Use of postpartum vaginoscopic (visual vaginal) examination of dairy cows for the diagnosis of endometritis and the association of endrometritis with reduced reproductive performance

Combined effect of purulent vaginal discharge and anovulation on pregnancy status in a large multi-state population of Holstein cows

The objective of this observational prospective cohort study was to evaluate the combined effect of purulent vaginal discharge (PVD) and anovulation (ANOV) on the reproductive performance of a large multi-state population of Holstein cows. Data were prospectively collected from 11,729 cows in 16 herds located in 4 regions in the United States [Northeast (4 herds), Midwest (6), Southeast (1), and Southwest (5)]. Cows were enrolled at calving and monitored weekly for disease occurrence, reproductive events, and survival. Prevalence of PVD was evaluated at 28 ± 3 d in milk and defined by the presence of mucopurulent to fetid vaginal discharge. Resumption of ovarian cyclicity was determined via transrectal ultrasonography at 40 ± 3 and 54 ± 3 d postpartum. Pregnancy diagnosis was performed by ultrasonography on d 32 ± 3 after artificial insemination (AI) and reconfirmed at d 60 ± 3 of gestation. Pregnancy loss (PL) was defined as a cow diagnosed pregnant at 32 ± 3 but nonpregnant at 60 ± 3 d after AI. The association of PVD and ANOV with pregnancy traits was analyzed using 4 PVD-cyclicity categories that considered the following combinations: NPVD-CYC = absence of PVD and cycling; PVD-CYC = presence of PVD and cycling; NPVD-ANOV = absence of PVD and anovular; and PVD-ANOV = presence of PVD and anovular. Multiple logistic regression and Cox proportional regression were used for the analysis of potential associations between PVD and cyclicity categories and pregnancy at first AI (PAI1), days from calving to pregnancy, and PL at first AI. The odds (95% confidence intervals) of pregnancy increased from cows in the PVD-ANOV category (reference category) to cows in NPVD-ANOV [2.09 (1.62-2.50)], PVD-CYC [2.52 (2.02-3.14)], and NPVD-CYC [3.46 (2.84-4.23)]. Similarly, days from calving to pregnancy were less for NPVD-CYC, followed by PVD-CYC, NPVD-ANOV, and PVD-ANOV (121.4, 137.2, 137.3, and 157.4 d, respectively). On the contrary, no clear association was identified between groups and PL. The results indicate that both PVD and ANOV had a negative impact on PAI1 and days from calving to pregnancy. The results indicated a variable magnitude in the negative impact on the reproductive traits analyzed when both conditions were combined.

Using vaginal discharge score (VDS) grading system to evaluate the effect of clinical endometritis on reproductive performance of dairy cows in China

Clinical endometritis (CE) is a major cause in affecting the reproductive performance of dairy cows. The objectives of this study were to ascertain the prevalence of CE and to evaluate the effect of CE on reproductive performance in dairy cows using vaginal discharge score (VDS) grading system. 803 dairy cows were examined by vaginoscope with 4-point VDS at 26 ± 3 days in milk (DIM) and classified into six groups: non-endometritis with VDS 0 (control; CON), endometritis with VDS 1 (MEM), non-treated endometritis with VDS 2 (NTME), treated endometritis with VDS 2 (TME), non-treated endometritis with VDS 3 (NTPE), and treated endometritis with VDS 3 (TPE). Cows in TME and TPE groups were treated with 200 mL of 50% dextrose solution by intrauterine infusion. The prevalence of CE was 33% at 26 ± 3 DIM. Binary logistic regression analysis revealed cows in MEM, NTME and NTPE groups had a less likelihood of first artificial insemination (AI) pregnancy than those in CON group (P < 0.05). Kaplan-Meier survival curves for days open were statistically different (P = 0.004). In Cox regression model, cows in NTME and NTPE groups had a reduced pregnancy rate than those in CON group (P < 0.05). The hazard of pregnancy in NTME group was lower than that in TME group (P = 0.044). Similarly, it was lower for the hazard of pregnancy in NTPE group than in TPE group (P = 0.048). Cows in MEM, NTME, and NTPE groups required more services per pregnancy than those in CON group (P < 0.05). In conclusion, CE examined by the VDS grading system impaired reproductive performance, and mild endometritis with VDS 1 should be treated in the early postpartum period to ameliorate fertility in dairy herds.

Predicting the probability of conception in dairy cows with clinical endometritis based on a combination of anamnestic information and examination results

The objective of this study was to improve prediction of the probability of conception in dairy cows with clinical endometritis by means of a combination of examination results. For this purpose, a total of 1386 dairy cows were screened for clinical endometritis and data from 286 cows were collected including the calving history, puerperal or concurrent diseases and cow-specific data (breed, parity, BCS at puerperal control 1 (PC 1 = 22-45 days in milk (DIM)), and daily milk yield). The diagnosis of clinical endometritis was made at PC 1 by vaginal discharge scoring with a Metricheck device on a scale from 1 to 3 (endometritis score (ES) 1 to 3). A detailed clinical and gynecological examination including external inspection, transrectal palpation and ultrasonographic examination of the genital tract (cervix, uterus, and ovaries), vaginoscopy and microbiological analysis of the intrauterine content were performed. All cows with clinical endometritis (n = 286) were treated according to the ovarian findings (corpus luteum, dominant follicle) at PC 1. A second puerperal control was performed 21 ± 1 days later. Data was collected until 200 DIM. The risk factors for ES 3 and their effect on the distribution of ES were determined by the Chi-square test and binary logistic regression. Multivariable implications of a large sum of examination parameters on the pregnancy outcome at different DIM (100, 150 and 200 DIM) were analyzed on the basis of conditional inference trees. The prevalence of clinical endometritis was 28%. The ovarian findings at PC 1 did not have any impact on reproductive performance. Puerperal diseases prior to the study, visible vaginal discharge (VVD) and the presence of Trueperella pyogenes (TP) were associated with an ES 3. The prediction of pregnancy status for all DIM times was dominated significantly by VVD or TP as decisive factors. Cows with VVD or TP had lower conception rates at all DIM times than cows without these findings, but the predictive accuracy was similar for both groups. These results suggest that VVD is a valuable and practical examination parameter, which can be used for pregnancy prediction on farm. Therefore, it might facilitate early breeding decisions in cows with clinical endometritis under farm conditions.

Impact of endometritis on post-partum ovarian cyclicity in dairy cows

Endometritis in dairy cows is a major global issue and has been associated with a decrease in reproductive performance. The aim of this study was to quantify the effect of endometritis (as defined by the presence of any abnormal vaginal discharge after 21 days post-partum) on post-partum ovarian cyclicity in dairy cows. Milk progesterone analysis was used to monitor reproductive cyclicity in 170 dairy cows across three different commercial herds. Associations between the occurrence of endometritis and the incidence risk of a variety of atypical cycle profiles during the calving to conception period were investigated to establish the importance of endometritis on post-partum ovarian activity. Endometritis increased the incidence odds of atypical ovarian profiles (P < 0.05) with prolonged luteal activity being the most affected (P < 0.05), but also showed prolonged time (3 days) to onset of luteal activity after parturition (P < 0.05). Using milk progesterone analysis, we found a relatively low incidence odds for reproductive cycle problems in healthy cows during the calving to conception period. However, the incidence odds of cycle problems, in particular prolonged luteal activity, were high in cows that had experienced endometritis, which would have significantly impaired reproductive function.

Cytological endometritis and its agreement with ultrasound examination in postpartum beef cows

Background::

Endometritis, which is one of the most common diseases in dairy cows postpartum, causes severe economic losses, including increased open days, calving intervals, and numbers of services to achieve conception.

Aim::

This study aimed to evaluate the ultrasound method and its agreement with the endometrium cytology method, which is used to diagnose cytological endometritis in beef cows. Moreover, we determined which method has higher sensitivity and specificity at 4 and 5 weeks postpartum.

Materials and Methods::

The study was conducted 20-35 days postpartum. A total of 53 clinically healthy beef cows (28 Brangus and 25 Kedah–Kelantan breeds) from three beef farms were obtained. All cows were evaluated at 4 and 5 weeks postpartum, using ultrasound and cytobrush endometrial examination methods to diagnose cytological endometritis.

Results::

Endometrial cytology result showed that 11.3% (6/53) and 9.4% (5/53) of the cows exhibited cytological endometritis 4 and 5 weeks postpartum, respectively. A weak-to-moderate agreement found between the diagnostic methods (k=0.29 - 0.50; p<0.01 and k=0.38 - 0.49) at 4 and 5 weeks postpartum respectively.

Conclusion::

The percentage of beef cows that were positive to cytological endometritis was low (polymorphonuclear cells, ≥8%) at 4 and 5 weeks postpartum. Results showed that the ultrasound method is useful and practical for diagnosing endometritis 4 and 5 weeks postpartum. This method exhibited 60% sensitivity, 93.8% specificity, and a 0.50 kappa value, especially when presence of intrauterine fluids and measurement of cervix diameter used in combination.

Treatment of clinical endometritis in dairy cows by previously used controlled internal drug release devices

Postpartum endometritis is considered as one of the diseases that lead to a potential profit reduction in dairy cows. The aims of the present study were to promote follicle growth by a previously used controlled internal drug release (CIDR) device and to evaluate its effect on the likelihood of recovery and the reproductive performance of clinical endometritis (CE) cows. Endometritis was diagnosed using ultrasonographic examination at 31 ± 3 (Day 0 of the experiment) days in milk, and CE cows were included in one of the three experimental groups according to the presence of a CL on their ovaries. Cows without CL on their ovaries received a reused CIDR device, which was previously used for 14 days (CIDR-14, n = 108), or PGF2α (PG-1, n = 112) on Day 0. In the third group, those with CL on their ovaries received PGF2α (PG-2, n = 107) at the same time. Ovarian structures, serum estradiol and progesterone concentrations were measured on Days 0, 7, and 14. Controlled internal drug release devices were removed, and response to treatment was evaluated in all treated cows on Day 14. Diameters of ovarian follicles were 11.61 ± 0.50, 12.46 ± 0.25, and 18.36 ± 0.60 mm on Day 7 and 11.63 ± 0.58, 14.35 ± 0.40, and 21.96 ± 0.77 mm on Day 14 in PG-1, PG-2, and CIDR-14 cows, respectively (P < 0.05). Serum estradiol concentrations were higher in CIDR-14 cows (141.17 ± 1.04 pg/mL) than in PG-1 (116.85 ± 1.05 pg/mL) and PG-2 (119.10 ± 1.05 pg/mL) cows on Day 7 (P < 0.05). Higher progesterone concentrations were observed in PG-2 cows than in PG-1 and CIDR-14 cows on Days 0, 7, and 14 (P < 0.001). The likelihood of clinical cure was 54.46%, 62.61%, and 64.81% in PG-1, PG-2, and CIDR-14 cows, respectively (P = 0.11). First-service conception risk, days to the first service, calving to conception interval, proportion of cows bred and pregnant by 120 days in milk did not differ among the treated groups (P > 0.05). The cumulative pregnancy risk was lower in PG-1 (77.67%) cows than in CIDR-14 (87.07%) and PG-2 (87.85%) cows (P = 0.02). In conclusion, reused CIDR would be contributed to the treatment of CE by promotion of follicle growth and induction of sustainable sources of endogenic estrogen secreted by the dominant follicle.

Effect of intrauterine dextrose on reproductive performance of lactating dairy cows diagnosed with purulent vaginal discharge under certified organic management

The objectives of the study were to assess responses to treatments (clinical cure and resumption of estrous cycles) of cows with purulent vaginal discharge (PVD) that received intrauterine infusion of a hypertonic solution of 50% dextrose (DEX) or untreated control (CON) cows and the subsequent pregnancy per artificial insemination (PAI) in cows with and without PVD. Cows (n=2,852) from 2 dairy herds were screened for PVD using the gloved hand technique at exam 1 [26±3 d in milk (DIM)]. Cows with vaginal discharge scores of 2 or 3 (0-3 scale) were stratified by parity and randomly allocated into 1 of 2 treatment groups: (1) intrauterine infusion (~200 mL) of 50% DEX solution (n=456), or (2) untreated control animals (CON, n=491). Fourteen days posttherapy (40±3 DIM), cows with PVD were re-examined at exam 2 (40±3 DIM) to assess the response to treatments. All cows were subjected to the same reproductive program, which consisted of estrus detection twice daily (using tail chalking and visual observation) for the first 5 artificial inseminations; then, open lactating cows were turned out with bulls. Cows displaying signs of standing estrus underwent AI and no reproductive hormones were used. Pregnancy diagnosis (PD) was performed via transrectal palpation at 40±3 d post-AI. The risk of culling within 14 d posttherapy was not different among treatment groups. Cows with PVD had greater cervical diameter at exam 1 and decreased PAI compared with cows without PVD. Treatment with DEX increased the proportion of cows with clear vaginal discharge (clinical cure) and cyclicity 14 d posttherapy compared with CON cows. Pregnancy per AI for DEX (29.2±2%) cows was significantly greater than that for CON (22.5±2%) cows. Cows without PVD had a greater proportion of cycling cows (65.6%) and PAI (37%) with reduced pregnancy losses (5.7%) compared with DEX or CON cows. The use of intrauterine DEX alone improved reproductive performance of cows with PVD.

Transition diseases in grazing dairy cows are related to serum cholesterol and other analytes

The objectives of this study were to describe the incidence of postpartum disease and to evaluate the association with serum cholesterol concentrations during the first 3 weeks after calving in grazing dairy cows. The association between non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), calcium and postpartum diseases was also evaluated. A total of 307 Holstein dairy cows from 6 commercial grazing herds in Osorno, Chile, were monitored from calving until 21 days in milk. Cases of retained placenta, clinical hypocalcemia and clinical mastitis were recorded by the farmer using established definitions. Twice weekly, cows were evaluated for metritis by the same veterinarian based on vaginal discharge and body temperature. Postpartum blood samples were collected weekly and analyzed for serum concentrations of cholesterol, NEFA, BHBA and calcium. Cows were considered as having subclinical ketosis if BHBA >1.2 mmol/L, and subclinical hypocalcemia if calcium <2.0 mmol/L in any of the 3 weekly samples. Overall, 56% of the cows studied developed at least one clinical or subclinical disease after calving. Incidence of individual diseases was 8.8% for retained placenta, 4.2% for clinical hypocalcemia, 11.7% for clinical mastitis, 41.1% for metritis, 19.9% for subclinical hypocalcemia and 16.6% for subclinical ketosis. Lower postpartum cholesterol in cows was associated with developing severe metritis or having more than one clinical disease after calving. For every 0.4 mmol/L decrease in serum cholesterol cows were nearly twice as likely to be diagnosed with multiple clinical diseases after calving. Higher BHBA concentrations and lower calcium concentrations during week 1 were associated with severe cases of metritis. Low serum calcium concentration during week 1 was also associated with developing more than one clinical disorder after calving. In conclusion, the incidence of postpartum diseases can be high even in grazing herds and lower serum cholesterol concentrations were associated with occurrence of clinical postpatum disorders.

Persistence of uterine bacterial infection, and its associations with endometritis and ovarian function in postpartum dairy cows

We investigated the relationship between the persistence of uterine bacterial infections with cytologically determined endometritis and ovarian function in 65 postpartum Holstein cows. Vaginal mucus discharges were collected, and endometrial smear samples (n = 130) were collected for cytological and bacteriological examinations from the cows at weeks 5 and 7 postpartum (pp). Blood samples were collected at weeks 3, 5 and 7 pp to determine plasma progesterone concentrations to monitor ovarian activity. According to the bacteriological examination, cows were classified into four groups. The first group (n = 32; 49%) comprised cows negative for bacteria at weeks 5 and 7 pp. The second group (n = 11; 17%) comprised cows with bacterial infections at week 5 pp but that were clear of infection at week 7 pp. The third group (n = 12; 19%) comprised cows without bacteria at week 5 pp but that acquired an infection by week 7 pp. The fourth group (n = 10; 15%) comprised cows with bacterial infections at weeks 5 and 7 pp (persistence of infection). A positive correlation (P < 0.001) was noted between the severity of cytologically determined endometritis, purulent vaginal discharge and the persistence of infection. Cows with persistent infections had a significantly (P < 0.01) prolonged luteal phase compared with cows without infection. In conclusion, the prevalence of cytologically determined endometritis and prolonged luteal phase were significantly increased in cows with persistent infections.

Clinical endometritis in an Argentinean herd of dairy cows: risk factors and reproductive efficiency

The objectives of this study were to assess the clinical and metabolic risk factors for clinical endometritis, the likelihood for having a normal vaginal discharge during postpartum, and the effects of endometritis on milk yield, reproductive efficiency, and metabolic status in Holstein cows. The study was conducted in a commercial dairy herd (Cordoba, Argentina) where 303 Holstein cows were enrolled. Cows were body condition scored (1 to 5) and tail bled on -14, 7, 21, 31, 41, and 50 d relative to parturition. Cows having a vaginal discharge with presence of pus between 21 and 41 d postpartum (dpp) were diagnosed as having clinical endometritis. Plasma blood samples were analyzed for nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), and blood urea nitrogen using commercial kits and insulin-like growth factor 1, insulin, and leptin by RIA. Data were analyzed with PROC MIXED, PROC GENMOD, and PROC PHREG of SAS (SAS Institute Inc., Cary, NC). Abnormal calving and puerperal metritis increased the risk for endometritis [adjusted odds ratio (AOR)=2.21 for both]. High prepartum NEFA and high postpartum BHBA increased the risk for endometritis (AOR=1.003 and 1.001, respectively), whereas high prepartum blood urea nitrogen reduced it (AOR=0.853). Cut-offs of 456.6 μM NEFA and 402.5 μM BHBA had sensitivities of 0.69 and 0.58, and specificities of 0.88 and 0.86, respectively. The likelihood for having normal vaginal discharge increased with time (∼1% × dpp) and with normal calving. Cows with endometritis had higher milk yield than normal herdmates (27.8±0.9 vs. 25.7±0.4 kg/d), lower risk for pregnancy by 100 dpp (AOR=0.10), higher nonpregnancy risk by 200 dpp (AOR=2.87), and higher risk for culling than normal cows (AOR=2.28). Cows with endometritis had a lower hazard rate (0.44) for pregnancy and had approximately 70 d longer calving-to-conception intervals. Finally, endometritis had no effect on metabolic hormones. In conclusion, the risk for clinical endometritis increases with abnormal calving and puerperal metritis, as prepartum NEFA and postpartum BHBA concentrations increase. Prepartum NEFA and postpartum BHBA could be useful for the prediction of endometritis. Last, clinical endometritis has detrimental effects on reproductive efficiency, as affected cows take longer to get pregnant and are at higher risk for culling.

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.

Using non-steroidal anti-inflammatory drugs around calving: maximizing comfort, productivity and fertility

Non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic, anti-inflammatory, anti-endotoxic and anti-pyretic effects in cattle. As such, they could be expected to have significant effects in cows and calves in the post-calving period. This review evaluates the published data on the use of NSAIDs in the dam and its calf after dystocia, the impact of NSAIDs on uterine involution, the restoration of ovarian function and prevention and treatment of the metritis complex, and the benefits of using NSAIDs in the recumbent cow. Overall, the published data are very limited, despite frequent use of NSAIDs by veterinarians in the post-calving cow, and the small number of published studies focus on blanket treatment of calving cows rather than targeted treatment after dystocia. Blanket treatment had no economic benefit; indeed, some studies reported adverse effects, such as pyrexia and increased risk of metritis. There is even less information on the value of treating calves with NSAIDs after dystocia, despite significant tissue damage which may benefit from NSAID use. Appreciably more studies have evaluated the influence of NSAIDs on uterine and ovarian function, but clinical relevance is limited. In cows with a normal puerperium, prolonged treatment with NSAIDs may slow the restoration of normal function, but most reported studies are small and use NSAIDs more frequently and for longer periods than is common in general practice. The evidence of a clinical benefit in cows with puerperal disease is limited and equivocal, and the evidence base for the use of NSAIDs in the treatment of recumbent cows is also small, even though an expert panel concluded that NSAIDs were a key aspect of veterinary treatment of downer cows. The lack of evidence identified by this review supports the contention that NSAIDs are likely to be under-used and sub-optimally prescribed in the post calving period. Further research on the use of NSAIDs in the post-calving cow and calf is required.

Evaluation of vaginoscopy for the diagnosis of clinical endometritis in dairy cows

The objective of the study was to evaluate the visual assessment of vaginal discharge by vaginoscopy for the diagnosis of clinical endometritis (CE) in dairy cows. In an in vivo trial, inter- and intraobserver repeatability of vaginoscopic examination (VE) was determined and the effect of transrectal palpation and experience of the investigator evaluated. Holstein-Friesian cows (n=380) were examined by vaginoscopy between 21 and 27 d in milk by 3 investigators twice. Vaginal discharge was categorized on a 4-point classification system (0=clear mucus, 1=mucus containing flecks of pus, 2=discharge containing less than 50% pus, 3=discharge containing more than 50% pus). Cows with a vaginal discharge score (VDS) of 0 were classified as healthy, whereas cows with a VDS of 1 to 3 were classified as having CE. Vaginal discharge score on a scale from 0 to 3 has moderate intra- (Cohen's kappa coefficient, κ=0.55-0.60) and interobserver (κ=0.44) repeatability. The prevalence of CE was comparable between the 3 investigators (first VE: 42.6, 34.8, and 38.7; second VE 46.8, 36.9, and 43.7%). Transrectal palpation (relative risk=0.96-1.03) or experience of the investigator (relative risk=0.9-1.1) did not affect results of VE. In an in vitro trial, sensitivity and specificity of visual assessment were determined utilizing 33 images showing yellow and pink areas in certain percentages as a reference standard. Pus was represented by yellow areas and the mucosa, including clear mucus, by pink areas. These images were visually assessed by 30 investigators via PowerPoint presentation (experiment 1) and by 23 investigators via a simulated vaginal examination (experiment 2) utilizing the same 4-point classification system. Sensitivity was 99.6 and 96.3% and specificity was 96.7 and 90.1% in experiments 1 and 2, respectively. The results provide evidence that a visual assessment conducted by vaginoscopic examination is not perfect but can be considered a reasonable measurement of vaginal discharge and is a practical tool to distinguish healthy from diseased cows.

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.

The effects of endometritis on the establishment of pregnancy in cattle

Endometritis is common in post partum dairy cows and is associated with impaired reproductive performance reflected in reduced first service conception, reduced hazard of pregnancy over the breeding period and increased risk of reproductive culling. The observed effects may be mediated directly by bacterial products, such as lipopolysaccharide (LPS, endotoxin), or indirectly by inflammatory mediators, such as cytokines, eicosanoids, nitric oxide and oxidative stress affecting sperm, ovarian, uterine and embryonic function. An inflammatory milieu in the uterus has been associated with changes in sperm motility and function as well as increased sperm phagocytosis. Zygotes resulting from fertilisation of oocytes with sperm subjected to oxidative stress are less likely to develop to the blastocyst stage. In addition, LPS and tumour necrosis factor-α (TNFα) impair follicular steroidogenesis, growth and ovulation. Oocytes exposed to LPS or prostaglandin (PG) F2α during maturation are less likely to develop to blastocyst stage after fertilisation. Embryos exposed to inflammatory mediators during development have fewer trophoectoderm cells. Nitric oxide impairs development of preimplantation embryos and TNFα increases blastomere apoptosis. Endometritis in women has been associated with higher rates of implantation failure. Extragenital inflammation (e.g. mastitis) is also associated with an increased rate of embryonic loss in cattle. These observations make it clear that direct and indirect effects of endometritis, and inflammation in general, can interrupt successful reproduction at several crucial stages.

Definitions and diagnosis of postpartum endometritis in dairy cows

The objectives of this observational study were to determine and compare diagnostic criteria for postpartum endometritis in dairy cows. Data generated from 1,044 Holstein cows (6 herds) enrolled in a randomized clinical trial were used. Cows were examined for endometritis at 35±3 d (exam 1) and 56±3 d (exam 2) after parturition, using endometrial cytology (cytobrush technique), vaginal discharge scoring (Metricheck device; Simcrotech, Hamilton, New Zealand), and cervical diameter measurement (transrectal palpation). Reproductive data were recorded until 200 d after parturition. Diagnostic criteria for cytological and clinical endometritis were determined based on detrimental effect on subsequent reproductive performance, using logistic regression and Cox proportional hazard models accounting for the effect of herd clustering. Comparison of diagnostic criteria was performed using endometrial cytology as reference test or by quantifying the agreement between diagnostic approaches. At exam 1, diagnostic criteria were ≥6% polymorphonuclear cells and mucopurulent or worse (purulent or foul) vaginal discharge for cytological and clinical endometritis, respectively. At exam 2, diagnostic criteria were ≥4% polymorphonuclear cells and mucopurulent or worse vaginal discharge for cytological and clinical endometritis, respectively. Cows were classified as having cytological endometritis only, clinical endometritis only, or both cytological and clinical endometritis. Prevalence at exam 1 was 13.5, 9.4, and 5.8% for cytological endometritis only, clinical endometritis only, and both cytological and clinical endometritis, respectively. The detrimental effects of cytological and clinical endometritis on reproductive performance were additive. Among cows with clinical endometritis, only 38 and 36% had cytological endometritis at exam 1 and exam 2, respectively. Combination of diagnostic criteria improved neither the accuracy for predicting cytological endometritis nor the agreement between cytological and clinical endometritis. Overall, these results suggested that cytological and clinical endometritis may represent different manifestations of reproductive tract disease. They also suggested that use of the terminology clinical endometritis may not be accurate and that purulent vaginal discharge may be more descriptive.

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

The effect of ovarian predominating structures and uterine condition on the result of some diagnostic tools for the evaluation of endometritis was studied in postpartum (pp) Holstein-Friesian dairy cows (n = 58). Endometrial cytology (EC) and the evaluation of vaginal mucus by vaginoscopy or Metricheck were performed weekly from week 3 to 7 pp. The ovarian studies involved the predominating structures including cystic follicles with plasma progesterone (P(4) ; more or <1 ng/ml; >23 mm), corpus luteum (CL), pre-ovulatory follicles (10-23 mm) and small follicles (<10 mm). The uterine conditions comprised uterine involution, tonicity and fluid in uterus (FIU) regarding echogenicity extent. During week 5, the percentage of polymorphonuclear neutrophils (PMN%) was higher (p < 0.05) in animals with pre-ovulatory follicles (mean ± SEM, 26.3 ± 7.6%) than animals having CL (11.0 ± 3.6%). In cystic ovaries, during week 5, PMN% was higher (p < 0.05) in follicular cysts with low progesterone (P(4) < 1 ng/ml; 9.3 ± 2.6%) than those with high P(4) (P(4) ≥ 1 ng/ml; 1.5 ± 1.1%). Moreover, PMN% was higher (p < 0.01) in animals with non-involuted uterus (11.5 ± 7.4%) than those with involuted uterus (2.7 ± 0.6%) during week 7 pp. The animals that had abnormal mucus determined by Metricheck was higher in animals with atonic uterus than those with tonic uterus during week 6 (82.6% vs 51.5%; p < 0.05) and 7 (71.4% vs 25.7%; p < 0.01) pp. In addition, by vaginoscopy, the prevalence of animals with abnormal discharge showing small follicles (100%, 5/5) during week 3 pp and pre-ovulatory follicles (40.0%, 8/20) during week 5 pp was higher (p < 0.05) when compared to those having CL during week 3 (33.3%; 1/3) and week 5 pp (7.7%; 2/26), respectively. In conclusion, endometrial cytology, Metricheck and vaginoscopy were influenced by the predominating various ovarian structures and uterine condition in early pp high-yielding dairy cows.

Analysis of some factors affecting fertility levels in a high-producing dairy herd in south-western Japan

The present study aimed to know whether all cows have been showing declining fertility or only a proportion of cows are attributed to the declining fertility, and to describe factors affecting the level of fertility. A total of 131 cows calved from February 2005 to December 2007 in a dairy herd were examined. Fourteen cows were excluded from the study because of early culling. Of the remaining 117 cows, 47 (40%) conceived within 115 days postpartum after 1-3 artificial insemination (AI) (normal fertility cows), 42 (36%) conceived after 115 days postpartum following 1-3 AI or were culled after 1-2 (sub-fertility cows/culled), and 28 (24%) were inseminated more than three times without detectable genital tract abnormalities (repeat breeders). Calving to conception interval in the normal fertility group was 72 + 3 days, while in the sub-fertility/culled and repeat breeding groups the intervals were 170 + 8 and 259 + 16 days, respectively. Endometritis was the risk factor for sub-fertility/culled (odds ratio (OR) = 3.76). Prolonged luteal phase (OR = 4.08), delayed first ovulation (OR = 6.02), and delayed corpus luteum formation after AI (OR = 8.55) were the risk factors for repeat breeding. In conclusion, 60% cows showed reduced fertility in a herd, while the other 40% had normal fertility. Uterine infection and some ovarian disorders contributed to reduced fertility.

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.

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.

Prevalence of endometritis during the postpartum period and its impact on subsequent reproductive performance in two Japanese dairy herds

The objectives of this study were to ascertain the prevalence of different degrees of endometritis during different periods postpartum, to define 'clinically relevant endometritis', to determine its impact on subsequent reproductive performance, and to determine some risk factors for the incidence of clinically relevant endometritis in dairy cows. Holstein Friesian cows (n=135) from two commercial dairy herds were examined vaginoscopically and by per rectal palpation of genital organs for the first time between 15 and 60d postpartum. Cows with any proportion of pus in the cervico-vaginal discharge were defined as having endometritis and were classified into mild, mucopurulent, or purulent endometritis or postpuerperal metritis. The overall prevalence of endometritis during early (15-20d), intermediate (21-28d) and late (29-60d) postpartum period was 67.8%, 40.5% and 14.4%, respectively. Survival analysis was used to derive a case definition of clinically relevant endometritis based on factors associated with reduced pregnancy rate. Accounting for different factors, mucopurulent and purulent endometritis and postpuerperal metritis, but not mild endometritis each was associated with a significant decrease in pregnancy rate. The presence of mucopurulent or purulent cervico-vaginal discharge on vaginoscopy between 15 and 60d postpartum was defined as clinically relevant endometritis. The prevalence of clinically relevant endometritis was 25.9%. Cows with clinically relevant endometritis had a hazard ratio of 0.39 (P=0.001) for pregnancy (61% reduction in pregnancy rate) and a hazard ratio of 0.40 (P=0.001) for pregnancy per insemination. Cows with clinically relevant endometritis had more days open (325 vs. 120; P<0.001) and required more inseminations for 50% cows to become pregnant (5 vs. 2; P<0.001) than those without clinically relevant endometritis. Clinically relevant endometritis diagnosed between 15 and 20d postpartum was also associated with reduced pregnancy rate (HR=0.34; P=0.05). Based on logistic regression analysis, herd (P=0.002), higher parities (P=0.04), retention of fetal membranes (odds ratio, OR=4.24; P=0.05), early postpartum complications (OR=15.2; P=0.001) and earlier postpartum period at examination (P<0.001) significantly increased the risk of diagnosing clinically relevant endometritis within 60d postpartum. In conclusion, 25.9% cows had clinically relevant endometritis within two months postpartum that adversely affected the subsequent fertility in two Japanese dairy herds.