pathophysiology of uterine involution and its therapeutic management

uterine involut








pathophysiology of uterine involution and its therapeutic management

1. PATHOPHYSIOLOGY OF UTERINE INVOLUTION AND ITS THERAPEUTIC MANAGEMENT Himanshu pandey M.V.Sc Scholar Div. Of Animal Reproduction Roll No.- 16-M-GO-03

2. Uterine involution is very much essential for a Normal puerperal period Extension of puerperium may have detrimental effect on reproductive performance of animal Disturbances during this period due to delay of uterine involution reduce the lifetime reproductive and productive efficiency INTRODUCTION

3. Reduction in size of genital tract is called involution Reduction is size of myofibrils from 400-750 µm on first day to less than 200 µm over the next few days ( Gier et al., 1968 ) Diameter of the previously gravid horn halved by 5 th days and its length halved by 15 days ( Gier and Marion., 1968) Uterus is palpated per rectum by 8 and 10 days postpartum in primiparae and pluriparae respectively Involution

4. Days Postpartum Diameter of gravid uterine horn Between 4-9 days 12-14 cm By Day 14 7 cm By day 25 2-4 cm (Morrow et al., 1986) ( Gier and Marion, 1968)

5. Mechanism of uterine involution ( S heldon et al ., 2007)

6. Smooth muscles play an important role in the expulsion of the uterine contents and reduction of the uterine size ( Bajcsy et al., 2005 ) Uterine contraction & P hysical shrinkage

7. Contraction FREQ after calving 8.9 per hour < 1 per hour Decrease to Minimum Time 12 h 42 h 48 hour ( Bajcsy et al., 2005) By 24 hours post calving decreases by over 50% of that present at 6 hours postpartum ( Burton, 1986 ) The force of uterine contraction can be augmented by the action of some agonists such as oxytocin and PGF2α by promoting the action potential and increasing the intracellular calcium concentration ( Shmygol et al., 2006)

8. N ormal healthy cows decline immediately after calving and start to increase again from 24 to 36 h onwards ( Szenci et al ., 1994 ) R educe uterine activity Milk fever Faccid uterus B lood Ca2 + concentration S evere Hypocalcaemia Delayed involution Experimentally induced ( Noakes , 1989) ( Bajcsy , 2001)

9. OXYTOCIN IN MYOMETRIAL CONTRACTION D irectly I ndirectly Myometrial oxytocin receptors Release of pgf2 α , Paracrine route. ( Ivell et al ., 2000) (Lye and Challis, 1989) Myometrial contraction Marked decline in receptors in first day post partum ( Fuchs et al ., 1992) Oxytocin induced prostaglandin response also decreased with the advancing of the postpartum period ` ( Vecchio et al ., 1990)

10. U ncomplicated puerperium RFM/ E ndometritis M assive release of PGF2 α can be seen as PGFM for 2- 3 weeks Involutrion - 21 days Duratiom of pg release – 15 days 32 days 10 days Role of Prostaglandins Uncomplicated puerperium RFM/ Endometritis Involution 21 days 32 days Duration of pg release 15 days 10 days ( Kindahl et al., 1999)

11. Decrease in total collagen accompanies the decrease in uterine weight during involution. ( Woessner , 1980) The average collagen content of the genital tract was found to rise from a non-pregnant value of 84 g to 439 g at term ( Kaidi , 1989 ) collagen Pre-partum 5 th day 24th day Molar ratios of urinary pyridinoline and deoxypyridinoline 12.5 28 11.5 ( Kaidi , 1991)

12. Early necrotic changes in septal mass of caruncle Constriction of caruncular blood vessels and Sloughing of necrotic material Small blood vessels protrudes from surface of caruncles (McEntee, 1990 ) bw day 10 and 15 First 48 hour Day two Day five Proliferation of spindle shaped cells A necrotic leukocyte layer covers the endometrium N ecrosis , and sloughing of the caruncles

13. Regeneration of inter caruncular area is completed by Day 8 C omplete re epitheliazation of caruncle 25 day onwards Acute phase protein increase rapidly after calving, reaching peak at 1-3 days and decline to basal levels by 2-4 week. (Sheldon et al., 2001)

14. M ajority of first dominant follicles (70- 82 %),and ovulations, occur in the ovary contralateral to the previously gravid horn (Nation et al., 1999 ) Larger follicles on the i psilateral ovary are associated with better fertility (Bridges et al., 2000) Appearance of large follicle in cyclic animals during early postpartum period enhanced uterine involution ( Lohan et al ., 2004) Post partum cyclicity and involution

15. Age Primiparae Season of year spring and summer nutrition Periparturient abnormalities- Delayed return to cyclicity Dystocia Retained placenta Hypocalcemia Ketosis Twin calves M etritis ( Maizon et al., 2004) Factors influencing involution process (Zhang et al., 2010) ( Noakes , 2009) ( Lohan et al ., 2004 )

16. After parturition the vulva is relaxed and cervix dilated leads to Contamination of the uterus by microbs C hemokines Nutrophils migration Cytoplasmic granules ROS NO Protease phospholipase Formation of Pus TNF α, IL1 & IL6 Pyrexia & + ve feedback to nutrophils Phagocyte die Uterine infection delays involution (Sheldon, 2007)

17. Intrauterine administration of most antiseptics and disinfectants ( Noakes et al ., 2002 ) Impaired immune system Unhygienic conditions Leukocyte phagocytic activity Uterine infection and inflammation can result in uterine atony (Frazer, 2005) Cont..

18. Strategies for improving uterine involution

19. Diets rich in fermentable energy and diet with CP content higher than 11% (Curtis et al ., 1985; Grummer , 1998) Fat supplementation (Staples et al., 1998) P rotected source essential fatty acids (linoleic acid) (Santos et al ., 2003 ) High Calcium level 200 gm daily along with vitamin D ( Otterby et al., 1983) Vitamin A supplementation 30,000 to 50,000 IU daily Prepartum injection of Vit . E + selenium ( Qureshi et al., 1997) G ood quality nutrition

20. Careful surveillance and assistance at the time of calving

21. Using 50 IU of oxytocin i.m on the first day postpartum. ( Bajcsy et al ., 2006) Methyl Ergometrin injection 5 mg directly after parturition (day 2) ( Alagar ., 2016) Injection of GnRH at 13 to 14 days postpartum (Foote and Rick, 1999) Single injection of PGF2 α during 2 nd or 3 rd week or double injection of PGF2 α in 2 nd week accelerate reproductive performance ( Elsheikh and Elzubeir , 2005) Indigenous herbal preparations Uterotone @ 100-125 ml Exapar @100 ml initial dose followed by 50 ml bid Prevention of postpartum diseases

22. Early diagnosis and treatment of postpartum uterine abnormalities Retained placenta- Retain for more than 24 hr Rx Oxytocine 20 IU three to four times daily ( Youngquist and Threlfall , 2007 ) Manual removal after 24 hour Antibiotics systematically and NSAID’S in fever Indigenous preparations- Harera , uterotone etc Calcium boroguconate (if associated with milk fever) Collagenase therapy ( E lier et al., 1993) P recaution Manual removal (fever) & use of glucocorticoids

23. M etritis Puerperal metritis - E nlarged uterus + fetid watery red brown discharge + systemic sign within 21 days Rx Systemic antibiotics NSAIDS Antihistaminics Clinical metritis - E nlarged uterus purulent discharge + no systemic sign within 21 days Systemic antibiotics. Uterine lavage Clinical endometritis – Purulent discharge (50% pus) 21 days or more after Intrauterine antibiotics Pgf2 alpha (if CL is present) (Sheldon, 2004)

24. conclusion The main aim of any farm is to obtain one calf a year for this this proper reproductive management is required Puerperium is the period in which animal is most susceptible for the disease, And involution of uterus is very much required for the timely breeding of animal The prolongation of involution in cow depend on the degree of infection and damage to endometrium and then clinical uterine involution can be prolonged 50 to 60 days But if proper care is provided in peripartum period like proper feeding, hygienic practice and other preventive measures, the chances of delayed uterine involution can be minimize.