A rare case of adventitious placentation (diffuse semi-placenta) in a Jersey cow

Placental abnormalities more frequently occur during pregnancy of somatic cell clones and may lead to pregnancy loss or dystocia. Adventitious placentation, or diffuse semi-placenta, is determined by the development of areas of accessory placentation between the cotyledons due to the abnormal growth of placentomes.After a full-term pregnancy, a 3-year-old Jersey heifer was referred for dystocia which resulted in the delivery of a dead calf. The cause of dystocia was found to be foetal malposition, while the placenta was physiologically expelled after dystocia resolution.Grossly, cotyledons appeared reduced in size and number in one placental horn, while the surface of the other horn was covered with microplacentomes. Numerous villous structures without trophoblastic coating were highlighted after histopathology. The dominant sign was an inflammatory reaction. The findings were consistent with inter-cotyledonal placentitis, which led to adventitial placentation.Diffuse semi-placenta compensates for the inadequate development of placentomes and may occur as a congenital or acquired defect. The outcome depends on its severity: in the worst scenario, pregnancy may not proceed beyond midterm and may be complicated by hydrallantois. In the case under examination, the dimensions of the cotyledons (from 2 to 10 cm) allowed for the natural course of pregnancy.

Assisted vaginal birth in 21st century: current practice and new innovations

Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman's preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39-0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32-2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers' and babies' lives across the world.

Tafoxiparin, a novel drug candidate for cervical ripening and labor augmentation: results from 2 randomized, placebo-controlled studies

BACKGROUND

Slow progression of labor is a common obstetrical problem with multiple associated complications. Tafoxiparin is a depolymerized form of heparin with a molecular structure that eliminates the anticoagulant effects of heparin. We report on 2 phase II clinical studies of tafoxiparin in primiparas. Study 1 was an exploratory, first-in-pregnant-women study and study 2 was a dose-finding study.

OBJECTIVE

Study 1 was performed to explore the effects on labor time of subcutaneous administration of tafoxiparin before onset of labor. Study 2 was performed to test the hypothesis that intravenous treatment with tafoxiparin reduces the risk for prolonged labor after spontaneous labor onset in situations requiring oxytocin stimulation because of dystocia.

STUDY DESIGN

Both studies were randomized, double-blind, and placebo-controlled. Participants were healthy, nulliparous females aged 18 to 45 years with a normal singleton pregnancy and gestational age confirmed by ultrasound. The primary endpoints were time from onset of established labor (cervical dilation of 4 cm) until delivery (study 1) and time from start of study treatment infusion until delivery (study 2). In study 1, patients at 38 to 40 weeks of gestation received 60 mg tafoxiparin or placebo daily as 0.4 mL subcutaneous injections until labor onset (maximum 28 days). In study 2, patients experiencing slow progression of labor, a prolonged latent phase, or labor arrest received a placebo or 1 of 3 short-term tafoxiparin regimens (initial bolus 7, 21, or 35 mg followed by continuous infusion at 5, 15, or 25 mg/hour until delivery; maximum duration, 36 hours) in conjunction with oxytocin.

RESULTS

The number of participants randomized in study 1 was 263, and 361 were randomized in study 2. There were no statistically significant differences in the primary endpoints between those receiving tafoxiparin and those receiving the placebo in both studies. However, in study 1, the risk for having a labor time exceeding 12 hours was significantly reduced by tafoxiparin (tafoxiparin 6/114 [5%] vs placebo 18/101 [18%]; P=.0045). Post hoc analyses showed that women who underwent labor induction had a median (range) labor time of 4.44 (1.2-8.5) hours with tafoxiparin and 7.03 (1.5-14.3) hours with the placebo (P=.0041) and that co-administration of tafoxiparin potentiates the effect of oxytocin and facilitates a shorter labor time among women with a labor time exceeding 6 to 8 hours (P=.016). Among women induced into labor, tafoxiparin had a positive effect on cervical ripening in 11 of 13 cases (85%) compared with 3 of 13 participants (23%) who received the placebo (P=.004). For women requiring oxytocin because of slow progression of labor, the corresponding results were 34 of 51 participants (66%) vs 16 of 40 participants (40%) (P=.004). In study 2, tafoxiparin had no positive effects on the secondary endpoints when compared with the placebo. Except for injection-site reactions in study 1, adverse events were no more common for tafoxiparin than for the placebo among either mothers or infants. There were few serious or treatment-related adverse events.

CONCLUSION

Subcutaneous treatment with tafoxiparin before labor onset (study 1) may be effective in reducing the labor time among women undergoing labor induction and among those requiring oxytocin for slow progression of labor. Moreover, tafoxiparin may have a positive effect on cervical ripening. Short-term, intravenous treatment with tafoxiparin as an adjunct to oxytocin in patients with labor arrest (study 2) did not affect labor time or other endpoints. Both studies suggest that tafoxiparin has a favorable safety profile in mothers and their infants.

Soft-tissue dystocia due to paradoxical contraction of the levator ani as a cause of prolonged second stage: concept, diagnosis, and potential treatment

Smaller pelvic floor dimensions seem to have been an evolutionary need to provide adequate support for the pelvic organs and the fetal head. Pelvic floor dimension and shape contributed to the complexity of human birth. Maternal pushing associated with pelvic floor muscle relaxation is key to vaginal birth. Using transperineal ultrasound, pelvic floor dimensions can be objectively measured in both static and dynamic conditions, such as pelvic floor muscle contraction and pushing. Several studies have evaluated the role of the pelvic floor in labor outcomes. Smaller levator hiatal dimensions seem to be associated with a longer duration of the second stage of labor and a higher risk of cesarean and operative deliveries. Furthermore, smaller levator hiatal dimensions are associated with a higher fetal head station at term of pregnancy, as assessed by transperineal ultrasound. With maternal pushing, most women can relax their pelvic floor, thus increasing their pelvic floor dimensions. Some women contract rather than relax their pelvic floor muscles under pushing, which is associated with a reduction in the anteroposterior diameter of the levator hiatus. This phenomenon is called levator ani muscle coactivation. Coactivation in nulliparous women at term of pregnancy before the onset of labor is associated with a higher fetal head station at term of pregnancy and a longer duration of the second stage of labor. In addition, levator ani muscle coactivation in nulliparous women undergoing induction of labor is associated with a longer duration of the active second stage of labor. Whether we can improve maternal pelvic floor relaxation with consequent improvement in labor outcomes remains a matter of debate. Maternal education, physiotherapy, and visual feedback are promising interventions. In particular, ultrasound visual feedback before the onset of labor can help women increase their levator hiatal dimensions and correct levator ani muscle coactivation in some cases. Ultrasound visual feedback in the second stage of labor was found to help women push more efficiently, thus obtaining a lower fetal head station at ultrasound and a shorter duration of the second stage of labor. The available evidence on the role of any intervention aimed to aid women to better relax their pelvic floor remains limited, and more studies are needed before considering its routine clinical application.

New labor curves of dilation and station to improve the accuracy of predicting labor progress

BACKGROUND

The diagnosis of failure to progress, the most common indication for intrapartum cesarean delivery, is based on the assessment of cervical dilation and station over time. Labor curves serve as references for expected changes in dilation and fetal descent. The labor curves of Friedman, Zhang et al, and others are based on time alone and derived from mothers with spontaneous labor onset. However, labor induction is now common, and clinicians also consider other factors when assessing labor progress. Labor curves that consider the use of labor induction and other factors that influence labor progress have the potential to be more accurate and closer to clinical decision-making.

OBJECTIVE

This study aimed to compare the prediction errors of labor curves based on a single factor (time) or multiple clinically relevant factors using two modeling methods: mixed-effects regression, a standard statistical method, and Gaussian processes, a machine learning method.

STUDY DESIGN

This was a longitudinal cohort study of changes in dilation and station based on data from 8022 births in nulliparous women with a live, singleton, vertex-presenting fetus ≥35 weeks of gestation with a vaginal delivery. New labor curves of dilation and station were generated with 10-fold cross-validation. External validation was performed using a geographically independent group. Model variables included time from the first examination in the 20 hours before delivery; dilation, effacement, and station recorded at the previous examination; cumulative contraction counts; and use of epidural anesthesia and labor induction. To assess model accuracy, differences between each model's predicted value and its corresponding observed value were calculated. These prediction errors were summarized using mean absolute error and root mean squared error statistics.

RESULTS

Dilation curves based on multiple parameters were more accurate than those derived from time alone. The mean absolute error of the multifactor methods was better (lower) than those of the single-factor methods (0.826 cm [95% confidence interval, 0.820-0.832] for the multifactor machine learning and 0.893 cm [95% confidence interval, 0.885-0.901] for the multifactor mixed-effects method and 2.122 cm [95% confidence interval, 2.108-2.136] for the single-factor methods; P<.0001 for both comparisons). The root mean squared errors of the multifactor methods were also better (lower) than those of the single-factor methods (1.126 cm [95% confidence interval, 1.118-1.133] for the machine learning [P<.0001] and 1.172 cm [95% confidence interval, 1.164-1.181] for the mixed-effects methods and 2.504 cm [95% confidence interval, 2.487-2.521] for the single-factor [P<.0001 for both comparisons]). The multifactor machine learning dilation models showed small but statistically significant improvements in accuracy compared to the mixed-effects regression models (P<.0001). The multifactor machine learning method produced a curve of descent with a mean absolute error of 0.512 cm (95% confidence interval, 0.509-0.515) and a root mean squared error of 0.660 cm (95% confidence interval, 0.655-0.666). External validation using independent data produced similar findings.

CONCLUSION

Cervical dilation models based on multiple clinically relevant parameters showed improved (lower) prediction errors compared to models based on time alone. The mean prediction errors were reduced by more than 50%. A more accurate assessment of departure from expected dilation and station may help clinicians optimize intrapartum management.

Genetic correlation estimates between calving ease in primiparous cows and economically important traits in Nellore cattle

This study aimed to estimate (co)variance components and genetic parameters for calving ease (CE) and their genetic correlations with growth, reproductive, carcass, and feed efficiency traits in Nellore cattle. Phenotypes for CE are scored in two categories: normal calving and assisted calving. The traits considered were probability of precocious calving, age at first calving, stayability, adjusted scrotal circumference at 365 days of age, accumulated cow productivity, age at puberty of males, gestation length, birth weight, adjusted weights at 210 and 450 days of age, adult cow weight, frame score, hip height, rib eye area, subcutaneous backfat thickness, rump fat thickness, intramuscular fat percentage, residual feed intake and dry matter intake. The estimation of genetic parameters was performed using a two-trait threshold-linear animal model, except for CE, stayability, and probability of precocious calving, which were evaluated through a two-trait threshold animal model. The direct (0.27) and maternal (0.19) heritability estimates for CE in heifers primiparous Nellore indicated that selecting for this trait is feasible. The selection to improve the female sexual precocity should consider CE during the selection and mating decisions to reduce calving problems. Genetic correlation estimates between CE and BW suggest that selecting low birth weight to reduce calving problems is not an appropriate strategy to improve calving ease in heifers Nellore. Therefore, adopting a multi-trait selection model with CE and BW in the Nellore breed would reduce calving difficulties, particularly in sexually precocious heifers, without impairing the growth, reproductive, feed efficiency conversion, and carcass indicator traits.

Molecular identification of sparganum of Spirometra mansoni isolated from the abdominal cavity of a domestic cat in Vietnam

Cats normally play a role of the definitive host in which the plerocercoid (sparganum), the second larval form of Spirometra spp., develops into an adult in the intestines. However, some cases of cats with visceral or subcutaneous sparganosis were sporadically reported worldwide. We herein documented the discovery of a sparganum in abdominal cavity of a domestic cat during a surgery of dystocia. The larva was molecularly identified as Spirometra mansoni, belonging to Type I, that was recently misidentified to be S. erinaceieuropaei in several Asian countries. This is the first report for sparganum of S. mansoni in the cat. The future study is necessary to provide further insights into the species of Spirometra causing sparganosis and spirometrosis in humans and other animals.

Recumbency decreases mare and foal survival following in-hospital dystocia management

BACKGROUND

Mare and foal survival are increased with prompt dystocia management. Data regarding mortality outcomes in mares and foals, when mares are recumbent at admission for dystocia resolution, are scarce.

OBJECTIVES

To evaluate recumbency at hospital admission as a risk factor for survival of mares and foals following dystocia management. Subsequent mare fertility was also evaluated.

STUDY DESIGN

Retrospective cohort.

METHODS

Data were obtained from medical records at Rood and Riddle Equine Hospital of mares with dystocia between 1995 and 2018. Mare signalment, ambulation status, survival data and foaling records were collected. The proportion of mare survival and mare fertility were analysed using chi-squared tests. Foal survival was analysed using Fisher's exact test. Odds ratios were calculated using multivariable logistic regression.

RESULTS

There were 1038 ambulatory mares and 41 recumbent mares included in the analysis. Survival rates after dystocia resolution were 90.5% (977/1079) in mares and 37.3% (402/1079) in foals. Ambulatory mares had higher odds of survival (OR 6.93, 95% CI: 3.25-14.78, p < 0.001) than recumbent mares. Foals delivered from ambulatory mares had higher odds of survival (OR 22.7, 95% CI: 3.11-165.44, p = 0.002) compared with foals delivered from recumbent mares. Fertility was not statistically different for surviving Thoroughbred mares within 3 years following dystocia resolution between ambulatory and recumbent mares.

MAIN LIMITATIONS

Retrospective study design and small case number of recumbent mares.

CONCLUSIONS

Mare and foal survival was significantly decreased when mares with dystocia were recumbent at hospital admission. Subsequent fertility, as defined for this study, of surviving mares was not affected by ambulation status at the time of dystocia resolution.

Clinical applicability of external and internal body dimensions in predicting dystocia in late-gestation Holstein-Friesian heifers

The objective of this study was to determine the clinical applicability of maternal intrapelvic area (PA) and selected morphometric parameters that can be measured before parturition in predicting dystocia in dairy heifers. The measurements were performed in 374 late-gestation Holstein-Friesian heifers. Inner pelvic height and width were measured using a pelvimeter, and PA was calculated. The heifers were monitored continuously around the time of calving, and calving difficulty was categorized as: unassisted calving (UC), slight assistance (SA), considerable difficulty (CD) and veterinary assistance (VA). Calving performance was analysed with the χ2 test, and the effect of body dimensions on the course of parturition was evaluated by one-way analysis of variance. Dystocia (CD + VA) was predicted with the use of the classification tree method. Dystocia accounted for 29.14% of all deliveries. The percentages of stillbirths and retained placenta increased (p < .01) with increasing calving difficulty. Average PA immediately before parturition was smaller (p < .01) in group VA (223.2 cm2 ) than in group UC (253.3 cm2 ). According to the classification tree, dystocia may occur (74.07% odds) in heifers with PA < 254.2 cm2 and a rump angle <5.68° before parturition. Measurements of heifer's cannon circumference and sire's body size improve the accuracy of dystocia prediction.

Pelvic dimensions and occurrence of dystocia in Black-and-White and Holstein-Friesian heifers

The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia has increased. Dystocia occurs most frequently in heifers, and it is associated with high calf weight and/or too narrow pelvic openings in heifers. The aim of this study was to evaluate retrospectively the effects of pelvic dimensions and rump angle on calving ease in two cattle breeds. The research was carried out in four barns where BW and HF cattle were used. The course of parturition was evaluated in 317 heifers (BW, n=169; HF, n=148) based on direct observations. Calves were weighed, external and internal pelvic measurements were performed (using the Rice pelvimeter), and rump angle was determined in heifers. Based on the course of parturition, heifers of both breeds were divided into easy calving (EC) and difficult calving (DC) groups. The frequency of DC was 24.3% in HF heifers and 13.1% in BW heifers. In comparison with DC heifers, EC heifers had a larger pelvic area, in particular the internal dimensions of the bony pelvis, and a higher rump angle. In comparison with BW heifers, HF heifers had a smaller rump angle, a narrower pelvis and a lower ratio of pelvic area to calf weight. High dystocia rates in HF heifers could result from a relatively large fetus size and a less preferable pelvic size and rump angle. High variation in the internal pelvic dimensions in HF heifers indicates that the incidence of dystocia can be reduced through selection for a larger pelvic size and the optimal rump angle.

Trace element concentrations in blood samples from dairy cows with uterine torsion and their neonatal calves

Background and Aim

Mineral deficiencies can lead to dystocia and abnormalities in neonates. Stillbirth of neonatal calves in dairy cows due to dystocia has become an economic problem. Uterine torsion (UT) is a common form of dystocia observed in dairy cows. However, to the best of our knowledge, there have been no reports on the characteristics of serum trace element concentrations in dairy cows with UT. This study aimed to comprehensively measure serum trace element concentrations in dairy cows with UT and dystocia.

Materials and Methods

Dairy cows with (n = 15) and without (n = 27) UT and neonates (n = 9 and n = 26, respectively) were included in this study. Blood samples (10 mL) were collected, and serum trace element concentrations were evaluated using inductively coupled plasma mass spectrophotometry.

Results

The mortality rate at birth was significantly higher in calves delivered by cows with UT than those delivered by cows without UT. The odds ratio for mortality rate at birth in dairy cows with UT was 7.85. Serum zinc (Zn) levels were significantly lower in cows with UT than in cows without UT (p = 0.01). The copper: Zn ratio was significantly higher in cows with UT than in cows without torsion (p = 0.05). In contrast, serum Cobalt (Co) concentrations were significantly higher in neonates from cows with UT than in neonates from cows without UT (p = 0.01).

Conclusion

Uterine torsion is associated with a high mortality rate at birth and considerable economic losses. Cows with UT had low serum Zn levels, and neonates born to these cows had high serum Co levels.

Mmp2 Deficiency Leads to Defective Parturition and High Dystocia Rates in Mice

Parturition is the final and essential step for mammalian reproduction. While the uterus is quiescent during pregnancy, fundamental changes arise in the myometrial contractility, inducing fetal expulsion. Extracellular matrix (ECM) remodeling is fundamental for these events. The gelatinases subgroup of matrix metalloproteinases (MMPs), MMP2 and MMP9, participate in uterine ECM remodeling throughout pregnancy and parturition. However, their loss-of-function effect is unknown. Here, we determined the result of eliminating Mmp2 and/or Mmp9 on parturition in vivo, using single- and double-knockout (dKO) mice. The dystocia rates were measured in each genotype, and uterine tissue was collected from nulliparous synchronized females at the ages of 2, 4, 9 and 12 months. Very high percentages of dystocia (40-55%) were found in the Mmp2-/- and dKO females, contrary to the Mmp9-/- and wild-type females. The histological analysis of the uterus and cervix revealed that Mmp2-/- tissues undergo marked structural alterations, including highly enlarged myometrial, endometrial and luminal cavity. Increased collagen deposition was also demonstrated, suggesting a mechanism of extensive fibrosis in the Mmp2-/- myometrium, which may result in dystocia. Overall, this study describes a new role for MMP2 in myometrium remodeling during mammalian parturition process, highlighting a novel cause for dystocia due to a loss in MMP2 activity in the uterine tissue.

Multicenter study of uterine tears and other reproductive complications in periparturient goats presented to veterinary teaching hospitals

BACKGROUND

Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are largely unreported.

OBJECTIVES

(1) To report the frequency of periparturient reproductive complications in does presented to university veterinary hospitals and (2) to identify factors associated with uterine tears in the study population.

ANIMALS

A total of 198 periparturient does presented to 9 university veterinary hospitals from October 2021 to June 2022.

METHODS

Multicenter, cross-sectional study, with data collected from questionnaires completed by attending veterinarians. Logistic regression was used to identify factors associated with diagnosis of uterine tears.

RESULTS

Ninety-three (47%) does had at least 1 periparturient reproductive complication. Periparturient complications included retained fetal membranes (n = 38, 26%), vaginal or perineal trauma (n = 33, 19%), uterine tears (n = 32, 18%), metritis (n = 22, 13%), uterine or vaginal hemorrhage (n = 8, 5%), Cesarean section complications (n = 8, 8%), and uterine prolapse (n = 1, 0.5%). A positive interaction effect was found between small breeds (Nigerian Dwarf and Pygmy) and manipulation on the farm by a layperson upon diagnosis of uterine tears (odd ratios [OR], 5.48; 95% confidence interval [CI], 1.41, 21.25; P = .01).

CONCLUSIONS AND CLINICAL IMPORTANCE

Periparturient reproductive complications were common. Small breed combined with manipulation on the farm by layperson was associated with diagnosis of uterine tears. Clients should be educated that in the event of dystocia, small breed does are at greater risk of uterine tears and prompt veterinary intervention is critical.

Prenatal Diagnosis of Canine and Feline Twins Using Ultrasound: A Retrospective Study

Prenatal diagnosis comprises a set of investigations, both instrumental and laboratory-based, which aim to monitor the health of the foetus during pregnancy, from the early stages of embryonic development to the moments preceding delivery. A growing interest is emerging for the preterm ultrasound morphological screening of embryos and foetuses, aimed at assessing the integrity and viability of the conceptus, as well as the early diagnosis of anomalies which can cause complications. This study is a retrospective study of the ultrasonographic findings of twins in the authors' clinical activity from 2016 to 2022. Only seven cases of monochorionic twins were recorded, out of the whole number of evaluations performed on 3120 foetuses, with a prevalence of 0.6% and 0.2% in feline and canine foetuses. All the twins had their own amniotic sac and umbilical cord but presented a single placenta and a single allantoic sac. Unfortunately, the three feline cases were not more recognizable at term. In the four canine cases, three were of opposite sex and then necessarily dizygotic. Twins may have an impact on the success of a pregnancy due to the risk of dystocia, as observed in some of the reported cases. Prenatal ultrasound allows early recognition of twins in dogs and cats.

Intrapartum ultrasound for fetal head asynclitism: Is it possible to establish a degree of asynclitism to correlate to delivery outcome?

OBJECTIVE

To investigate the role of intrapartum ultrasound (IU) in the diagnosis of asynclitism and the importance of asynclitism degree in labor outcomes.

METHOD

This prospective cohort study included 41 low-risk pregnant women with fetus in singleton-vertex. The IU assessment to diagnose asynclitism was performed during labor at two specific steps, including the suspicion and/or diagnosis of labor arrest. The "four-chamber view" and "squint sign without nose" were classified as marked/severe asynclitism. The "midline deviation" and "squint sign with nose" findings were classified as moderate asynclitism. Obstetric outcomes and maternal-fetal complications were compared with the degree of asynclitism.

RESULTS

Severe and moderate asynclitism was seen in 17 (41.7%), 10 (58.8%) and seven (41.2%) women, respectively. All pregnant women diagnosed with asynclitism delivered by vacuum extraction (VE) or cesarean section (CS). CS was performed in nine patients with asynclitism (52.9%). The difference between asynclitism type and VE/CS ratios was statistically significant (P = 0.039). Four fetuses with squint sign without nose delivered by VE. A significant correlation was seen between the presence of squint without nose sign and second-/third-degree perineal injury.

CONCLUSION

Severe asynclitism is associated with increasing operative birth and maternal-fetal complications. Detection of asynclitism degree by IU could be useful, alerting the obstetrics team to possible perinatal problems during delivery.

Capsaicin and 1,25-Dihydroxyvitamin D3 Glycoside: Effects on the Reproductive Performance of Hyper-Prolific Sows

This study evaluated the effect of a natural source of vitamin D3 [1,25-(OH)2D3] and capsaicin (CAP) in the dietary supplementation of sows in the final phase (85-114 days) of gestation (Gest) and lactation (Lact) on the reproductive performance of the sows and health of piglets through two experiments (Exp I and II). In Exp I, 120 sows were subjected to four treatments: T1-control (without [1,25-(OH)2D3] and supplemental CAP); T2-3.5 µg 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-1.75 µg Vit 1,25-(OH)2D3 + 3.5 µg CAP/Gest/day and 3.5 µg 1,25-(OH)2D3 + 7.0 µg CAP/Lact/day. In Exp II, 200 sows were randomly blocked, factorial 2 × 2 (without or with Vit 1,25-(OH)2D3 and without or with CAP): T1-control (without Vit 1,25-(OH)2D3 and CAP); T2-3.5 µg Vit 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-3.5 µg Vit 1,25-(OH)2D3 + 7 µg CAP/Gest/day; and 7.0 µg Vit 1,25-(OH)2D3 + 14.0 µg CAP/Lact/day. The duration of delivery (3:48 vs. 4:57 h) and the percentage of stillbirths (5.37% vs. 7.61%) were improved (p < 0.05) in the group that received Vit 1,25-(OH)2D3 (Exp II) compared to the control group. Moreover, the dystocia rate decreased (p < 0.05) in Exp II, which received Vit 1,25-(OH)2D3 (4.21 vs. 27.63%), and in Exp I, which received the combination of Vit 1,25-(OH)2D3 + CAP (12 vs. 40%) compared to the respective control groups. Colostrum production was greater (p < 0.05) in sows that received Vit 1,25-(OH)2D3 supplementation compared to the control group, consequently resulting in higher colostrum intake (p < 0.05) of the piglets (330 vs. 258 g/piglet). The additives reduced the incidence of diarrhea (p < 0.05) in piglets (Exp I and II). Thus, the use of additives improved the reproductive performance of sows and contributed to litter growth.

Management of dystocia due to secondary uterine inertia in rabbit (Oryctolagus cuniculus): A case report

In the present report a rabbit doe with dystocia due to uterine inertia was successfully managed medically by administration of oxytocin, calcium borogluconate and multivitamins, with delivery of three live kits.

Association of precalving serum NEFA concentrations with postpartum diseases and reproductive performance in multiparous Holstein cows: Cut-off values

BACKGROUND

High concentrations of NEFA relative to a defined reference or 'cut-point' values before calving can predict the risk of specific or collective periparturient disease events.

OBJECTIVES

A field-based cohort study was conducted to evaluate the value and critical points of serum nonesterified fatty acids (NEFA) at the precalving time to predict the occurrence of postpartum diseases and reproductive performance in dairy cows.

METHODS

Blood samples were taken from 521 high-yielding dairy cows at 1 week (±3 days) before calving and NEFA levels were measured. Health and reproduction information of each cow includes dystocia, retained placenta, milk fever, metritis, mastitis, pregnancy in the first insemination and pregnancy in the first two inseminations, and culling in the first 60 days of lactation and milk production.

RESULTS

Our results show that there are significant relationships between precalving NEFA with the probability of pregnancy at the first and the first two inseminations after calving. The cows that had NEFA concentrations less than 0.5 mmol/L at the last week of pregnancy were 3.51 and 3.15 times more likely to be pregnant at first insemination and the first two inseminations, respectively. Also, our results showed that there are significant relationships between precalving NEFA concentration and the likelihood of dystocia and milk fever. The probability of dystocia and milk fever occurrence were 2.56 and 1.91 times greater in those cows that had NEFA concentrations more than 0.3 mmol/L, respectively.

CONCLUSIONS

The present results indicated that Increasing NEFA during the prepartum period could adversely affect the reproductive efficiency of dairy cows.

The In Vitro Contractile Response of Canine Pregnant Myometrium to Oxytocin and Denaverine Hydrochloride

In pregnant bitches, the response to oxytocin and denaverine hydrochloride in dystocia management is usually poor. To better understand the effect of both drugs on myometrial contractility, the circular and longitudinal muscle layers were examined in an organ bath. For each layer, three myometrial strips were stimulated twice, each with one of three oxytocin concentrations. The effect of denaverine hydrochloride was studied once in direct combination with oxytocin and alone with subsequent oxytocin administration. Contractions were recorded and evaluated for average amplitude, mean force, area under the curve (AUC), and frequency. Effects of different treatments were analyzed and compared within and between layers. In the circular layer, oxytocin significantly increased amplitude and mean force compared to untreated controls regardless of stimulation cycles or concentrations. In both layers, high oxytocin concentrations caused tonic contractions, while the lowest concentration created regular rhythmic contractions. Longitudinal layer tissue responded to oxytocin with a significantly decreased contractility when stimulated twice, presumably a sign of desensitization. Denaverine hydrochloride neither affected oxytocin induced contractions nor showed a priming effect to subsequent oxytocin. Thus, no benefit of denaverine hydrochloride on myometrial contractility was found in the organ bath. Our results suggest a better efficiency of low-dose oxytocin in canine dystocia management.

Surgical management of dystocia in a colobus monkey (Colobus guereza)

A 14-year-old female black and white colobus monkey (Colobus guereza) presented in labor with fetal arms visible protruding from the vulva. Manual manipulation for assisted delivery of the fetus was unsuccessful. Radiographs identified a large fetal skull and hysterotomy was required with ovariohysterectomy elected to follow. The fetus was confirmed to be deceased during hysterotomy, but the dam recovered from the procedure uneventfully. The detailed description of the anesthesia and surgical procedure in this case may aid other clinicians when presented with similar dystocia cases in this species.

Egg Removal via Cloacoscopy in Three Dystocic Leopard Geckos (Eublepharis macularius)

Dystocia is a multifactorial, life-threatening condition commonly affecting pet reptiles. Treatment for dystocia can be either medical or surgical. Medical treatment usually involves the administration of oxytocin, but in some species or, in some cases, this treatment does not work as expected. Surgical treatments such as ovariectomy or ovariosalpingectomy are resolutive, but invasive in small-sized reptiles. In this paper, we describe three cases of post ovulatory egg retention in three leopard geckos (Eublepharis macularius) successfully treated through a cloacoscopic removal of the retained eggs, after a non resolutive medical treatment. The intervention was fast, non-invasive, and no procedure-related adverse effects were noted. The problem relapsed six months later in one animal, and a successful bilateral ovariosalpingectomy was performed. Cloacoscopy should be considered a valuable, non-invasive tool for egg removal in dystocic leopard geckos when the egg is accessible to manipulation. Recrudescence or complications such as adhesions, oviductal rupture, or the presence of ectopic eggs should recommend surgical intervention.

The impact of maternal obesity on in vivo uterine contractile activity during parturition in the rat

Maternal obesity is associated with increased risk of prolonged and dysfunctional labor and emergency caesarean section. To elucidate the mechanisms behind the associated uterine dystocia, a translational animal model is required. Our previous work identified that exposure to a high-fat, high-cholesterol (HFHC) diet to induce obesity down-regulates uterine contractile associated protein expression and causes asynchronous contractions ex vivo. This study aims to investigate the impact of maternal obesity on uterine contractile function in vivo using intrauterine telemetry surgery. Virgin female Wistar rats were fed either a control (CON, n = 6) or HFHC (n = 6) diet for 6 weeks prior to conception, and throughout pregnancy. On Day 9 of gestation, a pressure-sensitive catheter was surgically implanted aseptically within the gravid uterus. Following 5 days recovery, intrauterine pressure (IUP) was recorded continuously until delivery of the 5th pup (Day 22). HFHC induced obesity led to a significant 1.5-fold increase in IUP (p = 0.026) and fivefold increase in frequency of contractions (p = 0.013) relative to CON. Determination of the time of labor onset identified that HFHC rats IUP (p = 0.046) increased significantly 8 h prior to 5th pup delivery, which contrasts to CON with no significant increase. Myometrial contractile frequency in HFHC rats significantly increased 12 h prior to delivery of the 5th pup (p = 0.023) compared to only 3 h in CON, providing evidence that labor in HFHC rats was prolonged by 9 h. In conclusion, we have established a translational rat model that will allow us to unravel the mechanism behind uterine dystocia associated with maternal obesity.

Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study

The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the "dystocic pain", that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS.

A Case Report of Uterine Body Constriction Precluding Normal Parturition Leading to Dystocia in a Mare

A 13-year-old multiparous Quarter Horse mare was presented to the Michigan State University's, Large Animal Emergency service for dystocia. Clinical evaluation revealed a minimally dilated cervix on vaginal examination, with a palpable deceased fetus. Postmortem evaluation following owner-elected humane euthanasia revealed a circumferential, tan, fibrous band at the base of the uterine body that constricted the uterus and was adhered to the left and right ovaries. A routine histologic section of the incarcerating cord attached to the ovary consisted predominately of dense fibrous connective tissue, large blood vessels, and a central oviduct suggestive of a rent in the broad ligament. To the authors' knowledge, this is the first case report to describe uterine body constriction that precluded vaginal delivery of a fetus in a late gestation mare.

Pharmacological Interventions in Labor and Delivery

While there is not a wide range of pregnancy-specific drugs, there are some very specific high-risk areas of obstetric care for which unique pharmacological approaches have been established. In preterm birth, labor induction and augmentation, and the management of postpartum hemorrhage, these pharmacological approaches have become the bedrock in managing some of the most common and problematic areas of antenatal and intrapartum care. In this review, we summarize the existing established and emerging evidence that supports and broadens these pharmacological approaches to obstetric management and its impact on clinical practice. It is clear that existing therapeutics are limited. They have largely been developed from our knowledge of the physiology of the myometrium and act on hormonal receptors and their signaling pathways or on ion channels influencing excitability. Newer drugs in development are mostly refinements of these two approaches, but novel agents from plants and improved formulations are also discussed.

Impact of Dystocia on Milk Production, Somatic Cell Count, Reproduction and Culling in Holstein Dairy Cows

This study investigated the effects of dystocia on milk production, somatic cell count, reproductivity, disease, and milk production. A total of 2159 cows across 21 dairy farms in Alberta, Canada were enrolled in this study. Multivariable models were created to explore associations between outcome variables and calving ease score. In total, 89.5% of calvings were unassisted, 6.1% were an easy pull, and 4.3% were a moderate-hard pull. Cows that had a moderate-hard pull produced 4.01 kg less milk, 0.12 kg less volume of milk fat, and 0.12 kg less milk protein per day than those that had an unassisted calving. No difference was found between calving ease groups with respect to SCC. Cows with a moderate or hard pull produced 510 kg less milk per lactation than unassisted cows. Cows with a moderate to high level of assistance at birth had a higher hazard of being culled over the duration of their lactation. Cows with an easy pull had increased odds of developing a retained placenta. It is evident that assistance at calving, particularly a moderate-hard pull, is associated with significant impacts on future milk production and risk of being culled; therefore, efforts should be made to minimize dystocia and prevent these impacts.

Do Calving-Related Injuries of the Vestibulum Vaginae and the Vagina Affect the Reproductive Performance in Primiparous Dairy Cows?

The aim of this study was to investigate the influence of calving-related injuries of the vestibulum vaginae and the vagina on fertility measures in heifers. German Holstein heifers (n = 236) were checked for vestibulum vaginae and vaginal injuries. These were scored according to localization, depth and length. The healing process was assessed until day 42 post partum. Calving ease and the occurrence of metritis and endometritis were evaluated. In 160 heifers, the following fertility measures were calculated to assess the reproductive performance of heifers: mean interval from calving to first insemination, mean days open, mean interval from first insemination to conception, mean calving interval, mean pregnancy index, percentage of animals pregnant at 200 days p.p., and first service conception rate. On the one hand, dystocia was a risk factor for injuries of the soft birth canal, and, on the other hand, those injuries were a risk factor for metritis and endometritis. In this study, calving-related injuries of the vestibulum vaginae and the vagina had no statistically significant effect on the reproductive performance of heifers. One reason for this outcome was probably the overall good healing tendencies of those injuries in heifers.

Impact of age at first calving on performance traits in Irish beef herds

Reducing age at first calving (AFC) has been a challenge in beef herds. There is anecdotal evidence that herd owners choose to calve heifers older because of the perceived consequences of calving heifers at 24 mo of age compared to 36 mo on performance traits in beef herds. The objective of this study was to estimate the association of calving heifers at younger ages on subsequent performance traits, calving interval, longevity, cow weight, dystocia, and progeny weaning weight for parities 1 to 5. Available to the study after data edits were 219,818 calving interval records, 219,818 longevity records, 118,504 cow live-weight records, 230,998 dystocia records, and 230,998 weaning weight records. Linear mixed models were used to quantify performance of each trait in AFC groups for each parity. As parity increased, there was a favorable reduction in calving interval and dystocia (P < 0.001), while the likelihood of cows surviving reduced (P < 0.001). Both cow live weight and progeny weaning weight increased as parity increased. Age at first calving only had a significant association with dystocia within parity 1 (P < 0.001), where older heifers at first calving subsequently had lower risk of calving. Calving interval for parity 1 cows was observed to be longer by 6 d in cows that calved for the first time at 33 to 36 mo compared to cows calved for the first time at 22 to 24 mo (P < 0.001). No statistical difference was observed for longevity between cows with an AFC of 22 to 24 mo compared to cows with an AFC of 33 to 36 mo (P > 0.05). Cows that calved at a younger age did wean lighter calves for their first three lactations (P < 0.01) but had no association with weaning weight for parity 4 and 5 cows (P > 0.05). Cows with a lower AFC were lighter for parity 1 to 4 (P < 0.001); at parity 5, AFC had no association with cow live weight (P > 0.05). The performance of mature cows for calving interval, longevity, calving difficulty, cow live weight, and weaning weight was not impacted by AFC. In conclusion, calving cows for the first time at younger ages do pose risks and associated performance loss but this risk and loss should be minimized by good management.

Associations between polymorphisms in the myostatin gene with calving difficulty and carcass merit in cattle

A fully functional myostatin gene inhibits muscle fiber growth. The objective of the present study was to quantify the association between 21 known myostatin mutations with both calving and carcass traits in 12 cattle breeds. The myostatin genotypes of 32,770 dam-progeny combinations were used in the association analysis of calving dystocia, with the genotypes of 129,803 animals used in the mixed model association analyses of carcass weight, conformation, and fat score. The mixed model included additive genetic, maternal, and permanent environmental effects where appropriate. The mutant genotypes of nt821, Q204X, and F94L were all associated (P < 0.01) with more calving difficulty when present in either the dam or the progeny. The nt821 deletion had the greatest association with calving difficulty when the homozygous deletion was present in either the calf (0.37 points greater calving difficulty score relative to calves carrying no copies of the deletion based on a one to four scale) or the dam (1.30 points greater calving difficulty score relative to dams carrying no copies of the deletion), although the association between the calf's nt821 genotype and calving difficulty differed depending on the nt821 genotype of the dam. With the exception of nt748_78, nt414, and nt374_51, all other seven segregating myostatin variants were associated (range of allele substitution effect size relative to animals with no copies of the mutant allele) with carcass weight (2.36 kg lighter to 15.56 kg heavier), all 10 segregating variants with conformation (0.15 units less conformed to 2.24 units more conformed assessed on a scale of 1 to 15), and all segregating variants other than E226X with carcass fat (0.23 units less carcass fat cover to 3.85 units more carcass fat cover assessed on a scale of 1 to 15). Of these, the F94L, Q204X, and nt821 mutations generally had the greatest association with all three carcass traits, giving rise to heavier and more conformed carcasses. Despite the antagonistic genetic relationship between calving difficulty and carcass traits, the nt374_51, F94L, and E226X mutations were all associated with improved carcass merit while having minimal expected consequences on calving difficulty. Thus, animals carrying these mutation(s) may have favorable genetic merit for calving difficulty and carcass merit. Furthermore, depending on the dam genotype, a bull with two copies of the nt821 mutation can produce progeny with improved carcass merit while minimizing calving problems.

An intrapartum calculator for predicting cesarean birth due to dystocia: Preliminary findings from a single-center study in Korea

BACKGROUND

Previous calculators based on antepartum or pre-labor factors preclude intrapartum counseling. We aimed to develop a reliable, programmable, intrapartum calculator to predict the risk of cesarean birth (CB) due to dystocia and to increase the discriminatory accuracy of the predictive model.

METHODS

Data were obtained retrospectively for 1326 singleton term deliveries with cephalic presentation. Two predictive multivariable logistic regression analysis models were constructed using pre-active labor variables alone (model A) or with active labor variables (model B). The discriminatory accuracies and goodness-of-fit of the models were compared using receiver operating characteristic (ROC) curves or -2log-likelihood ratios, Akaike information criterion (AIC), and Bayesian information criterion (BIC), respectively. Both models were internally validated using a bootstrapping procedure.

RESULTS

Model A yielded an area under the curve (AUC) of 0.859 and adequate goodness of fit (P = 0.970). Model B yielded a significantly higher AUC of 0.887 and adequate goodness of fit (P = 0.624), as well as a significantly lower AIC and BIC (P &lt; 0.001). Internal validation revealed a minimal optimism of 0.0070491 and 0.0068976 for models A and B, respectively. Finally, the logistic regression equations were converted into programmable calculators to yield easy-to-understand basic (model A) and additional intrapartum CB calculators (model B).

CONCLUSIONS

The programmable calculators developed herein can augment intrapartum counseling. Our findings suggest that the risk of CB due to dystocia during labor should be estimated using a calculator that corresponds to labor progression. Further studies should explore external validation of these statistical models before translation to a clinical setting.

Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.

Defining "Normal" in Pig Parturition

Simple Summary

The dual considerations of efficient food production and good animal welfare have never been so important nor under such strong public scrutiny as they are in current times. Intensive animal production industries play an important role in feeding an ever-growing, increasingly affluent population that is hungry for animal proteins. The efforts to improve efficiency in these production systems must not come at the cost of animal welfare. One pain point in pig production is that of parturition, where factors such as litter size and sow-housing type have been shown to influence the process and outcome. However, there are still many gaps in knowledge surrounding the normal physiology and endocrinology in a farrowing and this review seeks to summarise what is known and highlight areas where further work is required.

Abstract

Animal production industries rely on efficient and successful reproductive outcomes, with pigs being no exception. The process of parturition in pigs (farrowing) can be especially prolonged, due to the large numbers of piglets being born (on average, approximately 13 piglets per litter in Australian conditions). Difficulties in farrowing (dystocia) lead to poor piglet outcomes and health problems in sows, in turn, causing economic loss for producers and welfare concerns for the animals. Despite the importance of this topic and publications in the area stretching back nearly 50 years, there is still no consensus on the prevalence of dystocia in pigs nor on how to identify a pig experiencing the condition. Understanding the process of parturition and the factors that influence its success is a crucial step towards the early identification of sows undergoing dystocia and development of best practices to assist them. This article describes the key factors that contribute to successful farrowing and identifies areas in which more research is required before the parturition process in the pig can be fully understood.

Birth traits of Holstein calves compared with Holstein, Jersey, Montbéliarde, Normande, and Viking Red-sired crossbred calves

Holstein (HO) calves, 3-breed crossbred calves of Montbéliarde, Viking Red, and HO (MVH), and 3-breed crossbred calves of Normande, Jersey, and Viking Red (NJV) were compared for gestation length (GL), calf weight at birth (CW), calving difficulty (CD), and stillbirth (SB) in 2 research herds at the University of Minnesota. Calves were born from January 2009 to December 2019. For the St. Paul and Morris herds, HO calves (n = 1,121) were compared with MVH calves (n = 1,393) from primiparous and multiparous cows. For the single herd analysis at Morris, HO calves (n = 476), MVH calves (n = 922), and NJV calves (n = 405) were compared from primiparous and multiparous cows. Primiparous and multiparous births were analyzed separately because multiparous cows had multiple births, and CD and SB are likely different traits for primiparous and multiparous cows. Statistical analysis of GL, CW, CD, and SB included fixed effects of sex of calf, herd, breed group of calf, and year-season of calving. For the St. Paul and Morris herds, HO calves from primiparous (278 d) and multiparous (279 d) HO cows had shorter GL compared with MVH calves from primiparous (280 d) and multiparous (282 d) crossbred cows. The HO calves (39.4 and 43.2 kg, respectively) from primiparous and multiparous HO cows had lower CW compared with MVH calves (40.3 and 44.3 kg, respectively) from primiparous and multiparous crossbred cows. Calving difficulty and SB were not different for HO and MVH calves from primiparous and multiparous cows. For the single herd analysis at Morris, HO calves (278 and 279 d, respectively) from primiparous and multiparous HO cows had shorter GL compared with MVH calves (281 and 282 d, respectively) and NJV calves (282 and 282 d, respectively) from primiparous and multiparous crossbred cows. The CW of HO calves (38.6 and 42.0 kg, respectively) from primiparous and multiparous HO cows was lower compared with MVH calves (39.7 and 42.9 kg, respectively), but higher compared with NJV calves (35.1 and 38.0 kg, respectively) from primiparous and multiparous crossbred cows. Calving difficulty and SB did not differ for HO, MVH, and NJV calves from primiparous and multiparous cows. The longer GL for crossbred calves and higher CW for MVH calves did not increase CD and SB for primiparous and multiparous cows. Dairy producers may implement 3-breed rotational crossbreeding systems that include the HO, Jersey, Normande, Montbéliarde, and Viking Red breeds, and some breeds may increase GL and CW without an increase in CD and SB.

Study on NGF and VEGF during the Equine Perinatal Period-Part 2: Foals Affected by Neonatal Encephalopathy

Neonatal Encephalopathy (NE) may be caused by hypoxic ischemic insults or inflammatory insults and modified by innate protective or excitatory mechanisms. Understanding the underlying pathophysiology is important in formulating a rational approach to diagnosis. The preliminary aim was to clinically characterize a population of foals spontaneously affected by NE. The study aimed to: (i) evaluate nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) levels in plasma samples obtained in the affected population at parturition from the mare’s jugular vein, umbilical cord vein and foal’s jugular vein, as well as in amniotic fluid; (ii) evaluate the NGF and VEGF content in the plasma of foals affected by NE during the first 72 h of life/hospitalization; (iii) evaluate NGF and VEGF levels at birth/admission in relation to selected mare’s and foal’s clinical parameters; (iv) evaluate the relationship between the two trophic factors and thyroid hormone levels (TT3 and TT4) in the first 72 h of life/hospitalization; and (v) assess the mRNA expression of NGF, VEGF and brain-derived neurotrophic factor (BDNF), and their cell surface receptors, in the placenta of mares that delivered foals affected by NE. Thirteen affected foals born from mares hospitalized for peripartum monitoring (group NE) and twenty affected foals hospitalized after birth (group exNE) were included in the study. Dosage of NGF and VEGF levels was performed using commercial ELISA kits, whereas NGF, VEGF, and BDNF placental gene expression was performed using a semi-quantitative real-time PCR. In group NE, NGF levels decreased significantly from T0 to T24 (p = 0.0447) and VEGF levels decreased significantly from T0 to T72 (p = 0.0234), whereas in group exNE, only NGF levels decreased significantly from T0 to T24 (p = 0.0304). Compared to healthy foals, a significant reduction of TT3 levels was observed in both NE (T24, p = 0.0066; T72 p = 0.0003) and exNE (T0, p = 0.0082; T24, p < 0.0001; T72, p < 0.0001) groups, whereas a significant reduction of TT4 levels was observed only in exNE group (T0, p = 0.0003; T24, p = 0.0010; T72, p = 0.0110). In group NE, NGF levels were positively correlated with both TT3 (p = 0.0475; r = 0.3424) and TT4 levels (p = 0.0063; r = 0.4589). In the placenta, a reduced expression of NGF in the allantois (p = 0.0033) and a reduced expression of BDNF in the amnion (p = 0.0498) were observed. The less pronounced decrease of the two trophic factors compared to healthy foals, their relationship with thyroid hormones over time, and the reduced expression of NGF and BDNF in placental tissues of mares that delivered affected foals, could be key regulators in the mechanisms of equine NE.

Association of Herd Size with Stillbirth and Dystocia Rates in Japanese Black Cattle

The objective of this study was to investigate the effect of herd size on stillbirth and dystocia rates; the relationships between herd size, calving season, parity, and gestation length in Japanese Black cattle were also explored. Data were collected for 41,184 calvings from 15,512 animals on 905 farms between 2006 and 2010. In this study, herds were classified into three groups based on size: small (1−10 cows), medium (11−50 cows), and large (≥51 cows). Herd size had an effect on the dystocia rate (p < 0.05) but not the stillbirth rate. Additionally, interactions between herd size and gestation length were associated with the dystocia rate (p < 0.05), and the dystocia rate was the highest in small herds, followed by medium and large herds for cows with a gestation length of 281−300 days, which is considered a pregnancy of normal duration. In summary, in Japanese Black cattle, there were different effects of herd size on the stillbirth rate and dystocia rates, as herd size was associated with the dystocia rate but not with the stillbirth rate.

Out of step societal and Darwinian adaptation during evolution is the cause of multiple women's health issues

During human evolution, major changes in our societal conditions and environment took place without sufficient time for concomitant genetic alterations, leading to out of step adaptation and diseases in women. We first discuss recent societal adaptation mismatch (menstrual bleeding; increases in cancers of reproductive organs, endometriosis; mother's nursing; polycystic ovarian syndrome; transgenerational epigenetic modifications), followed by Darwinian out of step adaptation (labor difficulties; sex chromosomes, human diseases and sex disparity in genomic DNA). We discuss the evolutionary basis of menstrual bleeding, followed by recent increases in cancers of reproductive organs and endometriosis. The importance of breastfeeding by mothers is also emphasized. Earlier onset of menarche, decreased rates of childbirths and breastfeeding resulted in increased number of menstrual cycles in a lifetime, coupled with excess estrogen exposure and incessant ovulation, conditions that increased the susceptibility to mammary and uterine cancers as well as ovarian epithelial cancer and endometriosis. Shorter lactation duration in mothers also contributed to more menstrual cycles. We further discuss the evolutionary basis of the prevalent polycystic ovary syndrome. During the long-term Darwinian evolution, difficulties in childbirth evolved due to a narrowed pelvis, our upright walking and enlarged fetal brain sizes. Because there are 1.5% genomic DNA differences between woman and man, it is of significance to investigate sex-specific human physiology and diseases. In conclusion, understanding out of step adaptation during evolution could allow the prevention and better management of female reproductive dysfunction and diseases.

Dystocia in the Standardbred Mare: A Retrospective Study from 2004 to 2020

Dystocia as a prolonged stage II parturition (>30 min) was associated with a higher risk of complications. The hypothesis of the study was that any type of dystocia could affect the foal’s health, even when the stage II was <30 min. Clinical reports on 222 Standardbred mares and their foals hospitalized at the Veterinary Teaching Hospital of the University of Bologna from 2004 to 2020 were reviewed. Mares were divided into the Eutocia Group (165, eutocic delivery) and the Dystocia Group (57, dystocic delivery). The incidence of dystocia was 4.9%. Stage II was longer in the Dystocia Group (median 20 min) than in the Eutocia Group (median 12 min). All occurrences of dystocia were retrospectively classified into three categories of severity: mild, moderate and severe dystocia. The occurrence of postpartum complications in mares and neonatal diseases and failure of passive transfer of immunity in foals was higher in the Dystocia Group. Foal venous lactatemia and serum creatine kinase were significantly higher in the Dystocia Group (median 3.9 mmol/L; 262 UI/L respectively) than in the Eutocia Group (median 3.1 mmol/L; 187 UI/L respectively). The APGAR score was lower in the Dystocia Group (median 8) than in the Eutocia Group (median 10) and significantly lower in severe dystocia (median 3). The duration of stage II should not be considered the only parameter of dystocia in mares: even a rapid resolution of dystocia could pose health risks to the foal and the mare.

Establishment of a method to predict dystocia due to physical imbalance between foetus and maternal pelvis in Japanese Black cattle

This study aimed to clarify the relationship between the maternal pelvis and calf size in normal and dystocia groups (Experiment 1) and to establish a method to predict dystocia due to physical imbalance between foetus and maternal pelvis before calving based on the parameters found in Experiment 1 (Experiment 2). In Experiment 1, 26 pairs of dams and their offspring were tested immediately after calving, and various parameters of offspring size and maternal pelvis were measured in normal and dystocia cases. The longitudinal diameter of the maternal pelvis was smaller (P < 0.01), and ratios of the offspring's birth weight and the width of the hoof crown (hoof width; measured using callipers) to the longitudinal diameter of the maternal pelvis were larger (P < 0.01) in the dystocia group than those in the normal group. In Experiment 2, 37 cows were tested, and in addition to the measurement items of Experiment 1, the inner pelvic diameter and the foetal hoof width were measured via ultrasonography at 285 days of gestation. The ratio of the internal diameter of the maternal pelvis (longitudinal diameter, transverse diameter, and area) to the foetal hoof width was compared and was greater (P < 0.01) in the dystocia group than in the normal group. In conclusion, the risk of dystocia can be estimated by the ratio of the foetal hoof width to the longitudinal diameter of the maternal pelvis before calving.

Physiological plateaus during normal labor and birth: A scoping review of contemporary concepts and definitions

BACKGROUND

Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth.

METHODS

We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review.

RESULTS

Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, "rest and be thankful" stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth.

CONCLUSIONS

Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth.

Review on a cesarean section in the cow: Its incision approaches, relative advantage, and disadvantages

Dystocia is an abnormal and difficult birth in which the first or the second stage of labour is markedly prolonged and subsequently found impossible for the dam to deliver without artificial aid. In cattle, it can be relieved by different obstetric methods, including the cesarean operation and fetotomy. Caesarean section is the extraction of the fetus or foeti from the dam, through a surgical opening in the abdominal wall and the uterus. This surgical method can be performed by about eight alternative surgical approaches in bovines with its advantages and disadvantages. However, the selection is dependent on many factors like the type of dystocia, the cows and environmental conditions, the availability of assistants, and the surgeon's preference. For cows, most surgeons use a standing left paralumbar celiotomy. However, the left oblique approach is also preferable under most circumstances because the uterus is readily exteriorized, limiting peritoneal cavity contamination. Besides, alternative approaches are also available that will further limit the potential for contamination but many junior surgeons perform the left paralumbar celiotomy using the same approach each time due to their comfort with one specific approach or lack of familiarity with other available options. Therefore, the objective of this review is to provide basic insights and highlight the cesarean section incision approaches with their relative advantages and disadvantages in cows.

Retrospective analysis of 302 ovine dystocia cases presented to a veterinary hospital with particular attention to uterine torsion

Background

Dystocia is common in sheep, and foetal causes are predominant. Among maternal causes, insufficient cervical dilatation is the most frequent problem. Uterine torsion has been considered rare by many authors.

Objectives

This study was conducted to investigate causes of dystocia in sheep presented for veterinary attention, and particular focus was set on the description of uterine torsion and analysis of potentially predisposing factors for this condition.

Methods

Clinical records of 302 sheep treated for dystocia were evaluated retrospectively. Known and proposed risk factors for uterine torsion in cattle were analysed regarding their potential importance in sheep. These included lamb birth weights, ewe age, parity, season, nutrition, breed type, litter size and husbandry.

Results

Maternal causes of dystocia accounted for 67.2% (203/302) of the presented cases. Of these, insufficient cervical dilatation (121/203, 59.6%) was the most frequent diagnosis. Another substantial proportion of maternal causes (60/203, 29.6%) was identified as uterine torsion. Husbandry, breed type and litter size showed significance in univariate analyses, with lower odds for meat breeds (OR 0.22; p < 0.001), twin‐ (OR 0.49; p = 0.020) or multiple‐bearing ewes (OR 0.19; p = 0.013) and higher odds for fully housed animals (OR 17.87; p < 0.001). Year‐round housing was identified as the most influential factor in a subsequent multivariate analysis.

Conclusions

Uterine torsion was identified as a relevant cause of dystocia in our case load. The condition is likely to be underdiagnosed in sheep, and increased farmer and veterinary awareness is necessary to ensure adequate treatment of affected animals and to prevent unnecessary suffering.

Conditional knockout of leptin receptor in the female reproductive tract reduces fertility due to parturition defects in mice

Leptin is required for fertility, including initiation of estrous cycles. It is therefore challenging to assess the role of leptin signaling during pregnancy. While neuron-specific transgene approaches suggest that leptin signaling in the central nervous system is most important, experiments with pharmacologic inhibition of leptin in the uterus or global replacement of leptin during pregnancy suggest leptin signaling in the reproductive tract may be required. Here, conditional leptin receptor knockout (Lepr cKO) with a progesterone receptor-driven Cre recombinase was used to examine the importance of leptin signaling in pregnancy. Lepr cKO mice have almost no leptin receptor in uterus or cervix, and slightly reduced leptin receptor levels in corpus luteum. Estrous cycles and progesterone concentrations were not affected by Lepr cKO. Numbers of viable embryos did not differ between primiparous control and Lepr cKO dams on days 6.5 and 17.5 of pregnancy, despite a slight reduction in the ratio of embryos to corpora lutea, showing that uterine leptin receptor signaling is not required for embryo implantation. Placentas of Lepr cKO dams had normal weight and structure. However, over four parities, Lepr cKO mice produced 22% fewer live pups than controls, and took more time from pairing to delivery by their fourth parity. Abnormal birth outcomes of either dystocia or dead pups occurred in 33% of Lepr cKO deliveries but zero control deliveries, and the average time to deliver each pup after crouching was significantly increased. Thus, leptin receptor signaling in the reproductive tract is required for normal labor and delivery. Summary sentence. Mice lacking leptin receptor in the reproductive tract produce fewer live pups and have more adverse labor outcomes than controls, but normal numbers of embryos near term, showing that leptin receptor signaling is required for normal parturition.

Can the Dynamic External Pelvimetry Test in Late Pregnancy Reveal Obstructed and Prolonged Labor? Results From a Pilot Study

Background The size and mobility of the maternal pelvic space are fundamental factors in successful childbirth and can allow operators to screen for dystocia. This pilot study including a group of 70 pregnant women aimed to test whether the external dynamic pelvimetry test can be used to predict the likelihood of obstructed labor. Methodology The study cohort consisted of 70 pregnant women in their third trimester. The cohort was divided retrospectively into an obstructed labor group and a control group. Obstructed labor was defined using the following obstetric outcomes: augmentation with oxytocin from the first phase of the dilating period, Kristeller's maneuvers, vacuum extractor (kiwi), forceps, and the cesarean section following the onset of labor. Results The measurements obtained for the longitudinal hemi-diameter of Michaelis, the inter-tuberous diameter, and the base of the Trillat's triangle were statistically significant in every position. The difference in the measurements of the transverse diameter of Michaelis between standing and hands-and-knees position and the difference in the sizes of the bi-cristal diameter between hands-and-knees and squatting position were statistically significant. Conclusions Dimension and biomechanical properties of the pelvic tissue and spaces influence the evolutionary childbirth process. After clinical confirmation on a large population, hypomobility of specified external pelvic diameters measured in shifting positions can become a screening tool to detect the contracted pelvis and prevent damage caused by dystocia and prolonged labor in women and newborns.

Prediction of vaginal birth after cesarean for labor dystocia by sonographic estimated fetal weight

OBJECTIVE

To estimate the association of the weight difference between the index trial of labor after cesarean (TOLAC) sonographic estimated fetal weight (sEFW) and prior delivery birth weight with TOLAC success rate among women with previous labor dystocia and no prior vaginal delivery.

METHODS

A retrospective cohort study including all women with prior cesarean for labor dystocia and no prior vaginal delivery undergoing TOLAC during between March 2011 and June 2020 with a sEFW within 1 week from delivery.

RESULTS

Overall, 168 women were included, of those 107 (63.7%) successfully delivered vaginally. The mean sEFW and mean birth weight were lower in the TOLAC success group (P = 0.010 and P = 0.013, respectively). The rate of higher sEFW in the current delivery compared with the previous delivery did not differ between study groups. The rate of higher TOLAC birth weight was lower in the TOLAC success group (odds ratio 0.30; 95% confidence interval 0.15-0.58). In multivariable regression analysis, maternal age older than 30 years, induction of labor, and higher birth weight were independently negatively associated with TOLAC success (adjusted odds ratio [95% confidence interval]: 0.27 [0.10-0.70], 0.27 [0.08-0.90], and 0.43 [0.19-0.94]; P = 0.008, P = 0.034, and P = 0.035, respectively).

CONCLUSIONS

sEFW characteristics did not predict the success or failure of TOLAC among women with prior labor dystocia and no previous vaginal delivery.

Risk factors associated with dystocia in swine

Background and Aim:

Dystocia in swine can increase the stillbirth rate; however, its importance in pig-breeding systems has been underestimated. Until now, few studies have investigated dystocia and associated risk factors. Therefore, in this study, we aimed to evaluate the effects of various risk factors on dystocia in swine.

Materials and Methods:

Out of 5,557 piglets, we included 4,997 piglets in risk analysis study. The dependent variable was dystocia, which was recorded when a birth interval exceeded 45 min or when obstetric assistance was applied. The independent variables were parity, gestation length, litter size, birth order, gender, presence of a dead piglet, birthweight, crown rump length, body mass index, ponderal index, and oxytocin use. We used generalized linear mixed models to examine the associations between potential risk factors and dystocia at the piglet level.

Results:

A total of 6% of the piglets were born with a dystocia event, and 47.2% of the farrowing experienced at least one event. Dead piglets and piglets with a crown rump length of >31 cm were associated with an increased dystocia rate. This rate decreased from birth order 2 to 7, stabilized to 11, and then increased till the end of the fetal expulsion process.

Conclusion:

Dystocia is common in swine. Therefore, this condition should be carefully addressed by veterinarians and farrowing house personnel so that its adverse effect on welfare and productivity of sows and survivability of piglets can be reduced. Further studies investigating dystocia status and risk factors in different swine farrowing systems should be undertaken to provide more knowledge about this neglected condition.

Correlation of foetal body weight by coronet width measurement using ultrasonography in prepartum cows: a pilot study

This study aimed to clarify the effectiveness of foetal body weight estimation by measuring foetal coronet width using transrectal ultrasonography in beef cows during near-term pregnancy. A characteristic 'gull wing' pattern was obtained from the foetal coronet cross-section from the dewclaw side using ultrasonography. This pattern was matched to the bone surface of the distal part of the middle phalanx. Then, the relationship between coronet width and body weight at birth of 22 Japanese Brown calves was analysed and a high correlation coefficient of 0.8965 (P < 0.001) was obtained. In conclusion, the coronet width of the fetus is depicted as a 'gull wing' hyperechoic structure and can be measured by ultrasonography per rectum during near-term pregnancy. This technique may be a useful tool to identify high-risk cows with dystocia before calving. High foetal coronet values may predispose cattle to dystocia.

Mortality of Dairy Sheep during the Peri-Parturient Period: Results of a Field Investigation in Greece

Simple Summary

The paper presents a field investigation into the death of ewes around the peri-parturient (lambing) period. The problem is financially important because, in such cases, the capital (i.e., the ewes) is lost along with the increased expenses incurred by farmers during gestation. The problem was found to occur sporadically. Most cases of death occurred before lambing. Pregnancy toxaemia, an important metabolic disease, was the clinical problem most often associated with peri-parturient death. Factors found to be significantly associated with occurrence of the problem included the average lambing rate, the season of the year during which the lambing period took place, and the number of animals in the flock.

Abstract

Objectives of the study were (a) to investigate the incidence risk of peri-parturient mortality in dairy flocks in Greece, (b) to study when such mortality occurs in relation to lambing, (c) to identify clinical problems associated with the deaths, and (d) to evaluate potentially associated factors. The deaths of ewes during the peri-parturient period (10 days before to 7 days after lambing) were monitored in 60 flocks over two years. In the ewes that died, detailed post-mortems were performed. The incidence risk of peri-parturient deaths was 0.7%. The daily incidence rate of deaths before, at, and after lambing was 0.05, 0.04, and 0.03%, respectively. Clinical problems most frequently associated with peri-parturient deaths were pregnancy toxaemia, ruminal acidosis and post-partum genital problems. For the occurrence of peri-parturient deaths in flocks, the average lambing rate in the flocks was the only significant factor. Regarding deaths before or after lambing, the season during which lambing took place and the number of animals in the flock, respectively, were found to be significant. Most ewes (54.5%) that died at lambing (dystocia) were primigravidae.

The continuum of a prolonged labor and a second stage cesarean delivery

OBJECTIVE

To investigate the association of the timing of primary cesarean delivery with the progress of labor and the operative delivery rate at the subsequent successful trial of labor.

METHODS

A retrospective study of women with a primary cesarean and subsequent term cephalic vaginal delivery in two medical centers. Cesarean deliveries were classified as planned, intrapartum first stage or intrapartum second stage. The second stage duration and the operative delivery rate, adjusted to epidural analgesia and oxytocin use, were compared between the groups. χ² and Kruskal-Wallis tests were used for analysis of categorical and continuous variables, respectively.

RESULTS

The study population included 1166 women. The second stage of labor was longer when the previous cesarean delivery occurred during the second stage compared to planned or first stage (1.7 h vs 1.3 h vs 1.3 h, p = 0.005). The proportion of operative deliveries was greater among women with previous cesarean in the second stage of labor (39.6%), compared to planned (26.9%) or first stage (28.8%), p = 0.006.

CONCLUSION

Cesarean delivery at the second stage of labor is associated with a longer second stage and an increased operative delivery rate at the subsequent vaginal birth. Our findings attest to the delicate passenger-passage relations that can exist in some parent-couples.

Practising with an obstetric box and a dummy improves students' confidence in performing obstetric procedures involving large animals

BACKGROUND

Usually, the teaching process of eutocia and dystocia on large animals is supported by the use of photographs, videos, animations and texts with descriptions of the births and the difficulties of delivery, being not enough to provide an effective experiential learning process in veterinary obstetrics. This study aimed to evaluate the learning and the student's perception of the impact of using an obstetric box and an articulated dummy as a teaching resource in a dynamic game methodology on learning obstetric diagnoses and procedures.

METHODS

Veterinary students attended a theoretical class about foetal disposition and obstetrics manoeuvres and later attended a practical class about the same topic using an obstetric box and an articulated foal dummy. All students were evaluated by questionnaires and tests after each class addressing the topics of the objectives of this study.

RESULTS

The teaching methodologies facilitated students' understanding of how to perform obstetric manoeuvres and significantly increased their test scores and their confidence to execute obstetric procedures in a real professional situation in the future.

CONCLUSION

The use of obstetric box and dummy combined with a dynamic game methodology in practical classes stimulated the students' learning process and helped graduate more confident professionals.