The effect of treatment of clinical endometritis on reproductive performance in dairy cows

Incidence of subclinical endometritis and its effects on reproductive performance of crossbred dairy cows

In dairy cattle, uterine infections are not life threatening and often unavoidable; however, they reduce fertility and increase the production costs of properties. The aim of this study was to evaluate the incidence of subclinical endometritis from 32 to 70 days in milk (DIM) and its effects on the reproductive performance of crossbred dairy cows. Lactating cows (Holstein/Gir; n = 172), with no history of retained placenta, without clinical signs of uterine infection were used. The body condition score (BCS) was evaluated on a scale from 1 to 5. Ultrasound examination was performed to evaluate uterine lining and ovarian activity, while vaginal mucus was analyzed by gloved hand. The diagnosis of subclinical endometritis was performed by endometrial cytobrush technique. The samples were collected, stained, and examined microscopically; positive cases for subclinical endometritis were considered with the presence of ≥5 % of neutrophils. Later, the cows were submitted to conventional artificial insemination or timed artificial insemination. The incidence of subclinical endometritis in the herd was 26 %, and this was not affected by the season of calving, presence of corpus luteum, DIM, and parity. Cows with a BCS ≤2.50 had a higher incidence of subclinical endometritis. The conception rate to first insemination and pregnancy rate at 150 days postpartum were not influenced by the presence of subclinical endometritis in crossbred dairy cows.

Perspective on physiological/endocrine and nutritional factors influencing fertility in post-partum dairy cows

Increasing reproductive performance of post-partum lactating dairy cows is a multi-factorial challenge involving disciplines of production medicine, nutrition, physiology and herd management. Systems of programmed timed insemination have been fine-tuned to achieve pregnancy per artificial inseminations (AI) approximating 45%. Systems have optimized follicle development, integrated follicle development with timing of induced corpus luteum regression and fine-tuned sequential timing of induced ovulation and AI. Use of programmes for insemination have identified occurrence of anovulatory ovarian status, body condition, uterine health and seasonal summer stress as factors contributing to reduced herd fertility. Furthermore, programmes of timed insemination provide a platform to evaluate efficacy of nutritional and herd health systems targeted to the transition and post-partum periods. The homeorhetic periparturient period, as cows deal with decreases in dry matter intake, results in a negative energy balance and is associated with a period of immunosuppression. Cows that transition well will cycle earlier and have a greater risk of becoming pregnant earlier post-partum. The innate arms of the immune system (acute and adaptive) are suppressed during the periparturient period. Cows experiencing the sequential complex of disorders such as dystocia, puerperal metritis, metritis, endometritis and subclinical endometritis are subsequently less fertile. Targeted strategies of providing specific nutraceuticals that provide pro- and anti-inflammatory effects, such as polyunsaturated fatty acids (e.g., linoleic, eicosapentaenoic/docosahexaenoic, conjugated linoleic acid), sequential glycogenic and lipogenic enrichment of diets, and organic selenium appear to differentially regulate and improve the immune and reproductive systems to benefit an earlier restoration of ovarian activity and increased fertility.

Receiver operating characteristic curve analysis to determine the diagnostic performance of serum haptoglobin concentration for the diagnosis of acute puerperal metritis in dairy cows

Acute puerperal metritis (APM) in dairy cows is characterized by fever and fetid vaginal discharge within 21 days in milk (DIM). Increased serum haptoglobin concentration (Hp) can support the diagnosis of APM. However, there is a dearth of information of the test performance of Hp as a measure for APM with a consistent definition and considering parity. The objective of this trial was to study the test performance of Hp to distinguish healthy cows from cows with APM. A total of 33 of 60 (55.0%) primiparous cows and 43 of 133 (32.3%) multiparous cows developed APM. Primiparous cows with APM had the greatest Hp. However, in primiparous cows Hp did not significantly differ between healthy cows (DIM 2: 1.49 ± 0.64 mg/mL; DIM 5: 2.13 ± 0.66 mg/mL; DIM 10: 1.46 ± 0.85 mg/mL) and cows with APM (DIM 2: 1.78 ± 0.62 mg/mL; DIM 5: 2.48 ± 0.64 mg/mL; DIM 10: 1.60 ± 0.81 mg/mL). In multiparous cows, Hp was greater in cows with APM (DIM 2: 1.27 ± 0.68 mg/mL; DIM 5: 1.89 ± 0.94 mg/mL; DIM 10: 1.23 ± 0.78 mg/mL) than in healthy cows (DIM 2: 0.99 ± 0.68 mg/mL; DIM 5: 1.10 ± 0.80 mg/mL; DIM 10: 0.83 ± 0.68 mg/mL). Sensitivity and specificity of Hp to diagnose APM in multiparous cows ranged from 72% to 79% and 54% to 71% on DIM 2, 5 and 10, respectively.

Strategies for the treatment of dairy cows at high risk for postpartum metritis and for the treatment of clinical endometritis in Argentina

The objectives of this study were to evaluate the efficacy of (1) administering ceftiofur hydrochloride in dairy cows with calving-related disorders to prevent metritis and (2) a combination of GnRH and PGF2α for the treatment of clinical endometritis, under Argentinean dairy farming conditions. Cows at high risk (HRC) for metritis (dystocia, RFM >12 h postpartum, hypocalcaemia, twins, or stillbirth) were randomly assigned to receive either 1.1 mg/Kg of ceftiofur hydrochloride on three consecutive days (HRC treated group HRCT, n = 110) or remained untreated (HRC control group HRCC, n = 126). Cows with low risk (LRC, no calving-related disorders, n = 868) did not receive any treatment (LRC group, n = 868). All cows were examined for metritis between days 4 and 10 and for clinical endometritis between 24 and 30 days postpartum. The body condition score (BCS) was recorded at both examinations. Cows with endometritis at days 24 to 30 postpartum received either 1.5 mg of D-cloprostenol (PGF; n = 129) or 100 μg of GnRH followed by D-cloprostenol after 7 days (GnRH+PGF, n = 119). There was no overall effect of treatment on the incidence of metritis or on time to pregnancy. Treatment, however, reduced the incidence of metritis in cows with high BCS (HRCT = 24.0 %, HRCC = 38.5 %) but had no effect in cows with low BCS (HRCT = 38.7 %, HRCC = 37.5 %). The proportion of pregnant cows by days in milk was greater (P < 0.01) in LRC group compared with that of the HRCT and HRCC groups. No significant differences were found between groups PG and PG+GNRH. GnRH+PGF treatment, however, tended (P = 0.06) to increase pregnancy rate in cows with a moderate loss of BCS (76.5 vs 65.2 %) but tended to reduce pregnancy rate (54.5 vs 76.0 %) in cows with a more pronounced loss in BCS (>0.75 points).

Secretion of prostaglandins and leukotrienes by endometrial cells in cows with subclinical and clinical endometritis

The aims of this study were (1) to measure the secretion of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), leukotriene B4 (LTB4), and leukotriene C4 (LTC4) by endometrial cells collected by a cytobrush from healthy cows and cows with subclinical and clinical endometritis in the fourth week postpartum, and (2) to evaluate the relationship between the mediators' levels of secretion and the number of polymorphonuclear neutrophils (PMNs) in the uterine smears of cows with subclinical endometritis. The study included cows without any signs of clinical endometritis (n = 63) and cows with clinical endometritis as a positive control (ENDOM, n = 12). Two different threshold ratios (>5% and >18% of PMNs) were used to categorize the cows without clinical signs as with or without cytologic endometritis (CE). Considering the first or second threshold, the animals with CE were included in group CE POS I or CE POS II, whereas the healthy cows were assigned to group CE NEG I or CE NEG II, respectively. The prevalence of CE was 68.25% (42/63) and 57.14% (36/63) according to the first and second thresholds, respectively. The highest level of secretion of all of the measured mediators occurred in the ENDOM group and differed significantly (P < 0.05) from the CE POS and CE NEG groups, regardless of the threshold. PGF2α secretion in the CE POS II group (1629 pg/mL) was significantly lower (P < 0.05) when compared with the CE NEG II group (2797 pg/mL), whereas there was no significant difference between the CE POS I and CE NEG I groups. PGE2 secretion differed between both groups with CE; higher concentrations were measured in the CE POS II group (6.68 ng/mL) when compared with the CE POS I (2.4 ng/mL) and CE NEG II (2.37 ng/mL) groups (P < 0.05). No significant differences were observed in the LTB4 and LTC4 secretion between the CE POS and CE NEG groups, considering both thresholds. It seems that CE does not fully mimic the inflammatory cascade associated with clinical signs. The response in the subclinical cases was limited to enhanced production of PGE2, which was particularly well-pronounced in cows with high numbers of PMNs (>18%) in the endometrial scrapings.

Effects of 1 or 2 treatments with prostaglandin F₂α on subclinical endometritis and fertility in lactating dairy cows inseminated by timed artificial insemination

The objectives of the current study were to investigate the efficacy of PGF₂α as a therapy to reduce the prevalence of subclinical endometritis and improve pregnancy per artificial insemination (P/AI) in cows subjected to a timed artificial insemination (AI) program. A total of 1,342 lactating Holstein dairy cows were allocated randomly at 25 ± 3 d in milk (DIM) to remain as untreated controls (control, n=454) or to receive a single PGF₂α treatment at 39 ± 3 DIM (1PGF, n=474) or 2 treatments with PGF(α at 25 ± 3 and 39 ± 3 DIM (2PGF, n=414). All cows were enrolled in the double Ovsynch program at 48 ± 3 DIM and were inseminated at 75 ± 3 DIM. A subset of 357 cows had uterine samples collected for cytological examination at 25 ± 3, 32 ± 3, and 46 ± 3 DIM to determine the percentage of polymorphonuclear leukocytes (PMNL). Subclinical endometritis was defined by the presence of ≥ 5% PMNL. Vaginal discharge score was evaluated at 25 ± 3 DIM and used to define the prevalence of purulent vaginal discharge. Body condition score was assessed at 25 ± 3 DIM. Pregnancy was diagnosed 32 d after AI and reconfirmed 28 d later. At 32 ± 3 DIM, the prevalence of subclinical endometritis was reduced by treatment with PGF₂α at 25 ± 3 DIM in 2PGF (control=23.5% vs. 1PGF=28.3% vs. 2PGF=16.7%); however, this benefit disappeared at 46 ± 3 DIM, and 14% of the cows remained with subclinical endometritis. One or 2 treatments with PGF₂α did not influence P/AI on d 32 or 60 after timed AI, which averaged 39.9 and 35.2%. Similarly, treatment with PGF₂α had no effect on pregnancy loss between 32 and 60 d of gestation (11.9%). Cows diagnosed with both purulent vaginal discharge and subclinical endometritis had the lowest P/AI and the highest pregnancy loss compared with those diagnosed with only 1 of the 2 diseases or compared with cows having no diagnosis of uterine diseases. Interestingly, subclinical endometritis depressed P/AI and increased pregnancy loss only when it persisted until 46 DIM. On d 32 after AI, cows not diagnosed with subclinical endometritis and those that resolved subclinical endometritis by 46 DIM had greater P/AI than those that remained with subclinical endometritis at 46 DIM (45.4 and 40.0 vs. 25.0%, respectively). Similar to P/AI, cows not diagnosed with subclinical endometritis and those that resolved subclinical endometritis by 46 DIM had less pregnancy loss than those with subclinical endometritis at 46 DIM (9.6 and 13.5 vs. 43.9%, respectively). One or 2 treatments with PGF₂α before initiation of the timed AI program were unable to improve uterine health, P/AI, and maintenance of pregnancy in lactating dairy cows. Cows diagnosed with both purulent vaginal discharge and subclinical endometritis had the greatest depressions in measures of fertility at first AI, particularly when subclinical endometritis persisted in the early postpartum period.

Clinical trial of treatment programs for purulent vaginal discharge in lactating dairy cattle in New Zealand

Studies of treatment of postpartum endometritis in dairy cows indicate that prostaglandin (PGF2α) might result in similar outcomes as intrauterine antibiotics, but the effect might depend on the presence of a CL. The objective was to compare reproductive performance in cows with purulent vaginal discharge treated on the basis of having or not having a CL (CL-dependent treatment; CLdep), versus treatment of all affected cows with an intrauterine antibiotic alone. Cows (N = 756) from 36 seasonal calving dairy herds in New Zealand were enrolled on the basis of having a vaginal discharge score (VDS) ≥2 (mucus with flecks of pus or more purulent) after examination with the Metricheck device (Simcro, Hamilton, New Zealand) and ≥14 days after calving. The presence of a CL was assessed by transrectal palpation. Cows were randomly assigned within farm to be treated with an intrauterine antibiotic (0.5 g cephapirin) irrespective of CL status, or treated with PGF2α if a CL was present and cephapirin if a CL was not present (CLdep). The VDS was reassessed 14 days later. Cows were bred using standard practices and pregnancy was tested to define the date of conception. The proportion of cows clinically cured (i.e., with a VDS ≤1 at reexamination) did not differ between treatment groups (0.82 ± 0.03 vs. 0.80 ± 0.03) for the group of cows treated with an intrauterine antibiotic irrespective of CL status and the CLdep groups, respectively (P = 0.66). The proportions of cows submitted for AI by 21 days into the breeding program, pregnant to first breeding, pregnant by 42 days into the breeding program, and at the end of the breeding program, and the interval from the start of the mating program to pregnancy did not differ among treatment groups. Cows that had positive VDS (i.e., >1) at Day 14 after treatment had lower proportions of conception and pregnancy than those with lower (<2) VDS. A treatment protocol in which cows with purulent vaginal discharge with a palpable CL were treated with PGF2α and those without a CL with intrauterine cephapirin resulted in reproductive performance that was not inferior to treating all cows with an intrauterine antibiotic.

Effect of intrauterine dextrose or antibiotic therapy on reproductive performance of lactating dairy cows diagnosed with clinical endometritis

The objectives of this study were to assess the responses to treatments (clinical cure and cow survival 14 d posttherapy) of cows with clinical endometritis (CE) that received intrauterine infusion of a hypertonic solution of 50% dextrose (DEX) or subcutaneous ceftiofur crystalline free acid (CCFA) and subsequent pregnancy per artificial insemination (P/AI) in cows with CE compared with cows without CE. Cows (n=760) from 2 dairy herds were screened for CE using vaginoscopy and measurement of cervix diameters [exam 1; 26±3 d in milk (DIM)]. Cows with vaginal discharge scores of 2 or 3 (scale 0-3) were stratified by parity and randomly allocated into 1 of 3 treatment groups: (1) intrauterine infusion (∼200 mL) of 50% DEX solution (n=79); (2) 6.6 mg/kg single-dose of subcutaneous administration of CCFA (n=75); or (3) untreated control animals (CON, n=83). Fourteen days posttherapy (at 40±3 DIM), cows with CE were re-examined (exam 2; 40±3 DIM) to assess the response to treatments. All cows were presynchronized with 2 injections of PGF(2α) given 14 d apart (starting at 26±3 DIM) followed by Ovsynch (OV; GnRH-7 d-PGF-56 h-GnRH 16 h-timed-AI) 12 to 14 d later. Cows displaying signs of standing estrus any time during the protocol were inseminated, whereas the remaining cows were subjected to timed AI 16 h after the second GnRH of OV. Pregnancy diagnosis was performed via transrectal ultrasonography at 39±3d post-AI followed by pregnancy reconfirmation 30 d after the first pregnancy diagnosis. Uterine swabs revealed that Arcanobacterium pyogenes and Escherichia coli were the most predominant bacteria isolated at the time of treatments. Mortality within 14 d posttherapy was not different among treatment groups. Cows with CE had greater cervical diameter at exam 1 and decreased P/AI compared with cows without CE. Treatment with CCFA or DEX increased the proportion of cows with clear vaginal discharge (score 0; clinical cure) 14 d posttherapy compared with CON cows. Pregnancy per AI from DEX (29.8±4%) cows tended to differ from that of CON (21.1±4%) or CCFA cows (19.7±4%), but it resulted in similar P/AI as those cows without CE (39.1±2%). The use of intrauterine DEX alone or as an adjunct of antibiotic therapy for the treatment of CE needs further investigation.

Evidence-based medicine: quality and comparability of clinical trials investigating the efficacy of prostaglandin F2α for the treatment of bovine endometritis

The objective of this study was to evaluate the quality and comparability of published literature, and to summarize the effect of prostaglandin F2α (PGF2α) for the treatment of endometritis. It has been postulated that there is a dearth of high-level evidence-based research results in veterinary medicine. Also, there is a marked variation in the quality of studies in veterinary and animal science. Post-partum uterine infections occur commonly in dairy cattle and are reported to have a negative impact on reproductive performance. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilizing specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51·5%) were at least 20 years old. Furthermore, we found that about one third (36·8%) of all trials were controlled and randomized, while 3 of those (4·4%) were also blinded. Of those trials which calculated a calving-to-conception interval (n=30), 50% of the authors claimed an improvement, which was statistically significant in 23·3% of the cases. We conclude that there is a wide discrepancy between research results investigating the efficacy of PGF2α.

Therapeutic efficiency of antibiotics and prostaglandin F2α in postpartum dairy cows with clinical endometritis: an evidence-based evaluation

The occurrence of vaginal discharge in postpartum dairy cows is generally diagnosed as clinical endometritis. This uterine condition is associated with reduced fertility and economic loss for the dairy industry. Therapeutic approaches include the systemic or intrauterine application of antibiotics or the injection of prostaglandin F2α and analogues to cause luteolysis and uterine contractions to evacuate the infected content. The treatment of clinical endometritis remains a subject of considerable controversy in the literature. Better understanding of the reproductive biology of normal versus abnormal uterine involution and immune mechanisms will allow more efficient diagnostic methods and a more efficient therapeutic approach.

Evaluation of the effectiveness of intrauterine treatment with formosulphathiazole of clinical endometritis in postpartum dairy cows

In cattle, elimination of bacterial contamination from the uterine lumen after parturition is often delayed or compromised, and pathogenic bacteria can persist, causing uterine disease and infertility. The aim of this study was to compare the clinical and bacteriologic recovery following a single intrauterine administration of formosulphatiazole, cephapirin or placebo in cows with clinical endometritis. Cows (n = 80), no less than 28 days postpartum, with clinical endometritis were enrolled in the study. Endometritis was diagnosed by a complete reproductive examination, including rectal palpation, ultrasonography, vaginoscopy and uterine swab. All cows were randomly assigned to receive one of three intrauterine treatments (T0): 2500 mg of formosulphatiazole (Group A); 500 mg of cephapirin (Group B); placebo (4250 mg of propylene glycol; Group C). Cows were examined at the first estrus after treatment or no more than 30 days after (T1). Bacteria isolated were E. coli, A. pyogenes, Pasteurella spp. and Streptococcus spp. After treatment, in Group A and B only 6/30 (20.0%) and 6/24 (25.0%) cows showed a positive bacteriologic culture (P > 0.05), while in Group C the number of positive animals was significantly higher (19/26; 73.1%; P < 0.05). At T0, total clinical scores were similar between the three groups (Group A: 5.84 ± 1.07; Group B: 5.91 ± 1.0; Group C: 5.62 ± 1.17; P > 0.05) and indicative of clinical endometritis. At T1, endometritis scores were significantly lower than those reported before uterine infusion (P < 0.05); however, Group A and B score, 0.4 ± 0.9 and 1.0 ± 2.1, respectively, correspond to no and slight endometritis, while animals in Group C reported a total endometritis score significantly higher (4.6 ± 3.5; P < 0.05) corresponding to endometritis. In the present study, a commercial formosulphatiazole preparation was as effective as cephapirin and more effective than placebo for the treatment of clinical endometritis.

Reproductive tract defense and disease in postpartum dairy cows

This paper briefly reviews recent data and concepts on the development and mitigation of infection and inflammation in the reproductive tract of dairy cows during the first 2 mo after calving. The incidence of metritis is typically between 10 and 20%, of clinical endometritis or purulent vaginal discharge (PVD) approximately 15%, and of subclinical or cytological endometritis a further 15%. Worse postpartum negative energy balance is associated with more severe or prolonged uterine inflammation. Changes in feed intake, expression of genes for pro-inflammatory cytokines, notably interleukin (IL) 1, IL6 and IL8, circulating concentrations of beta-hydroxybutyrate (BHBA) or nonesterified fatty acids (NEFA), and innate immune function precede both metritis and endometritis by several weeks. Infections with Escherichia coli and Arcanobacterium pyogenes are associated with both metritis and PVD. There are new data to suggest that specific virulence factors in E. coli associated with adherence may be important in metritis and PVD. Cytological endometritis and PVD are overlapping but largely distinct conditions, and there are emerging data that cervicitis exists both concurrent with and separate from endometritis. Much remains to be learned about what initiates and sustains harmful inflammation of the reproductive tract. Such information is necessary to develop effective treatments for the various forms of disease and, more importantly, to develop means to prevent endometritis and cervicitis. In particular, vaccination against specific uterine pathogens and interventions to modulate innate immune response appear to be important avenues for investigation. Presently, commonly recommended best management practices for cows in the transition period are likely to be helpful to mitigate the risk of reproductive disease.

Time-dependent mRNA expression of selected pro-inflammatory factors in the endometrium of primiparous cows postpartum

BACKGROUND

Inflammatory processes and infections of the uterine wall must be accepted as a physiological event in dairy cows after calving. This might result in clinical or subclinical endometritis which is assumed to impair reproductive performance in the current lactation. Several cytokines and acute phase proteins have been discussed as local and systemic mediators of these inflammatory processes. The aim of the present study was to investigate the endometrial mRNA expression of the chemokine CXC ligand 5 (CXCL5), interleukin 1β (IL1B), IL6, IL8, tumour necrosis factor alpha (TNF), prostaglandin-endoperoxide synthase 2 (PTGS2) and haptoglobin (HP) in the postpartum period.

METHODS

Endometrial samples were obtained from primiparous cows (n = 5) on days 10, 17, 24, 31, 38 and 45 postpartum (pp) using the cytobrush technique. Cytological smears were prepared from cytobrush samples to determine the proportion of polymorphonuclear neutrophils (PMN). Total RNA was extracted from endometrial samples, and real-time RT-PCR was performed.

RESULTS

A time-dependent mRNA expression of the investigated factors was found for the course of the postpartum period. In detail, a significantly higher expression of these factors was observed on day 17 pp compared to day 31 pp. Furthermore, the proportion of PMN peaked between days 10-24 pp and decreased thereafter to low percentages (< 5%) on day 31 pp and thereafter. In addition, CXCL5, IL1B, IL8 and HP mRNA expression correlated significantly with the proportion of PMN (P < 0.05). A significantly higher CXCL5, IL1B, IL6, IL8, PTGS2 and TNF mRNA content was observed in samples from cows with an inflamed endometrium compared with samples from cows with a healthy endometrium (P < 0.05).

CONCLUSIONS

These results show that inflammatory cytokines and acute phase proteins are expressed in the bovine endometrium in a time-related manner during the postpartum period, with a significant expression peak on day 17 pp as a possible mucosal immune response in the uterus. The evaluation of the expression patterns of such candidate genes may reveal more information than only determining the percentage of PMN to judge the severity of an inflammation.

Risk factors for clinical endometritis in postpartum dairy cattle

Bacterial contamination of the uterine lumen after parturition occurs in most dairy cattle. The presence of clinical endometritis beyond three weeks post partum depends on the balance between microbes, host immunity, and other environmental or animal factors. The present study tested the hypothesis that clinical endometritis is associated with animal factors, such as retained fetal membranes, assisted calving and twins, as well as fecal contamination of the environment. The association between selected risk factors and the lactational incidence risk of clinical endometritis was examined in 293 animals from four dairy herds. Multivariate analysis was used to identify risk factors and quantify their relative risk (RR) and population attributable fraction (PAF) based on the proportion of cows exposed to each factor. The lactational incidence of clinical endometritis was 27% and significant risk factors for clinical endometritis were retained fetal membranes (RR=3.6), assisted calving (RR=1.7), stillbirth (RR=3.1), vulval angle (RR=1.3), primparity (RR=1.8), and male offspring (RR=1.5) but not the cleanliness of the environment or the animal. The highest PAF was associated with male offspring (0.6) so the use of sexed semen has the greatest potential to reduce the incidence of clinical endometritis. The dominant association between retained fetal membranes and clinical endometritis was supported by an expert panel of clinicians. The risk factors for clinical endometritis appear to be associated with trauma of the female genital tract and disruption of the physical barriers to infection rather than fecal contamination.

Associations between the clinical signs of chronic endometritis with ovarian cysts and body condition loss in German Holstein Friesian cows

The objective of this retrospective field study was to associate the type and smell of discharge, the size of the uterus, the ovarian and treatment status, and the time to diagnosis of animals with chronic clinical endometritis (CCE) with the incidence of ovarian cysts and with a marked loss in body condition in German Holstein Friesian cows. Two hundred and sixty-four cows diagnosed with CCE from day 14 to day 42 postpartum participated in this study. In addition, 100 days milk production and the parity of the animals were included in the analysis. With the use of logistic regression, a purulent vaginal discharge (>/= 50% pus), the decision not to treat the animals for CCE and a high 100 days milk production proved to be significant factors for the incidence of ovarian cysts. Additionally, the type of discharge showed interactions with the parity and the smell of the discharge, as more animals with fetid and purulent discharge and more animals in the first lactation with a purulent discharge developed ovarian cysts. A high milk production and the parity showed associations with an excessive body condition score loss. Additionally, more animals with a diagnosis of an oversized uterus in comparison to cows with an early involution experienced a considerable reduction in their nutritional condition.

Sensitivity to antibiotics of Arcanobacterium pyogenes and Escherichia coli from the uteri of cows with metritis/endometritis

The aim of the study was to determine the in vitro sensitivity of 161 Arcanobacterium pyogenes strains and 99 Escherichia coli strains isolated from the uteri of 312 cows with metritis/endometritis. Animals with pathological discharges were clinically diagnosed per rectum and per vaginum, and then swabs from the lumen of the uterus were aseptically collected. Bacteriological examination of swabs was according to commonly accepted procedures with the additional use of API tests. Sensitivity to antibiotics was tested by the disk diffusion method and performed in Mueller-Hinton agar. Arc. pyogenes strains were the most sensitive to amoxicillin/clavulanic acid (Amc) (97.3%), bacitracin (96.7%), ceftiofur (95.8%) and cephapirin (77.5%). E. coli strains were the most sensitive to norfloxacin (98.1%), marbofloxacin (95.8%), gentamycin (88%), Amc (80.7%) and ceftiofur (73.1%). Arc. pyogenes and E. coli were most resistant to oxytetracycline (63.7% and 31%, respectively).

Efficacy of homeopathic remedies as prophylaxis of bovine endometritis

The objective of this study was to evaluate the efficacy of 2 different homeopathic prophylactic strategies for the prevention of endometritis. The drugs used were Lachesis compositum (Lachesis), Carduus compositum (Carduus), and Traumeel LT (Traumeel). Each drug contained a mixed formula of homeopathic remedies. All 929 cows received the first treatment within 24 h postpartum. The second to fourth treatments were conducted at 7 to 13, 14 to 20, and 21 to 27 d in milk, respectively. In the first group, the 4 treatments were Traumeel, Lachesis, Carduus, and Carduus, respectively (n = 206). In the second group, Lachesis was administered 3 times, followed by 1 treatment with Carduus (n = 198). The control group received 4 injections of saline (n = 189). In the fourth week after calving, the prevalence of clinical endometritis, uterine involution, and ovarian activity was monitored by rectal palpation and by ultrasonography. To assess the resumption of ovarian activity, blood samples were taken to determine the concentration of serum progesterone. The concentrations of beta-hydroxybutyrate and nonesterified fatty acids in blood serum were examined to evaluate energy metabolism. The incidence of clinical endometritis at 21 to 27 d in milk did not differ between the groups (44.4, 44.8, and 36.9% in the Traumeel, Lachesis, Carduus, and Carduus group; the 3x Lachesis, followed by Carduus group; and the control group, respectively). The proportion of cows with cyclic activity at 21 to 27 d in milk and the proportion of cows above threshold values of progesterone, beta-hydroxybutyrate, and nonesterified fatty acids did not differ significantly between groups. When reproductive performance data were analyzed, no significant differences were found between groups. Hence, the treatment protocols tested were not effective in preventing bovine endometritis or in enhancing reproductive performance in this study.

Comparison of two methods of detecting purulent vaginal discharge in postpartum dairy cows and effect of intrauterine cephapirin on reproductive performance

OBJECTIVE

Part 1: compare the use of a Metricheck device (a stainless steel probe with a semi-spherical rubber cup attached at one end) to sample the contents of the anterior vagina with a vaginal speculum examination for the diagnosis of pus in the vagina of postpartum dairy cows and to investigate the association of that pus with reproductive performance. Part 2: assess the effect of a single intrauterine infusion of 500 mg cephapirin in cows diagnosed with vaginal purulent or mucopurulent discharge 7 to 28 days after calving on reproductive performance.

PROCEDURE

Six herds were visited fortnightly to examine cows that had calved between 7 and 28 days (n = 423) with both the Metricheck device and a vaginal speculum to score, by each method, the vaginal discharge from 0 (clear or absent) to 3 (purulent) for each animal included in the study. Half of the cows that had a positive discharge score (1 to 3 by either examination method) were then treated with an intrauterine infusion of 500 mg of cephapirin. The relationship between Metricheck score, vaginoscopy score, treatment and reproductive performance was assessed.

RESULTS

There was a substantial measure of agreement between each method when scores were analysed by status. Cows that were positive with either method had inferior reproductive performance compared with cows with a score of zero. Treatment of cows diagnosed with a purulent or mucopurulent discharge with intrauterine cephapirin improved reproductive performance in both the vaginoscopy and Metricheck groups.

Veterinary decision making in relation to metritis--a qualitative approach to understand the background for variation and bias in veterinary medical records

Background

Results of analyses based on veterinary records of animal disease may be prone to variation and bias, because data collection for these registers relies on different observers in different settings as well as different treatment criteria. Understanding the human influence on data collection and the decisions related to this process may help veterinary and agricultural scientists motivate observers (veterinarians and farmers) to work more systematically, which may improve data quality. This study investigates qualitative relations between two types of records: 1) 'diagnostic data' as recordings of metritis scores and 2) 'intervention data' as recordings of medical treatment for metritis and the potential influence on quality of the data.

Methods

The study is based on observations in veterinary dairy practice combined with semi-structured research interviews of veterinarians working within a herd health concept where metritis diagnosis was described in detail. The observations and interviews were analysed by qualitative research methods to describe differences in the veterinarians' perceptions of metritis diagnosis (scores) and their own decisions related to diagnosis, treatment, and recording.

Results

The analysis demonstrates how data quality can be affected during the diagnostic procedures, as interaction occurs between diagnostics and decisions about medical treatments. Important findings were when scores lacked consistency within and between observers (variation) and when scores were adjusted to the treatment decision already made by the veterinarian (bias). The study further demonstrates that veterinarians made their decisions at 3 different levels of focus (cow, farm, population). Data quality was influenced by the veterinarians' perceptions of collection procedures, decision making and their different motivations to collect data systematically.

Conclusion

Both variation and bias were introduced into the data because of veterinarians' different perceptions of and motivations for decision making. Acknowledgement of these findings by researchers, educational institutions and veterinarians in practice may stimulate an effort to improve the quality of field data, as well as raise awareness about the importance of including knowledge about human perceptions when interpreting studies based on field data. Both recognitions may increase the usefulness of both within-herd and between-herd epidemiological analyses.

Increased risk of conception failure in German Holstein Friesian cows with chronic endometritis

The objective of this retrospective field study was to evaluate the effect of chronic clinical endometritis (CCE) on days open in German Holstein Friesian cows. Two hundred and sixty-four cows diagnosed with CCE from day 14 to 42 postpartum were included in this study. A Cox’s proportional hazards regression model with stepwise forward selection for days open was used and the variables type of vaginal discharge, ovarian cysts and a marked loss of body condition score proved to be significant with hazard ratios of 1.5, 2.0 and 1.9 respectively. Although not remaining in the model, a weak positive effect of treatment for CCE and a negative effect of high milk production could also be found in the univariate analysis. These results suggest that the suppression of fertility of animals diagnosed with CCE varies according to the different symptoms, which could be used to support decisions regarding treatment. Management factors such as a marked loss in body condition and high milk production prolonged the number of days open of animals with CCE.

A study on postpartum metritis in Iraqi buffalo cows: bacterial causes and treatment

The objectives of the present study were to determine the relationship between bacteriological findings, clinical signs and histopathological changes in postpartum metritis. Evaluation of the treatment efficiency of using systemic or intra-uterine infusion of antibiotics with some hormonal preparations for the treatment of postpartum metritis. Data were collected from 50 buffalo cows with history of calving of more than 1 month. All buffaloes were subjected to detailed clinical examination including external inspection, vaginoscopy and transrectal palpation of the cervix, uterus and ovaries. Swabs for bacteriology and biopsies for histopathology were collected from uterine lumen from each buffalo included in the present study. Bacteria identified using API systems following aerobic and anaerobic cultures. Vaginal mucus scored for character, odour and estimation of polymorphonuclear cells (PMNs). Treatment conducted using oxytetracycline in local intrauterine infusion or systemically with hormonal treatment including prostaglandin F2 alpha (PGF2 alpha) and oestradiol benzoate. Results revealed that the most predisposing factor for postpartum uterine infection was retained placenta and toxic puerperal metritis. The most prevalent bacteria in uterine lumen were Escherichia coli, Archanobacterium pyogenes, Bacteroides fragilis and Fusobacterium necrophorum the most prevalent bacteria in buffaloes with postpartum metritis. A. pyogenes and F. necrophorum were an important pathogens causing severe uterine inflammation as found in histopathological examinations. Buffaloes with postpartum metritis showed good clinical cure when oxytetracycline injected systemically with PGF2 alpha. Intrauterine infusion of oxytetracycline had no advantage for the treatment of uterine infection in buffalo cows with postpartum metritis. PGF2 alpha improved clinical cure of buffaloes with postpartum metritis.

Uterine diseases in cattle after parturition

Bacterial contamination of the uterine lumen is common in cattle after parturition, often leading to infection and uterine disease. Clinical disease can be diagnosed and scored by examination of the vaginal mucus, which reflects the presence of pathogenic bacteria such as Escherichia coli and Arcanobacterium pyogenes. Viruses may also cause uterine disease and bovine herpesvirus 4 (BoHV-4) is tropic for endometrial cells, causing a rapid cytopathic effect. The elimination of pathogens by the innate immune system is dependent on pattern recognition receptors binding pathogen-associated molecules. Uterine epithelial and stromal cells express receptors such as Toll-like Receptor 4 that binds E. coli lipopolysaccharide. The infertility associated with uterine disease is caused by damage to the endometrium and disruption of ovarian cyclic activity. Bacteria modulate endometrial prostaglandin secretion, and perturb ovarian follicle growth and function. Understanding the molecular basis of uterine disease will lead to novel approaches to treating infertility.

Postpartum uterine infection in cattle

Postpartum uterine infections results from uterine contamination with bacteria during parturition. The prevalence of uterine infections varies considerably among studies. Uterine infection implies adherence of pathogenic organisms to the mucosa, colonization or penetration of the epithelium, and/or release of bacterial toxins that lead to establishment of uterine disease. The development of uterine disease depends on the immune response of the cow, as well as the species and number (load or challenge) of bacteria. The postpartum uterus has a disrupted surface epithelium in contact with fluid and tissue debris that can support bacterial growth. A variety of species of bacteria, both Gram-positive and Gram-negative aerobes and anaerobes, can be isolated from the early postpartum uterus. Most of these are environmental contaminants that are gradually eliminated during the first 6 weeks postpartum. A normal postpartum cow resolves uterine infection by rapid involution of the uterus and cervix, discharge of uterine content, and mobilization of natural host defenses, including mucus, antibodies and phagocytic cells. Clinical signs of uterine infection vary with the virulence of the causative organisms and the presence of factors that predispose to the disease. The treatment of endometritis and metritis in bovine should be directed towards improving fertility. The antibiotic should be active against the main uterine pathogens and should maintain its activity in the environment of the uterus. Also, should not inhibit the normal defense mechanisms and should be well tolerated and not induce irritation in the endometrium. Effective use of hormones in uterine infection requires knowledge of both normal reproductive endocrinology and the therapeutic characteristics of available hormonal preparations.

The impact of uterine infection on a dairy cow's performance

The aim of this study was to assess the predisposing factors leading to uterine infection in dairy cows and evaluate its impact on the cow's performance. Performance indicators included feed intake, milk fat and protein composition, milk yield, fertility and culling. Data were studied from 2914 completed lactations from the Holstein Friesian Langhill Dairy herd between January 1990 and August 2005. There were 402 cases of uterine infection (from 321 cows) in the Langhill herd, a level of 13.8% during the study period. Calving assistance was highly associated with the incidence of uterine infection (chi(2)=106.63, P<0.001). Failure to conceive (chi(2)=3.89, P<0.05; chi(2)=11.20, P<0.001) and culling (chi(2)=13.66, P<0.001, chi(2)=8.55, P<0.01) were also implicated with calving assistance and uterine infection, respectively. The main predisposing factors related to an incidence of uterine infection were calving assistance, twin births, malpresented calves, and retained placenta. First-time calvers and cows with a shorter gestation length were associated with more cases of uterine infections. Additionally, lower daily dry matter intakes and milk yields during the first 100 days in milk (DIM) were associated with higher incidence levels of uterine infection. Also, a higher incidence level of uterine infection was related to lower milk protein composition from 1 to 21 DIM and a poorer body condition from 101 to 300 DIM. Cows with poorer drying off body condition scores and longer lactation lengths were associated with a higher incidence level of uterine infection. Calving assistance was associated with male and twin births, first-time calvers and cows with oversized calves. Cows with an assisted calving were also associated with an increased number of days from calving to first service. The predisposing factors influencing the occurrence of calving assistance can be influenced by suitable management to reduce the chances of oversized calves, the detrimental effects of twin births (such as calving assistance and retained placentas) and prenatal knowledge of the calf's sex. The occurrence of uterine infection can be reduced by minimising the need for assistance at calving. Assistance should only be carried out when necessary and appropriate hygiene should be used to decrease the incidence of uterine infections from intervention and involuntary culling due to cows failing to conceive.

Bacterial complications of postpartum uterine involution in cattle

The bacterial contamination of the postpartum uterus is a frequent finding which by itself does not disturb the anatomical and histological restoration of tubular genital tract. The improper balance between uterine infection and the intrauterine antimicrobial self-defence mechanisms, however, often results in complications, such as puerperal metritis, clinical endometritis, pyometra and subclinical endometritis. After reviewing the bacteriology of uterine involution, and the predisposing factors for its bacterial complications, this paper defines the different clinical forms, and summarizes their pathology, furthermore, the recent progress in diagnostic considerations and principles of current treatments for these diseases of bovine genitals.

Milking Frequency, Estradiol Cypionate, and Somatotropin Influence Lactation and Reproduction in Dairy Cows

Our objectives were to determine lactational and reproductive outcomes in response to increased milking frequency (MF), injection of estradiol cypionate (ECP), and treatment with bovine somatotropin (bST). Lactating dairy cows (n = 144) were blocked by lactation number (1 vs. 2+) and assigned randomly to a 2 x 2 x 2 factorial experiment consisting of 8 treatment combinations: 1) MF consisting of 4x daily milking (4x) for the first 30 d in milk (DIM) vs. 2x daily milking (2x), with all cows milked 2x after 30 DIM; 2) 10 mg of ECP given postpartum at 8 +/- 3 DIM versus controls that received ECP diluent (oil); and 3) biweekly bovine somatotropin (bST), starting sometime after 60 DIM, versus no bST. Ovulation before the first artificial insemination was synchronized by using Heatsynch (GnRH injection 7 d before PGF2alpha followed in 24 h by ECP), and cows were artificially inseminated after detected estrus or at 48 h after ECP, whichever came first. Pregnancy was assessed by transrectal ultrasonography 28 to 30 d after artificial insemination. Daily yield and weekly components of milk were measured during the first 90 DIM. Intervals to first and second postpartum ovulation were unaffected by treatment, but cows were in estrus earlier after 2x (24 +/- 4 d) than 4x (41 +/- 4 d) daily MF, and sooner after ECP (25 +/- 3 d) than after oil (39 +/- 4 d) treatment. Pregnancy rates among 4x cows increased for ECP versus oil (52.8 vs. 27.8%) more than for cows with 2x MF treated with ECP versus oil (50.0 vs. 39.4%). Increased MF increased daily milk yields and energy-corrected milk yields during the first 30 DIM. Although milk yields were increased acutely by ECP during the 10 d after its injection, subsequent milk yields were decreased for ECP-treated cows previously milked 4x daily. Treatment with bST increased overall daily milk yields most in cows previously milked 2x daily and treated with oil and those milked 4x daily and treated with ECP. We concluded that early postpartum ECP injection increased pregnancy rates, but generally had detrimental effects on milk yields after 30 DIM for ECP-treated cows previously milked 4x daily, unless those cows also were treated with bST.

Defining postpartum uterine disease in cattle

Uterine function is often compromised in cattle by bacterial contamination of the uterine lumen after parturition, and pathogenic bacteria often persist, causing uterine disease, a key cause of infertility in cattle. However, the definition or characterization of uterine disease frequently lacks precision or varies among research groups. The aim of the present paper was to provide clear clinical definitions of uterine disease that researchers could adopt. Puerperal metritis should be defined as an animal with an abnormally enlarged uterus and a fetid watery red-brown uterine discharge, associated with signs of systemic illness (decreased milk yield, dullness or other signs of toxemia) and fever > 39.5 degrees C, within 21 days after parturition. Animals that are not systemically ill, but have an abnormally enlarged uterus and a purulent uterine discharge detectable in the vagina, within 21 days post partum, may be classified as having clinical metritis. Clinical endometritis is characterised by the presence of purulent (> 50% pus) uterine discharge detectable in the vagina 21 days or more after parturition, or mucuopurulent (approximately 50% pus, 50% mucus) discharge detectable in the vagina after 26 days post partum. In the absence of clinical endometritis, a cow with subclinical endometritis is defined by > 18% neutrophils in uterine cytology samples collected 21-33 days post partum, or > 10% neutrophils at 34-47 days. Pyometra is defined as the accumulation of purulent material within the uterine lumen in the presence of a persistent corpus luteum and a closed cervix. In conclusion, we have suggested definitions for common postpartum uterine diseases, which can be readily adopted by researchers and veterinarians.

Association between endometritis diagnosis using a novel intravaginal device and reproductive performance in dairy cattle

Endometritis reduces reproductive performance in dairy cattle. Diagnosis of endometritis is undertaken using a variety of techniques including vaginoscopy, manual examination, cytology and ultrasonography. The current studies compared a novel test device ("metricheck") that is inserted into the vagina with vaginoscopy and then examined the relationship between the metricheck test score at 35 days before the start of the seasonal breeding programme and subsequent reproductive performance. Cows (n = 191; Study 1) with a history of a peripartum disease were examined by both vaginoscopy and the metricheck device and any material viewed within the vagina (using vaginoscopy) or retrieved (by the metricheck device) was scored on a 0 (no material) to 5 (grossly purulent and with an odour) scale. Within each herd the order of examination was randomized with sequentially presented pairs of cows. All cows (n = 2793; Study 2) from nine herds were examined and scored using the metricheck device 35 days before the start of the seasonal breeding programme. All cows were pregnancy tested to determine date of conception. In Study 1, more cows were defined as infected (i.e. score > 1) following metricheck than vaginoscopic examination (60% versus 43%, respectively; P < 0.05) and the level of agreement between the two tests was moderate (kappa = 0.45). The metricheck device had a higher sensitivity, but lower specificity, than vaginoscopy. Endometritis (i.e. score > 1) was detected in 21.2% of cows examined in Study 2. The prevalence of endometritis varied among herds, declined with time postpartum (P < 0.05) and was higher in cows recorded as having a peripartum disease (P < 0.01). Cows diagnosed with endometritis were at higher risk of not being detected in oestrus before the start of breeding (P < 0.01), took longer to be inseminated after the start of the seasonal breeding programme (P < 0.01), had a lower first service conception rate (P < 0.01), had lower 56-day and final pregnancy rates (P < 0.05) and took longer to conceive than cows without endometritis (P < 0.05). It is concluded that examination with the metricheck device is more sensitive in detecting endometritis than vaginoscopy. Diagnosis of endometritis with the metricheck device was associated with poorer subsequent reproductive performance.

Use of the cow as a large animal model of uterine infection and immunity

For most of the reproductive cycle in both humans and animals, the uterus is clear of pathogenic bacteria. However, it is readily contaminated with pathogens, such as Escherichia and Tritichomonas species, during sexual intercourse and after parturition. Uterine infection is particularly common after parturition in cattle (Bos taurus), causing clinical disease and infertility. The endocrine and immune responses to uterine infection in cattle have been investigated in vivo and using tissue culture. Cattle are of sufficient size to permit monitoring of reproductive and immune function throughout uterine infections, and primary cell cultures are readily established. In the whole animal, uterine infections suppress GnRH and LH secretion, and inhibit the growth of ovarian follicles and their estradiol secretion. The immune response is characterized by an influx of neutrophils into the uterus and increased concentrations of acute phase proteins in peripheral plasma. In vitro, the endometrial and ovarian cell function is modified by challenge with bacteria, their products such as lipopolysaccharide or pro-inflammatory cytokines. However, it is interesting to note that the susceptibility to uterine infection and the immune response are partially regulated by the ovarian steroid hormone mileu. In conclusion, the ease of working with cattle, the availability of tissues and the similarity of uterine infection between mammals, make Bos taurus a good model for studying uterine infection and immunity.

Effect of presence of clinical and subclinical endometritis at the initiation of Presynch-Ovsynch program on the first service pregnancy in dairy cows

The present study examined the effect of presence of clinical or subclinical endometritis at the initiation of Presynch-Ovsynch estrous synchronization program on the first service pregnancy rate in dairy cows. Lactating Holstein cows (N=275) were given a thorough reproductive examination at 32-38 days in milk, 3 days prior to the scheduled start of Presynch-Ovsynch program. Based on the reproductive exam findings the cows were diagnosed and classified into three groups as clinical endometritis, subclinical endometritis and normal. All cows received two set-up injections of 25mg PGF(2alpha) (Lutalyse((R)), Pfizer Animal Health, New York, NY, USA) i.m., 14 days apart starting at 35-42 days in milk (DIM). All cows received 75microg of GnRH (Cystorelin, Merial, Iselin, NJ, USA) i.m. 14 days after the second pre-synchronization injection of PGF(2alpha), followed by a third injection of 25mg PGF(2alpha) i.m. 7 days later. Cows received a second injection of 75microg of GnRH i.m. 54h after the third PGF(2alpha), and received timed artificial insemination at the time of the second GnRH injection or 24h later. Multivariate logistic regression was used to analyze the odds of pregnancy at the first service. Variables included in the model were endometritis status (clinical endometritis, subclinical endometritis and normal), farm (two), presence of corpus luteum (CL, yes or no), timing of second GnRH in relation to AI (0 or 24h), sire fertility (bulls with greater compared with lesser estimated relative conception rates), parity (primiparous and multiparous) and their interactions. Of all variable included in the model, cows with corpus letuem (OR=1.83 versus OR=1.00; P=0.05) 3 days prior to the scheduled start of Presynch-Ovsynch program and primiparous cows (OR=1.00 versus OR=0.55; P=0.04) had increased odds of becoming pregnant at the first service. No differences were found in the odds of first service pregnancy among clinical, subclinical endometritis and normal cows (P>0.1). In summary, presence of clinical or subclinical endometritis at the initiation of Presynch-Ovsynch estrous synchronization program does not harm the first service pregnancy rate in dairy cows.