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Veterinary obstetrics, including the diseases of breeding animals and of the new-born online

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Retained Placeiita in the Cow 805

firmly attached to it, but sloughed away from the uterine walls.
The removal of the cotyledons and chorion, with irrigation of the
uterus, was followed by uneventful recovery, without destroying
the fertility of the cow.

Because of these experiences with necrosis of the cotyledons,
we hold in all those cases where the uterine walls are compara-
tively sound and the cotyledons have undergone necrosis, that
the veterinarian is not only warranted in removing them, but
that their removal is clearly indicated as the proper surgical
procedure.

Such removal of the cotyledons in the cow is somewhat anal-
ogous to the curetting of the placenta in woman. It produces,
in proper cases, the same results. It removes the decaying frag-
ments of the fetal membranes and the irrecoverably diseased
maternal placenta.

While the decomposing chorionic tufts are incarcerated within
the crypts of the cotyledons, and the cotyledons are yet alive but
diseased, the diseased surface, from which bacterial poisons may
be absorbed, is the superficial area of the mucosa of all the pla-
cental crypts. When the cotyledon has been removed, the re-
ceptive surface is reduced to the area of the cross section of the
cotyledonal stalk — probably less than loooth part of the area of
the placental epithelium.

The collateral handling will vary greatly, according to cir-
cumstances. If the patient is not seriously depressed, if she is not
straining abnormally, if her temperature and appetite are good,
there is no call for general medication. When there are evi-
dences of serious constitutional disturbances, such as fever and
weakness, the patient should be supported and strengthened by
easily-digested, nutritive foods, if she will take them, to which
may be added stimulants and tonics. Alcohol is especially use-
ful, and may be given in large and frequent doses. When sj'mp-
toms of septicaemia appear, it has been our practice to administer
large doses of quinine, and in our experience the results have
been good.

Some have practiced and advised the administration of
ecbolics such as ergot, savin and rue, but this is opposed by many
and the clinical evidence of the value of this group of drugs is
not clear.



8o6 Veterinary Obstetrics

Others, and with more reason, advise and use carminatives and
aromatics internally, such as anise seed, fenugrec, gentian, and
camotjiile, or the gum-resins like camphor and others. They
are probably of distinct value as adjuncts to the local handling.

In many cases, great good may come from prompt catharsis,
and for this purpose we prefer one of the hypodermic cathartics,
such as eserine or arecoline. Owing to the feebleness of the
heart, we would administer it in small and repeated doses, com-
bined with strychnine, and continue it until the desired evacua-
tion of the bowels has been brought about. This in itself fre-
quently causes a great reduction of the temperature, and marked
improvement of the general symptoms.

The food should be easily digestible. Such highly nutritious
food as linseed meal serves an excellent purpose, while roots are
also valuable, because of their keeping the bowels more or less
freely open.

The prevention of retained afterbirth in the cow is an im-
portant problem, which offers hope for success in numerous cases.
It is highly important, from the standpoint of prevention,
that, in all cases of dystokia attended by a veterinarian, the after-
birth should be removed, if possible, immediately after the re-
moval of the fetus, followed by irrigation of the uterus, bringing
about its firm contraction. It is also important that the owners
of pregnant animals should keep them in vigorous condition,
allowing plenty of exercise, air and light, with an abundance of
good digestible food, for some weeks at least prior to parturition.

A very important element in the prevention of retained pla-
centa, and for which the veterinarian is directly responsible, is
the question of handling in cases of dystokia. In discussing the
general handling of dystokia on page 620, we have already em-
phasized the value of aseptic precautions in all these operations.
It is well to repeat here the duty of the veterinarian to take every
possible precaution against carrying infection into the uterine
cavity while he is dealing with a case of dystokia. To this end,
he needs to follow out carefully the rules which we have alreadj^
laid down regarding sterilization or disinfection of his clothing,
his hands and arms, his instruments, and the exposed parts of
the patient.

As soon as fears of placental retention are entertained, the
veterinarian can, and should, do much to obviate the disease.



Retained Placenta iyi the Cow 807

Copious irrigation of the uterine cavity, within a few hours after
calving, washes away placental debris, fetal fluids and retained
blood clots, stimulates uterine involution, and greatly favors the
spontaneous expulsion of the membranes.

The irrigating fluid should be at least as warm as the uterine
cavity, but not of appreciably higher temperature, and should be
of soft water or softened by the addition of soda bi-carbonate, to
which may be added 0.6% of salt.

The irrigation should be begun as early as convenient after
calving, and may be repeated every 4 to 6 hours. The irriga-
tion is to be carried out under antiseptic precautions, and very
gently. When the horse stomach tube we have advised is used
for irrigation, the properly lubricated end can be pushed forward
gently, and with some rotary motion, through the vagina and
into the uterine cavity, usually without inserting the hand, thus
avoiding the manual introduction of infection. The tube is
rigid enough to be reasonably subject to external direction, and
pliable enough to obviate any danger of wounding the genital
tract.

The prognosis of retained placenta is exceedingly variable,
but must always be cautious. Whenever the afterbirth can be
completely removed manually within 24-48 hours after calving,
the prognosis is highly favorable. It must, however, depend
upon the state of the uterus itself, and upon the general vigor of
the animal. If the uterus is highly inflamed and paretic, the out-
look is always serious.

In our experience, the most serious cases have usually been
those where some party has unsuccessfully attempted to remove
the membranes, and has merely succeeded in tearing away the
major portion of the chorion, leaving many of the fetal placentae
still firmly attached to the cotyledons, and naturally leaving many
of the cotyledons themselves more or less seriously injured.
When this has been done, and severe straining follows, accom-
panied by a high temperature and loss of appetite, we have found
the disease highly fatal. On the other hand, the uterine walls
may be very intensely inflamed, firm, paretic, and yet recovery
occur. Pomayer has emphasized the value, in this disease, of
the degree of leucocytosis in the uterine walls. It is, he says,
the number of leucocytes which exist in the uterine walls, or



8o8 Veteri7iary Obstetrics

which may be attracted to them, which brings about recovery.
If the infection of the cotyledons and of the uterine walls is of
such a character as to destroy the leucocytes, recovery cannot
occur.

2. Retained Placenta in the Mare.

Retention of the placenta is much less frequent in the mare
than in the cow. Clinically, retention of the placenta in the
mare is divisible into two separate forms, total and fragmentary.

Total retention of the fetal membranes in the mare corre-
sponds in a measure to the disease in the cow. It is, however,
very rare, not only as related to placental retention in other ani-
mals, but also as compared with the fragmeutal retention in this
animal.

The rarity of placental retention in the mare is explained upon
various hypotheses. Most significant, perhaps, is the compara-
tive simplicity of the chorionic tufts, so that any swelling of the
uterine mucosa does not tend materially to incarcerate them and
hold the chorion. It bears another important difference when
compared with ruminants ; the placenta is diffuse. The chorion
is thick, rigid, not readily compressible. When involution of
the uterus occurs, the area of attachment in the uterine mucosa
rapidly decreases, while the opposing chorionic attachments are
not subject to like diminution in area and are consequently de-
tached. The placentse of sheep and goats are essentially as intri-
ate as those of the cow, and are upon the same general plan, but
retention of the fetal membranes in rhese is very rare as com-
pared with the cow. According to our observations also the dis-
ease is less common in the ewe than in the mare. Hence the
arrangement of the placental structures does not wholly control
the probability of retention.

The causes of total placental retention in the mare are analo-
gous to those already mentioned in the cow, such as placentitis
as an accompaniment of contagious abortion, and fatigue of the
uterine walls during difficult labor, followed by infection.

The symptoms of total placental retention in the mare usu-
ally consist merely of the visible protrusion from the vulva of
the umbilic cord and portions of the chorion. There is rarely
any straining. If neglected, and infection occurs, as it does very
quickly, a diffuse endometritis quickly follows, the chorion usu-



Retained Placenta m the Mare 809

ally sloughs away, the uterine walls become paretic, voluminous
excretions into the uterine cavity occur, and the cavity of the
organ is soon occupied by two to five or more gallons of a dirty
grayish, flocculent, stinking semi-fluid mass. Following closely
upon these changes, perhaps even noted first, parturient lamini-
tis occurs.

The handling of total retained placenta in the mare consists
of the manual removal, and should be undertaken at the earliest
convenient time subsequent to parturition. In cases of dystokia,
the veterinarian should remove the membranes as soon after de-
liver}' has been completed as possible, allowing merely a few
minutes for the animal to recover from her exhaustion.

In removing the afterbirth of the mare it is to be remembered
that ordinarily the chorion comes away everted, but when we
desire to remove it artificially it should be done right side out.
First the veterinarian needs locate the margins of the rupture in
the chorion through which the fetus has been expelled. Neces-
sarily' this margin is detached for some distance from the torn
border.

Secure the torn border and carefully draw it out through the
vulva. Insert the open hand or clenched fist between the chorion
and uterine wall, and, while exerting enough traction upon the
ruptured margins to keep the chorion tense, gently and cau-
tiously push the hand along between the chorion and uterine
wall. The process should be carried out almost equally around
the entire circumference of the uterus, and the chorion gradually
detached until the coruna are reached and included.

In many cases of retention in the mare, it is not actually needful
to insert the hand into the uterus. If the protruding chorion be
carefully grasped, folds of it picked up first here and then
there, and gentle traction exerted upon each area by turn, if will
soon be found that drawing upon a given part of the chorionic
sac causes dehiscence of the placenta and distinct advance is
made. Section after section is cautiously tested, and gradually
the entire chorion comes away with the placental side outward.

If there has been no infection, if the operator has not inserted
his hand, nothing further is demanded.

If there is infection in the uterus or if the operator has inserted
his hand, the uterus should be well irrigated with tepid water to
which 0.5% carbolic acid may be added. This should be repeated
as frequently as conditions demand.



8io Veterinary Obstetrics

Fragmentary placental retention is in a way peculiar to the
mare. It consists in the accidental transverse rupture of the
chorion of the non-gravid cornu, followed by the chorionic mass
from the gravid cornu and uterine body coming away, and leav-
ing behind the small isolated fragment in the non-gravid horn.

This fragment is usually 8 to 12 inches in length, and its lumen
sufficiently large to admit of the insertion of a man's hand into
its cavity.

The cause of this retention is not far to .seek. The chorionic
mass of the mare is very heavy, and she usually stands while the
membranes are being expelled. The non-gravid cornu is last to
expel its membranes, so that, before the chorion in the non-gravid
cornu becomes detached, it must support the weight of the re-
mainder of the membranous mass. At this time the greater mass
of the chorion hangs outside the vulva, and the umbilic cord
drags upon the ground, where it may be stepped upon and the
attached area of chorion torn off. Possibly the cord is still intact
and the foal, in trying to rise, may partly do so and fall, giving
a violent pull upon the cord, which is promptly transmitted to
the still attached strip of chorion in the non-gravid cornu, and
causes it to give way.

Once this fragment becomes separated, the narrow horn has
little or no expulsive power and the mechanical assistance ordi-
narily afforded through the weight of the other portions of the
chorion is wanting.

Infection of the isolated fragment quickly follows. In two to
five days the chorionic fragment has become well decomposed,,
the uterine wall has become inflamed, the abdomen is very
tender upon pressure, the infection has spread throughout
the uterus (purulent endometritis), extensive purulent col-
lections have occurred in the uterine cavity, the uterine
walls are thick, hard and paretic, and parturient laminitis is
present.

At about this time, if the veterinarian will carefully explore
the uterine cavity he will be able to recognize by touch the re-
tained segment of chorion, somewhat loosened and readily de-
tached, putrid, fragile and extremely fetid. He will not always
find the piece as it may have sloughed away and passed out. In
one such case, as we approached the recumbent patient, she sud-
denly sprang to her feet. As she did so, there came a gush of
pus from the vulva, in which was the tell-tale fragment of chorion.



Retained Placenta in Small Animals 8i i

The handling consists fundamentally of a careful search for,
and removal of, the retained chorionic fragment, followed by the
proper handling of the resulting endometritis and laminitis.
These we shall discuss later.

This type of retention is subject to preventive measures.
The veterinarian, when attending a mare in labor, or removing
the fetal membranes when completely retained, should always
carefully note whether the two horns of the chorion are complete.
If not, the missing apex should at once be removed and the
uterine cavity well irrigated.

3. Retained Placenta in the Smaller Animals.

The smaller domestic animals do not suffer so frequently from
retained placenta as do the cow and mare. The ewe and goat
with cotyledonal placenta suffer occasionally. The sow and car-
nivora suffer but rarely from retention. De Bruin records teta-
nus infection in the ewe as a result of placental retention. Gen-
erally the disease in the ewe has about the same danger as in the
cow. The sow withstands the disease well.

The handling is somewhat similar to that in the cow. If the
genital canal is large enough to admit of the insertion of the
operator's hand, manual removal may be carried out as in the
cow. Otherwise the uterine cavity is to be irrigated with warm
normal salt solution, thus mechanically cleansing the organ,
stimulating normal involution of the uterus and increasing pre-
sumably the number of leucocytes in the uterine walls. De Bruin
condemns the use of antiseptics in these cases.

Should chronic metritis, with chronic vaginal discharge or
with vaginal prolapse, follow, hysterectomy, page 669, may be
indicated in the sow and carnivora.



11. WOUNDS AND INJURIES TO THE GENITAL
AND NEIGHBORING ORGANS.

PosT-PARTUM Hemorrhage.

Post-partum hemorrhage is comparatively rare iu domestic
animals, and occurs chiefly in the larger species. In woman
hemorrhage following childbirth is very common as a result of
the highly developed and vascular placenta, but in domestic
animals, in which there are generally more or less diffuse pla-
centse of the disseminated or cotyledonous form, the conditions
are such that we rarely observe spontaneous placental hemorrhage.
In fact we have no definite records to show that serious placental
hemorrhage proper, occurs in animals, although slight hemor-
rhage from the placenta is quite commonly observed in the mare
and cow, and to a lesser degree in other domestic animals.

The hemorrhages which occur during or immediately subse-
quent to parturition in domestic animals are generally due to
traumatic injury which is more or less independent of the pla-
centa, although it may naturally involve that structure. We
have already had occasion to mention, on page 457, that in rare
instances uterine hemorrhage occurs during gestation and may
with extreme rarity prove serious.

During the act of giving birth to young, serious and fatal
hemorrhage is not exceedingly rare, especially in the mare, as a
result of a rupture of the uterine walls involving some of the
great vessels of the organ. Necessarily in the mare it involves
in the lesion the placenta itself, since this is distributed over the
entire organ. After the expulsion of the fetus, whether in the mare
or the cow, there frequently follows immediately a considerable
discharge of blood, which may be placental in origin, but which
is more probably due to the rupture of uterine vessels of con-
siderable size. The point of origin and the exact character of
such a hemorrhage is ver)' rarely determined.

After the fetus has been expelled, the rude removal of the fetal
membranes by laymen or empirics frequently induces profuse
hemorrhage, which may even end fatally. In the mare, if the
chorion is very firmly adherent to the uterus and violence is used
to bring about separation, the mucosa may be wounded to such a
degree as to cause profuse hemorrhage. In some cases of re-



IVoicnds and Injuries to the Getiital Organs 813

tention it is impracticable to separate the envelopes at once be-
cause of hemorrhage due to the uterine injuries. In the cow,
when the placenta is retained and involution of the uterus has
not 3ret occurred, and the layman or empiric attempts to de-
tach the membrane, profuse and fatal hemorrhage is liable to
result, which is greatly accentuated when the cotyledons are rudely
torn away from the uterus.

In one instance observed by us, an empiric attempted to remove
the membranes from a cow immediately after calving, and, by
tearing them away, brought on a hemorrhage which proved fatal
to the patient in the course of a few hours. When we were
called, the entire uterine cavity was filled with a great mass of
blood ; much blood had already escaped from the vulva ; the
cow was down, and unable to rise ; the mucous membranes were
blanched ; the animal was pulseless, and in a dying condition.
In the mare we have observed fatal hemorrhage as a result of
ruptures during difficult labor.

Hemorrhage from the uterus occurs also in cases of pro-
lapse or inversion, and usually of two types. There may be a
general capillary hemorrhage from the entire mucous surface, or
rather from the placental surfaces of the uterus, and there may
also occur hemorrhage from wounds of the uterine walls or
placentae involving large vessels.

Symptoms. Generally there is an escape of blood from the
vulva. The blood may, however, be largely retained within the
uterus, and coagulate promptly. In case of rupture of the uterine
walls, and especiallj^ of the uterine floor, when involving large
vessels, a profuse and even fatal hemorrhage may occur into
the peritoneal cavity, without any appreciable amount of blood
escaping from the vulva. In these instances of intra-uterine
or intra-peritoneal hemorrhage, the symptoms, in general, are
those of internal hemorrhage, such as the blanching of the
mucous membranes, weakness Of the animal, pain, anxiety and
sweating. Death frequently follows quickly. The diagnosis
must be made by these symptoms, in conjunction with a manual
exploration of the uterine cavity.

The indications in uterine hemmorrhage will depend largely
upon the cause and origin. When due to extensive wounds of
the uterine walls, involving the large vessels, and the uterus is in
position, it is well-nigh beyond the obstetrist's control, though



8 14 Veterinary Obstetrics

it might be possible in some cases to secure the wounded vessel if
it could be identiiied. In the milder forms of hemorrhage, where
the quantit}' of blood is not great, it may not be necessary or even
advisable to interfere, especially if the uterine cavitj^ is in an
aseptic condition. When the hemorrhage is dependent upon
a want of involution, contraction should be encouraged by such
means as we have at command.

If the organ is intact, we may hasten involution b}^ the injec-
tion into it of a tepid solution of an antiseptic or a normal salt
solution, or we may attempt to favor involution by the ad-
ministration of ergot or of stimulants. It may be also that the
involution can be hastened in some cases by the introduction of
cold water or of ice into the uterine cavity, and at the same time
the hemorrhage somewhat checked by the cold.

In hemorrhage from the prolapsed uterus, we can not hope to
check that of a capillar\' character except by the reposition of
the organ; while that from any torn vessels of importance can be
readily controlled with the aid of forceps or by ligation or other
means in common use. Digital compression, applied for some
time, may bring success.

When a quantity of blood has accumulated in the uterus and
coagulated, it should be promptly removed and means applied to
cause uterine involution.

2. Rupture of the Uterus and Vagina.

In all domestic animals, rupture of the uterus or vagina is
liable to occur at any time during labor, and especially toward
the close of the act, as the fetus is being forced along the genital
passages. The organs are again subject to rupture because of
their prolapse or eversion of the organs.

The accident occurs in a great variety of ways. Frequently it
occurs through the projection of some part or extremity of the
fetus in an improper direction, so that it is forced through the
wall of the organ because of a concentration of pressure upon a
small area. Ruptures from this cause naturally occur most fre-
quently in the mare and cow, where the fetus has long and rigid
extremities; which are capable of inducing great injury when
they become misdirected.

In transverse presentations in the mare, when version, is at-
tempted without embryotomy, there is always danger of an



Rnphire of the Uterus and Vagina 815

extremity becoming so misdirected that, during the expulsive
efforts of the mother, it may be forced through the uterine wall
and bring about a perforating wound of the peritoneal cavity.

In the anterior presentation, with the two posterior limbs ex-
tended beneath the body of the fetus and lodged just in front of
the pubic brim upon the uterine floor, the forcing of the fetus
into the passage brings about a great concentration of pressure
upon the uterine floor by the feet. The croup and thighs are
rigidly and firmly pressed against the sacrum and lumbar verte-
brae, while the extended limbs are forced, under enormous pres-
sure, downward and forward against the floor of the uterus.
Such pressure is constantly liable to cause the toes of the fetus
to force their way through the uterine floor.

When the fetus presents anteriorly in the dorso-sacral position,
with a foot crossed over the head, or a foot misdirected upward
from other causes, the misplaced extremity tends constantly to
push upward and force its way through the roof of the vagina.
So with other misdirections of the anterior or posterior ex-
tremities.

In the bicornual development of the fetus, as already described
on page 716, extensive and fatal rupture of the uterus is very
liable to occur when traction is applied in order to bring about
delivery.

In torsion of the uterus, as already related on page 704, trans-
verse rupture is a common result of the displacement, and follows
regularly when the torsion has acquired an extreme degree.

A further and not rare can.se of uterine rupture is the attempt



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