Malaysia Veterinary Forum (Archive)

kcniv · Joined: 15 Jan 2006 Posts: 52

Hello Drs,
Nak tanye, apakah maserasi fetus (Pada lembu) selalu berakhir dengan culling ??? Apakah ada pengubatan untuk kes2 seperti ini???

Dr. TanDY · Posted: Mon Jan 16, 2006 10:19 pm Post subject:

Foetus maceration is another name of mummification in cattle. Is your farm facing this problem frequently?

kcniv · Joined: 15 Jan 2006 Posts: 52

Dr. TanDY wrote: Foetus maceration is another name of mummification in cattle. Is your farm facing this problem frequently?

Sorry Dr.TanDy, tapi maserasi fetus dan mumifikasi adalah 2 kes yang berbeza... Maserasi dan mumifikasi tidak sama... Dan proses terjadinya kes ini berbeza... Maserasi disebabkan infeksi (mostly bacteria) tapi mummification itu (tanpa bakteria)... Are u agree with me Doctor???

kcniv · Joined: 15 Jan 2006 Posts: 52

Errr, bagaimana kalau digunakan dengan Oxytocin dan Estrogen (untuk kes maserasi fetus)? Apakah kemungkinan fetus itu akan keluar ?? Kes ini tidak banyak terjadi tapi apakah selalu berakhir dengan culling ?? Mostly, vet menyarankan untuk di culled kerana alasannya sistem reproduksinya sudah tidak berfungsi dengan baik..

Dr. TanDY · Posted: Wed Jan 18, 2006 12:11 pm Post subject:

Fetus maceration and mummification are both examples of embryonic fetal death. If the fetus died and there was no infection in the uterus then resorption will occur and what left behind will be a mummified form of the fetus (mummification). If there was an active infection by the bacteria the soft tissues of the death fetus will be decayed (maceration).

You are right. Both terms should not be used interchangeably to avoid confussion.

As for your question about Oxytocin and Estrogen, I think I would rather leave it for other large animal clinician to answer it. In the meantime you can find out a scientific article about the methods to remove mummified foetus from cattle at

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15581286&query_hl=4&itool=pubmed_docsum

Hope that helps! :lol:

Dr csh · Joined: 21 Jan 2006 Posts: 425

If you want to try hormonal treatment to expell macerated fetus from cattle, the use of Prostaglandin F2 alpha would make more sense. If the cow is in any other stage of estrus other than estrus, the cervix will be closed and the fetus cannot be expelled anyway. But if the cow is in estrus, the cow will have a high basal level of estrogen so treatment with estrogen might not even be necessary. The oxytocin receptors on the uterus that causes uterine contractions are estrogen dependent so unless the cow has a high level of estrogen, there will be no effect of oxytocin on uterine contraction and the only effects of oxytocin will be milk let down. If the cervix is not open, it may be even harmful to cause uterine contractions with exogenous estrogen and oxytocin. PGF 2a will short cycle the cow if the cow have a responsive Corpus Luteum and cause the cow to through the estrogenic phase and dilate the cervix.
However, it is my experience that the prognosis of the fetus being expelled is guarded at best. The protocol for PGF F2a that we use here is 25 mg i.m. and a repeat dose 2 weeks later. Like I said, the chances of success is not good.
We have tried both partial hysterectomy of the affected horn and hysterotomy to remove the fetus but there are several challenges to this procedure such as the location of the usterus is deep within the pelvis of the cow which makes the access to the uterus from a flank approach tricky at best. Even if you do succeed to removing the fetus surgically, there is no study on how well the cow will breed back so you will be taking on some financial gamble with unknown prognosis for reproduction. Therefore, I will not suggest surgery unless the cow is of some significant economic value (embryo doner, show cow, etc.) the best course of action is to continue milking the cow until her production goes below the farm threshold and then the cow can be culled. Macerated fetus seldom causes systemis signs so it probably will not be much of a welfare issue.

So, to summarize, if you diagnose a macerated fetus you should:

1) try 2 shots of PGF F2a 25 mg i.m. 2 weeks apart

if the treatment fails (which often it does) then make a judgement if you want to proceed with surgery,

or

2) Continue milking the cow but designate the cow as a DO-NOT-BREED until she no longer makes much milk, then cull.

Hope this helps

kcniv · Joined: 15 Jan 2006 Posts: 52

soonhoncheong wrote: If you want to try hormonal treatment to expell macerated fetus from cattle, the use of Prostaglandin F2 alpha would make more sense. If the cow is in any other stage of estrus other than estrus, the cervix will be closed and the fetus cannot be expelled anyway. But if the cow is in estrus, the cow will have a high basal level of estrogen so treatment with estrogen might not even be necessary. The oxytocin receptors on the uterus that causes uterine contractions are estrogen dependent so unless the cow has a high level of estrogen, there will be no effect of oxytocin on uterine contraction and the only effects of oxytocin will be milk let down. If the cervix is not open, it may be even harmful to cause uterine contractions with exogenous estrogen and oxytocin. PGF 2a will short cycle the cow if the cow have a responsive Corpus Luteum and cause the cow to through the estrogenic phase and dilate the cervix.
However, it is my experience that the prognosis of the fetus being expelled is guarded at best. The protocol for PGF F2a that we use here is 25 mg i.m. and a repeat dose 2 weeks later. Like I said, the chances of success is not good.
We have tried both partial hysterectomy of the affected horn and hysterotomy to remove the fetus but there are several challenges to this procedure such as the location of the usterus is deep within the pelvis of the cow which makes the access to the uterus from a flank approach tricky at best. Even if you do succeed to removing the fetus surgically, there is no study on how well the cow will breed back so you will be taking on some financial gamble with unknown prognosis for reproduction. Therefore, I will not suggest surgery unless the cow is of some significant economic value (embryo doner, show cow, etc.) the best course of action is to continue milking the cow until her production goes below the farm threshold and then the cow can be culled. Macerated fetus seldom causes systemis signs so it probably will not be much of a welfare issue.

So, to summarize, if you diagnose a macerated fetus you should:

1) try 2 shots of PGF F2a 25 mg i.m. 2 weeks apart

if the treatment fails (which often it does) then make a judgement if you want to proceed with surgery,

or

2) Continue milking the cow but designate the cow as a DO-NOT-BREED until she no longer makes much milk, then cull.

Hope this helps

Saya sudah mencuba dengan menggunakan Oxytocin 20 ml and Estrogen 10 ml... and the result... BERHASIL..
Thanx for ur info...

Dr csh · Joined: 21 Jan 2006 Posts: 425

Terima kasih kerana mengkongsi maklumat. Saya ingin tanya apakah konsentrasi oxytosin and estrogen yang diguna. Estrogen yang diguna... apakah nama "active ingredient" atau "brand name"? Saya ingin tahu kerana saya ingin membincang dengan rakan sekerja tentang protokol ini. Terima kasih.

Dr Free · Joined: 20 Jan 2006 Posts: 33 Location: ASEAN

Nampaknya dengan nasihat Dr Chong, masalah telah diselesaikan. Syabas... Harap saudara Kcniv dapat menjawab soalan beliau. Ini adalah penting untuk penyelidikan and pengubatan untuk kes yang sama pada masa depan.

kcniv · Joined: 15 Jan 2006 Posts: 52

Dr csh wrote: Terima kasih kerana mengkongsi maklumat. Saya ingin tanya apakah konsentrasi oxytosin and estrogen yang diguna. Estrogen yang diguna... apakah nama "active ingredient" atau "brand name"? Saya ingin tahu kerana saya ingin membincang dengan rakan sekerja tentang protokol ini. Terima kasih.

Estrogen
OESTRADIOL BENZOATE (Intervet) Atau CIDIROL (1mg/ml) pun boleh...
Active Ingredient = Oestradiol Benzoate

Oxytocin
Oxytocin (Leo) or Oxytocin-S (Intervet) (10 units/ml)
Active Ingredient = Oxytocin

Sebelum melakukan cara penyuntikan dengan hormone ini sebelumnya saya berkonsultasi dengan Dr.Kurnia from Indonesia coz menurut pengalaman dia selama lebih 15 tahun difarm, kes ini memang dapat dicuba dengan Oxytocin dengan Estrogen..

Dr csh · Joined: 21 Jan 2006 Posts: 425

Firstly, let me appologize for my mistaken post. I was confused about fetal mummification and fetal maceration by all the prior discussion and my post was for fetal mummification. Yes it is two VERY different conditions and I must say I am a little embarrased to get the two terms confused. So, let me start again. I would treat fetal mummification as I explained in the Jan 21 post. Fetal maceration, yes kcniv is absolutely correct in saying that maceration happens when there is bacterial decomposition of the fetus in utero.

So, how to treat the cow.

Firstly assess the cow systemically. It may be necessary to treat the septic shock or other sustemic conditions before dealing with the macerated fetus itself. If the cow has sunken eyes and have a dehydration level of 10% assessed by skin turgidity and eyeball depression, I would give I/V fluid replacement + continue the drip throught the procedure to avoid. My usual fluid is lactated ringers but you can give bolus hypertonic saline up to 2 liters of a 7% NaCl for immediate circulating volume replacement. A shock dose of steroids may be a good idea too.

The next step is to prepare the cow for fetal extraction. It is a good idea to start the antibiotics and NSAIDs before you do whatever procedure. I like to use procaine penicillin G i.m. at 44,000 IU/kg and flunixin meglumine at 2.2 mg/kg IV. No matter what you do, you probably want to give the cow an epidural I like using 5 ml of 2% lidocaine without epinephrine with 20 mg xylazine into the epidural space.... should last for about 12 hours.

So, there is a reason why the calf became macerated.... it could not be delivered for whatever reason and bacterial infection sets in causing the fetus to get bloated. So, whether it was fetal oversize, uterine torsion, malposition of the calf, uterine inertia, or even failure of cervical dilation, we need to correct that to have any chance of per vaginal delivery. Even then, the fetus is now usually very swollen and hard to extract. So, assuming the cervix is now dilated, it is still a challenge to get the calf out because it is so swollen. But if the fetus is macerated enough, we could break the bones and remove the calf piece by piece either with fetotomy or the clever use of a blade. Just remember that the uterus could be friable and extra care need to be taken to prevent this. Also, a useful tip is to add some tincture iodine very dilute into your rectal sleeves because messing around with macerated fetus often causes the vet's arm to get some strep dermatitis and the dilute iodine really helps. Yes, I said in the sleeve so it will be wet in the sleeve.

Of course, it is just as likely that either the cervix is closed or too tight for per vaginal extraction of the calf . In these cases, you need to decide if you want to do a c-section or try giving some drugs to dilate the cervix. In my humble experience, only prostaglandin E works. I've tried to induce calving with dexamethasone, PGF 2a, tried, estradiol benzoate, all did not work too well. You need a functional placenta to induce meaningful parturition with dexamethasone and PGF 2a which is unlikely in the case of a macerated fetus.
So, that leaves C-Section. The problem with macerated fetus is the exteriorization of the uterus is difficult with a macerated fetus because the uterus is usually tightly wrapped around the calf. Therefore, the paramammary approach is the best for macerated fetus c sections. FOr this approach, you need to keep the cow down by tying the head up and feet so the cow doesn't kick you and doesn't try to get up. Then, you also need to watch out for the superficial caudal epigastric veins (Milk veins) and you may need to ligate and cut them. I find this approach really helps with the experiorisation. My policy is "if I cannot exteriorise the uterus quickly, I will just cut into it inside the body and risk severe contamination rather than keep trying and damaging the already friable uterus. I usually flush the abdomen with 10 liters of lactated ringers and that hopefully helps reduce the effects of contamination.

As long as you can control shock, the next most critical part is to make sure the uterus is closed properly as even the smallest leak will lead to a dead cow. It is my working theory that cows can survive massive contamination ONCE. especially if you flush but cannot survive continuous leakage even if it is small. I have scooped rotting hooves out of body cavities and the cow survive just fine and I have necropsied cows that c section was nice and clean but a small section was not closed properly and eventually died.

Post Op care, antibiotics for 5 days, flunixin meglumine for 2 days, and supportive care. Remember there is increased meat and milk witholding times for extra label use of drugs.

Sorry for the really LONG post.

Dr csh · Joined: 21 Jan 2006 Posts: 425

kcniv, Saya ingin meminta maaf terlebih dahulu kerana saya tidak setuju dengan protokol Dr Kurnia. Saya tidak berniat menunjuk pandai atau menghina sesiapa. Saya hanya ingin mengemukakan beberapa soalan.

Estrogen diguna dengan dos yang munasabar tetapi dos oxytocin tidak masuk akal langsung. Mengapa dos oxytocin and diguna begitu tinggi? apakah rasional disebalik menggunakan dos itu?

"Half-life" oxytocin hanya beberapa minit dan dos yang tinggi mungkin mengakibatkan sakit perut. Saya telah membincang dengan beberapa pakar reproduki lembu, pakar endokrin, and pakar perubatan lembu dan mereka tidak boleh fikir alasan manggunakan protokol ini. Jika kcniv boleh tanya Dr kurnia sekali lagi rasional terapi ini, mungkin kita semua dapat membelajari ilmu baru. Terima kasih terlebih dahulu.

Dr. TanDY · Posted: Tue Feb 28, 2006 2:40 pm Post subject:

Quote: Yes it is two VERY different conditions and I must say I am a little embarrased to get the two terms confused.

Me too mixed up the terms in my previous post. But now I think the issue has been resolved.

Bear in mind that Doctors are just human, sometimes we might not get everything perfectly right all the time. In fact, no one will in any of the professions. Docs will however, in my opinion, try their best to make things right, if not 100% then will aim for 99.99%...

kcniv · Joined: 15 Jan 2006 Posts: 52

Dr csh wrote: kcniv, Saya ingin meminta maaf terlebih dahulu kerana saya tidak setuju dengan protokol Dr Kurnia. Saya tidak berniat menunjuk pandai atau menghina sesiapa. Saya hanya ingin mengemukakan beberapa soalan.

Tidak ada manusia yang sempurna...semua pun pasti ada salah...hehehe... Anyway, sorry Dr csh... Dr Kurnia now in New Zealand so I can't find the answer... Bagaimanapun, saya juga masih tertanya-tanya terhadap protokol ini... Tidak sempat untuk tanya-tanya... Anyway, the lembu yang diberi oxytocin and estrogen itu sekarang sudah kelihatan sihat-sihat saja... But, saya masih belum tanya ke staff AI (artificial insemination) apakah reproductive performancenya seperti biasa atau gettin worst... Coz this farm milik seorang kawan...
Once again sorry Dr csh...

Dr.TanDY... you r absolutely right 100%... kesalahan atau human error itu dapat terjadi dimana dan bila-bila masa saja... So, it's okay Dr.TanDY... Saya juga masih belajar dan ingin terus belajar serta berkongsi ilmu dengan senior-senior saya... Coz u all yang terdahulu makan garam....hehehe...

Dr csh · Joined: 21 Jan 2006 Posts: 425

kcniv, please don't appologize to me. You did nothing wrong and in fact, I think my posts were more offensive although I definitely DO NOT mean to offend anybody.
I just cannot see a scientific justification for that dose of oxytocin.... I'm sure Dr Kurnia had his reasons but maybe it was a last ditch attempt where you just give everything and hope something works.
Thank you anyway for your clarifications. You have given me plenty of topics for discussion with my collegues.