Performance and financial consequences of stillbirth in Holstein dairy cattle

Stillbirth is an economically important trait on dairy farms. Knowledge of the consequences of, and the economic losses associated with stillbirth can help the producer when making management decisions. The objectives of this study were to determine the effects of stillbirth on productive and reproductive performance as well as financial losses due to stillbirth incidence in Iranian Holstein dairy farms. Economic and performance data were collected from nine Holstein dairy farms in Isfahan and Khorasan provinces of Iran from March 2008 to December 2013. The final data set included 160 410 calving records from 53 265 cows. A linear mixed model was developed to evaluate the effects of stillbirth on performance of primiparous and multiparous cows separately and overall. An economic model was used to estimate the economic losses due to stillbirth. The incidence of stillbirth cases per cow per year was 4.2% on average (3.4% to 6.8% at herd level). The least square means results showed that a case of stillbirth significantly (P0.05). Overall, a case of stillbirth reduced 305-day milk yield by 544.0±76.5 kg/cow per lactation. Stillbirth had no significant effects on 305-day fat and protein percentages in either primiparous or multiparous cows. Overall, cows that gave birth to stillborn calves had significantly increased days open by 14.6±2.6 days and the number of inseminations per conception by 0.2 compared with cows that gave birth to live calves (P<0.01). In general, the negative productive and reproductive effects associated with stillbirth were smaller and non-significant for primiparous cows compared with multiparous cows. The financial losses associated with stillbirth incidence averaged US$ 938 per case (range from $US 767 to $US 1189 in the nine investigated farms). The loss of a calf was not the only cost associated with stillbirth, as it accounted for 71.0% of the total cost. The costs of dystocia (7.6%) and culling and replacement expenses (6.3%) were the next most important costs associated with stillbirth. These results can be used to assess the potential return from management strategies to reduce the occurrence of stillbirths.

A randomized controlled trial of a new treatment for labor dystocia

OBJECTIVE

Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.

MATERIAL AND METHODS

Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the "non-bicarbonate-group", stimulation with oxytocin was started immediately. In the "bicarbonate-group", bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups.

OUTCOME MEASURED

if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.

RESULTS

Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome.

CONCLUSIONS

An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

UTERINE RUPTURE AND CESAREAN SURGERY IN THREE RIO CAUCA CAECILIANS (TYPHLONECTES NATANS)

A uterine rupture of unknown etiology during gestation causing the death in a Rio Cauca caecilian ( Typhlonectes natans ) and successful anesthesia using tricaine methanesulfonate and cesarean section in three occasions in two other specimens because of suspected dystocia are described. One of the surgeries was performed at an early stage of embryo development, thereby preventing the survival of the neonates.

Effects of dystocia on blood gas parameters, acid-base balance and serum lactate concentration in heavy draft newborn foals

Dystocia is often lethal for neonatal foals; however, its clinicopathological features remain largely unknown. We investigated the effect of dystocia on the foal blood profile. Venous blood samples were collected from 35 foals (5 Percheron and 30 crossbreds between Percheron, Belgian, and Breton heavy draft horses) at 0 hr, 1 hr, 12 hr and 1 day after birth. Dystocia was defined as prolonged labor >30 min with strong fetal traction with or without fetal displacement. The dystocia group (n=13) showed lower mean values for pH (P<0.01), bicarbonate (P<0.01), total carbon dioxide (P<0.05), and base excess (P<0.01) and higher mean values for anion gap (P<0.05) and lactate (P<0.01) immediately after birth than the normal group (n=22). Remarkably high pCO₂ values (>90 mmHg) were observed in three foals in the dystocia group but in none of the foals in the normal birth group immediately after birth. These results suggest that dystocia results in lactic acidosis and may be related to respiratory distress.

The presence of vaginal Lactobacillus species does not contribute to a measureable difference in amniotic fluid lactate levels collected from the vaginal tract of laboring women

INTRODUCTION

Amniotic fluid lactate research is based on the hypothesis that a relationship exists between fatigued uterine muscles and raised concentrations of the metabolite lactate, which is excreted into the amniotic fluid during labor. To assess potentially confounding effects of lactate-producing organisms on amniotic fluid lactate measurements, we aimed to determine if the presence of vaginal Lactobacillus species was associated with elevated levels of amniotic fluid lactate, measured from the vaginal tract of women in labor.

MATERIAL AND METHODS

Results from this study contribute to a large prospective longitudinal study of amniotic fluid lactate at a teaching hospital in Sydney, Australia. Amniotic fluid lactate measurement was assessed at the time of routine vaginal examination, after membranes had ruptured, using a hand-held lactate meter StatStripXPress (Nova Biomedical). Vaginal swab samples were collected at the time of the first amniotic fluid lactate measurement and stored for later detection and quantification of Lactobacillus species using a TaqMan real-time PCR assay. Swab sample and amniotic fluid lactate results were paired and analyzed.

RESULTS

The PCR assay detected Lactobacillus species in 48 of 388 (12%) vaginal swab specimens (8% positive, 4% low positive) collected from women in labor after membranes had ruptured. There was no significant difference in median and mean (respectively) amniotic fluid lactate levels with (8.35 mmol/L; 8.95 mmol/L) or without (8.5 mmol/L; 9.08 mmol/L) Lactobacillus species detected.

CONCLUSION

There was no association between the presence or level of vaginal Lactobacillus species and the measurement of amniotic fluid lactate collected from the vaginal tract of women during labor.

Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery

OBJECTIVE

To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal occiput position at delivery and the mode of delivery.

METHODS

Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal occiput position at delivery and the incidence of operative delivery were investigated.

RESULTS

Overall, 368 women were included in the study. Fetal position at delivery was occiput anterior in 339 (92.1%) cases and occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°.

CONCLUSION

A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Effect of calving process on the outcomes of delivery and postpartum health of dairy cows with unassisted and assisted calvings

Welfare aspects of obstetrical assistance were studied in multiparous Holstein-Friesian cows (n=176) with (1) unassisted calving in an individual pen (UCIP; n=42), (2) unassisted calving in a group pen (UCG; n=48), (3) assisted calving with appropriately timed obstetrical assistance (ACAP; n=50), and (4) assisted calving with inappropriately timed (premature) obstetrical assistance (ACIN; n=36). Duration of the stages of calving, the prevalence and the degree of dystocia, stillbirth ratio, newborn calf vitality, and the occurrence of postpartum health problems (i.e., retained placenta and vulvovaginal laceration) were recorded. The time from amniotic sac and hooves appearance to birth and the total duration of calving (from the onset of calving restlessness to delivery) were shorter for UCG cows than for any other groups. The overall incidence of dystocia was 31.3% in the calvings studied. The prevalence of dystocia was below 10% in cases of unassisted calvings. The proportion of severe dystocia was higher in ACIN cows than in ACAP cows (47.2 vs. 12.0%, respectively). The prevalence of stillbirths was the highest in ACIN calvings (22.2%), followed by ACAP, UCI, and UCG cows (8.0, 4.8, and 0.0%, respectively). The ACIN calves had lower vitality scores than calves born from ACAP, UCG, and UCIP dams immediately after delivery and 24h after birth. Although ACAP calves had lower vitality scores than UCG and UCIP calves at birth, a delayed recovery of vitality was mirrored by satisfactory vitality scores 24h after birth. Retained placenta and vulvovaginal laceration occurred more often with assisted dams (i.e., ACAP and ACIN animals) compared with UCIP cows with the highest prevalence in ACIN cows. In UCG cows, no injuries occurred in the vulva or vagina, and we noted only 4 cases of retained placenta (8.3%), proportions lower than in cows with unassisted calving in the maternity pen. Our results suggest that calving in a group might have benefits over calving in an individual pen in terms of calving ease, duration of the delivery process, and postpartum health of the dam vitality of her offspring. Premature obstetrical assistance leads to a high prevalence of dystocia, impairs postpartum health of the dam, and poses a potential risk to calf survival.

The "occiput-spine angle": a new sonographic index of fetal head deflexion during the first stage of labor

BACKGROUND

Fetal head "attitude" (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor, although the use of ultrasound to support clinical diagnosis has been recently reported.

OBJECTIVES

The aims of this study were: (1) to quantify the degree of fetal head deflection via the use of sonography during the first stage of labor; and (2) to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the course and outcome of labor.

STUDY DESIGN

This was a prospective multicentric, cross-sectional study conducted at the Maternity Unit of the University of Bologna and Parma from January 2014 to April 2015. A nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to transabdominal ultrasound during the first stage of labor. If fetal position was occiput anterior or transverse, the angle between the fetal occiput and the cervical spine (the occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the occiput spine-angle were performed offline by 2 operators who were blinded to the labor outcome. The intra- and interobserver reproducibility and the correlation between the occiput-spine angle and the mode of delivery were evaluated.

RESULTS

A total of 108 pregnant women were recruited, 79 of which underwent a spontaneous vaginal delivery and 29 were submitted to obstetric intervention (19 cesarean delivery and 10 instrumental vaginal deliveries). The mean value of the occiput-spine angle measured in the active phase of the first stage was 126° ± 9.8° (SD). The occiput-spine angle measurement showed a very good intraobserver (r = 0.86; 95% confidence interval [95% CI] 0.80-0.90) and a fair-to-good interobserver (r = 0.64; 95% CI 0.51-0.74) agreement. The occiput-spine angle was significantly narrower in women who underwent obstetric intervention (cesarean or vacuum delivery) due to labor arrest (121° ± 10.5° vs 127° ± 9.4°, P = .03). Multivariable logistic regression analysis showed that narrow occiput-spine angle values (OR 1.08; 95% CI 1.00-1.16; P = .04) and nulliparity (OR 16.06; 95% CI 1.71-150.65; P = .02) were independent risk factors for operative delivery. A larger occiput-spine angle width (i.e., >125°) showed to be significantly associated with a shorter duration of labor (hazard ratio = 1.62; 95% CI 1.07-2.45; P = .02).

CONCLUSION

We described herein the "occiput-spine angle," a new sonographic parameter to assess fetal head deflection during labor. Fetuses with smaller occiput-spine angle (<125°) are at increased risk for operative delivery.

Parturition dysfunction in obesity: time to target the pathobiology

Over a third of women of childbearing age in the United States are obese, and during pregnancy they are at increased risk for delayed labor onset and slow labor progress that often results in unplanned cesarean delivery. The biology behind this dysfunctional parturition is not well understood. Studies of obesity-induced changes in parturition physiology may facilitate approaches to optimize labor in obese women. In this review, we summarize known and proposed biologic effects of obesity on labor preparation, contraction/synchronization, and endurance, drawing on both clinical observation and experimental data. We present evidence from human and animal studies of interactions between obesity and parturition signaling in all elements of the birth process, including: delayed cervical ripening, prostaglandin insensitivity, amniotic membrane strengthening, decreased myometrial oxytocin receptor expression, decreased myocyte action potential initiation and contractility, decreased myocyte gap junction formation, and impaired myocyte neutralization of reactive oxygen species. We found convincing clinical data on the effect of obesity on labor initiation and successful delivery, but few studies on the underlying pathobiology. We suggest research opportunities and therapeutic interventions based on plausible biologic mechanisms.

Genetic analysis of calving traits by the multi-trait individual animal model

Five alternative models were applied for analysis of dystocia and stillbirth in first and second parities. Models 1 and 2 were included only to estimate the parameters required for model 4, and models 3 and 5 are included only as comparisons to the model 4 estimates. Variance components were estimated by multi-trait REML, including cows with valid calving records for both parities. For the effects of sire of calf on first and second parities, variance components were estimated including only calvings with the same sire of calf for both parities. All heritabilities for the cow effect were quite low, but higher for dystocia than for stillbirth and higher in first parity. The sire-of-calf heritabilities were higher than the cow effect heritabilities, except for stillbirth in parity 2. Unlike the effect of cow correlations, all sire of calf correlations were >0.6, and the correlations for the same trait in parities 1 and 2 were >0.9. Thus, a multi-trait analysis should yield a significant gain in accuracy with respect to the sire of calf effects for bulls not mated to virgin heifers. A multi-trait individual animal model algorithm was developed for joint analysis of dystocia and stillbirth in first and second parities. Relationships matrices were included both for the effects of cow and sire of calf. In addition, random herd-year-season and fixed sex of calf effects were included in the model. Records were preadjusted for calving month and age. A total of 899,223 Israeli Holstein cows with first calvings since 1985 were included in the complete analysis. Approximate reliabilities were computed for both sire of cow and sire of calf effects. Correlations between these reliabilities and reliabilities obtained by direct inversion of the coefficient matrix for a sire of cow-sire of calf model were all close to 0.99. Phenotypic trends for cows born from 1983 through 2007 were economically unfavorable for dystocia and favorable for stillbirth in both parities. Genetic trends were economically unfavorable for both dystocia and stillbirth in first parity. First-parity sire of calf trends were unfavorable for dystocia, but favorable for stillbirth. All environmental trends were nearly zero. Regressions of evaluations of the complete analysis on a model including only calvings before 2011 were all >0.8. All evaluations met the Interbull Method 3 criterion for unbiasedness. Model 4, which computed genetic evaluations for all animals for all 4 traits accounting for all known relationships and correlations among the traits, is recommended for routine genetic evaluation of calving traits.

Intrapartum sonographic signs: new diagnostic tools in malposition and malrotation

In the past years, numerous studies have been published on the use of ultrasound during labor, showing this is an effective, accurate and objective tool for the assessment of the fetal head position and station. Literature affirmed that traditional transvaginal digital examination is highly subjective and dependent on the operator's experience. On the contrary, the use of intrapartum suprapubic transabdominal ultrasound can improve accuracy in determination of fetal head position and the precise knowledge of the location of specific fetal head landmarks in relationship to maternal pelvis. Intrapartum ultrasound will assist obstetricians in the diagnosis of normal labor progression, suggesting when medical and or operative intervention should be taken in case of complications. During each fetal head movement, there is a very specific relationship between fetal head landmarks and well-identified maternal structures, so the ultrasound diagnosis is performed step by step. In this review, we summarized the clinical situation of the fetal head in the pelvis and the relative ultrasonographic signs. Moreover, we collected all the ultrasonographic measures to diagnose the fetal head progression and rotations in the birth canal.

Obstetrics anal sphincter injury and repair technique: a review

The Urogynecology Committee of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) has held seminars and workshops on various urogynecological problems in each country in the Asia-Oceania area in order to encourage young obstetricians and gynecologists. In 2013, we organized the operative seminar for obstetrical anal sphincter injuries (OASIS) in which we prepared porcine models to educate young physicians in a hands-on workshop at the 23rd Asian and Oceanic Congress of Obstetrics and Gynaecology in Bangkok, Thailand. Laceration of the anal sphincter mostly occurs during vaginal delivery and it can develop into anal sphincter deficiency, which causes fecal incontinence, if an appropriate suture is not performed. OASIS has become an important issue, especially in developing countries. The prevalence of OASIS of more than the third degree is around 5% in primary parous women and the frequency is higher when detected by ultrasonographic evaluation. Several risk factors, such as macrosomia, instrumental labor, perineal episiotomy and high maternal age, have been recognized. In a society where pregnant women are getting older, OASIS is becoming a more serious issue. An intrapartum primary appropriate stitch is important, but the 1-year outcome of a delayed operation after 2 weeks postpartum is similar. A randomized controlled study showed that overlapping suture of the external sphincter is better than that of end-to-end surgical repair. The Urogynecology Committee of the AOFOG would like to continue with educative programs about the appropriate therapy for OASIS.

Relationship between gestational fasting plasma glucose and neonatal birth weight, prenatal blood pressure and dystocia in pregnant Chinese women

BACKGROUND

Little is known about the optimal cut-off point of fasting plasma glucose for the diagnosis of gestational diabetes mellitus for pregnant Chinese women. This study investigates the relationship between gestational fasting plasma glucose and several variables: neonatal birth weight, prenatal blood pressure and dystocia rate of pregnant women. In this study, we hoped to provide a useful tool to screen gestational diabetes mellitus in pregnant Chinese women.

METHODS

For 1058 pregnant women enrolled in our hospital at pregnancy weeks 22-30, fasting plasma glucose, neonatal birth weight and prenatal blood pressure, as well as dystocia conditions, were examined. We analysed the correlations between the following: gestational fasting plasma glucose and neonatal birth weight; prenatal blood pressure and gestational fasting plasma glucose as well as dystocia rate and gestational fasting plasma glucose group.

RESULTS

A modest correlation was observed between gestational fasting plasma glucose and neonatal birth weight (r = 0.093, p = 0.003). The macrosomia rate was smallest when the gestational fasting plasma glucose was in the range 3.51-5.5 mmol/L. Prenatal blood pressure increased linearly with increasing gestational fasting plasma glucose (p = 0.000). There was a significant difference between the dystocia rates in different fasting plasma glucose groups (chi-squared = 13.015, p = 0.043). The results showed that the dystocia rate significantly increased when gestational fasting plasma glucose was >4.9 mmol/L; p = 0.03, OR = 2.156 (95% CI, 1.077-4.318).

CONCLUSION

We suggest that the optimal range of gestational fasting plasma glucose for pregnant Chinese women is in the range 3.5-4.9 mmol/L.

Bioeconomic factors of beef heifer maturity to consider when establishing criteria to optimally select and/or retain herd replacements

Understanding the biology of heifer maturity and its relationship to calving difficulty and subsequent breeding success is a vital step in building a bioeconomic model to identify optimal production and profitability. A limited dependent variable probit model is used to quantify the responses among heifer maturities, measured by a maturity index (MI), on dystocia and second pregnancy. The MI account for heifer age, birth BW, prebreeding BW, nutrition level, and dam size and age and is found to be inversely related to dystocia occurrence. On average there is a 2.2% increase in the probability of dystocia with every 1 point drop in the MI between the MI scores of 50 and 70. Statistically, MI does not directly alter second pregnancy rate; however, dystocia does. The presence of dystocia reduced second pregnancy rates by 10.67%. Using the probability of dystocia predicted from the MI in the sample, it is found that on average, every 1 point increase in MI added 0.62% to the probability of the occurrence of second pregnancy over the range represented by the data. Relationships among MI, dystocia, and second pregnancy are nonlinear and exhibit diminishing marginal effects. These relationships indicate optimal production and profitability occur at varying maturities, which are altered by animal type, economic environment, production system, and management regime. With these captured relationships, any single group of heifers may be ranked by profitability given their physical characteristics and the applicable production, management, and economic conditions.

Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment

BACKGROUND

Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour.

METHOD

Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not.

RESULTS

Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours.Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P <0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5).

CONCLUSIONS

There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not.

Genetic parameters for direct and maternal calving ease in Walloon dairy cattle based on linear and threshold models

Calving ease scores from Holstein dairy cattle in the Walloon Region of Belgium were analysed using univariate linear and threshold animal models. Variance components and derived genetic parameters were estimated from a data set including 33,155 calving records. Included in the models were season, herd and sex of calf × age of dam classes × group of calvings interaction as fixed effects, herd × year of calving, maternal permanent environment and animal direct and maternal additive genetic as random effects. Models were fitted with the genetic correlation between direct and maternal additive genetic effects either estimated or constrained to zero. Direct heritability for calving ease was approximately 8% with linear models and approximately 12% with threshold models. Maternal heritabilities were approximately 2 and 4%, respectively. Genetic correlation between direct and maternal additive effects was found to be not significantly different from zero. Models were compared in terms of goodness of fit and predictive ability. Criteria of comparison such as mean squared error, correlation between observed and predicted calving ease scores as well as between estimated breeding values were estimated from 85,118 calving records. The results provided few differences between linear and threshold models even though correlations between estimated breeding values from subsets of data for sires with progeny from linear model were 17 and 23% greater for direct and maternal genetic effects, respectively, than from threshold model. For the purpose of genetic evaluation for calving ease in Walloon Holstein dairy cattle, the linear animal model without covariance between direct and maternal additive effects was found to be the best choice.

The labour scale--assessment of the validity of a novel labour chart: a pilot study

BACKGROUND

Labour dystocia is the most common indication for caesarean section (CS). This study assessed the validity of the labour scale (WHO partograph modification) as an intrapartum management tool to minimise over-diagnosis of labour dystocia.

MATERIALS AND METHODS

The study included 77 women in the early active phase of labour using the scale. This scale covers the same titles as the partograph with the cervico-graph modified using National Institute of Clinical Excellence (NICE) recommendations that adjust interference according to clinical circumstances. Labour progress was plotted on the labour scale then on the partograph to compare outcomes. Maternal and fetal outcomes were compared with international and local reports.

RESULTS

Only 21 (27.3%) women crossed the 'membrane line', which promotes amniotomy, and 35 women (45.5%) crossed the 'augmentation line' and received oxytocin. Four women were delivered by CS for failure to progress. When the same data were re-plotted on the partograph, twenty-eight women were diagnosed with failure to progress. The outcome difference between the 'labour scale' and the partograph was significant (P < 0.0001). Maternal and neonatal outcomes were excellent.

CONCLUSIONS

We suggest that the 'labour scale' is a promising tool for labour management that minimises labour dystocia without additional maternal or fetal risk.

Diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women

BACKGROUND

Dystocia is one of the important causes of maternal morbidity and mortality in low-income countries. This study was aimed to determine the diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women.

MATERIALS AND METHODS

This prospective cohort study was conducted on 447 nulliparous women who referred to Omolbanin hospital. Several maternal anthropometric measurements such as height, transverse and vertical diameters of Michaelis sacral rhomboid area, foot length, head circumference, vertebral and lower limb length, symphysio-fundal height, and abdominal girth were taken in cervical dilatation ≤ 5 cm. Labor progression was controlled by a researcher blind to these measurements. After delivery, the accuracy of individual and combined measurements in prediction of dystocia was analyzed. Dystocia was defined as cesarean section and vacuum or forceps delivery for abnormal progress of labor (cervical dilatation less than 1 cm/h in the active phase for 2 h, and during the second stage, beyond 2 h or fetal head descend less than 1 cm/h).

RESULTS

Among the different anthropometric measurements, transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm, maternal height ≤ 155 cm, height to symphysio-fundal height ratio ≤4.7, lower limb length ≤78 cm, and head circumference to height ratio ≥ 35.05 with accuracy of 81.2%, 68.2%, 65.5%, 63.3%, and 61.5%, respectively, were better predictors. The best predictor was obtained by combination of maternal height ≤155 cm or the transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm and Johnson's formula estimated fetal weight ≥3255 g, with an accuracy of 90.5%, sensitivity of 70%, and specificity of 93.7%.

CONCLUSIONS

Combination of other anthropometric measurements and estimated fetal weight with maternal height in comparison to maternal height alone leads to a better predictor for dystocia.

[Uterine torsion in cattle--therapy and consequences for calf and cow]

AIM

To summarize the available literature on the therapy of uterine torsion in cattle and the consequences for cow and calf.

MATERIAL AND METHODS

Analysis of the literature using electronic libraries (PubMed, Medline), German veterinary medical journals and obstetrical textbooks.

RESULTS

The therapy includes the attempt to rotate the uterus back into its physiological position. Direct and indirect methods of retorsion are available and applied according to the case conditions. Subsequently, the extraction of the calf can be performed via vaginal delivery or caesarean section. The presence of uterine torsion always leads to dystocia. Following a successful retorsion, the time and degree of uterine torsion strongly influence the progress of the birth. The prognosis also depends on the aforementioned factors and varies between good to unsuccessful. The vitality of the calf displays great variation depending on the literature (14-90%), however, is generally greater under field than clinical conditions. Focussing on the puerperal development of the cow, all grades from mild irritations of the uterine involution to fatal complications occur. The influence on fertility depends on the progress of the birth and existing secondary complications. The risk for electrolyte disturbances is increased (approximately 50%) as is the risk of birth-associated injuries (approximately 20%). The incidence of placental retention varies widely between different authors (3-52%).

Relation between intravascular electrolyte level and course of parturition in dairy cows

OBJECTIVE

To determine the intravascular electrolyte status in dairy cows with respect to age and different courses of parturition to clarify etiological factors influencing peri- or intrapartal imbalances of electrolyte homeostasis.

MATERIAL AND METHODS

A total of 64 cows at birth were evaluated (primiparous n = 34, pluriparous n = 30). Thirty-three cows showed normal delivery, while 31 cows had a complicated birth. Blood samples were collected intra partum (i. p.) and 2, 4, 6, 8, 12, 16, 24 h post partum (p. p.) as well as [2, 3, 4, 5, 7, 10 days p. p. and levels of total calcium (Catotal), ionized calcium (Caion), inorganic phosphate (Pa), Mg, Na, K, Cl were determined.

RESULTS

The results revealed that electrolytes show great fluctuation during and immediately p. p. in relation to age. Already during parturition pluriparous cows had a lower Catotal and Pa concentration compared to primiparous animals. Cows with dystocia exhibited a more intensive and longer lasting decrease of Ca compared to cows with normal birth. In relation to age and severity of birth Pa concentration showed a differing but basically typical course for this electrolyte. Mg, Na, K and Cl concentrations were higher during and immediately after birth compared to p. p. values. Until day 10 p. p. these electrolyte concentrations declined more in older cows with dystocia compared to younger animals. However, the influence of dystocia on concentration of these electrolytes was milder in contrast to Ca and Pa.

CONCLUSIONS

In summary, primarily older cows are predisposed to imbalances of electrolyte homeostasis intra partum and at the beginning of the lactation. These changes are potentiated in case of complications during parturition. Intravascular Catotal, Caion as well as Pa are most severely affected.

CLINICAL RELEVANCE

These results may constitute the basis for a comprehensive metaphylaxis during the peripartal period, especially in cows after dystocia, to positively influence the early convalescence phase.

Indication

Should the indications for therapies differ from one nation to the next? What are the reasons behind controversial therapeutic variations? What roles do cultural history and authoritarian conflict among clinicians play in the adoption of therapies? When I worked at a rural hospital in Kenya, a woman experiencing obstructed labor made me ponder many questions-but only after our emergency ended in the death of her newborn son. In recounting and learning from this episode, I listened to the disparate Kenyan voices of the patient, the hospital's director, the consultant obstetrician, and to the even more controversial voices of evidence-based medicine. In reflecting on this process, I have learned at least 3 lessons-about the transmissibility of arrogance, the role of guests in other countries, and the nature of science.

Bilateral clavicle fracture in two newborn infants

BACKGROUND

The fracture of clavicle is the most frequently observed bone fracture as birth trauma and it is usually unilateral. It is seen following shoulder dystocia deliveries or breech presentation of macrosomic newborns.

CASE PRESENTATION

We report two macrosomic newborns with bilateral clavicle fracture and brachial plexus palsy due to birth trauma. Chest X-rays confirmed bilateral fracture of clavicles. Both patients were recovered without any sequel.

CONCLUSION

Bilateral clavicular fracture should be considered in any neonate with bilateral absent Moro reflexes.

Stillbirths in Macaca fascicularis

BACKGROUND

Stillbirths in non-human primates are a major problem and represent failure of the maternal-fetal-placental unit to maintain normal relationships because of various endogenous, undetermined or environmental factors.

METHODS

Records of 236 stillborns and their dams in a Macaca fascicularis colony during a 7-year period were reviewed retrospectively.

RESULTS

The 7-year stillbirth incidence was 11.99% (236 stillbirths, 1967 live births). Most (61.02%, n = 144) were of undetermined etiology. Fetal causes included trauma (22.46%, n = 53), fetal pneumonia (0.85%, n = 2) and congenital anomalies (0.42%, n = 1). Maternal causes included dystocia (9.75%, n = 23) and uterine rupture (0.42%, n = 1). Forty-nine placentas were available for histologic evaluation; there was placentitis in five, necrosis in five and placental abruption in two. Most stillbirths occurred close to term. First stillbirths usually occurred in 8- to 12-year-old animals during the first six pregnancies.

CONCLUSIONS

Most stillbirths were of undetermined etiology. Fetal trauma was the most common cause.

Vertebral fractures in newborn calves

A prospective study on vertebral fractures in newborn calves is described. Vertebral fractures were found in 7.0% of necropsied calves of the Danish Holstein-Friesian (SDM) and Red Danish Dairy (RDM) breeds. Cases were not found in submitted calves of the Jersey breed or beef breeds. At least in beef breeds this was probably due to the low number necropsied. The rate of vertebral fractures in SDM and RDM breeds and between males and females were similar. Most cases occurred in calves born by heifers, and manual traction force had been applied in all cases. All fractures which in most cases consisted of a simple epiphysiolysis were located at the thoraco-lumbar area, and especially the posterior epiphysis of T13 was afflicted.

The use of clenbuterol for the management of large animal dystocias: surgical corrections in the cow and ewe

Clenbuterol (Ventipulmin(R) Solution) was included in the corrective management of dystocia cases requiring obstetrical surgery encountered in a Quebec rural practice. Data were collected on a total of 69 cases: 63 bovine and three ovine caesareans, and three bovine fetotomies. Ease of exteriorization of the gravid uterus and postoperative development of uterine adhesions were compared in two groups of bovine caesarean cases: a clenbuterol-treated group (Group A, n = 63) and a nontreated control group (Group B, n = 90). Clenbuterol produced a potent myometrial relaxant effect making its use beneficial in the correction of the bovine and ovine dystocias. It provided significantly improved uterine maneuverability (x(2) = 47.63, P < 0.001) and significantly reduced postoperative development of adhesions (x(2) = 14.05, P < 0.001) except in bovine caesarean cases with a high degree of myometrial distension. Neonatal and maternal health were not impaired and retention of fetal membranes was not increased. When used as directed, clenbuterol was a safe, reliable, and efficacious drug.