428 CHAPTER 55

CHAPTER 55
Dropsical Conditions
Affecting Pregnancy
SIMON F. PEEK

H
ydrallantois and hydramnios, hydrops of the tomized sheep, however, point to a link between the
allantois and the amnion, respectively, are the estrogen-to-progesterone ratio and fetal fluid volume.8,9
two most common causes of dropsy of the fetal The clinical signs associated with hydrallantois vary
membranes and fetus in cattle. Other, less common with the volume of fluid at presentation. Abdominal dis-
causes include edema of the chorioallantois, fetal tention rarely has been noted as early as the fifth month
anasarca, and fetal edema with ascites and hydrothorax.1 of gestation.3 The typical case of hydrallantois, however,
In the largest published retrospective study of hydrops to is characterized by a larger than normal accumulation of
date, Vandeplassche and associates documented that of a allantoic fluid during a 5- to 20-day period in the last
total of 60 cases, hydroallantois accounted for 88%, 5% trimester of pregnancy3 (Fig. 55-2). Mild cases may
of the cases were hydramnios, and 7% involved both remain undiagnosed or may be suspected only at partu-
compartments.2 rition when an abnormally large volume of fetal fluids is
expelled. In such instances, the producer may have
assumed that the dam was carrying twins. In the more
HYDRALLANTOIS
severe cases, progressive abdominal distention during the
Hydrallantois is the single pathologic factor present in last 4 to 6 weeks of pregnancy worsens to such an extent
85% to 90% of dropsical conditions in the bovine.1,2 Pla- as to decrease appetite and cause difficulty moving or
cental dysfunction is thought to be the cause of hydral- rising.10 Progressive maternal tachycardia, anxiety,
lantois, although this condition is observed with both reduced appetite, and dehydration should be anticipated
uterine and placental disease. Adventitious placentation with untreated hydrallantois. Recumbency and metabolic
commonly is present (Fig. 55-1), and the number of problems, particularly ketosis, are therefore potential
caruncles also may be deficient. This deficiency may be complications associated with advanced cases of hydral-
due to a congenital lack of development or to uterine lantois, and these will be even more likely should the con-
disease acquired later in life. A reduction in the number dition be associated with multiple fetuses. The combined
of caruncles also has been noted with hydrallantois, and weight of the fetus(es) and allantoic fluid also may result
those that are present tend to be hypertrophied.3 The con- in either prepubic tendon rupture or secondary ventral
dition is seen sporadically in both dairy and beef cows, abdominal muscle herniation.
and dams carrying multiple fetuses are at greater risk for A definitive diagnosis of hydrallantois can be obtained
hydrallantois. An increased prevalence of hydrallantois by rectal palpation. The external appearance of the cow
has been noted in recipient cattle carrying fetuses pro- may suggest the presence of vagal indigestion, but rectal
duced by in vitro fertilization and by transgenic and palpation will quickly distinguish between the two con-
cloning technologies.4,5 ditions. In hydrallantois, the abdominal cavity will be
The structural and functional changes in the chorioal- dominated by the fluid-filled uterus, frequently preclud-
lantois that lead to hydrallantois result in the excessive ing palpation of other structures, whereas vagal indiges-
production of a transudative fluid that resembles plasma.1 tion will be characterized by a prominent, enlarged L- or
In severe hydrallantois, the accumulated fluid volume V-shaped rumen. The fetus and placentomes usually are
may reach 150 to 250 L, and the combined weight of the not palpable in cases of hydrallantois, and it is therefore
dropsical fluids, membranes, and fetus can exceed difficult to ascertain the viability of the fetus without fetal
225 kg.3 Fluid composition studies comparing allantoic heart rate measurement. Evaluation of fetal number and
fluid from normal cows in late gestation and from those viability is best performed by transabdominal ultrasound
suffering from hydrallantois have demonstrated marked examination with a 2.5- or 5-MHz sector scanner.
differences in sodium, potassium, chloride, and creati-
nine levels.2,6,7 In hydrallantois, the levels of these elec-
HYDRAMNIOS
trolytes are much higher, more closely resembling plasma
levels.8 In addition, lower peripheral plasma concentra- Hydramnios causes approximately 10% of the cases of
tions of estradiol have been observed in cows suffering hydrops of the fetal membranes in cows.1 The condition
from hydrallantois.7 The exact role of estrogen deficiency is characterized by gradual accumulation of excessive
in the maintenance of fetal membrane permeability and amniotic fluid, with progressive abdominal enlargement
its effect on allantoic and amniotic fluid volume in the in the dam during the last trimester of pregnancy. The
cow remains uncertain. Studies in pigs and ovariec- abdominal distention typically is slower to develop than
 Dropsical Conditions Affecting Pregnancy 429

inherited as autosomal recessive traits have been associ-

ated with hydramnios in specific breeds of cattle:
• Dexter cattle pregnant with bulldog calves. These
fetuses usually are aborted between 5 and 8
months of gestation.
• Angus cattle pregnant with brachygnathic calves
whose skeletons also lack marrow cavities. Affected
cows demonstrate abdominal enlargement in the
last month of pregnancy.
• Red Danish cattle pregnant with muscle
contracture monsters
• Guernsey cattle pregnant with calves suffering
from pituitary hypoplasia or aplasia. Prolonged
gestational length also is seen in this condition
Fig. 55-1 Abnormal cotyledon from the placenta of a cow with owing to the abnormal fetal pituitary-adrenal axis.
hydrallantois (8 months of gestation). The cotyledon, measur- • Hereford cattle pregnant with hydrocephalic
ing 5 inches in diameter, has been sectioned; note the excessive calves.1
edema within the intercotyledonary placenta. The nongenetic causes of hydramnios in cattle include
those anomalies that impair the ability of the fetus to
swallow amniotic fluid, such as schistosomus reflexus.
Hydramnios also has been reported in hybrid crosses
between American bison and domestic cattle.11

TREATMENT OF HYDRALLANTOIS
AND HYDRAMNIOS
The decision whether to treat a cow suffering from
hydrallantois or hydramnios should always be tempered
by practical considerations regarding the likelihood of
success and the etiology of the specific condition. Sal-
vaging the cow for slaughter should be considered in all
cases of hydrops in the cow.1,3,11 The cause of hydrallan-
tois is uterine or placental disease, or both, so the likeli-
hood of recurrence should be considered.3 In cases of
hydramnios, an inherited etiology should be considered
and the fact that the fetus most likely will be anomalous
should be borne in mind. If the fetal anomaly is due to
an established autosomal recessive disorder, both the dam
and the sire will be carriers.1,3
The severity of the condition at presentation also
should play an important role in decision making. In
Fig. 55-2 Severe bilateral abdominal distention secondary to severe cases of hydrallantois in which the patient is
hydrallantois is evident when this adult Holstein cow is viewed already recumbent and unable to rise, or prepubic tendon
from the rear. (Courtesy of Dr. W. C. Rebhun.) or abdominal wall rupture has already occurred, the
prognosis becomes increasingly grave, and immediate
slaughter should be considered. In dairy cattle, because
individual animals are in negative energy balance and
in hydrallantois.3 Hydrops of the amnion usually is the often within the last trimester at the time of diagnosis,
result of an abnormal fetus and is therefore considered a they may never obtain projected production levels
fetal problem, whereas hydrallantois is due to maternal despite successful termination of a pathologic pregnancy.
abnormalities of placentation. From midgestation to For the aforementioned reasons, salvage usually is con-
term, amniotic fluid normally is swallowed or inhaled sidered unless the cow or the fetus is particularly valuable
into the large bronchi of the fetus and subsequently and the pregnancy is within 2 to 3 weeks of term.10
absorbed.11 Hydramnios results from fetal abnormalities If the decision is made to treat the condition, several
that prevent swallowing or intestinal transport of amni- options exist. Most clinicians agree that elective cesarean
otic fluids.1 During late gestation, the volume of normal section is rarely as successful as induced parturition.3,10,11
amniotic fluid reaches between 3.8 and 7.6 L; however, in Uterine atony due to overdistention, retained fetal mem-
hydramnios, the volume will increase to 19 to 114 L. The branes, and severe metritis are complications that should
fluid is viscous and syrupy in consistency.1 always be anticipated after either induced parturition or
Hydramnios can be associated with both genetic and elective surgery. Debate exists among different authors
nongenetic fetal abnormalities. Certain fetal anomalies about whether hydrops patients are markedly dehydrated
430 CHAPTER 55

or not; some sources support the hypothesis,1,10 whereas has normal colostrum. With exceptionally valuable calves
others refute it.11 The induction of parturition, however, it is wise to consider plasma administration, because
will result in a slower release of uterine fluids than the colostrum absorption may be compromised by precocious
rapid decompression that occurs after surgery. The rapid gut closure induced by chronic in utero swallowing of
release of up to 250 L of allantoic fluid would certainly excessive fetal fluid.
seem to predispose the patient to hypovolemic shock The prognosis for individual animals suffering from
subsequent to compartmental shifting into the splanch- hydrallantois, particularly if the condition is advanced at
nic pool.11 Some clinicians advocate the use of a trocar the time of diagnosis, is much poorer for life and future
or plastic tube inserted percutaneously through the fertility than is the case with hydramnios. Retained fetal
abdominal and uterine walls to draw off fluid gradually membranes and potentially severe metritis should be
during a 24-hour period before elective cesarean.6 This anticipated with both conditions, but especially with
procedure will predispose the cow to the development of hydrallantois, particularly if parturition is induced or the
peritonitis and/or metritis, however, and whether this cervix is still significantly closed at the time of elective
maneuver actually allows a significant volume of fluid to cesarean section. Prophylactic antibiotics should be insti-
drain is uncertain.3 Drainage also can be attempted trans- tuted if the cow is not being sold for slaughter.
cervically if the cervix is relaxed enough to permit
passage of a suitable catheter. In cases of hydrallantois
treated by cesarean section, some authors have observed OTHER DROPSICAL CONDITIONS
that the uterus may continue to fill with a significant OF CATTLE
volume of transudative fluid for up to 48 hours after Dropsical conditions other than hydrallantois and
surgery.1 hydramnios are very rare but include the following:
To induce either abortion or calving, 25 to 35 mg of
prostaglandin F2α can be injected intramuscularly either Fetal ascites. This condition has been associated
alone or in combination with dexamethasone.3 An alter- with both infectious and noninfectious fetal
native regimen involves the administration of 10 to pathology. Fetal ascites and fetal and placental
20 mg of flumethasone intramuscularly. Some clinicians edema can be seen with intrauterine fetal death
advocate the use of 6 to 8 mg of estradiol cypionate intra- and autolysis from whatever cause, and the degree
muscularly once daily until parturition to relax the cervix of fetal enlargement dictates whether or not
and caudal reproductive tract. The combination of a dystocia results.1
prostaglandin and an abortifacient steroid reliably Edema of the chorioallantois. Excessive edema of
induces parturition in late gestation in a normal cow the chorioallantois has been classically associated
within 24 to 48 hours, but the response can be rather with Brucella abortus infection.1
more unpredictable in cases of hydrops. Fetal anasarca or excessive fetal edema. Both of
After induction of parturition, the cow should be care- these conditions can be seen in isolation or in
fully monitored and regularly examined for signs of labor. combination with hydrallantois or hydramnios.1
Periodic vaginal examination is important to ascertain Fetal anasarca can be an inherited condition in
the progress of cervical dilation and to rupture the fetal the Ayrshire breed as an autosomal recessive
membranes as soon as possible.3 Once the fetus can be disorder.12
palpated per vagina, it should be assessed for size, posi- In all of these conditions, with the possible exception of
tion, and the presence of any anomalies that may hinder edema of the chorioallantois, abdominal enlargement
vaginal delivery. In many cases of hydrallantois, parturi- usually is not noted.1
tion may not progress beyond this point as a result of
uterine atony, and assistance will be required to complete
delivery.
After induction, the cow should be kept in a deeply
References
bedded stall with good footing, to limit the chances of
1. Roberts SJ: Disease and accidents of gestation. In Veterinary
catastrophic musculoskeletal injury associated with par-
obstetrics and genital diseases, 3rd ed. Woodstock, VT: pub-
turition. If dehydration is suspected or if the cow has lished by the author, 1986, p 223.
evidence of other metabolic complications (ketosis, 2. Vandeplassche M, Oyaert W, Bouters R, et al: Uber die Ein-
hypocalcemia), then supportive polyionic intravenous hautwassersucht beim Rind. Wiener Tieraztl Monatsschr
fluids augmented with dextrose and calcium are indi- 1965;5:461.
cated. In a field situation, acute hypovolemic shock can 3. Elmore R, Morris D, Brinsko S, et al: Bovine hydrallantois and
be addressed with smaller volumes of hypertonic saline hydramnios. Theriogenology Handbook. Hastings, NE: Society
(2–3 L of 7% sodium chloride given intravenously, fol- for Theriogenology, 1988, p B-2.
lowed by access to water and electrolyte solutions). In 4. Hill JR, Roussel AJ, Cibelli JB, et al: Clinical and pathologic
dairy cows, milking should be initiated as soon as the calf features of cloned transgenic calves and fetuses (13 case
studies). Theriogenology 1999;51:1451.
is delivered, although it often can be challenging to
5. Van Wagtendonk-de Leeuw AM, Aerts BJ, den Daas JH:
achieve projected production levels in cows that have Abnormal offspring following in vitro production of bovine
experienced a dropsical pregnancy. A majority of fetuses preimplantation embryos: a field study. Theriogenology
will be small, nonviable, or anomalous, but in the rare 1998;49:883.
case of an apparently viable calf, colostrum must be pro- 6. Skydsgaard JM: The pathogenesis of hydrallantois bovis. Acta
vided from an alternative source, because the dam rarely Vet Scand 1965;6:193.