Retention of the Placenta

By R. A. MCINTOSH*
T HE foetal membranes and the placentae are foetal outgrowths and, in
reality, belong to the foetus. During the act of birth, the umbilical cord
is ruptured and as soon as that happens, they become functionless and are
foreign to the mother and are expelled from the uterus.
During intra uterine life, they are vital to the life of the developing
foetus for they are the medium through which it receives the elements of
food from which its body is formed. They also act as lungs for the foetus
because the oxygen required for foetal life is obtained through the placenta
and CO2 is eliminated through the same channel.
They commence to develop in the embryonic stage of foetal life and
their growth and enlargement is as continuous and persistent as the growth
and development of the foetus itself. This, of course, is necessary in order
to meet with the requirements of the ever-growing and developing foetus.
In their character, they are membranous structures, the chorionic one
being very vascular and profusely supplied with blood vessels. The
chorionic tufts are, in reality, endothelial outgrowths from the capillaries
of the umbilical vessels. In the bovine species, these chorionic tufts grow
only in circumscribed areas which correspond to the cotyledons of the
maternal uterus.
To understand the reason for placental retention, it is necessary to know
the factors responsible for the normal maintenance of their attachment
during pregnancy and also the reason for their normal expulsion following
the birth of the foetus.
Immediately following conception, the hormone-progesterone, derived
from the corpus luteum of the ovary, causes nidation (the receptive phase
in the uterus); that is, it favours gestation. The recurrence of oestrum
is prevented, the uterine circulation becomes active, the cervix constricts
tightly, the uterine seal is formed and the muscular coat of the organ
remains inactive. This influence persists throughout the entire pregnancy
period and is fundamental in the development and retention of placental
attachment. Other factors also play a part. There is intra-uterine pressure
due to the growing foetus and the foetal fluids around it. This is made
possible by the sealing of the cervix and, undoubtedly, has much to do with
the maintenance of their relation to the uterine wall. Then, there is foetal
blood pressure. The dispensation of the umbilical blood vessels is in the
form of capillaries of which placental tufts are composed chiefly. They are
intimately related to the cotyledonary structures of the maternal uterus
and during pregnancy are constantly engorged with foetal blood. This
engorgement assists in the maintenance of attachment. There is also the
intimate relationship of the chorionic villi (placental tufts) with the uterine
crypts in the cotyledons. They dove tail and fit each other very closely.
*Ontario Veterinary College, Guelph,

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[Ail Canadian Journal of Retention of the Placenta February 1940
L46 JComparative Medicine Vol. IV-No.2

The reasons for their normal, expulsion are as follows: First, they
are foetal appendages and as such are of no value to the mother and must
be gotten rid of for they become lifeless and inert the moment the rupture
of the umbilical cord occurs. Second, the disruption of all of those fac-
tors responsible for the maintenance of their attachment happens during
the act of parturition. The cervix dilates, intra-uterine pressure is
abolished, and the foetal fluids are expelled. The nidation period is
concluded, the uterine musculature becomes intensely active and wave
after wave of motion follows to force the foetus toward the pelvic outlet.
This tends to break down and sever the intimate relationship of the placental
tufts within the wall of the uterus. Ultimately, the umbilical cord ruptures
which is immediately followed by the collapse of the umbilical blood vessels
and capillaries. This latter feature is probably one of the most important
in the detachment of the placental structures in the bovine species. Finally,
there is the continued contraction and involution of the uterus which always
normally follows the expulsion of the foetus.
With the foregoing information referable to the normal state, the con-
trast of abnormality and the retention of the afterbirth can be made more
vivid. The fundamental cause for retention of the after birth is in the
vast majority of cases an inflammaton of the cotyledonary and placental
structures. There may be some contributory causative factors, but they
are not important. That retention is caused by inflammation is well il-
lustrated in Bang's Disease where the site of the lesions are in the pregnant
uterus and more specifically in the cotyledonary and placental tissues. On
many occasions, Bang's infected cows retain their afterbirth. Infections
other than that of Bang's disease may also be responsible for the condition.
On some occasions, a diseased condition of the uterus resulting in an inertia
of the organ and a failure of contraction may cause retention. This may
be apart from infection. In practically all cases, however, there is an in-
flammatory reaction. The severity of the condition will, in most instances,
depend upon the virulency and pathogenicity of the infection.
An inflammation in these structures behaves in much the same manner
as it does in any other tissue. There is heat, increased sensitiveness, con-
gestion, swelling and exudation. The tumefaction of the cotyledons and
the organization of the exudate are probably the most important features in
retention of the afterbirth for they imprison the placental tufts in the
crypts of the cotyledon and by the organization of the exudate retain them,
In many instances, the swelling and squeezing of the placental tufts cause
their death and necrosis. Under these circumstances, if an attempt is made
to separate the placental tuft from the cotyledon, it cannot be accomplished
for the membrane just tears off, leaving the tuft on the cotyledon. This,
of course, represents the most serious form of the condition, and as one
meets with cases of retained placenta, one is confronted with those in which
practically all of the cotyledons are involved to those in which only a few
are affected and are relatively simple cases. The gravest cases are those
in which the placental tufts have undergone necrosis and remain firmly
adherent to the cotyledon. Under these circumstances, a degree of toxemia
occurs due to the absorption of toxic material. In the more serious cases.
Canadian Journal of Retention of the Placenta February 1940 FA71
Comparative Medicine Vol. IV-No.2 L4J

as a rule, there is also a failure of the involution of the organ. This is

undoubtedly due to the diseased condition of the uterine walls. It is in these
cases, too, that the more grave systemic reactions are observed. These
consist of fever, anorexia, and toxemia.
The Treatment and Handling
Many practitioners are more or less dogmatic in their handling of these
cases. They adopt a rule of not attempting the removal of the afterbirth
for forty-eight hours after parturition. This may be justified particularly
in districts where people demand the removal of the membranes at the least
possible expense. On the other hand, such a procedure is not logical for
the proper handling of each case should be in accordance with its individual
requirements.
Normally, the afterbirth is expelled within a few hours after parturition,
and if not, should be given consideration in twelve hours. In some instances,
it can be removed manually in a short time. If it cannot be accomplished
with expedition, no attempt should be made to remove it, and the features
that will enable one to make a decision in the matter are as follows. If it is
found that the cotyledons are greatly tumefied, very sensitive and bleed
easily and the patient strains with such manipulation, it is not advisable
to proceed with the removal of the afterbirth. To do so is to invite trouble
for such a patient is often worse after the ordeal than if she had been left
alone, There are, however, certain things which should be done. These
consist of picking up all of the loose ends of the membranes and drawing
them and as much of the bulk of the afterbirth as possible up through the
cervix and leaving it there. That portion of it hanging through the vulva
Rhoujld be wrapped with a bandage, soaked with a disinfectant and deodorant
solution and allowed to hang. It should be soaked with the solution every
few hours. The reason for advocating this procedure is that the weight tends
to drag the uterine cavity up to the level of the pelvis and discharges get
away better,-leaving considerable bulk in the cervix tends to prevent too
rapid a contraction of that structure. Before leaving the case on this oc-
casion, inject iodized mineral oil in around the afterbirth in the utero-
chorionic space or place uterine capsules in such positions. It is advisable
to do this for it minimizes the putrefactive processes, allays the tendency
toward a metritis and prevents serious toxemias. It is also advisable to
administer pituitrin for it materially assists in the involution of the organ.
Some cases are also greatly improved by the administration of a cathartic
dose of magnesium sulphate in concentrated solution. Second, third, and
fourth visits at twenty-four to thirty-six hour intervals should be made
to watch the progress of the case, and, on each occasion, an examination
made and mineral oil or capsules placed in the uterus, as required. A certain
amount of traction on the freed afterbirth at each visit should be applied
to assist in its separation. Care should be taken, however, not to tear it
apart. Ultimately, in most instances, it will separate itself and come away
more or less intact. It is important during all this time to do everything
possible to improve and restore the general well being of the patient for
the tone and involution of the uterus are improved with it. On occasions
[48] Canadian journal
Comparative
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Medicine Retention of the Placenta February
Vol. 1940
I V-No.2

subsequent to the expulsion of the membranes a purulent discharge persists.

In these cases if the uterus has contracted, it is of value to irrigate the
organ with a mild antiseptic solution, using a return flow catheter to enable
the removal of all of the irrigating fluid. If such cows fail to manifesi
oestrum, the corpus luteum of pregnancy is usually still functioning and
inhibiting the occurrence of heat. Under such circumstances, if the cow
is in good health otherwise it is advisable to dislodge the corpus and stim-
ulate the resumption of oestrum for it greatly assists in restoring the normal
tone and function of the organ.
Many veterinarians in practice may not agree with the foregoing sug-
gestions, but the writer feels that retained afterbirth cases should be given
individual consideration, and this is particularly true of highly bred and
high-producing dairy cows of nervous temperament. The Journal, however,
would be pleased to have comments or constructive criticism.
0

I Parasitic Skin Diseases

By ALAN L. SECORD*
IN GENERAL, parasitic skin diseases are more likely to occur in young
animals while non-parasitic dermatitis usually occurs in adult and aged
dogs. Evidence of parasitic skin dermatitis usually occurs on the extremi-
ties, abdomen, around the eyes and the outer surface of the ears, while
lesions of non-parasitic skin disease are more likely to be found on the
body, particularly on the back and base of the tail.
Follicular Mange
This is caused by Demodex canis. Short-coated dogs appear to be more
susceptible than long-coated breeds. Bostons, Dachshunds, smooth-haired
terriers and bulldogs are the breeds most frequently attacked, but infection
will occasionally appear in any breed. The young is more susceptible than
the old dog. A difference of opinion prevails as to whether follicular mange
is truly contagious. Some consider the mite as a harmless saprophyte in
many animals, only becoming pathogenic in a few individuals. The author
has frequently found it necessary to treat two or three puppies in a litter
while the balance raised in the same kennel remained healthy. Case histories
appear to indicate that dogs develop the disease spontaneously with no
recent exposure to infected dogs. Some consider the disease mildly con-
tagious and almost hereditary inasmuch as it develops in certain strains of
dogs. The explanation of this may be that the mite exists as a true sapro-
phyte in adult life but when transmitted to the young dog it causes a disease
syndrome.
Symptoms.-Dry patches denuded of hair usually appear on the face,
around the eyes and occasionally on the legs or body. Generalized infesta-
lPresented before 36th Annual Meeting of the Central Canada Veterinary Association, Ottawa
Toronto, Ont.