimental and control group) of six. The experimental group was injected with MULTIMIN™ + Se + Cu at a dosage of 1 ml/45 kg BW and Calci 50 p.i. at a dosage of 100-150 ml/500 kg BW at an interval of 6 weeks (from June to October 2017). Blood samples were collected before every injection date. The t test was used to relate the mean weight gain and serum metabolite between the experimental and control groups. The body weight gain was significantly higher in the experimental group compared to the non-supplemented group. Supplemented cows had significantly (p < .05) high levels of triglycerides and creatinine kinase. A case of retained placenta and dystocia among non-supplemented cows were noted. Thus, mineral supplementation can be used to improve productivity and reproductive well-being.

Public provision of emergency obstetric care: a case study in two districts of Pakistan.

OBJECTIVES: Pakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed. SETTING: We analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts. PARTICIPANTS: Using a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics. PRIMARY OUTCOME MEASURES: We investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN). RESULTS: Deliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities. CONCLUSIONS: Both districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.

Effects of pegbovigrastim administration on periparturient diseases, milk production, and reproductive performance of Holstein cows.

The aim of this study was to evaluate the effects of treating Holstein cows with pegbovigrastim on periparturient diseases, milk production, and reproductive performance while exploring the mode of action of an immunomodulatory protein. Cows were randomly allocated to 1 of 2 treatments, untreated control (CTR, n = 423) and pegbovigrastim (PEG, n = 417). At 7 d from the anticipated calving date (d -7), cows allocated to PEG received a subcutaneous injection of 15 mg of pegylated recombinant bovine granulocyte colony stimulating factor (pegbovigrastim injection, Imrestor, Elanco Animal Health, Greenfield, IN). A second injection was administered within 24 h after calving (d 0). Blood samples were obtained from a subset of cows (CTR, n = 103; PEG, n = 102) at -7 and 0, 3, 7, and 14 d relative to parturition. Samples were used for hemogram and quantification of haptoglobin, nonesterified fatty acids, ß-hydroxybutyrate, and trace and macro minerals. Vaginal cytobrush was performed on the same subset cows at d 0, 7, and 14 to assess the relative neutrophil count. Additionally, colostrum samples were collected to measure IgG, IgM, IgA, and lactoferrin concentrations. Postpartum disease occurrence was recorded from calving until 30 d in milk (DIM). Weekly milk yield was recorded for the first 12 wk after calving. Cows treated with PEG had a 3- to 4-fold increase in circulating polymorphonuclear leukocyte, lymphocyte, and monocyte numbers, with a peak at 3 d after treatment followed by a gradual decline, but the counts remained significantly greater compared with CTR at 14 DIM. The administration of PEG did not affect the incidence of clinical and subclinical mastitis, retained fetal membranes, metritis, puerperal metritis, and endometritis. Primiparous cows treated with PEG tended to have lower odds of developing hyperketonemia than CTR [odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.23 to 1.42]. Cows treated with PEG had higher odds of being diagnosed with lameness within 30 DIM compared with CTR (OR = 1.79, 95% CI = 1.16 to 2.76); however, we found no significant differences by 60 DIM. Treatment with PEG increased the odds of displaced abomasum (OR = 8.27, 95% CI = 1.02 to 66.6). Cows treated with PEG had higher odds of being diagnosed with 1 or more clinical diseases compared with CTR cows (OR = 1.39, 95% CI = 1.02 to 1.90). We observed no differences in linear scores or milk composition between treatments. Furthermore, primiparous cows treated with PEG produced more milk than CTR primiparous cows during the first 12 wk postpartum (PEG = 37.51 ± 0.66; CTR = 35.91 ± 0.65 kg), but no differences were observed on energy-corrected milk. Treatment did not alter reproductive performance; additionally, cows diagnosed with metritis or puerperal metritis and treated with PEG tended to have higher proportion of neutrophils in the vaginal mucosa when compared with CTR metritic cows. Although PEG treatment increased circulating polymorphonuclear leukocyte, monocyte, and lymphocyte numbers, as expected, it was detrimental to cow health because it increased morbidity.

Administration of an herbal powder based on traditional Chinese veterinary medicine enhanced the fertility of Holstein dairy cows affected with retained placenta.

Herbal powder consisted of Leonurus artemisia (Laur.) S.Y. Hu F, Angelica sinensis (OLIV.) DIELS (radix), Ligusticum chuanxiong HORT (radix), Sparganium stolonif erum (Graebn.) Buch.-Ham.exJuz (radix), Curcuma zedoaria (Christm.) ROSC (radix), Cyperu srotundus Linn. (radix), and Glycyrrhiza uralensis FISCH (radix) has a high efficacy in facilitating earlier expulsion of the placenta and lowering puerperal metritis risk, and reproductive outcomes might represent the ultimate therapeutic goal of a treatment option for retained placenta in cows. This trial was carried out to further evaluate the effect of the herbal powder on the subsequent fertility of Holstein dairy cows with retained placenta. The animals were treated with herbal powder (n = 85, 0.5 g crude herb/kg bw, p.o.) once daily for 1-3 day(s) or ceftiofur hydrochloride (n = 72, 2.2 mg/kg bw, i.m.) twice daily for 3 consecutive days, and 75 cows with no clinically visible pathological conditions, given without assistance and with no retained placenta diagnosis were included into the control group. Calving-to-first-AI interval (67.2 ±â€¯16.2 vs. 81.9 ±â€¯28.7, p < 0.01), services per conception (1.9 ±â€¯1.2 vs. 2.4 ±â€¯1.7, p < 0.05), and calving-to-conception interval (101.8 ±â€¯47.0 vs. 129.6 ±â€¯56.6, p < 0.01) were lower in the herbal group than in ceftiofur group. Percentage of cows pregnant within 180 days postpartum was the higher in cows from the herbal group compared to cows in ceftiofur group (75.0% vs. 90.6%, p < 0.01). Additionally, the cows in the herbal group had a very similar fertility compared to the healthy controls, including calving-to-first-AI interval (67.2 ±â€¯16.2 vs. 66.3 ±â€¯16.9, p＞0.05), first AI conception proportion (48.2% vs. 50.6%, p＞0.05), services per conception (1.9 ±â€¯1.2 vs. 2.0 ±â€¯1.1, p＞0.05), percentage of cows pregnant within 180 days postpartum (90.6% vs. 93.3%, p＞0.05) and calving-to-conception interval (101.8 ±â€¯47.0 vs. 99.0 ±â€¯44.7, p＞0.05). Herbal powder used in this trial might have a beneficial clinical efficacy, and thus, might represent a potential effective treatment strategy to improve the subsequent fertility of dairy cows with retained placenta.

Differential effects of a single dose of oral calcium based on postpartum plasma calcium concentration in Holstein cows.

Our objectives were to determine (1) the effect of a single dose of an oral Ca bolus within 24 h after parturition on plasma Ca concentration, (2) the response of primiparous (PP) and multiparous (MP) cows to this supplementation strategy, and (3) differential responses based on plasma Ca at enrollment. For objective 1, cows from 1 commercial dairy in New York State were enrolled within 19 h after parturition (mean ± standard deviation = 8.3 ± 5.3 h) and randomized within parity group (first, second, and ≥third) to control [CON (n = 25); no placebo] or a single dose bolus treatment [BOL (n = 25); 3 oral Ca boluses supplying 54 to 64 g of Ca]. Plasma Ca was measured repeatedly between 1 and 24 h following treatment. For objectives 2 and 3, cows on 6 commercial farms in New York State were assigned to treatment as for objective 1 (CON, n = 1,973; BOL, n = 1,976). Herd records for health, reproduction, and Dairy Herd Improvement Association test day milk production were collected. Mixed effect multivariable models were developed using repeated measures ANOVA, Poisson regression, or proportional hazard models. Objective 2 analyses considered treatment with periparturient risk factors, whereas objective 3 analyses also considered Ca status. No difference was observed for plasma Ca between 1 and 24 h after treatment. Primiparous cows assigned to BOL calving at >712 d old had decreased risk of one or more health disorders [≤30 d in milk; risk ratio (RR) = 0.65, 95% confidence interval (CI) = 0.51 to 0.84] and those with body condition score >3.5 responded to BOL with increased milk production (CON = 31.7 ± 1.1, BOL = 35.1 ± 1.1 kg/d), as did those with days carried calf >277 (CON = 31.9 ± 1.0, BOL = 34.7 ± 1.0 kg/d). Reduced risk of one or more health disorders was observed in parity ≥3 (RR = 0.85, 95% CI = 0.81 to 0.89) and MP cows with body condition score >3.5 (retained placenta; RR = 0.70, 95% CI = 0.58 to 0.84) or that were lame (displaced abomasum; RR = 0.49, 95% CI = 0.32 to 0.75). Differential responses for PP cows by Ca status were minimal. For MP cows with low plasma Ca, BOL decreased risk of additional Ca treatment (≤1.8 mmol/L; RR = 0.57, 95% CI = 0.40 to 0.80) as well as risk of one or more health disorders (≤2.15 mmol/L; RR = 0.90, 95% CI = 0.85 to 0.95). Supplementation with a single oral dose of Ca could be targeted to periparturient risk groups for improved health. Calcium status did not differentiate responses of PP cows, but MP cows with low Ca at parturition had improved health status when supplemented.

The Feasibility of Conservative Management for Morbidly Adherent Placenta Accidentally Encountered after Vaginal Delivery.

OBJECTIVE: To evaluate the feasibility of conservative management for patients with morbidly adherent placenta (MAP) accidentally encountered after term vaginal delivery. METHODS: Medical records of patients with MAP who were accidentally encountered after term vaginal delivery and treated in our hospital from January 2009 to December 2015 were retrospectively reviewed. RESULTS: A total of 8 eligible patients were included in this analysis. Primary postpartum hemorrhage occurred in 5 (62.5%) cases. Emergent uterine artery embolization, intrauterine balloon occlusion, and blood transfusion were performed in 5 (62.5%), 2 (25%), and 2 (25%) cases, respectively. Placentas were left in situ in all these 8 cases. Subsequent adjunctive medication treatments, including methotrexate, mifepristone, and traditional Chinese medicine, were administered in 7 (87.5%), 4 (50%), and 3 (37.5%) cases, respectively. The retained placenta spontaneously passed out in 4 (50%) patients. Additional curettage operation was performed in 3 (37.5%) patients. Emergent hysterectomy was performed in 1 (12.5%) patient due to cardiac insufficiency and acute pulmonary edema caused by sepsis. No other severe adverse events were identified. CONCLUSIONS: Conservative management is feasible for patients with MAP accidentally encountered after vaginal delivery with close follow-up.

Comparison of Intrauterine Antibiotics versus Ozone Medical Use in Sheep with Retained Placenta and Following Obstetric Assistance.

This study outlines a new approach to reproductive tract treatment using ozone foam spray for certain ovine obstetrical problems, such as retained foetal membranes and possible uterine infections following obstetric assistance (OA), in comparison with classical antibiotics treatments. The study was conducted on 256 ewes from 11 sheep farms in north-western Croatia. A total of 139 ewes were diagnosed with dystocia (DT) and 49 with retention of placenta (RP). Ewes with RP were treated either with ozone foam spray (Riger spray G; Novagen(®) ) applied into the body of the uterus for 2-3 s (first or RPO group; n = 24) or with two foaming, intrauterine tablets of oxytetracycline hydrochloride (Geomycin(®) F) (second or RPA group; n = 25). The third and fourth groups consisted of ewes that received OA for dystocia (including ringwomb, foetal oversize and assistance of abnormal position and posture). The third group (DTO; n = 70) was treated with ozone foam spray, while ewes in fourth group (DTA; n = 69) were treated with antibiotics. The ewes in the control group (CTL) with physiological puerperium were randomly selected (n = 70) from all herds. Transrectal ultrasonography (transversal diameter of uterine horns) was used for the control of uterus regression on days 2 and 25 after parturition. There was a difference in transversal uterine horn diameter in the RP groups, that is RPO and RPA (5.40 ± 0.53 cm vs. 5.43 ± 0.40 cm), ewes with dystocia, that is DTO and DTA (5.37 ± 0.49 cm vs. 5.54 ± 0.60 cm) and ewes from the CTL group (4.98 ± 0.35 cm) one day after parturition. Average transversal uterine diameter of all groups at day 25 post-partum was 1.80 ± 0.15 cm. The intrauterine ozone treatment in ewes with RP and after manual obstetrics attained similar results to spontaneously delivered ewes (CTL group), showed as the physiological regression of the uterus with a similar transversal diameter without the presence of lochia in the uterine lumen, indicating that this could be a novel potential alternative therapy.

Retained placenta: will medical treatment ever be possible?

The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro-placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments.

Supplementation of prepartum dairy cows with ß-carotene.

The prepartum supplementation of dairy cows with ß-carotene was evaluated. Cows were blocked by parity and expected calving date and assigned to a treatment: ß-carotene (1.2 g/cow per d) or control (no supplementation). The same total mixed ration batch was offered to all cows, and ß-carotene was top dressed to individual cows once per day. The data set contained 283 Holsteins that received a treatment for >14 d (29.1±6.9 d). Frequency distributions were analyzed with the GENMOD procedure of SAS using logistic regression for binomial data. Continuous variables were analyzed with the MIXED procedure of SAS. Within parity, nonparametric estimates of the survivor function for reproductive variables were computed using the product-limit method of the Kaplan-Meier method with the LIFETEST procedure of SAS. Plasma ß-carotene concentration before supplementation was similar between supplemented and nonsupplemented cows (2.99µg/mL) and peaked at 3.26±0.175µg/mL on d -15±2.4 precalving for supplemented cows (2.62±0.168µg/mL for control). Colostrum density, milk yield, and milk composition were similar between treatments. ß-Carotene tended to increase milk protein content from 2.90 to 2.96% and to decrease the proportion of primiparous cows with a milk fat to protein ratio >1.5 from 22.6 to 6.4%. The proportion of primiparous and multiparous cows with difficult calving, metritis, progesterone >1 ng/mL at 21 d and at 42 d in lactation, % conception at first service, and % pregnancy at 90 and 150 d in lactation were similar between treatments. A trend for decreased incidence of somatic cell count >200,000 cells/mL was present in multiparous cows supplemented with ß-carotene (38.9% vs. 28.1%). ß-Carotene was associated with a reduction in the proportion of multiparous cows with retained placenta 12 h postpartum from 29.9 to 21.7%; time of placenta release was 392 min (340 to 440) for ß-carotene and 490 min (395 to 540) for control (median and 95% confidence interval). For primiparous cows, placenta release was not affected by ß-carotene (incidence was 15.4%). The intervals from calving to first estrus, to first service, and to conception were not affected by ß-carotene supplementation in either parity. However, independent of treatment, cows with improved reproductive efficiency had increased postpartum ß-carotene concentration in plasma. The prepartum supplementation of ß-carotene increased plasma concentration around calving. No response in milk yield or reproductive performance was detected. Beta-carotene supplementation was associated with a lower incidence of retained placenta in multiparous cows.

Deficiências minerais em vacas em lactação da bacia leiteira do município de Rondon do Pará, estado do Pará / Mineral deficiencies in lactating cows from the dairy basin of Rondon do Pará, Brazil

Realizou-se um estudo das deficiências minerais em vacas em lactação de rebanhos leiteiros pertencentes a 13 propriedades da bacia leiteira do município de Rondon do Pará, estado do Pará. Foram determinados os níveis de fósforo (P) no osso, e os níveis de cobre (Cu), cobalto (Co), selênio (Se) e zinco (Zn) no fígado de 47 vacas leiteiras no 2º terço da lactação. Estas amostras foram coletadas por meio de biópsias realizadas no terço superior da 12a costela do lado direito e no bordo caudal do lobo caudado do fígado, respectivamente. Os rebanhos eram formados por animais mestiços (Holandes x Zebu), mantidos em sistema de produção extensivo em pastos de Brachiaria brizantha cv Marandu e recebiam suplementação mineral. A mistura mineral em 12 propriedades era do tipo comercial, dita "completa", acrescida de quantidades de NaCl acima do recomendado pelos fabricantes em dez propriedades. Em sete propriedades as misturas minerais eram fornecidas em cochos sem cobertura e em oito, o fornecimento da mistura mineral não era realizado diariamente. Em 11 propriedades, havia históricos clínicos condizentes com deficiências minerais nos rebanhos. Nessas fazendas a retenção de placenta e a osteofagia foram as alterações mais relatadas. Após as análises minerais observou-se deficiência de P em cinco propriedades, de Co em três propriedades, de Se em nove propriedades e de Zn em dez propriedades. Conclui-se que ocorre a deficiência de P, Co, Se e Zn; a suplementação mineral realizada na maioria das propriedades não atendeu as exigências diárias de P, Se e Co, baseadas no consumo estimado de 30 g de NaCl/animal/dia; os cochos pouco adequados ou inadequados para a suplementação, assim como o fornecimento inconstante das misturas minerais possivelmente contribuíram para a deficiência de um ou mais minerais.

A study of mineral deficiencies was performed in lactating cows from dairy herds belonging to 13 farms of Rondon do Pará, state of Pará, Brazil. We determined the levels of phosphorus (P) in the bone and levels of copper (Cu), cobalt (Co), selenium (Se) and zinc (Zn) in the liver of 47 dairy cows in lactation 2. The samples were collected by means of biopsies taken on the top third of the 12th rib of the right side and the caudal edge of the caudate liver lobe, respectively. The herds were composed of crossbred (Holstein x Zebu) cattle, kept in extensive production system on Brachiaria brizantha cv. Marandu pasture and received mineral supplementation. The mineral mixture on 12 farms were commercial type, called "full" and the owners added a quantity of salt above the manufacturer's recommendations on ten farms. The mineral mixtures were provided in troughs without covering on seven farms and on other eight, providing of the mineral mix was not performed daily. On 11 farms there were clinical histories consistent with mineral deficiencies in livestock, and placenta retention and osteophagia were the most frequently reported ones. The results of chemical analysis showed deficiency of P on five farms, of Co on three farms, of Se on nine farms and of Zn on ten farms. It is concluded that the mineral supplementation performed on the farms do not supply the daily demands of P, Se and Co, based on the estimated daily consumption of 30g of NaCl per animal; the little adequate or inadequate troughs for proper supplementation, as well as inconstant supply of mineral mixtures contribute to the deficiency of one or more minerals.

Effect of injectable vitamin E on incidence of retained fetal membranes and reproductive performance of dairy cows.

The objectives were to evaluate the effects of injectable vitamin E during the last 3 wk prepartum on the incidence of retained fetal membranes (RFM) and reproductive performance. Dairy cows (n=890), 390 Holsteins (132 nulliparous and 258 parous) and 500 crossbred Holstein × Gyr (199 nulliparous and 301 parous), from 3 dairy farms in Brazil were assigned to the study. In all 3 farms, from October to March, prepartum cows grazed tropical grasses and received 2 kg/d of a mixture of finely ground corn, soybean meal, and minerals and vitamins. From April to September prepartum cows received a total mixed ration composed of corn silage, finely ground corn, soybean meal, and minerals and vitamins. During the prepartum period, cows were fed 280 (farm 1), 390 (farm 2), and 480 IU (farm 3) of supplemental vitamin E per day, and throughout postpartum, cows were fed 370 (farm 1), 500 (farm 2), and 600 (farm 3) IU of supplemental vitamin E. Within each farm, cows were randomly assigned to remain as untreated controls or to receive 3 i.m. injections of 1,000 IU each of dl-α-tocopherol administered at 19.2 ± 4.3, 12.9 ± 3.3, and 6.2 ± 2.9 d before calving (VitE). Blood was sampled from 141 cows immediately before enrollment to determine the α-tocopherol and cholesterol statuses. Blood was also sampled and analyzed for concentrations of cortisol and nonesterified fatty acids in the last 3 wk of gestation. The serum concentration of α-tocopherol or α-tocopherol:cholesterol ratio did not differ between treatments and averaged 2.97 ± 0.10 µg/mL and 4.46 ± 0.16 × 10(-3), respectively. In total, 53.2% of the cows had an inadequate concentration of serum α-tocopherol based on the 3.0 µg/mL cut-off for adequacy. The risk of RFM decreased as serum α-tocopherol increased. Milk production did not differ between controls and VitE cows. Treatment with injectable α-tocopherol decreased RFM from 20.1 to 13.5%, decreased incidence of stillbirth from 14.9 to 6.8%, and tended to decrease death by 200 d postpartum. VitE cows tended to have improved pregnancy per insemination at first AI (36.7 vs. 30.1%) because of decreased pregnancy loss from 31 to 62 d of gestation (12.5 vs. 20.5%). Despite a similar insemination rate, VitE cows had 22% greater pregnancy rate than control cows. Cows receiving vitamin E had decreased circulating cortisol and nonesterified fatty acids around calving. In summary, when cows were fed limited amounts of supplemental vitamin E, 28 to 48% of the recommendations, prepartum supplementation with injectable α-tocopherol decreased incidence of RFM and improved reproduction.

Interprofessional simulation of a retained placenta and postpartum hemorrhage.

To improve quality and safety in healthcare, national and international organizations have called for students to receive dedicated training in interprofessional communication and collaboration. We developed a simulation for nurse-midwifery and nurse-anesthesia students, using the Core Competencies for Interprofessional Collaborative Practice framework. The simulation, involving a postpartum women with a retained placenta and acute blood loss, allowed students to collaboratively manage a high-risk situation. We present the details of the simulation and evaluation to assist educators.

The intrauterine treatment of the retained foetal membrane in dairy goats by ozone: novel alternative to antibiotic therapy.

One of the major post-parturient complications in dairy goats is the retention of foetal membrane (RFM), which negatively influences their health, reproductive efficacy and welfare. The aim of this study was to compare the efficiency of intrauterine either ozone (OZ) or antibiotic (AB) treatments to establish the use of OZ as a novel and potential alternative to AB therapy in does with the RFM. The study was performed on 7 herds of dairy goats (n = 563) kept in the farms in Croatia. The conception rate was 563 of 641 total matings or 87.83%. The does from selected farms were observed during early puerperium and were divided into animals without the RFM (n = 522) and with the RFM (n = 41), treated either with foam spray OZ (n = 21) or with foaming AB oxytetracycline tablets (n = 20). The does with the RFM were mated successfully and became pregnant next kidding season, regardless of the treatment applied. Treatment with OZ attained similar results to the standard AB therapy, indicating that it could be novel potential alternative therapy of the RFM in dairy goats.

Acupuncture for retained placenta: a retrospective case series.

BACKGROUND: A placenta is considered to be retained when it remains undelivered 30 or 60 min after the birth of the baby following active or physiological management of the third stage of labour, respectively. It can be life threatening for the mother. METHODS: We retrospectively examined the influence of acupuncture on the delivery of retained placentas in the third stage of labour in 70 women. In all cases the third stage of labour was actively managed, and acupuncture was provided 30 min after delivery at points KI16 and SP6 for 15 min. RESULTS: After acupuncture 77% of placentas separated successfully. In 10% of cases some retained placental tissue was detected and manual removal of the avulsed cotyledon was performed, while in 13% the entire placenta was retained and manual removal of the placenta under general anaesthesia was necessary. CONCLUSIONS: Acupuncture may help to facilitate placental separation but further controlled trials are needed.

Effects of folic acid and vitamin B12 supplementation on culling rate, diseases, and reproduction in commercial dairy herds.

This study was undertaken to determine the effect of a combined folic acid and vitamin B12 supplement given in early lactation on culling rate, metabolic disorders and other diseases, and reproduction in commercial dairy herds. A total of 805 cows (271 primiparous and 534 multiparous cows) in 15 commercial dairy herds were involved. Every 2mo from February to December 2010 and within each herd, cows were assigned according to parity, previous 305-d milk production, and calving interval to 5mL of either (1) saline 0.9% NaCl (control group) or (2) 320mg of folic acid + 10mg of vitamin B12 (vitamin group). Treatments were administered weekly by intramuscular injections starting 3wk before the expected calving date until 8wk after parturition. A total of 221 cows were culled before the next dry period. Culling rate was not affected by treatment and was 27.5%; culling rate was greater for multiparous (32.2%) than for primiparous cows (18.8%). Within the first 60d in milk (DIM), 47 cows were culled, representing 21.3% of total culling, and no treatment effect was noted. Ketosis incidence based on a threshold ≥100µmol/L of ß-hydroxybutyrate in milk was 38.3±2.9% for the vitamin group and 41.8±3.0% for the control group and was not affected by treatment. The combined supplement of folic acid and vitamin B12 did not decrease incidence of retained placenta, displaced abomasum, milk fever, metritis, or mastitis. However, the incidence of dystocia decreased by 50% in multiparous cows receiving the vitamin supplement, although no effect was observed in primiparous cows. The first breeding postpartum for multiparous cows occurred 3.8d earlier with the vitamin supplement compared with controls, whereas no treatment effect was seen for primiparous cows. Days open, first- and second-breeding conception rates, number of breedings per conception, and percentage of cows pregnant at 150 DIM were not affected by treatment. The reduced percentage of dystocia combined with the earlier DIM at first breeding for multiparous cows receiving the combined supplementation in folic acid and vitamin B12 indicates that the vitamin supplement had a positive effect in older cows.

Efficacy of herbal tincture as treatment option for retained placenta in dairy cows.

Retained placenta remains therapeutic challenge in cattle. Certain traditional medicines are believed to be able to alleviate retained placenta condition and improve overall fertility in cows. The aim of the present study was to evaluate the efficacy of an herbal tincture for treatment of retained placenta. The herbal tincture was extracted from a combination of Herba Leonuri, Angelicae Sinensis Radix, Flos Carthami, Myrrha and Rhizoma Cyperi by percolation with 70% ethanol to a concentration of 0.5g crude herb/ml. Cows diagnosed with retained placenta (n=48) were randomly divided into one of two treatment groups (A and B), with animals in group A (n=26) receiving herbal tincture orally, and cows in group B (n=22) receiving oxytetracycline infusion into the uterus. Eighty six cows with no clinically visible pathological conditions, given birth alone and with no retained placenta diagnosis were included into control group (C). Retained placenta was expelled within 72h following initial treatment in 19 cows in group A, yet no cows in group B were recorded to expel placenta in the same time. The median number of days to first service (70.0 vs. 102.5 days; P<0.05) and median number of days open (76.0 vs. 134.0 days; P<0.01) were lower in group A than in group B. Percentage of cows pregnant within 100 days postpartum was the highest for animals in group A compared to controls (61.5% vs. 39.5%, P<0.05), and for animals in group B (61.5% vs. 22.7%; P<0.01). Herbal tincture used in the present study might facilitate expulsion of retained placenta and improve subsequent fertility, thus could present effective treatment option for retained placenta in cows.

The administration of Sheng Hua Tang immediately after delivery to reduce the incidence of retained placenta in Holstein dairy cows.

Sheng Hua Tang, a classical herbal formula consisting of Radix Angelicae sinensis, Ligustici rhizoma, Semen persicae, Zingiberis rhizoma, and Radix glycyrrhizae, is known to be beneficial in alleviating postpartum diseases and facilitating a return to normal reproductive function. This study investigated whether the administration of Sheng Hua Tang within 2 to 4 hours after delivery was effective as a preventive treatment for reducing the risk of retained placenta in Holstein dairy cows. A total of 357 cows, each of which had delivered its calf spontaneously, were randomly allocated to one of two groups. In the treatment group, the cows (n = 175) received Sheng Hua Tang with an oral dose of 0.36 g crude herb per kg·body weight once daily for three consecutive days. The controls (n = 182) received no treatment. The placental retention proportion was 4.0% and 17.0% within 12 hours after delivery in the treated and control animals, respectively (P < 0.01). We found decreases in the calving-to-first-service interval (73.2 ± 25.1 vs. 81.9 ± 32.8 days; P < 0.01), calving-to-conception interval (93.4 ± 38.8 vs. 114.6 ± 42.9 days; P < 0.01), and service per conception (1.5 ± 0.8 vs. 1.9 ± 1.0 days; P < 0.01) in the treatment group compared with the control group. The first artificial insemination conception proportion was higher in the treatment group than in the control group (60.4% vs. 41.1%; P = 0.01). Moreover, the between-group difference in the proportion of cows that were pregnant within 180 days postpartum approached statistical significance (88.2% vs. 80.6%; P = 0.07). Sheng Hua Tang showed beneficial effects in reducing the incidence of retained placenta and improving subsequent reproductive performance in cows. This preventive treatment strategy would be effective in improving the management of puerperal health. The potential benefits of Sheng Hua Tang warrant further investigation to determine whether this preventive treatment strategy can be endorsed as a general preventive approach in postpartum cows.