Impact of ovarian and uterine conditions on some diagnostic tests output of endometritis in postpartum high-yielding dairy cows

Predisposing factors, diagnostic and therapeutic aspects of persistent endometritis in postpartum cows

A certain level of endometrial bacterial infection and inflammation is involved in bovine uterine involution during the puerperal period. Factors that hamper normal uterine involution expose the uterine environment to pathological conditions, causing different endometritis levels. The lack of proper diagnostic tools extends the time to conception. Efforts have been made to elucidate the postpartum uterine environment, including bacterial flora, changes in transient endometrial inflammation, and the pathophysiology of endometritis, to improve bovine reproductive performance. E. coli and Trueperella pyogenes in the uterus are likely to cause persistent infection, and Mycoplasma bovigenitalium infection is associated with dystocia and cytological endometritis in postpartum dairy cows. Due to the widespread use of cytobrush as a diagnostic tool for bovine subclinical endometritis (SE) that enables quantification of the degree of inflammation, we found that endometritis at week 5 postpartum was associated with delayed first ovulation. Approximately 30% of open cows have SE during the postpartum period, and cows with low blood glucose during prepartum have a high risk of developing SE. Additionally, cows with purulent vaginal discharge do not always have endometritis but only vaginitis and/or cervicitis. Intrauterine infusion of polyvinylpyrrolidone-iodine (PVP-I) improves fertility and promotes endometrial epithelial cell regeneration after inducing transient uterine inflammation, suggesting that PVP-I could be a good alternative to antibiotics. In conclusion, prepartum management to prevent glucose deficiency, prompt diagnosis to identify causative agents and intrauterine inflammation levels, and appropriate treatment to minimize antimicrobial resistance is beneficial for tackling endometritis and improving reproductive performance in bovine herds.

Research of postpartum endometritis in Japanese Black cattle with cystic ovarian disease by vaginal mucus test and endometrial cytology

The relationship between endometritis and cystic ovarian disease (COD) is still unclear in Japanese Black cattle. Endometritis is classified into clinical endometritis (CE) and subclinical endometritis (SE). The objective of this study was to clarify the interaction between postpartum endometritis (CE and SE) and COD in Japanese Black cattle. Twenty-six suckled cows with COD (COD group) and 16 suckled cows with cyclical ovarian activity (CA group) were submitted for the experiment. Uterine conditions of cows were classified into three groups (normal, CE, and SE) with vaginal mucus test and endometrial cytology. The combined data of CE and SE were represented as data for total endometritis (EMT total). The prevalence of EMT total in the COD group (42.3 %, 11 / 26 ) was significantly higher than that of the CA group (12.5 %, 2 / 16 ). The mean percentage of polymorphonuclear neutrophils (PMN %) in the COD group was significantly higher than that of the CA group at 40-60 DPP (days postpartum). Compared to 61-295 DPP, the mean PMN % at 40-60 DPP was significantly higher in the COD group. The diameters of uterine horn and cervix did not differ among normal uterine condition, CE and SE in the COD group, and they did not differ between normal uterine condition and SE in the CA group. However, endometrial thickness during both 40-60 and 61-295 DPP were greater in the COD group than in the CA group. In conclusion, Japanese Black cattle with COD have a potential implication on endometritis at 40-60 DPP compared to the normal ovarian cycle. As a specific symptom was not observed by transrectal ultrasonography, endometrial cytology is effective for diagnosis of SE in Japanese Black cattle.

Relationship of vaginal discharge characteristics evaluated by Metricheck device to metabolic status in postpartum dairy cows

The relationship between vaginal discharge characteristics and metabolic status has been studied in postpartum dairy cows. Vaginal discharges at 2-6 weeks postpartum were scored weekly on a 1 (clear) to 5 (purulent material with stench) scale using the Metricheck device and classified into three groups as follows: Endometritis group (n = 19), greater than or equal to score 4 until 3 weeks postpartum; Delayed involution group (n = 9), score 2 or 3 after having score 1; Healthy group (n = 23), cows except those belonging to the Delayed involution and Endometritis groups. The uterus and cervix were assessed using ultrasonography. Blood samples were collected twice weekly from 1 to 6 weeks postpartum from all cows and were additionally obtained for 13,14-dihydro-15-keto-prostaglandin F2α (PGFM) measurements from multiparous cows. Cows with delayed involution had delayed onset of luteal activity (p < 0.05) and higher serum urea nitrogen (BUN) concentrations (p < 0.01) than healthy animals. Cows with endometritis had more peripartum diseases (p < 0.05), lower milk yield (p < 0.05), longer cervix diameter (p < 0.05), and lower serum albumin (p < 0.01), total cholesterol (p < 0.01), and magnesium (p < 0.01) concentrations, and higher aspartate aminotransferase levels (p < 0.05) than healthy cows. Plasma PGFM concentrations tended to be higher in the Delayed involution group (p = 0.083) and lower in the Endometritis group (p = 0.085) than in the Healthy group. In summary, delayed involution was shown to be associated with higher BUN concentration, and endometritis may have been caused by peripartum diseases and hepatic dysfunction.

Effect of diagnosis and treatment of clinical endometritis based on vaginal discharge score grading system in postpartum Holstein cows

In this study, the prevalence, effectiveness of diagnosis, and treatment based on vaginal discharge score (VDS) of clinical endometritis in cattle were evaluated. To detect clinical endometritis and classify its severity, vaginoscopy was performed during 21 to 60 days postpartum in 164 Holstein cows consisting of 229 lactations. Groups were defined using the 4-point VDS scale. Study groups included the following: non-endometritis (VDS=0; no/clear mucus; NEM group; n=168); mild endometritis, no treatment (VDS=1; mucus containing flecks of white/off-white pus; NTR group; n=30); and severe endometritis, treated with PGF2α (VDS≥2; discharge containing <50% pus; and VDS=3; discharge containing >50% pus, and fluid or uterine horn asymmetry; TEM group; n=31). Cows treated with PGF2α that did not recover (VDS≥1, n=5) received intrauterine procaine penicillin and streptomycin. Prevalence of clinical endometritis (VDS≥1) was 26.6%. The NTR group required significantly more artificial inseminations per pregnancy than NEM and TEM groups (2.8 ± 1.8 vs 2.0 ± 1.3, 1.9 ± 0.8, P<0.05). In survival analysis, the proportion of non-pregnant cows was higher in the NTR group compared to the NEM (P=0.012) and TEM (P=0.076) groups. In the TEM group, calving to first artificial insemination interval tended to be higher in cows treated 41 to 60 days postpartum than cows treated 29 to 40 days postpartum (97.2 ± 27.1 vs 74.4 ± 19.7, P=0.084). Our study suggests that cows with VDS=1 may require treatment to recover fertility. Diagnosis and treatment of clinical endometritis based on a VDS grading system may improve dairy herd reproductive performance.

Invited review: Systematic review of diagnostic tests for reproductive-tract infection and inflammation in dairy cows

The objective of this study was to conduct a systematic and critical appraisal of the quality of previous publications and describe diagnostic methods, diagnostic criteria and definitions, repeatability, and agreement among methods for diagnosis of vaginitis, cervicitis, endometritis, salpingitis, and oophoritis in dairy cows. Publications (n=1,600) that included the words "dairy," "cows," and at least one disease of interest were located with online search engines. In total, 51 papers were selected for comprehensive review by pairs of the authors. Only 61% (n=31) of the 51 reviewed papers provided a definition or citation for the disease or diagnostic methods studied, and only 49% (n=25) of the papers provided the data or a citation to support the test cut point used for diagnosing disease. Furthermore, a large proportion of the papers did not provide sufficient detail to allow critical assessment of the quality of design or reporting. Of 11 described diagnostic methods, only one complete methodology, i.e., vaginoscopy, was assessed for both within- and between-operator repeatability (κ=0.55-0.60 and 0.44, respectively). In the absence of a gold standard, comparisons between different tests have been undertaken. Agreement between the various diagnostic methods is at a low level. These discrepancies may indicate that these diagnostic methods assess different aspects of reproductive health and underline the importance of tying diagnostic criteria to objective measures of reproductive performance. Those studies that used a reproductive outcome to select cut points and tests have the greatest clinical utility. This approach has demonstrated, for example, that presence of (muco)purulent discharge in the vagina and an increased proportion of leukocytes in cytological preparations following uterine lavage or cytobrush sampling are associated with poorer reproductive outcomes. The lack of validated, consistent definitions and outcome variables makes comparisons of the different tests difficult. The quality of design and reporting in future publications could be improved by using checklists as a guideline. Further high-quality research based on published standards to improve study design and reporting should improve cow-side diagnostic tests. Specifically, more data on intra- and interobserver agreement are needed to evaluate test variability. Also, more studies are necessary to determine optimal cut points and time postpartum of examination.

Association among energy status, subclinical endometritis postpartum and subsequent reproductive performance in Egyptian buffaloes

Sixty pluriparous, clinically normal buffalo cows (n=60) were used to investigate the relationships between metabolic status, subclinical endometritis and reproductive performance. Subclinical endometritis was diagnosed by endometrial cytology (EC) and ultrasonography (US) during weeks 4-9 postpartum (pp). A comparative assessment of these diagnostic approaches was made with respect to reproductive outcomes. Blood samples were collected on a weekly basis from weeks 4 to 9 in order to estimate some blood metabolites including blood glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). Reproductive tract examination was carried out weekly from weeks 4 to 9 by endometrial cytology (percentage of polymorphonuclear cells; PMN%) and Ultrasonography (detection of fluid in uterus regardless to its amount or echogenicity; FIU). The percentage of buffalo cow suffering from subclinical endometritis as diagnosed by endometrial cytology was significantly (P<0.01) higher in non-pregnant cows (80%) at weeks 4 and 5 (60%) pp when compared with pregnant animals (0). HDL-c concentration was significantly lower (P<0.05) in cytologically diagnosed ENDM group (15.4±0.7mg/dl) if compared to NOENDM group (25.0±3.1mg/dl) during week 4 pp. During week 5 pp, triglycerides concentration was significantly high (P<0.05) in ENDM group, as diagnosed by the presence of FIU (184.6±12.4mg/dl) if compared to NOENDM group (102.7±30.6mg/dl). Total cholesterol concentration was significantly lower (P<0.01) in ENDM group (51.9±0.5mg/dl) than that of NOENDM group (85.9±2.0mg/dl) during week 6 pp. In conclusion, Weeks 4 and 5 pp are the best times to identify cytologically diagnosed endometritis. Furthermore, glucose and total cholesterol indicated that energy status is not a risk factor for cytologically diagnosed subclinical endometritis in buffalo cows.

Influences of metabolic traits on subclinical endometritis at different intervals postpartum in high milking cows

Seventy pluriparous high-yielding cows were used to investigate the impact of metabolic traits and body condition score (BCS) during early lactation on subclinical endometritis diagnosed at weeks 5, 6 and 7 postpartum (pp). Blood samples were collected from animals with no peripartum problems from the second (W2) to seventh (W7) weeks pp to estimate some blood metabolites including non-esterified fatty acids (NEFA), β-hydroxybutyric acid (BHBA), blood glucose, total cholesterol (T-chol) and blood urea nitrogen (BUN). Reproductive tract examination was carried out at weeks 5, 6 and 7 pp by endometrial cytology (percentage of polymorphonuclear cells; PMN%). Based on PMN%, animals having <5% were defined as subclinical endometritis group (ENDM group) while animals unaffected by endometritis were defined as no subclinical endometritis group (NOENDM group). Animals with endometritis during week 5 were identified as ENDM5, during week 6 identified as ENDM6 and during week 7 identified as ENDM7 or animals with no endometritis during weeks 5 (NOENDM5), 6 (NOENDM6) and 7 (NOENDM7) pp. Animals diagnosed at week 5; BUN and BCS were lower p < 0.05 in ENDM 5 than NOENDM5 group at W2, W4, W6 and W7. Cows diagnosed at week 6; T-chol was significantly higher (p = 0.05) in ENDM6 group (279.2 ± 12.5 mg/dl) than NOENDM6 group (246 ± 9.5 mg/dl) at W7. Moreover, blood glucose was significantly low (p < 0.05) in ENDM6 group when compared to NOENDM group at W4 pp (49.2 ± 1.8 vs 53.8 ± 1.3 mg/dl). BCS was significantly lower (p < 0.001) in animals suffered from endometritis during week 7 when compared to NOENDM7 cows at W3, W4, W5, W6 and W7. In conclusion, lower blood glucose, BUN and BCS could be a risk factor for cytologically diagnosed endometritis at weeks 5, 6 and 7 pp.