THERIOGENOLOGY
THE USE OF PROGESTINS IN THE TREATMENT OF PERSISTENT UTERINE HEMORRHAGE IN THE POSTPARTUM BITCH AND COW: A CLINICAL REPORT K. Arbeiter Klinik fUr Geburtshilfe und GynBkologie Tierlrztliche Hochschule Wien, Austria Linke Bahngasse 11 (Received July 30, 1975)
Persistent postpartum uterine hemorrhage is a rare but life-threatening event caused by injuries sustained during delivery, placental necrosis, or subinvolution of placental sites in the bitch (Beck and McEntee, 1966; Glenn!, 1968). This report is restricted to nontraumatic conditions in the bitch, as confirmed by colposcopic examination. Clinicallv, it is characterized bv the periodic discharge of fresh and coagulated blood, together, sometimes, with nucus, which is seen mostly when bitches lay resting, probably reflecting uterine contractions triggered by distension with blood and secreta. The histopathological evaluation of such uteri, removed by ovariohysterectomy, showed uterine hyperemid , considerable dilatation of blood vessels and cellular infiltration between myometrium and endometrium, necrosis of vessel walls by hyalinization and destruction of muscle fibers. In some cases, a general purulent, mucoid endometritis, glandular hypertrophy and formation of hemangiomas in the lamina propia were observed.
In our clinic, all recommended methods for conservative therapy in the bitch have been used without success, viz. the oral administration of hemostatic compounds, the parenteral use of compounds increasing myometrial tone, and decreasing the size of the placental zone (Arbeiter, 1959; Arthur, 1964); uterine curettage after laparotomy and uterotomy (Haraztin, 1964); and u,terine lavage with a chlorhexidine solution during laparotomy (Durfee, 1968). In all cases seen previously, the life-threatening condition required an ovariohysterectomy. In recent years a similar condition has been brought to our attention in postpartum cows. Again, blood is discharged intermittently, beginning from day 1 to 4 postpartum, caused by uterine contraction in response to disTraumatic injuries could be excluded. the foreooinq oarturitions tention. Bleedings seem to come from several caruncies. The uteri were uneventful. remained atonic. At slaughter, the flappy uteri were filled with partially coaqulated blood. Clinically, anemia, reduced body surface temperature, listlessness and exhaustion required the animal's disposal. Conservative therapy, including oxytocin, hemostatic compounds, Vitamins K, C, and 0, etc. is ineffective. No report on this or similar conditions in cattle has been found in the literature.
JULY 1975
VOL. 4 NO.
1
11
THERIOGENOLOGY
Two observations led to the study of progestins persistent postpartum uterine bleeding:
in the treatment
of
a) Satisfactory clinical results with a progestin (medroxyprogesterone acetate - MA) administered during the early postpartum period in bitches suffering from agalactia or a lack of uterine tone;
The frequency of postsurgical bleeding from the remaining uterine stump after hysterectonly of bitches in heat or with ovarian cysts or with estrogenproducing ovarian tumors.
b)
Since this bleeding and the persistent postpartum uterine bleeding are thought to result from an increase in capillary permeability in the endometrium and/or a decreased clotting time induced by estrogen, the use of anti-estrogenic progestin appears to be justified. Ten cases of persistent postpartum uterine hemorrhage in the bitch were treated with a single subcutaneous dose of 25-50 mg MA suspension Hemorrhage subsided within 24 hr, changed to a blood(2 mg/kg bodyweight). tinged mucous vaginal discharge on day 2, and disappeared on day 3.
In the bitch, half of the dose of MA was used unsuccessfully; a second treatment with the full dose controlled bleeding within 24-hr. Three to four days after treatment all bitches showed increased mammary development and milk production assuring vigorous growth of the pups. Four of 4 animals bred at the next heat conceived and had an uneventful gestation, parturition and puerperium. Encouraged by these results, another progestin, chlormadinone acetate (CAP) was used for the treatment of postpartum uterine hemorrhage in 15 cows. Afflicted animals received a single injection of 100 mg CAP in suspension, i.m., which was sufficient in 9 animals; 6 cows were in need for a second CAP injection 3 to 4 days later for complete control. The further course of recovery was uneventful in all animals.
In the bitch the progestin provides a much more satisfactory and economic therapeutic approach than the previously recommended and necessary ovariohysterectomy. In the cow, valuable animals could be saved. The condition described in both species can be interpreted as an estrogenie carryover effect from late gestation. Progestins acting as antiestrogens might reverse these conditions and promote uterine involution, hence an uneventful puerperium, as well as exert a beneficial effect on Similar effects have been confirmed for the postpartum use of lactation. progestins in the sow (Arbeiter et a., 1974) and in cattle, when administered prophylactically (Kordts, mtschitsch and Jochle, 1974), or therapeutically (GUnzler and Huber, 1970).
12
JULY
1975
VOL. 4 NO.
1
THERIOGENOLOGY
Acknowledgement -Histopathological preparations were prepared and analyzed by Prof. Dr. Hager, Abtlg. fUr Angewandte Histologie, Tierdrztl. Hochschule Wien. The author is grateful to Drs. W. Jdchle and M. Drost for help in preparing and translating this manuscript. REFERENCES 1.
AFlBEITER, K.: Die normale Geburt der HUndin und die Behandlung funktioneller Geburtsstdrungen mit dem Spasmolytikum "Monzal". Mh. Vet. Med., Leipzig, 14: 267, 1959.
2.
ARBEITER, K., K. Onderscheka, H.S. Choi, E. Weber & W. JBchle: Effect of megestrol acetate on milk production in sows and piglet growth. Theriogenology, 2. (4):77-87, 1974.
3.
ARTHUR, G.: Wright's Veterinary Obstetrics, 3rd Ed. Bailliere, Tindall and Cox, London, 1964.
4.
BECK, A.M. & K. McEntee: Subinvolution of placental sites in a 66: 269, 1969. postpartum bitch. Cornell Vet., -
5.
DURFEE, B.M.T.: Surgical treatment of post-parturient metritis in the bitch. J. Am. Vet. Med. Ass., 153: 40, 1968.
6.
GLENN, B.L.: Subinvolution of placental sites in the bitch. Proceed. 18th Gaines Veterinary Symposium, 7-10, 1968.
7.
GUNZLER, 0. & E. Huber: Beitrag zur Pathogenese und Therapie der postpartalen Sekretverhaltung beim Rind. Zuchthygiene, 5: 153, 1970.
8.
HARAZTIN, J.: Metrorrhagie-Behandlung durch Uteruscuretage nach Laparotomie. Personal communication, 1964.
9.
KORDTS, E., W. Jdchle & K. Kaltschitsch: Prophylactic effect of a progestin (chlormadinone acetate = CAP) on fertility of dairy cows after postpartum use. Theriogenology, l(5): 169-176, 1974.
JUL-Y 1975
VOL. 4 NO. 1
13
THE USE OF PROGESTINS IN THE TREATMENT OF PERSISTENT UTERINE HEMORRHAGE IN THE POSTPARTUM BITCH AND COW: A CLINICAL REPORT K. Arbeiter Klinik fUr Geburtshilfe und GynBkologie Tierlrztliche Hochschule Wien, Austria Linke Bahngasse 11 (Received July 30, 1975)
Persistent postpartum uterine hemorrhage is a rare but life-threatening event caused by injuries sustained during delivery, placental necrosis, or subinvolution of placental sites in the bitch (Beck and McEntee, 1966; Glenn!, 1968). This report is restricted to nontraumatic conditions in the bitch, as confirmed by colposcopic examination. Clinicallv, it is characterized bv the periodic discharge of fresh and coagulated blood, together, sometimes, with nucus, which is seen mostly when bitches lay resting, probably reflecting uterine contractions triggered by distension with blood and secreta. The histopathological evaluation of such uteri, removed by ovariohysterectomy, showed uterine hyperemid , considerable dilatation of blood vessels and cellular infiltration between myometrium and endometrium, necrosis of vessel walls by hyalinization and destruction of muscle fibers. In some cases, a general purulent, mucoid endometritis, glandular hypertrophy and formation of hemangiomas in the lamina propia were observed.
In our clinic, all recommended methods for conservative therapy in the bitch have been used without success, viz. the oral administration of hemostatic compounds, the parenteral use of compounds increasing myometrial tone, and decreasing the size of the placental zone (Arbeiter, 1959; Arthur, 1964); uterine curettage after laparotomy and uterotomy (Haraztin, 1964); and u,terine lavage with a chlorhexidine solution during laparotomy (Durfee, 1968). In all cases seen previously, the life-threatening condition required an ovariohysterectomy. In recent years a similar condition has been brought to our attention in postpartum cows. Again, blood is discharged intermittently, beginning from day 1 to 4 postpartum, caused by uterine contraction in response to disTraumatic injuries could be excluded. the foreooinq oarturitions tention. Bleedings seem to come from several caruncies. The uteri were uneventful. remained atonic. At slaughter, the flappy uteri were filled with partially coaqulated blood. Clinically, anemia, reduced body surface temperature, listlessness and exhaustion required the animal's disposal. Conservative therapy, including oxytocin, hemostatic compounds, Vitamins K, C, and 0, etc. is ineffective. No report on this or similar conditions in cattle has been found in the literature.
JULY 1975
VOL. 4 NO.
1
11
THERIOGENOLOGY
Two observations led to the study of progestins persistent postpartum uterine bleeding:
in the treatment
of
a) Satisfactory clinical results with a progestin (medroxyprogesterone acetate - MA) administered during the early postpartum period in bitches suffering from agalactia or a lack of uterine tone;
The frequency of postsurgical bleeding from the remaining uterine stump after hysterectonly of bitches in heat or with ovarian cysts or with estrogenproducing ovarian tumors.
b)
Since this bleeding and the persistent postpartum uterine bleeding are thought to result from an increase in capillary permeability in the endometrium and/or a decreased clotting time induced by estrogen, the use of anti-estrogenic progestin appears to be justified. Ten cases of persistent postpartum uterine hemorrhage in the bitch were treated with a single subcutaneous dose of 25-50 mg MA suspension Hemorrhage subsided within 24 hr, changed to a blood(2 mg/kg bodyweight). tinged mucous vaginal discharge on day 2, and disappeared on day 3.
In the bitch, half of the dose of MA was used unsuccessfully; a second treatment with the full dose controlled bleeding within 24-hr. Three to four days after treatment all bitches showed increased mammary development and milk production assuring vigorous growth of the pups. Four of 4 animals bred at the next heat conceived and had an uneventful gestation, parturition and puerperium. Encouraged by these results, another progestin, chlormadinone acetate (CAP) was used for the treatment of postpartum uterine hemorrhage in 15 cows. Afflicted animals received a single injection of 100 mg CAP in suspension, i.m., which was sufficient in 9 animals; 6 cows were in need for a second CAP injection 3 to 4 days later for complete control. The further course of recovery was uneventful in all animals.
In the bitch the progestin provides a much more satisfactory and economic therapeutic approach than the previously recommended and necessary ovariohysterectomy. In the cow, valuable animals could be saved. The condition described in both species can be interpreted as an estrogenie carryover effect from late gestation. Progestins acting as antiestrogens might reverse these conditions and promote uterine involution, hence an uneventful puerperium, as well as exert a beneficial effect on Similar effects have been confirmed for the postpartum use of lactation. progestins in the sow (Arbeiter et a., 1974) and in cattle, when administered prophylactically (Kordts, mtschitsch and Jochle, 1974), or therapeutically (GUnzler and Huber, 1970).
12
JULY
1975
VOL. 4 NO.
1
THERIOGENOLOGY
Acknowledgement -Histopathological preparations were prepared and analyzed by Prof. Dr. Hager, Abtlg. fUr Angewandte Histologie, Tierdrztl. Hochschule Wien. The author is grateful to Drs. W. Jdchle and M. Drost for help in preparing and translating this manuscript. REFERENCES 1.
AFlBEITER, K.: Die normale Geburt der HUndin und die Behandlung funktioneller Geburtsstdrungen mit dem Spasmolytikum "Monzal". Mh. Vet. Med., Leipzig, 14: 267, 1959.
2.
ARBEITER, K., K. Onderscheka, H.S. Choi, E. Weber & W. JBchle: Effect of megestrol acetate on milk production in sows and piglet growth. Theriogenology, 2. (4):77-87, 1974.
3.
ARTHUR, G.: Wright's Veterinary Obstetrics, 3rd Ed. Bailliere, Tindall and Cox, London, 1964.
4.
BECK, A.M. & K. McEntee: Subinvolution of placental sites in a 66: 269, 1969. postpartum bitch. Cornell Vet., -
5.
DURFEE, B.M.T.: Surgical treatment of post-parturient metritis in the bitch. J. Am. Vet. Med. Ass., 153: 40, 1968.
6.
GLENN, B.L.: Subinvolution of placental sites in the bitch. Proceed. 18th Gaines Veterinary Symposium, 7-10, 1968.
7.
GUNZLER, 0. & E. Huber: Beitrag zur Pathogenese und Therapie der postpartalen Sekretverhaltung beim Rind. Zuchthygiene, 5: 153, 1970.
8.
HARAZTIN, J.: Metrorrhagie-Behandlung durch Uteruscuretage nach Laparotomie. Personal communication, 1964.
9.
KORDTS, E., W. Jdchle & K. Kaltschitsch: Prophylactic effect of a progestin (chlormadinone acetate = CAP) on fertility of dairy cows after postpartum use. Theriogenology, l(5): 169-176, 1974.
JUL-Y 1975
VOL. 4 NO. 1
13
