The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study.

BACKGROUND: The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. METHODS: We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. RESULTS: The range of gestational age at delivery in our study was 12-21 weeks in 61 cases, 22-36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9-47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. CONCLUSION: The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.

Association between serum calcium dynamics around parturition and common postpartum diseases in dairy cows.

The objective of this study was to compare periparturient serum Ca dynamics (CaDyn) in cows with and without diseases in early lactation. The study enrolled 1,949 cows from a commercial dairy farm in northern Germany. Blood samples were drawn 7 d before expected calving date and on d 0, 1, 3, and 7 after calving and analyzed for serum Ca concentration. Cows were monitored for clinical hypocalcemia (CH), ketosis, left displaced abomasum (LDA), retained placenta, acute puerperal metritis (APM), mastitis, and pneumonia. To evaluate the association between CaDyn and diseases during the transition period, repeated measures ANOVA with first-order autoregressive covariance were performed. Serum CaDyn of healthy cows (i.e., without any of the aforementioned diseases) was compared with CaDyn of cows with one of the aforementioned diseases (CH, ketosis, APM, mastitis, LDA, and pneumonia), and cows with multiple diseases (CH+, ketosis+, APM+, mastitis+, LDA+, and pneumonia+). Separate models were built for primiparous and multiparous cows. For primiparous cows, we evaluated the association between CaDyn and ketosis (healthy cows vs. cows with ketosis vs. cows with ketosis+) and CaDyn and APM (healthy cows vs. cows with APM vs. cows with APM+). The same models were built for multiparous cows. Three additional models were built for multiparous cows to evaluate the association between CaDyn and CH (healthy cows vs. cows with CH vs. cows with CH+), mastitis (healthy cows vs. cows with mastitis vs. cows with mastitis+), or LDA (healthy cows vs. cows with LDA vs. cows with LDA+). In primiparous cows, serum Ca concentrations of cows with ketosis, APM, and APM+ were significantly reduced on d 3 and 7 after calving, compared with healthy cows. Serum Ca concentrations of primiparous cows with ketosis+ were reduced on d 3, but not on d 7 after calving. Multiparous cows with CH had significantly reduced serum Ca concentrations on d 0, 1, and 3 compared with healthy cows. On d 3 and 7, serum Ca concentration of CH+ cows was significantly reduced compared with healthy multiparous cows. Multiparous cows with ketosis and ketosis+ had significantly reduced serum Ca concentrations on d 1 and 3 compared with healthy cows. Cows with APM+ had significantly increased serum Ca concentrations on d 0 and reduced serum Ca concentrations on d 3, compared with healthy cows. Whereas multiparous cows with mastitis had a reduced serum Ca concentration on d 1, mastitis+ cows had a reduced serum Ca concentration on d 1 and 3, compared with healthy multiparous cows. Overall, multiparous cows with LDA+ had reduced serum Ca concentrations. Especially a delayed onset of hypocalcemia (d 3 and 7) was indicative for the development of disease in primiparous cows. In multiparous cows, reduced serum Ca concentrations on d 1 and 3 were associated with occurrence of diseases. Future studies should evaluate whether reduced serum Ca concentrations are a cause or concomitant circumstance of diseases in early lactation.

Acute-phase protein α-1-acid glycoprotein is negatively associated with feed intake in postpartum dairy cows.

α-1-Acid glycoprotein (AGP) is an acute-phase protein that may suppress dry matter intake (DMI), potentially by acting on the leptin receptor in the hypothalamus. Our objectives were to characterize plasma AGP concentration and associations with DMI during the transition period, and to determine the utility of AGP to identify or predict cows with low DMI. Plasma samples (n = 2,086) from 434 Holstein cows in 6 studies were analyzed on d -21, -13 ± 2, -3, 1, 3, 7 ± 1, 14 ± 1, and 21 ± 1 relative to parturition. A commercially available ELISA kit specific for bovine AGP was validated, and 2 internal controls were analyzed on each plate with interplate variation of 15.0 and 17.3%, respectively. Bivariate analysis was used to assess the relationship between AGP and DMI. For significant associations, treatment(study) was added to the model, and quadratic associations were included in the model if significant. Plasma AGP concentration (±SEM) increased from 213 ± 37.3 µg/mL on d -3 to 445 ± 60.0 µg/mL on d 14. On d 3, AGP was associated negatively with DMI in a quadratic manner for wk 1 and wk 2 and linearly for wk 3. Day 7 AGP was associated negatively with DMI in a quadratic manner for wk 2 and linearly for wk 3. Similarly, d 14 AGP was negatively associated with DMI for wk 3 and wk 4. As d 3 AGP concentration increased over the interquartile range, a calculated 1.4 (8.5%), 0.5 (2.7%), and 0.4 (1.9%) kg/d reduction in predicted DMI was detected during wk 1, 2, and 3, respectively. Using bivariate analysis, d 3 AGP explained 10% of the variation in DMI during wk 1. We explored the clinical utility of d 3 AGP to diagnose low DMI, defined as wk 1 DMI >1 standard deviation below the mean. Receiver operating characteristic analysis identified a threshold of 480.9 µg/mL, providing 76% specificity and 48% sensitivity (area under the curve = 0.60). Limited associations occurred between AGP and blood biomarkers; however, AGP was associated with plasma haptoglobin concentration postpartum and incidence of displaced abomasum, retained placenta, and metritis. These results demonstrate a negative association between plasma AGP concentration and DMI in early-postpartum dairy cows, although its diagnostic performance was marginal. Further investigation into whether AGP directly suppresses DMI in dairy cattle is warranted.

Can reticulorumen ph, temperature and cow activity registered before calving act as biomarkers of diseases after calving?

The aim of this study was to determine if reticulorumen ph, temperature and cow activity registered before calving can serve as indicators of diseases after calving.The cows were selected according to those fitting the profile of having had two or more lactations (on average 2.9±0.13 lactations), from 60 to 0 days before and the first 30 days after calving, and being clinically healthy. The clinical examination (identification of diseases after calving) was performed from 60 days before calving to 60 days after calving. Diseases after calving were diagnosed based on clinical symptoms specific to these diseases. The pH and temperature of the contents of the cow reticulorumens and cow activity were measured using specific smaX-tec boluses manufactured for animal care.We found that the highest pH and temperature before calving can serve as biomarkers of healthy cows after calving. The lowest reticulum temperature before calving can serve as an indicator of MF after calving. A positive correlation of reticulum pH and temperature before calving can serve as biomarkers of PR. Decreasing cow activity before calving can serve as an indicator of diseases after calving. For calving prognosis, temperature of the reticulorumen can be used; it decreased 6-7 days before calving.

Blood urea nitrogen may serve as a predictive indicator of retained placenta in dairy cows.

Retained placentae (RP) results in significant economic losses to dairy farmers. In Experiment 1, to screen biochemical indicators of RP, 21 cows with RP and 21 cows with no retained placenta (NRP) were selected as a control group, and blood was collected at -7 d, 0 h (parturition) and 12 h. Serum biochemical indicators were ascertained. Results indicate serum concentrations of phosphorus (P) and blood urea nitrogen (BUN) in cows of the RP group were markedly greater than in cows of the NRP group at -7 d (P < 0.01). In Experiment 2, to evaluate predictive indicators for RP, 34 cows with RP and 34 cows with NRP were selected, and there was blood sampling at -15 d, -10 d, -7 d, -4 d, and -1 d. Serum P, BUN, and total protein (TP) were evaluated. Associations of values among the three indicators and occurrence of RP were analyzed using binary logistic regression. Results indicate there was a negative correlation between only the values for BUN and RP (P = 0.016). In Experiment 3, to test hypothesis that relatively greater concentrations of BUN effects immune function in placental tissues, four cows were selected, placentae were collected at 0 and 12 h, and hematoxylin-eosin (HE) staining was performed. Results indicated that the extent of inflammatory cell infiltration and vascular proliferation were less at the 12 than 0-hour timepoint. Taken together, BUN at -7 d may serve as a predictive indicator of RP in cows.

[Retained placenta in mares - an analysis of 121 cases]. / Nachgeburtsverhaltung bei der Stute ­ eine Auswertung von 121 Fällen.

OBJECTIVE: The aim of this study was to analyze data concerning history, clinical course, and prognosis of retained fetal membranes in mares. MATERIAL UND METHODS: Patient records of 121 hospitalized mares with retained placenta were evaluated. In 82 cases, additional blood examinations were performed and analyzed. RESULTS: There was no significant correlation between age, parity or course of parturition and retained placenta. Eighty-one mares (66.9 %) were presented solely with retained fetal membranes, 40 mares (33.1 %) had additional diseases at presentation, most commonly injuries of the labia, followed by perineal tears and lochiometra. During hospitalization 50 mares (41.3 %) developed one or more diseases, most frequently lochiometra (23 mares, 19 %), laminitis (17 mares, 14 %) and thrombophlebitis (11 mares, 9.1 %). Eight mares (6.6 %) were euthanized due to the course of their diesease. Blood examinations revealed a mean leucocyte concentration of 9.8 ± 3.9 G/l at presentation. Mean concentration of serum ionized calcium amounted to 1.5 ± 0.2 mmol/l. There was no statistically significant influence of blood parameters on clinical course or development of additional diseases. CONCLUSION AND CLINICAL RELEVANCE: Retained placenta is a common disorder in the puerperium of the mare. In the presented study, most cases developed additional diseases and in 10 % of the mares, the clinical course led to euthanasia. No risk factors for the occurrence of retained fetal membranes or its clinical course could be identified.

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.

Targeted metabolomics: new insights into pathobiology of retained placenta in dairy cows and potential risk biomarkers.

A targeted quantitative metabolomics approach was used to study temporal changes of serum metabolites in cows that normally released their fetal membranes and those that retained the placenta. We identified and measured serum concentrations of 128 metabolites including amino acids, acylcarnitines, biogenic amines, glycerophospholipids, sphingolipids and hexose at -8 and -4 weeks before parturition, during the week of retained placenta (RP) diagnosis, and at +4 and +8 weeks after parturition. In addition, we aimed at identifying metabolite signatures of pre-RP in the serum that might be used as predictive biomarkers for risk of developing RP in dairy cows. Results revealed major alterations in the metabolite fingerprints of pre-RP cows starting as early as -8 weeks before parturition and continuing as far as +8 weeks after calving. Biomarker candidates found in this study are mainly biomarkers of inflammation which might not be specific to RP. Therefore, the relevance of serum Lys, Orn, acetylornithine, lysophophatidylcholine LysoPC a C28:0, Asp, Leu and Ile as potential serum biomarkers for prediction of risk of RP in dairy cows will have to be tested in the future. In addition, lower concentrations of LysoPCs, Trp, and higher kynurenine in the serum during prepartum and the week of occurrence of RP suggest involvement of inflammation in the pathobiology of RP.

Elevated non-esterified fatty acid and ß-hydroxybutyrate in transition dairy cows and their association with reproductive performance and disorders: A meta-analysis.

A meta-analysis including 36 different results of statistic models from 14 papers was conducted. It evaluated the association between elevated non-esterified fatty acids and/or ß-hydroxybutyrate (BHB) on the reproduction outcomes that were pregnancy at first insemination, estrous cyclicity, time to pregnancy, metritis and placental retention. Each association between BHB or NEFA and an outcome reported in literature was a model considered as raw-data for the meta-regression. For each outcome, the meta-regression adjusted the odds ratio, relative risk or hazard ratio with various moderators to reduce the heterogeneity among the studies. The relative risk for metritis and placental retention in case of high BHB or NEFA was in accordance to previous meta-regression and was 1.91 (IC95 = 1.72 to 2.12) and 1.51 (95%CI = 1.19 to 1.92), respectively. The relative risk for pregnancy at first insemination in case of high BHB was assessed to be 0,62 (95%CI = 0,41 to 0,93). The hazard ratio for time to pregnancy in case of high BHB and NEFA was 0.77 (95%CI = 0.61 to 0.97). The present meta-analysis failed to clearly conclude on the association between estrus cyclicity and high BHB or NEFA. The present work allowed a new overview on the association between hyperketonemia and reproductive performance and disorders. It updated the previous meta-regression and included new outcomes. It highlighted the urgent need of further intensive epidemiologic studies on this topic.

Fluctuation of neutrophil counts around parturition in Holstein dairy cows with and without retained placenta.

Retained placenta (RP) is often diagnosed in high-yielding dairy cows and can negatively affect reproductive performances. The objective of the present study was to investigate the hematological and biochemical profile of cows with RP before and immediately after parturition, with particular emphasis on neutrophil counts, since a previous study demonstrated the presence of peripheral neutropenia in dairy cows with RP sampled a few days after parturition. Results from 12 Holstein cows affected by RP and from 17 clinically healthy controls sampled one week pre-partum, within 12h after calving and between 48 and 72h after parturition were compared between groups and over time. Compared with controls, cows with RP had lower lymphocyte counts before parturition, lower leukocyte and neutrophil counts at parturition, lower monocyte counts at all times, and higher ß-hydroxybutyrate before and after parturition. Erythroid and biochemical parameters were similar over time in both groups, whereas RP cows did not show the increase of neutrophil counts that occurs in controls at parturition. Hence, the finding of a lower neutrophil count in a routinely hemogram performed at parturition could be used as an alarm signal suggesting to monitor the affected animals. Moreover, although the underlying pathogenetic mechanism should be better investigated, the present study describes for the first time the association between altered blood leukocyte concentrations at parturition in RP compared to control cows.

The associations between postpartum serum haptoglobin concentration and metabolic status, calving difficulties, retained fetal membranes, and metritis.

Measurement of serum haptoglobin (Hapto) concentrations results in only moderate reported specificity and sensitivity for the detection of metritic cows. The objective of this study was to evaluate associations between different variables and haptoglobin concentrations after calving. Parity, periparturient metabolic stress indicated by ß-hydroxybutyric acid (BHBA) and nonesterified fatty acids (NEFA), calving difficulties, retained fetal membranes (RFM), and acute puerperal metritis (APM) were evaluated. A total of 443 Holstein Friesian cows were enrolled in this retrospective observational study. Acute puerperal metritis was diagnosed when a cow had fetid, reddish-brown, watery vaginal discharge in combination with rectal temperature ≥39.5°C. The retention of the fetal membranes has been defined as the failure to expel the fetal membranes within 12h after calving. Results of blood samples from 2 and 5 d in milk (DIM) were analyzed for Hapto, BHBA, and NEFA. Primiparous cows had a greater median Hapto concentration than multiparous cows at 5 DIM [primiparous: 2.25g/L, interquartile range (IQR) 1.45-2.50, n=146; multiparous: 1.13g/L, IQR 0.52-2.22, n=302; P<0.05]. Therefore, different Hapto thresholds based on references from literature for all cows (1.4g/L), primiparous cows (2.49g/L), and multiparous cows (1.4g/L) were used for further analysis. Periparturient metabolic stress indicated by elevated BHBA (≥1.2mmol/L) at 5 DIM was associated with elevated Hapto (odds ratio 2.39-2.87) regardless of parity. In contrast, elevated NEFA (≥0.6mmol/L) at 2 DIM was not a risk factor for elevated Hapto. Multiparous cows with assisted calving had a 2.46 times higher risk for elevated Hapto, whereas primiparous cows with assisted calving had no elevated risk for elevated Hapto at 5 DIM. Moreover, multiparous cows with RFM were 5.51 times more likely to have elevated Hapto at 5 DIM than cows without RFM. Acute puerperal metritis within the first 5 DIM was associated with elevated Hapto (odds ratio 2.74-5.01), regardless of parity. We speculate that the association of calving ease, RFM, and periparturient metabolic stress could explain the moderate sensitivity and specificity reported for the detection of metritic cows by measuring Hapto.

Placental polyp - a rare case report.

Placental polyp is the retained fragment of placental tissue after the parturition or abortion for indefinite period which forms a polypoidal mass in the uterus. It is predominantly composed of necrotic and hyalinized chorionic villi (ghost chorionic villi). We report a case of 26-year-old G2P2 woman presenting with vaginal bleeding. Her last pregnancy had occurred five years ago. Laboratory investigations revealed a positive urine pregnancy test and serum levels of beta-human chorionic gonadotrophin (ß-hCG) was elevated. Ultrasonography revealed hyperechoic mass in uterine cavity. She underwent total abdominal hysterectomy and the pathological diagnosis was of a placental polyp.

Early post-partum hematological changes in Holstein dairy cows with retained placenta.

Retained placenta (RP) occurs frequently in dairy cattle but little is known about the pathogenic or prognostic role of the hematological changes in this disease. This retrospective study was designed to investigate the hematological changes associated with RP in the immediate post-partum period and to assess whether these changes are associated with an acute phase reaction. Data concerning hematology, acute phase proteins, markers of inflammation and serum biochemistry performed on cows at 3±1 days in milk (DIM) from two intensive farms were extracted from the database of the ProZoo project, a research project aimed to investigate the relationship between genomic traits and bovine health and production. After application of restrictive inclusion criteria, data from 45 cows, 22 with RP and 23 controls, were statistically compared. RBC count, d-ROMs concentration, and AST activity were significantly higher in the RP group than controls. Conversely, neutrophils, thiol groups, and serum zinc concentration were significantly lower in the RP group than controls. In conclusion, although retained placenta has to be considered as a syndrome with multifactorial causes, neutropenia may be a co-factor involved in its pathogenesis. Further studies are needed to clarify whether neutropenia acts as a contributor in the pathogenesis of RP or if it is a very early consequence of the syndrome, preceding any other inflammatory changes in blood.

Herd-level association of serum metabolites in the transition period with disease, milk production, and early lactation reproductive performance.

The objective was to identify herd-level indicators expressed as a proportion of sampled animals with increased nonesterified fatty acids (NEFA) or ß-hydroxybutyric acid (BHBA), or decreased calcium in wk -1 and wk +1 relative to calving that were associated with herd-level incidence of retained placenta, metritis and displaced abomasum, milk production, and probability of pregnancy at the first artificial insemination (AI). Fifty-five Holstein freestall dairy herds in the United States and Canada were visited weekly. Blood was collected from 2,365 cows around parturition, and serum concentrations of NEFA, BHBA, and calcium were determined. Different cow-level metabolite thresholds associated with detrimental health or productivity in previous studies were used to classify animals into high- and low-risk metabolite concentration groups. For wk -1 and wk +1 relative to calving, a herd-level threshold was determined as the proportion of sampled animals in the high-risk metabolite concentration groups with the strongest association with increased incidence of disease, milk loss, or decreased pregnancy at the first AI. The odds of displaced abomasum after calving were higher in herds that had ≥ 25% of the animals with BHBA ≥ 1,400 µmol/L in wk +1 [odds ratio (OR)=2.1; 95% confidence interval (CI)=1.0-4.2)] or ≥ 35% of the animals with calcium ≤ 2.1 mmol/L in wk +1 (OR=2.4; CI=1.3-4.3). Herd-level thresholds of ≥15% of the cows with BHBA ≥ 800 µmol/L in wk -1 and ≥ 15% of the cows with calcium ≤2.1mmol/L in wk +1 were associated with milk loss (±SE) of 4.4±1.7 and 3.8 ± 1.4 kg/d per cow, respectively. When only multiparous cows were considered, herds with ≥30% of the multiparous cows with NEFA ≥0.5 mEq/L in wk -1 were associated with a 3.0 ± 1.5 kg/d per cow milk loss. The odds of pregnancy at first AI were lower in herds that had ≥ 5% of the cows with calcium ≤ 2.1 mmol/L in wk -1 (OR=0.7; CI=0.5-1.0), or ≥ 30% of the cows with NEFA ≥ 1.0 mEq/L (OR=0.6; CI=0.4-0.9) or ≥ 25% of the cows with calcium ≤2.1 mmol/L in wk +1 (OR=0.7; CI=0.5-0.9). When only multiparous cows were considered, the odds of pregnancy at first AI were lower in herds that had ≥50% of multiparous cows with NEFA ≥0.5 mEq/L in wk -1 (OR=0.5; CI=0.2-0.9). In conclusion, several herd-level thresholds for the proportion of cows with increased NEFA or BHBA, or decreased calcium in the week before and after calving were associated with higher risk of displaced abomasum, milk loss at the first Dairy Herd Improvement Association test, and decreased pregnancy at first AI. The association found between precalving BHBA and milk production is promising due to the availability of several cow-side tests for measuring BHBA. Some of the herd-level associations differed from the previously described cow-level associations, suggesting the potential of interpreting periparturient metabolic challenges at the herd level, where changes in diet and management are generally implemented.

Intermittent parenteral administration of endotoxin triggers metabolic and immunological alterations typically associated with displaced abomasum and retained placenta in periparturient dairy cows.

This study sought to investigate the effects of induced intermittent endotoxemia on plasma mediators of carbohydrate and lipid metabolism, humoral immunity, and clinical health status in periparturient dairy cows. Sixteen pregnant Holstein cows were blocked by parity and day of calving, and were randomly allocated to 1 of 2 different treatment groups. Eight cows were infused intravenously (i.v.) with 100mL of sterile saline and served as the control group (CON). The other 8 cows were infused i.v. with 100mL of sterile saline containing 3 increasing doses of lipopolysaccharide (LPS), from Escherichia coli O111:B4, for 3 consecutive weeks during the 2 wk before and 1 wk after parturition as follows: (1) 0.01 µg of LPS/kg of body weight (BW) on d -14 and -10; (2) 0.05 µg of LPS/kg of BW on d -7 and -3; and (3) 0.1 µg of LPS/kg of BW on d 3 and 7 postpartum. Nine blood samples were collected during the experimental period (i.e., from -14 to 28 d postpartum) and analyzed for calcium, zinc, iron, copper, glucose, lactate, ß-hydroxybutyrate (BHBA), nonesterified fatty acids (NEFA), cholesterol, insulin, cortisol, serum amyloid A (SAA), lipopolysaccharide-binding protein (LBP), haptoglobin (Hp), and anti-LPS IgA, IgG, and IgM. Results showed that intermittently induced endotoxemia decreased feed intake and milk production and triggered alterations in plasma cholesterol, BHBA, Hp, Ca, Cu, and anti-LPS IgG and IgM. All of these changes were associated with a greater number of cows affected by metabolic disorders such as left displaced abomasum (LDA, 2 from 8 LPS cows vs. 0 from 8 CON cows) and retained placenta (RP; 4 from 8 LPS cows vs. 0 from 8 CON cows). In addition, the discriminant analysis differently clustered the cow responses within LPS group, each corresponding to LDA, RP, and the cows displaying no clinical health problems (LPS-NO). The stepwise selection procedure of the best discriminant variables revealed that plasma Ca and anti-LPS IgG, as well as glucose and cortisol, were the best discriminating variables for cows affected by LDA, whereas NEFA and cholesterol better discriminated for cows affected by RP. This analysis also revealed that the cluster of plasma variables including plasma Cu, SAA, BHBA, and anti-LPS IgA were the best discrimination for the LPS-NO group. In conclusion, our results indicate a role of endotoxemia, during the periparturient period, in development of metabolic and immune disturbances, as well as in the etiopathology of displaced abomasum and retained placenta in dairy cows.

Comparison of antioxidative/oxidative profiles in blood plasma of cows with and without retained fetal placental membranes.

Ante- and postpartum antioxidative/oxidative profiles in blood plasma of cows with and without retained placental membranes (RFM) were investigated. Twenty-two healthy pregnant cows were included in the study. Seven animals out of 22 suffered from RFM. Blood samples were obtained at 4, 3, 2, 1 weeks and 5 days antepartum (a.p.), at parturition and 1, 3, and 5 weeks postpartum. The following antioxidative parameters were measured using spectrophotometric methods: total antioxidant activity (TAC), ß-carotene, vitamin A, vitamin C, and ceruloplasmin. The oxidative profile was based on the content of intermediates and end products of lipid and protein peroxidative processes which were measured by spectrophotometric and spectrofluorimetric methods. The examined parameters revealed a dynamic profile within the experimental period. The highest antioxidant and oxidant activity was noted at 2 and 1 week a.p. with a drop towards parturition suggesting the presence of oxidative stress during this time period and an apparent appropriate metabolic response of the macroorganism. Except for TAC and vitamin A, the contents of oxidative and antioxidative blood constituents did not differ between cows with and without RFM. A TAC and vitamin A by time interaction indicated higher antepartal concentrations of TAC and vitamin A in cows without RFM than in cows with RFM suggesting a possible role of antioxidative/oxidative imbalances in the aetiology of RFM.

Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation.

PURPOSE: To present a new clinical observation made in three cases of retained adherent placenta, a rare obstetrical complication, associated with potentially life-threatening hemorrhage. METHODS: Three consecutive cases of retained adherent placenta are presented. RESULTS: Diagnosis of placenta increta in two and placenta percreta in one case was established with ultrasound and MRI. Methotrexate 50 mg i.v. (300 mg total dose) and follinic acid 0.1 mg/kg were administered on alternating days, over 12 days. On follow-up, placental perfusion on color Doppler was present up to the point when circulating hPL levels were no longer detectable; this was followed in all cases by spontaneous placental expulsion within 10 days. CONCLUSIONS: The observation that both color Doppler and human placental lactogen can be used to monitor response to therapy and predict placental expulsion should be evaluated in future cases of retained adherent placenta.

Evaluation of prepartum serum cholesterol and fatty acids concentrations as predictors of postpartum retention of the placenta in dairy cows.

OBJECTIVE: To identify serum biochemical and hematologic variables, as measured in the week before parturition, that predict postpartum retention of the placenta (RP) in dairy cows. DESIGN: Retrospective cohort study. ANIMALS: 1,038 cows in 20 commercial dairy herds. PROCEDURES: Serum concentrations of fatty acids (FAs), beta-hydroxybutyrate, cholesterol, glucose, urea, and calcium and blood leukocyte, neutrophil, lymphocyte, monocyte, and eosinophil counts were determined. These variables were evaluated for an association with development of RP by use of a multivariate logistic regression model. Parity, season of parturition, existence of twins or dystocia, body condition score, and vitamin E treatment were included in the model as covariates. RESULTS: High serum concentrations of cholesterol and FAs were associated with an increased odds of RP. There was a 5% relative increase in the odds of RP for each 0.1 mmol/L increase in cholesterol or FAs concentration in the week before parturition. Season of parturition and twinning were also identified as risk factors. CONCLUSIONS AND CLINICAL RELEVANCE: These associations indicated that prepartum energy metabolism contributes to the development of RP. Serum concentrations of cholesterol and FAs may be useful to identify cows with a metabolic abnormality or energy imbalance that might predispose them to RP and should be interpreted in conjunction with clinical risk factors such as twinning, dystocia, or parturient paresis.

Validation of a 13,14-dihydro-15-keto-PGF(2alpha) enzymeimmunoassay and its application for reproductive health monitoring in postpartum buffaloes.

The objective of the present study was to validate a simple, sensitive and direct enzymeimmunoassay (EIA) procedure for 13,14-dihydro-15-keto-PGF(2alpha) (PGFM) for use in buffaloes with postpartum reproductive disorders and determine the practicalities of using plasma concentrations of 13,14-dihydro-15-keto-PGF(2alpha) for monitoring their reproductive health. The EIA was used for determination of the circulating levels of PGFM associated with the retention of fetal membranes, postpartum endometritis and variable postpartum intervals. The concentrations of PGFM with retention of fetal membranes in the periparturient period were lower as compared to buffaloes that had uneventful parturitions. Concentrations of PGFM associated with postpartum endometritis were elevated as compared to those in buffaloes free of reproductive tract infections. Buffaloes having higher plasma concentrations of PGFM in early postpartum period had shorter postpartum intervals, indicating the association between PGFM concentrations postpartum and uterine involution as well as the resumption of estrous cycle in this species. The study presents the possibility of using circulating PGFM concentrations for monitoring the postpartum reproductive health of buffaloes.

The use of serial betaHCG to plan surgical evacuation of retained placenta in a case of placenta accreta.

Placenta accreta is a rare condition. Its management is always a dilemma. Traditionally, hysterectomy has been the treatment of choice. However, with appropriate case selection, conservative management is possible with or without using methotrexate. This case report describes conservative management of placenta accreta with serial monitoring of ssHCG.