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Retention of Fetal Membrane/Retained Placenta

Placentation is formation of placenta. Placenta is attachment of fetal membrane with the endometrium of dam to permit the physiological exchange between dam and fetus. It is required till term but once the animal delivers the calf then there is no need and dam have to expel it out otherwise body will take it as foreign. Most of dairy animals expel the placenta within 8 hours after delivery of their calf. If placenta is not expelled for 12 hours or more after parturition, it is indicative of abnormal condition and called as retention of fetal membranes.

Causes

Immature Placentomes:
In last 10-15 days of gestation corticosteroid level increases in blood and more estrogen is producted due to which contractions occur and sharp edges of cotelydons become flat and detach easily. Premature delivery or abortion leads to retention because of immature placentomes.

Delayed Gestation:
If something is wrong with pituitary, there is proliferation of epithelium in villi and a band like structure forms which interfere with the detachment of plancentomes.

Lack of Uterine Contractions:
Lack of uterine contractions due to uterine inertia (primary or secondary), low level of Ca, hormonal deficiency particularly of estrogen, improper balance of progesterone and estrogen.

Placentitis or Cotyledinitis:
Associated with bacterial, viral, and fungal diseases e.g. Burcella abortus, tuberculosis, Vibrio fetus, IBR, Staphylococcus aureus, E. coli, Corynebacterium pyogenes and Pseudomonas, IPV virus and various mold infections due to aspergilla or mucor

Uterine Atony:
Associated with dystocia, hypocalcaemia, hydropic and other pathological conditions

Severe Deficiency of Selenium, Vitamin A, D, E:
Glutathione peroxidase splits H2O2 whose integrity requires Se and Vitamin E. If there is deficiency of Se and vitamin E, this enzyme will not work properly and ultimately cells will be damaged by H2O2. Vitamin A is required for maturation of epithelium  

Miscellaneous Causes:
Short dry period, transport stress, changes in the locality in advanced pregnancy, high milk production, parasitic infestations and other causes of debility and underfed.

Symptoms

  • Loss of appetite

  • Decrease in milk production

  • High rise of temperature

  • Foul smelling

  • May lead to all symptoms of toxemia

  • Extreme retention leads to pyometra and septic metritis.


 

Treatment

There are three options:

Hormonal Treatment:

  • Oxytocin 50-100 IU in cattle/buffalo may be injected. It is recommended if some part of fetal membrane hanging from vulva or engaged the cervix. Oxytocin is not drug of choice if fetal membranes are retained inside. In that case it will lead to closure of cervix.

  • If case is reported late after 24 hours then before giving oxytocin you have to prime the uterus with estrogen by giving 1-2 cc estrogen and then after 30-60 min give oxytocin. Estrogen pulls the fetus and activates the receptors of oxytocin.

  • PGF2α is drug of choice in habitual cases but should be given within one hour after parturition.

  • Estrogen is never drug of choice for retention of fetal membrane rather if given then can cause prolapse of uterus. It should never be given through intramuscular route but through intrauterine rout. It can be given in lower doses. It can be given in diluted form 1 ml or 10-15 mg diluted in 50 ml and given as intrauterine infusion; it is drug of choice in case of complete retention.

  • All these hormones will just increase the uterine contraction. So they will work in case if retention is due to lack of uterine contraction.

Manual Removal:
It is not the preferred method now a days. It can be done if placenta is hanging. After restraining wash the hind quarters and hanging part of placenta. Epidural anesthesia is indicated to stop straining and preventing repeated defecation on gloves. Use sterile plastic or rubber sleaves. After proper lubrication insert hand. Give 2-3 twisting of the hanging part of membrane and with other hand hold caruncles in two fingers and remove cotyledons from them with the help of thumb.

If there is fresh bleeding then leave it as such and control toxemia by giving:

  • Glucose normal saline intravenously

  • Diuretics

  • Antibiotics intramuscularly

Never give antibiotic intrauterine before expulsion of fetal membrane. Animal expels fetal membrane by putrification. Antibiotics will stop the process of putrification and expulsion of fetal membrane. After manual removal when sure of fetal membrane removal then give utocyl (antibiotic + estrogen) tablets or passeries placed in uterus 4-5 in large animals for three days. Utocyl also contains small amount of oxytocin.

Prevention:
Prevention of retained afterbirth is mainly effected through nutritional supplements. Balanced ration especially in last 6-8 weeks of pregnancy should be given. Supplemental selenium may lower the incidence of this problem in areas deficient in selenium or those having acidic soils. Both selenium and vitamin E supplement can help control placental retention in dairy animals given ensiled feeds. Deficiency of vitamin A and fibre in feed is associated with an increased risk of retained afterbirth. Overconditioning of dairy animals should be avoided since such animals are predisposed to an increased incidence of the problem. In addition, any factors that increase the incidence of an assisted delivery, also increase the risk of placental retention.

 

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