Postpartum Uterine Infections

Muhammad Jameel
( 2018-M.Phil-2056 )
Department of Theriogenology
University of Veterinary & Animal Sciences, Lahore
Outlines
 Introduction
 Prevalence

 Predisposing factors

 Etiology

 Pathology

 Symptoms

 Diagnosis

 Treatment

 Prevention
Introduction

Postpartum period
Parturition to complete
uterine involution
(45 days)

Intermediate period
Puerperal period Post ovulatory period
Pituitary sensitivity
Calving to pituitary to GnRH to first Time of first ovulation
gland sensitive to GnRH postpartum ovulation to complete involution
(7-14 days) (26-30 days) (45 days)
Uterine Infections
Economic Importance

Metritis
Inflammation involving all
layers of the uterus
decreased
pregnancy rate
extended interval
to pregnancy Pyometra
Endometritis Accumulation of
increased culling Inflammation of the
purulent exudates
within the
endometrium endometrial cavity
and persistent C.L
Prevalence of uterine infections
 The prevalence of uterine infections varies considerably among studies
For example prevalence in cattle in:
 Spain 2.6 to 4.5% (Lopez-Gatius,2003)
 Denmark 6.25% (Bruunetal.,2002)
 Korea 47.6% (Kim and Kang, 2003)
 Australia 5.6% to 10.9% (Moss et al., 2002)
 USA 10.3% (Fonseca et al., 1983), 53% Gilbert et al. (2005)
 UK 10.1% (Borsbery and Dobson, 1989)
 Prevalence in buffaloes:
 India 24.7% (Gupta et al., 1978; Rao and Sreeman narayana, 1983)
38.54% Raman and Bawa (1977)
 Pakistan 24% Usmani et al. (2001)
 Malaysia 25-38% (Jainudeen, 1986)
 Egypt 38.9% Serur et al. (1982)
 Iran 33.2% Moghami et al. (1996)
Predisposing factors
Infectious causes
Trichomonas

Abortion foetus
 pre-mature birth Streptococcus sp

 twin births Stapylococcus sp

dystocia Corynebacterium

Retained placenta sp
Prolapse of uterus Fusobacterium

or vagina necroforum
Unhygienic Cmpylobacter sp

calving pan Bacteroides sp

E. coli sp
Pathogenesis
During the puerperal period

Mixed populations of bacteria in the uterus. Their numbers remain increased for
several days

In the intermediate period (up to the First postpartum ovulation), pathogenic

bacteria are eliminated from the uterus of normal cows

If conditions are favourable, C. pyogenes, Fusobacterium necrophorum and

Bacteroides spp. get established

Cause endometritis or metritis and are usually a signal for pyometra

 Chronic inflamed endometrium does not form PGF2u

Persistant of CL

Secretion of progesterone

Cervix remains closed

Favours the growth of micro-organisms

Stimulate exudation of a large number of leucocytes resulting in pus formation

Symptoms: Metritis
 Puerperal metritis: characterized by the presence of an abnormally
enlarged uterus, a fetid watery red-brownish uterine discharge associated
with signs of systemic illness, and fever (> 103 F) within 21 days in milk
 Clinical metritis: Animals without systemic signs but with an enlarged
uterus and a purulent uterine discharge within 21 postpartum classified as
having
(Sheldon et al., 2006)
Endometritis
 Clinical endometritis: Characterized by the presence of purulent (>
50%) uterine discharge after 21 postpartum or mucopurulent (50%
pus, 50% mucus) after 26 Endometritis
 Subclinical endometritis: Characterized by the presence of >18%
neutrophils (PMN) in uterine cytology samples collected between 21
and 33 postpartum
(Sheldon et al., 2006)
Pyometra
 Open pyometra: If the cervix is open, the infected material can leave the
It is more easier and safer to treat
 Closed pyometra: Here the cervix is fully closed, there is no discharge
from the vulva. The uterus may rupture and pus escapes into the
abdomen, causing peritonitis and possible rapid death
Diagnosis
 History: It includes (Age of the animal , Date of insemination, Come in heat
after 21, 40 days of insemination , Abnormal cyclicity)
 Clinical findings: It includes (Purulent or mucopurulent discharge from the
vagina, Large abdomen, Dullness, anorexia, Decressed milk
production)
 Physical examination: On rectal palpation:
 The cervix may remain close or open, Uterus feel like 2-3 months of pregnancy
 Corpus luteum persists, Uterine wall feels thicker, No uterine caruncles and fremitus
present
 There is not possible to slip alantochorion fetal membrane
 On pressure on the uterus the pus come out through the vagina
 Diagnosis can sometimes be difficult, particularly in the closed-cervix form of
pyometra where no pus is seen
 Vaginal examination
The vaginal examination using vaginal speculum to determined
the origin of exudates
 Bacterial culture
A uterine culture is an essential tool to determine the etiology of
uterine infection
 Vaginal or endometrial Cytology
Presence of inflammatory cells ( Neutrophils)
Ultrasonography
Treatment

 Hormonal therapy
 (a) Oestrogen and Oxytocin therapy: Oestradiol valerate 3-10 mg (I/M) followed by
Oxytocin 20 IU - 40 IU 24 hours later to sensitize the myometrium and dilate the
cervix
 (b) Oestrogen and glucocorticoid therapy:
 The use of oestradiol valerate (10 mg or 1 ml. I/M) followed by dexamethasone (5 ml.
I/M) have good result where oestrogen alone has failed
 (c) PGF2a analogues:
 The best treatment is the use of PGF2a analogues like Dinoprost trometamol @ 20-
25mg [ Lutalyse (5 ml I/M), Dinoprost (2 ml I/M)], Cloprostenol sodium @ 500µg
[Ovuprost]. These cause regression of the corpus luteum, dilatation of the cervix and
expulsion of pus within 5-7 days
 Antimicrobial therapy
 Parenteral antibiotics should be administered during the hormonal treatment
because it prevents spread of infection to the oviducts due to contraction of
uterus
 If an antibacterial drug is to be infused into the uterine lumen after expulsion of
pus, penicillin(10-40 lakh IU) for 3-5 days
 C. pyogenes and Gram-negative anaerobes remain in the uterus of most of the
cows with metritis or pyometra. These bacteria are usually sensitive to
intrauterine infusion of penicillin
 Other antibacterials such as Ceftiofur hydrochloride, tetracyclines or
ampicillin are also useful
 Pyometra
 In treating pyometra, regardless of the cause, the aims are first, to induce the
regression of the corpus luteum, second, to dilate the os uteri and third, to
produce prolonged contraction of the uterus and expel the pus:
 Rowson suggests three possible ways to accomplish these aims:
 By use of catheter and douche plus massage of the uterus through the rectal wall
 By expression of the corpus luteum
 By hormone therapy
Prognosis
 The cases that have existed only for 60 to 120 days, recover and conceive
more likely than the cases that have existed for 120 days or longer.
 In long standing cases the endometrium gets destroyed, the uterine wall
undergoes fibrotic changes resulting in permanent sterility
Prevention
 Good sanitation and controlled breeding program
 Virgin heifers should be mated only to young bulls which have not
previously been exposed to trichomoniasis
 Through physical examination before breeding
 Infected bulls should be removed from the herd
 AI by trained technician and should be free from contamination
References
 Applied Veterinary Gynaecoloy and Obstetrics by Dr. Pradeep Kumar,
M.V.Sc., Ph.D. (pursuing)
 Arthur's veterinary reproduction and obstetrics
www.merckvetmanual.com/
 https://en.wikipedia.org/wiki/
 veterinarymedicine.dvm360.com
 Veterinary Obstetrics and Genital diseasses (Theriogenology )1986 by S.J.
Roberts
 O.I. Azawi, 2008, Review: Postpartum uterine infection in cattle, Animal
Reproduction Science 105 (2008) 187–208
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