The association between history of retained placenta and success rate of misoprostol treatment for early pregnancy failure.

BACKGROUND: To date, the association between retained placenta and treatment success rate of misoprostol for early pregnancy failure has yet to be evaluated. The aim of this study was to evaluate this association and further investigated the connection between medical, clinical and sonographic parameters and treatment success. METHODS: We conducted a retrospective cohort study of women with early pregnancy failure treated with misoprostol from 2006 to 2021. The success rate of misoprostol treatment was compared between patients with history of retained placenta including women who underwent manual lysis of the placenta following delivery or patients who were found to have retained products of conception during their post-partum period (study group) and patients without such history (controls). Demographic, clinical, and sonographic characteristics as well as treatment outcomes were compared between the groups. RESULTS: A total of 271 women were included in the study (34 women in the study group compared to 237 women in the control group). Two-hundred and thirty-three women (86.0%) presented with missed abortion, and 38 (14.0%) with blighted ovum. Success rates of misoprostol treatment were 61.8% and 78.5% for the study and control groups, respectively (p = 0.032). Univariate analysis performed comparing successful vs. failed misoprostol treatment showed advanced age, gravidity, parity and gestational sac size (mm) on TVUS were associated with higher misoprostol treatment failure rate. Following a multivariate logistic regression model these variables did not reach statistical significance. CONCLUSION: Women who have an event of retained placenta following childbirth appear to have decreased success rate of treatment with misoprostol for early pregnancy failure. Larger studies are needed to confirm this finding.

[Administration of meloxicam to cows experiencing dystocia does not increase the incidence of retained placenta]. / Die Gabe von Meloxicam an Kühe nach Dystokie steigert nicht die Inzidenz der Retentio secundinarum.

OBJECTIVE: The post partum use of analgesics in cows has increased in consequence to society's increased awareness of animal welfare. However, it is known that the post partum administration of a subset of nonsteroidal anti-inflammatory drugs to cows may lead to an increased rate of retained placenta. Therefore, the aim of this study was clarify, whether a single administration of meloxicam to cows that experienced dystocia results in an increased rate of this disease. MATERIAL AND METHODS: The study was conducted in 63 Holstein-Friesian cows in 4 farms with random allocation into 2 groups: In animals of the treatment group (n = 27) a single subcutaneous injection of meloxicam (0.5 mg/kg) was administered within 2-8 hours after calving. The animals of the control group (n = 36) received the same volume of a bovine infusion solution (Amynin®, bovine infusion solution, Boehringer Ingelheim) subcutaneously. A clinical examination of the cows was performed on the day of parturition and on the 21st day post partum. Findings on the days in between were obtained by questioning of the farmers. The exact Fisher-test was calculated in order to test for statistical differences between the treatment and control groups. RESULTS: In cows of the treatment group, retained placenta was not observed more frequently than in cows of the control group. CONCLUSION AND CLINICAL RELEVANCE: A single administration of meloxicam to cows that experienced dystocia does not increase the incidence of retained placenta.

Chemotactic activity of cotyledons for mononuclear leukocytes related to occurrence of retained placenta in dexamethasone induced parturition in cattle.

Induction of parturition with glucocorticosteroids in cattle is used for research purposes, in diseased or injured pregnant cows, and as a management tool to time parturition. A negative side effect of induction of parturition with glucocorticosteroids is the high incidence of retained placenta that occurs after these calvings. Reaction of the maternal immune system against the 'foreign' foetal membranes contributes to the breakdown of the foetal-maternal attachment. Several studies indicate that failure of this immune assisted detachment increases the occurrence of retained placenta. We hypothesized that retained placenta occurring after induction of parturition with glucocorticosteroids is caused by failure of immune assisted detachment of the foetal membranes. The chemotactic activity of cotyledons for mononuclear leukocytes was used as a parameter to see whether immune assisted detachment of the foetal membranes had occurred. Cotyledons were collected from spontaneously calving non-retained placenta cows and from dexamethasone induced non-retained placenta and retained placenta cows. The study showed that the chemotactic activity of cotyledons for mononuclear leukocytes was lower (P < 0.001) in cotyledons obtained from retained placenta cows in which parturition was induced with dexamethasone compared to the chemotactic activity of cotyledons obtained from spontaneously calving non-retained placenta cows, whereas the chemotactic activity of cotyledons obtained from induced non-retained placenta cows was not lower (P = 0.10) than the chemotactic activity of cotyledons obtained from spontaneously calving non-retained placenta cows. We concluded that induction of parturition with dexamethasone causes a failure of immune assisted detachment of the foetal membranes and the accompanying release of chemotactic factors. As a result, the chemotactic activity of cotyledons for mononuclear leukocytes is lower in induced retained placenta cows than in cotyledons from non-retained placenta cows in which successful immune assisted detachment of the foetal membranes occurs.

Effects of the administration of ketoprofen at parturition on the milk yield and fertility of Holstein-Friesian cattle.

A total of 220 cows and heifers were treated with 3 mg/kg ketoprofen immediately after calving and 24 hours later, and 227 were left untreated as controls. The treated animals tended to have a lower incidence of retained fetal membranes and were 1.7 times less likely to develop the condition than the untreated animals. The treatment did not affect the incidence of milk fever, the endometritis score or the presence of a corpus luteum by 20 to 25 days after calving, and did not affect the cows' early lactation milk yield. There was no particular level of dystocia or periparturient conditions other than retained fetal membranes for which there might be a reproductive or productive advantage following the use of ketoprofen. The intervals from calving to first insemination or to pregnancy, the numbers of inseminations per pregnancy and the pregnancy rate to first insemination were also unaffected by ketoprofen treatment.

The effect of a monensin controlled-release capsule on the incidence of retained fetal membranes, milk yield and reproductive responses in Holstein cows.

The objective of this study was to determine the effect of a monensin controlled-release capsule on the incidence of retained fetal membranes (RFM), milk yield and conception rate at first service (CRFS). The study was conducted during May to August 2004 in a large dairy herd in Chihuahua, Mexico. Cows (n = 2,025) from 20 to 30 d before expected parturition were randomly assigned to either a treatment or a control group. The treated group (n = 1,010) received orally a capsule of monensin that released 335 mg/d for 95 d. Control cows (no capsule, n = 1,015) were randomly assigned and matched by parity. Outcome variables were the incidence of RFM, first three test day milk and CRFS. Monensin decreased the incidence of RFM by 3.9% only in multiparous cows. Therefore, multiparous cows treated with monensin were 0.78 times (95% C.I. = 0.71-0.86) as likely as control multiparous cows to develop RFM. Overall, milk yield was negatively affected by the RFM condition, but it was improved by monensin only in multiparous cows with RFM at test day 1. Conception rate at first service was depressed by 10.6% in multiparous cows with RFM. However, in RFM cows treated with monensin, CRFS improved to the level of treated cows without RFM.

Effect of injecting collagenase into the uterine artery during a caesarean section on the placental separation of cows induced to calve with dexamethasone.

A caesarean section was performed on 30 cows before normal term and 16 to 20 hours after the induction of parturition with dexamethasone. During the surgical procedure, 20,000 U of bacterial collagenase was injected into the uterine artery of 15 of the cows. The average periods of retention of the fetal membranes were 40 hours in the treated cows and 114 hours in the control cows (P<0.001). At 36 hours after the surgery six of the treated cows (40 per cent) but all 15 of the control cows had retained fetal membranes. The collagenase-treated cows showed no abnormal clinical signs during the 10 days after the operation.

Ascending dose tolerance study of intramuscular carbetocin administered after normal vaginal birth.

OBJECTIVE: To determine the maximum tolerated dose (MTD) of carbetocin (a long-acting synthetic analogue of oxytocin), when administered immediately after vaginal delivery at term. MATERIALS AND METHODS: Carbetocin was given as an intramuscular injection immediately after the birth of the infant in 45 healthy women with normal singleton pregnancies who delivered vaginally at term. Dosage groups of 15, 30, 50, 75, 100, 125, 150, 175 or 200 microg carbetocin were assigned to blocks of three women according to the continual reassessment method (CRM). RESULTS: All dosage groups consisted of three women, except those with 100 microg (n=6) and 200 microg (n=18). Recorded were dose-limiting adverse events: hyper- or hypotension (three), severe abdominal pain (0), vomiting (0) and retained placenta (four). Serious adverse events occurred in seven women: six cases with blood loss > or = 1000 ml, four cases of manual placenta removal, five cases of additional oxytocics administration and five cases of blood transfusion. Maximum blood loss was greatest at the upper and lower dose levels, and lowest in the 70-125 microg dose range. Four out of six cases with blood loss > or = 1000 ml occurred in the 200 microg group. The majority of additional administration of oxytocics (4/5) and blood transfusion (3/5) occurred in the dose groups of 200 microg. All retained placentae were found in the group of 200 microg. CONCLUSION: The MTD was calculated to be at 200 microg carbetocin.