Retained foetal membranes?

RE: Retained foetal membranes?

Michael Woodhouse — Sat, 11 Jul 2015 13:37:36 GMT

[quote user="Gauhar Saddique"]If not happens so, i practice the use of injection PGF2 alpha (Lutalyse) at a double dose. This removes the membrane easily in most of the cases.[/quote]

I'm sorry, but that viewpoint is not supported by any evidence. Back in the days when drug reps were allowed to say more than they could now they would frequently discuss the ability of the natural prostaglandin analog, dinoprost to stimulate uterine contractions. The suggestion was that this somehow was helpful in the expulsion of the retained foetal membranes. We already know that uterine activity is prolonged in cows with RFM. A quote I love is:

"Clinicians should appreciate that, despite what is promulgated by some pharmaceutical companies (ie, the need for uterine contractors), the retention of fetal membranes itself actually doubles the rate and increases the frequency of uterine contractions." http://www.ncbi.nlm.nih.gov/pubmed/15955444

I can find you a number of other references showing that prostaglandin is simply not supported by evidence of efficacy in treatment for RFM (has been shown simply not to work). http://www.ncbi.nlm.nih.gov/pubmed/20136715

If we go back to the OP (that admittedly is a few years old) and have a bit of a scratch through the evidence, it would suggest that manual removal confers no improvement in reproductive outcome, and that pessaries and intra-uterine antibiotics perform worse than injected antibiotics if you use fever as a threshold to treat. There is some evidence that manual removal can increase the risk of metritis developing.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Strategies+to+Improve+the+Therapy+of+Retained+Fetal+Membranes+in+Dairy+Cows

http://www.ncbi.nlm.nih.gov/pubmed/12517396

We certainly clease very few cows these days. ~75% of my time is dairy work and I haven't done one for months. Some farmers do their own, but more are educated in prevention and suitable monitoring and self treatment (inject if pyrexic, otherwise leave alone).

If you are a young vet reading this post - don't mess about with prostaglandins as they simply don't work.

RE: Retained foetal membranes?

Virginia Campbell — Sat, 11 Jul 2015 07:55:29 GMT

[quote user="Michael Woodhouse"]I personally do think the weight helps them cleanse. [/quote]

I think it does too. In my first job up in the hills with a lot of traditional farmers, we sometimes used to bundle the cleaning up above their hocks to keep it out of the way and tie it to a horseshoe (nails removed of course!) to add a bit of weight. Kept the people who liked old fashioned things happy. Systemic abs if pyrexic/sick.

RE: Retained foetal membranes?

Gauhar Saddique — Sat, 11 Jul 2015 05:47:08 GMT

I always wait for the first five days. Normally the membrane will detached by itself. If not happens so, i practice the use of injection PGF2 alpha (Lutalyse) at a double dose. This removes the membrane easily in most of the cases.

There is no need of antibiotics pessaries, until any signs of fever developed.

Re: Retained foetal membranes?

Julian Earl — Wed, 16 Apr 2014 16:05:47 GMT

I always remove them after five daysr or so aslong as they peel off the caruncles easily. Flushing the uterus first with twnety-plus litres of water, plain or with iodine added, seems to facilitate removal by being partially osmotically absorbedinto the membranes; ones which previously were stuxk fast often then peel relatively more easily.

Re: Retained foetal membranes?

Braden Collins — Thu, 02 May 2013 00:10:20 GMT

I agree o leave RFM's. Rather than cutting them off if hanging out, I will cover them with a rectal glove. This allows the weight of the membranes to help remove the rest gently. No need for Ab's unless the cow is unwell.

Re: Retained foetal membranes?

Clair Firth — Wed, 01 May 2013 20:56:31 GMT

Don't get me wrong, all the farmers I have met so far have been very nice, friendly and well-informed. But sometimes, because of the part-time nature of Austrian dairy farming, the "old" farmer (i.e. the previous generation who is more or less retired is left in charge of the farm during the day while "junior" is at work) is around when the vet calls and I think this is how these kind of stories occur - ie. the vet should do it the old way! (and here it definitely is more modern than in the UK, it would seem)

And I know that farmers are very well educated (having studied at Sutton Bonington alongside plenty of agrics! (Notts Uni before there was a vet school!), probably more so than pet owners who refer to Dr Google

Really appreciate your insights, thanks

Re: Retained foetal membranes?

Vet2Vet — Wed, 01 May 2013 20:43:05 GMT

I don't think you will have any problems . I honestly don't think this approach is particularly new or modern , I am sure that's what I was taught in the early nineties . Also , bear in mind that generally , now though , the farmers are much better educated and researched and may surprise the vet with the latest research / approach .

Re: Retained foetal membranes?

Busybee — Wed, 01 May 2013 20:22:13 GMT

I'm a young female vet working in a practice which has previously been dominated by older male vets and I have never encountered any problems from farmers (maybe we just have nice farmers!). But don't be afraid to stand your ground, explain your reasoning and do things your way. Trying to get your boss(es) on board first before you face a particular difficult farmer is always a good idea

Re: Retained foetal membranes?

Clair Firth — Wed, 01 May 2013 20:16:30 GMT

Thanks a lot for your replies - confirms what I thought/have been taught which is reassuring

Just one more question: do the farmers accept this "modern" approach? i.e. not removing the membranes? I suppose you're always going to get some who don't want to change but I'm just asking about the general trend......I have heard of new grads in Austria who have been told by their bosses to always removed membranes because that's the way it's always been done and that's what the farmers want

Here in Austria farming is generally a lot less industrial than in the UK (a "big" dairy farm has 30 cows!) and farmers are often part-time, working as tractor mechanics etc as well as milking 12 cows! So they don't have much time to keep up with modern methods of dairying (I know UK farmers don't have any free time either, but if it is their sole business then it may be easier to concentrate on it!)

Thanks for all the tips

Re: Retained foetal membranes?

Busybee — Wed, 01 May 2013 19:31:22 GMT

Agree with most of the above! I graduated three years ago and our teaching was very similar to yours (OP). My approach (for cows) is:

- do not touch before at least 5 days after calving unless cow is ill

- if they do need a visit for RFM, do a general exam and take a good history, especially if the farm has a high incidence of RFM which may elicit underlying predisposing factors. Look for signs of systemic infection.

- Use gentle traction on the RFM starting close to the vulva. Anything that doesn't come away with one hand and steady gentle pulling, gets left behind.

- I will cut off any long dangling ends if I can't remove it all.

- If it all comes away but is particularly smelly with a lot of purulent discharge and a sick cow, I will wash out the uterus using a siphon.

- Not a big fan of intra-uterine pessaries or antibiotic preparations.

- I will use systemic antibs only if the cow is showing signs of systemic infection.

And my number one tip - DOUBLE GLOVE! Believe me, the smell of 10 day old rotting membranes takes some shifting off your hands!

Re: Retained foetal membranes?

Michael Woodhouse — Wed, 01 May 2013 16:13:57 GMT

I will remove them if they will come away easily. If people want us to attend I will not go before 5 days unless cows sick. No antibiotics unless sick or pyrexia. If they don't come away easily at 5 days then will say I'll go back in 3 days. 95% of people ring to cancel the visit as they have cleansed.

I personally do think the weight helps them cleanse. You cannot be too traumatic to the caruncles as they all slough off anyway! I do believe in being gentle and not causing too much trauma. Never seen the point in antibiotic pessaries.

Re: Retained foetal membranes?

mariette asselbergs — Wed, 01 May 2013 16:11:19 GMT

Claire,

For horses the story is entirely different because of the real risk of laminitis as a consequence of retained placentas! Here I follow more what I was taught than from my more limited experience. Horse placentas must be removed the first day, and it seems to be eessential to make sure that no bits at all are left behind. Oxytocin helps. Then wash and wash under guidance of the temperature.

Having said that, I have seen horses without the washing procedures having no complications (owners insisted on treating with raspberry tea orally according to longstanding tradition in their community.....).

Mariette

Re: Retained foetal membranes?

Clair Firth — Wed, 01 May 2013 16:00:07 GMT

Hi Mariette

Thanks for your post. Yes, you've confirmed what we're taught - sorry I forgot to mention that antibiotics are given if body temp is greater than 39.2°C and that the "tail ends" hanging out of the vulva are cut off to avoid too much smell or the animal standing on them. On the other hand though, I have read in older books (and perhaps more relevant to horses) that they shouldn't be cut so that the weight gives gravity a helping hand! But like I said, that was in an older text book!

Of course once you have many years of experience then it's easier to decide these things but for us as students/new graduates it is hard to know which is the right method

Thanks again

Re: Retained foetal membranes?

mariette asselbergs — Wed, 01 May 2013 15:40:57 GMT

I have lived through many years and several different cultures of vetmedicine and I work less and less to dogmatic rules.

Retained membranes tend to be released within 10-14 days at first silent oestrus.

In the meantime in many cows a long piece of awfully smelly rotten necrotic tissue flaps around the backend and the udder. I see no point in leaving this, but I will also go through not much forceful removal activity. Anything that comes lose easily I remove, the rest I leave to mother nature because I do think trauma is bad in an infected environment, and traction on uterus horns with their fragile salpinxes does not seem the best idea either.

I do not believe that the hanging out bit has to stay to pull the retained bit out!

As for antibiotics (pessaries or injections) I tend to avoid them, because of development of resistance of bacteria, but I'll be guided by the cow's temperature. If she develops a fever, then I treat for lochiometra (with abx).

I may leave licensed abx with the farmer for him/her to check on temp and/or appetite/milk and decide according to a SOP.

Mariette