Bovis ISSN 2398-2993

Postpartum hemorrhage

Synonym(s): Postpartum vaginal bleeding

Contributor(s): Gwen Rees , Alexander Corbishley

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Introduction

  • Cause: mechanical trauma to the blood vessels of the pelvic region as a result of parturition, usually following dystocia or assisted calving.
  • Signs: can range from scant venous ooze through to profuse arterial hemorrhage.
  • Diagnosis: diagnosis of the location and severity of the laceration and hemorrhage is important. It may be possible to visually inspect the outer walls of the vagina and vulva, however generally manual examination of the uterus, cervix and vaginal walls is necessary to identify any tears or bleeding vessels.
  • Treatment: where possible, by clamping and ligating affected vessels. Occasionally packing the vagina in order to control bleeding may be necessary. Blood transfusion is indicated in some severe cases.
  • Prognosis: good if vessels can be identified and hemorrhage stopped. Future breeding ability may be affected and the animal should be assessed for viability of the reproductive tract before being allowed to breed again.

Pathogenesis

Etiology

  • Laceration, contusion and rupture of the blood vessels of the pelvic region secondary to mechanical trauma at parturition. 

Predisposing factors

Pathophysiology

  • Rupture of blood vessels in the pelvic region following mechanical trauma during parturition.
  • Subsequent pathology is dependent on the scale and site of the hemorrhage and affected blood vessels.
  • Laceration of the vaginal wall, with rupture of vaginal arteries cause profuse hemorrhage and in some cases the animal can exsanguinate and die before treatment can be initiated.
  • Arterial hemorrhage swiftly leads to hypovolemia which can be life-threatening.
  • Venous hemorrhage may cause a localized hematoma.
  • Trauma can lead to inflammation, contusions and increase the risks of metritis and localized soft-tissue infection.

Timecourse

  • Acute and immediate following trauma at parturition, although clinical signs may not be noted instantly due to internalized hemorrhage. 

Epidemiology

  • A sporadic event. No data available on prevalence.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

  • Recent references from PubMed and VetMedResource.
  • Dreyfuss D J, Tulleners E P, Donawick W J & Ducharme N G (1990) Third-degree perineal lacerations and rectovestibular fistulae in cattle: 20 cases (1981-1988). Journal of the American Veterinary Medical Association 196, 768-770 PubMed.
  • Roine K & Saloniemi H (1978) Incidence of some diseases in connection with parturition in dairy cows. Acta Veterinaria Scandinavica 19, 341-353 PubMed.

Other sources of information

  • Noakes D (2009) Arthur’s Veterinary Reproduction and Obstetrics. 9th edn. Saunders Elsevier.
  • Fubini S L & Ducharme N (2004) Farm Animal Surgery. 1st edn. Saunders Elsevier.


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