TREATMENT & MANAGEMENT OF POSTPARTUM UTERINE INFECTION IN DAIRY CATTLE
Dr.Manoj Singh Tanwar,SVO, Jodhpur
Being a field veterinary we come across maximum cases related to the Uterine Infection in Dairy cattle throughout India.These problems not only affect the health of the dairy cattle but also put great burden on Dairy farmers from economic point of view
Uterine infections in postpartum phase are the most common and of greatest economic importance in dairy animals. Uterine function is often compromised in cattle by bacterial contamination of the uterine lumen after parturition; pathogenic bacteria frequently persist, causing uterine disease, a key cause of infertility. Certain risk factors resulting in an increase in chance of clinical disease are retained placenta, dystocia, twins and stillbirth calves. Although many cows eliminate these bacteria during the first 5 weeks after parturition, but in 10–17% of animals infection persists which causes uterine disease. The presence of pathogenic bacteria in the uterus causes inflammation, histological lesions of the endometrium and delays uterine involution. In addition, uterine bacterial infection, bacterial products or the associated inflammation, suppress pituitary LH secretion, and perturbs postpartum ovarian follicular growth and function, which disrupts ovulation in cattle. Thus, uterine disease is associated with lower conception rates, increased intervals from calving to first service or conception, and more cattle culled for failure to conceive
Postpartum uterine infection
Postpartum period is defined as the period after parturition and lasts until reproductive function is restored so that another pregnancy can occur. There are four major events during this period which include: myometrial contractions and expulsion of secundus, endometrial repair, resumed ovarian function and elimination of bacterial contamination in the reproductive tract. Secundus begins three days postpartum, reaches its peak during second week and all the fluid is normally expelled by 18 days postpartum. Viscous consistency of normal secundus changes to foul smelling watery and reddish brown exudates because atonic uterus is not able to expel its content during puerperal metritis and increases the risk of bacterial complications. Uterine involution consists of the reduction in uterine size, clearing bacterial contamination, sloughing of caruncles and regeneration of the endometrium and is completed by 28 days postpartum .Resumption of cyclicity also occurs during this interval, with the first ovulation occurring around days 40 to 45 postpartum .This interval can be affected by nutrition, body condition, parity and can be extended due to uterine disease. Bacterial contamination of uterine lumen after parturition often hinders the uterine function ,Bacteria can be cultured from samples collected from uterine lumen of dairy cattle in the first 2 weeks after parturition without appearance of any apparent clinical signs .Polat et al., (2009) reported that 10-17% of cows have pathogenic bacteria two weeks post-calving while Sheldon (2007) found that intensively managed dairy cattle often have bacterial uterine contamination rates of 90 to 100% within the first two weeks postpartum. Prevalence of clinical and sub-clinical endometrits after parturition ranges between 5 to >30% and 11 to >70%, respectively (Galvao et al., 2009). Uterine infections can be classified as puerperal metritis, clinical endometritis, subclinical endometritis and pyometra. Uterine infection usually arises as part of a complex of diseases that is referred to as the ‘metritis complex’: retained fetal membranes, metritis, endometritis and pyometra. These diseases share the same causes, often lead to one another and have treatments in common so it makes sense to consider them together
1.Puerperal metritis
Metritis is a severe inflammatory response that occurs within all the layers of the uterus including the endometrium, submucosa, myometrium and perimetrium. Puerperal metritis usually occurs within Day 10 postpartum and is defined as an acute systemic illness caused by an infection of the uterus Important characteristic of puerperal metritis is rectal temperature greater than 39.5°C within 21 days after calving. Retained placenta, fetal maceration or difficult calvings are predisposing factors for occurrence of puerperal metritis Up to 40% animals develop metritis within the first fourteen days of calving and 10 to 15% of these animals have infection for at least another three weeks leading to a chronic uterine disease known as endometritis
2.Endometritis (whites)
In postpartum cows, endometritis continues to be a major cause of poor fertility and delayed conceptions .Two important types of endometritis have been recently recognized as the clinical and subclinical endometritis .Such cows do not show any signs of systemic illness .Clinical endometritis is defined as a purulent or mucopurulent discharge or a cervical diameter >7.5 cm after 20 days in milk (DIM) or mucopurulent discharge after 26 DIM .Cows with endometritis have deeper uterine tissue involvement, higher degrees of bacterial contamination .Endometritis is defined as inflammation of mucus membrane of uterus and presence of mucopurulent to purulent discharge in uterus after three weeks of parturition or later .Clinical findings by rectal palpation of the uterus are asymmetric uterine horns, thickened uterine wall and palpable presence of fluid during clinical endometritis Sub-clinical endometritis is characterized by scanty exudates accumulated in uterus resulting in complete lack of cervical discharge with pathognomic property and can be diagnosed by endometrial cytology if purulent discharge is absent in the vagina Sub-clinical endometritis can be defined by greater than18% neutrophils in uterine cytology samples at 20-33 days or greater than 10% neutrophils at 34-47 days postpartum
3.Pyometra
Pyometra is defined as accumulation of purulent exudate of variable amount in the uterine lumen. Cows having first postpartum ovulation, before bacterial contamination of the uterus has been eliminated, are most likely to develop pyometra Pyometra is characterized by the presence of corpus luteum on ovary and accumulation of fluid of mixed echodensity in the uterine lumen and distention of the uterus on ultransonographic examination There is functional closure of the cervix but the lumen is not always completely closed and some pus may discharge through the cervix into the vaginal lumen Prolongation of the luteal phase may be attributed to increased concentrations of luteotrophic prostaglandin PGE2 associated with endometrial bacterial infection. Pyometra can occur if ovulation occurs too early in the postpartum period and corpus luteum is formed during uterine infection Return of ovarian cyclic activity postpartum depends on the uterine immune response. High concentration of progesterone during luteal phase suppresses the immune response of the uterus and makes the uterus more susceptible to bacterial infection Negative effects of corpus luteum on the early postpartum uterus can be attributed to progesterone. Myometrium relaxation occurs due to effect of progesterone and hinders the clearing of bacterial contamination of uterus Also, increase in plasma progesterone concentration leads to decreased phagocytic activity of both uterine and peripheral blood neutrophils).
- Retained fetal membranes
Retained fetal membranes occur when the normal process of placental separation fails to take place. The actual definition of when membranes are retained is vague, because in normal calvings membranes are always retained until after the calf is born. Standard definitions simply apply easy to measure timings such as 12 hours (or membranes present in the evening in a cow that calved in the morning) or 24 hours (or membranes the day after calving), though research suggests that retention for >6 hours may have an adverse economic effect.
Diagnosis
Diagnosis of metritis within the first 10 days post partum is relatively easy. It is associated with the presence of pyrexia, fetid pus within the uterine lumen, vagina and discharging from the vulva accompanied with delayed uterine involution. Clinical and subacute endometritis may be more difficult to recognize. A complete clinical examination sometimes followed by laboratory tests is required for a definitive diagnosis. Clinical examination with detailed evaluation of the reproductive tract
• Rectal examination
• Vaginoscopy:
o Requires additional equipment and provides valuable information: presence of discharge from the cervical canal, condition of the vaginal mucosa, status of the external cervical orifice
The use of vaginsocopy or manual examination of the vagina and mucous discharging from the cervix is thus highly recommended. Manual examination is quick and inexpensive. Additional information such as the presence of vaginal lacerations and odour of the discharge is also obtained. Metricheck (Metricheck, Simcro, New Zealand), a device consisting of a stainless steel rod with a rubber hemisphere, can also be used to retrieve vaginal contents.
Treatment of uterine diseases-
Puerperal metritis
A great variety of intrauterine antimicrobial agents (oxytetracycline: 4 to 6 g/day) and antiseptic chemicals (iodine solutions: 500 ml of 2% Lugol’s iodine immediately after calving and again 6 hours later as a preventive measure), systemic antibiotics (penicillin or one of its synthetic analogues: 20,000 to 30,000 U/kg/cow), ceftiofur /third generation cephalosporin/: 2,2 mg/kg daily for 5 days) and supportive therapy (nonsteroidal anti-inflammatory drugs such as flunixin meglumine, fluid therapy in case of dehydration, therapy with calcium and energy supplements in case of depressed appetite), and hormone therapy (oxytocin: 20 to 40 U repeated every 3 to 6hours within 48 to 72 hours after calving; prostaglandin F2α or its synthetic analogues) have been introduced in the field . The prognosis for recovery from puerperal metritis varies with severity of the condition. According to our present knowledge intrauterine antimicrobial and antiseptic treatments are not recommended because of irritating the endometrium. Routine use of hormone therapies is also controversial and needs further confirmations. It seems that presently systemic antibiotic and supportive therapy can be recommended for the field
Retained placenta
The aim of the treatment for retained placenta is to reduce the occurrence of puerperal metritis and subsequently clinical and subclinical endometritis, decrease milk losses, reduce reproductive inefficiency, and decrease veterinary expenses. There are a great variety of treatment protocols (manual removal of retained membranes, intrauterine treatments with antibiotics or antiseptics, hormones (oxytocin, prostaglandin), ergot derivates, calcium, injection of collagenase into the umbilical arteries, versus no treatment recommended for the field. However, all of these methods have some limited values in the treatment of retained placenta . Recent findings confirm that systemic antibiotics without intrauterine manipulation and treatment can be as effective as conventional treatment . This was also confirmed in a later study in febrile cows It seems that systemic antibiotic is effective if the selection of treatment based on fever which may reduce the use of antibiotics compared with intra-uterine antibiotics . At the same time treatment of acute puerperal metritis with a single dose of flunixin meglumine in addition to antibiotic treatment had no beneficial effect on clinical cure, milk yield within 6 d after the first treatment, or reproductive performance
Clinical endometritis
If an active corpus luteum is present together with clinical endometritis the treatment of choice may be intrauterine antibiotics (cephapirin having minimal drugresidues in milk and meat) and/or prostaglandin (PGF2α or its synthetic analogues) injection(s). In the absence of an active corpus luteum, the treatment efficacy of clinical endometritis with only prostaglandin injection is limited however such a treatment according to Lewis may bring certain advantages as well. It is very important to diagnose and treat clinical endometritis 21 days after calving because there is a danger which may lead to pyometra
Pyometra
The best treatment protocol is to use prostaglandin (PGF2α or its synthetic analogues) injection(s) because of the presence of a persistent corpus luteum. Due to common relapse it is recommended to repeat the prostaglandin treatment 12 to 14 days later. Intra-uterine antibiotic therapy (cephapirin) may be used as well. Complete restoration of the endometrium may need 4 to 8 weeks therefore it is very important to diagnose and treat pyometra as soon as possible after calving to decrease the destructive nature of pyometra on the endometrium
Subclinical endometritis
Subclinical endometritis can be treated with a prostaglandin im injection (cloprostenol 500 mg) or an intrauterine antibiotic therapy (cephapirin) at 20–33 DIM to improve the reproductive performance
Prevention of uterine diseases
Cows having hypocalcaemia, dystocia, stillbirth, twins or retained placenta in the periparturient period are more likely to contract uterine infections than are cows that calve normally. Thus, management of sanitation, nutrition, population density, stress to prevent or reduce the incidence of these predisposing factors (especially dystocia) should be impeccable. Therefore prevention remains limited to general guidance on hygiene at calving , adequate nutrition (Ca, Se, Vit. E, etc.) and the control of infectious diseases. One of the pharmacological approaches to the prevention and treatment of retained placenta can be the administration of prostaglandin immediately after calving Routine systemic administration of ceftioufur hydrochloride may be beneficial for the prevention of metritis, but its effect on reproductive performance is not significantly different to that of no treatment
Homeopathic Treatment of Endometritis :
- Ferrum Phos 6 x : When the discharge is blood with foul smell.
Dose : 5 pills every 4 hrs for one week . - Pyroginum 200 or Anthracinum 200 : When the discharge is foetid, bloody
and pyrexia
Dose : B.I.D 2 to 3 days - Hydrastis 200 : With pyroginum 200 or Anthracinum 200. When the
purulent discharge with febrile condition.
Dose :B.I.D for 2 to 5 days - Kreosotum 200 : When the discharge is purulent and acrid, edema of vulva
Dose : B.I.D till improvement.
PYOMETRA :
Endometritis with a large amount of purulent fluid in the uterus and a persistent corpus luteum, occurring from 3 to 4 weeks after parturition.
Treatment :
- Folliculinum 1M on the 1st day orally.
- If the cyst is on right side Apis. mel 200 or 1M orally on 2nd day. If the CL is on Left Side Lachesis 200 or 1 M on 2nd day.
- On 3rd day, observe for ovarian changes for size, consistency, regression of P.C.L.
- Adopt the treatment of endometritis till the uterus is free from infection based on symptoms.
CERVICITIS :
By vaginal examination with a speculum, the cervical annual folds or ridges will be protruding out of the external os, depending on the degree of cervicitis. First degree of cervicitis is difficult to identify rectally, needs speculum examination, second and third degree cervicitis can be identified rectally.
Treatment : 1. Calendula Ointment is applied through the speculum over the cervix.
2. Aurum Muriaticum Natronatum 200 + Iodium 200
1 dose BID per week for 2 to 7 weeks till improvement
VAGINITIS :
- Arsenic Alb 30: When there is straining, burning micturition and reddening of vulval mucosa.
Dose : B.I.D for 7 days - Sulphur 200 : As intercurrent remedy, burning micturition, reddening of
vulval mucosa and if Arsenic fails.
Dose :B.I.D for 2 days - Acid Nitricum 30 : Vaginal mucus membrane with ulcers , animal is
weak
Dose :B.I.D 2- 4 days - Cantharis 30 : Frequent urination with straining and reddened mucus
membrane
Dose :B.I.D for 2 to 3 days - Merc Cor 200 : When there is bloody discharge and ulcers on vaginal
mucus membrane.
Externally the vagina is cleaned with calendula lotion and applied calendula + Echinacea ointment
RETENTION OF FOETAL MEMBRANES :
In one research study, made at, Tiruvanathapuram Milk Union, it was observed that Pyroginum 200 was given for 15 days to shed retained membranes with out manual removal, no casuality or illness or bad effects were noticed, If the membranes are partially or fully retained, pyroginum 200 + Pulsatilla 200 Q.I.D for 2 –3 days would be sufficient to expel, the membranes
Aconite 30 : Soon after calving Aconite 30 at intervals of 15 mts, 4 times will
generally expel the placenta in normal parturition.
Arnica 200 : One dose, after administration of 3 doses of Aconite 30, in cases of
suspected retention of placenta, and give Pulsatilla 200,
Dose : 2 doses at interval of 30 mts.
Secale Cor 30 : If Pulsatilla dose not give any help, if the discharges are foetied
and bloody, give Secale cor 30, at interval of 10 mts, till membranes are expelled.
Sepia 1M : If parturition, occurred in winter and the cow had stairy coat,
Dose : give one dose of Sepia. 1M
Homeopathic Combination :
Sepia 200
Sebina 200
Secale car 200
Cantharis 200
Caulophylum 200
Pyroginum 200
Dose : 10 pills every hr for 5 hrs along with gossypium Q, after 5th dose
repeat every 3 hrs, till placenta falls
Externally clean vulva and vagina with calendula lotion and apply Calendula + Echinacea ointment.
Post Partum Prolapse :
- If the animal is brought immediately, soon after the appearance of prolapsed
mass, clean the part with calendula lotion, and push it gently in side the vagina. If necessary apply retention sutures. - Podophylum 200 + Sepia 200 : Either alone or in combination 3 times a
day, till relief. - Helonias Q : 5 drops, in a cup of water, every 30 mts, till relief either alone
are along with treatment 2
