Changes

=Introduction=

=Introduction=

Endometritis is the infection of the uterine endometrium [[Image:Endometritis.jpg|thumb|right|200px|Endometritis,Copyright RVC 2008]]

Endometritis is the infection of the uterine endometrium [[Image:Endometritis.jpg|thumb|right|200px|Endometritis,Copyright RVC 2008]]

=Equine Endometritis=

=Equine Endometritis=

Endometritis is a common cause of low fertility in the mare. It occurs following uterine contamination during covering, artificial insemination, reproductive examination, parturition and as a result of poor conformation.

Endometritis is a common cause of low fertility in the mare. It occurs following uterine contamination during covering, artificial insemination, reproductive examination, parturition and as a result of poor conformation.

There are several types of endometritis that can occur:

==Types of Endometritis==

(1) Venereal Infectious Endometritis

(1) Venereal Infectious Endometritis

===Venereal Infectious Endometritis===

===Venereal Infectious Endometritis===

Three major pathogens cause endometritis in the mare:

Three major pathogens cause venereal endometritis in the mare:

* [[Taylorella equigenitalis|''Taylorella equigenitalis'']] - causing the '''notifiable''' Contagious Equine Metritis (CEM)

* [[Taylorella equigenitalis|''Taylorella equigenitalis'']] - causing the '''notifiable''' Contagious Equine Metritis (CEM)

* [[Klebsiella|''Klebsiella pneumoniae'']] - tests can be performed to identify types 1, 2 and 5 which are sexually transmitted  

* [[Klebsiella|''Klebsiella pneumoniae'']] - tests can be performed to identify capsule types 1, 2 and 5 which are sexually transmitted  

* [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']] - there is no available test to differentiate strains so all must be treated as pathogenic

* [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']] - there is no available test to differentiate strains so all must be treated as pathogenic

[[Equine Viral Arteritis|Equine Viral Arteritis]] (EAV) and [[Equine Herpesvirus 3|Equine Herpes Virus 3]] (EHV-3) are also classified and venereal infections however they do not cause endometritis or prevent conception.

 

The mare may present with vaginal discharge (ranging from scant to copious) in an acute infection. However she may also present in a carrier state, in which case there may be no outward clinical signs. Stallions are usually sub-clinical carriers of disease.

[[Equine Viral Arteritis|Equine Viral Arteritis]] (EAV) and [[Equine Herpesvirus 3|Equine Herpes Virus 3]] (EHV-3) are also classified as venereal infections however they do not cause endometritis or prevent conception.

 

Detailed guidelines on the diagnosis, treatment and prevention of all these infections can be found in the [http://codes.hblb.org.uk/| Codes of Practise] which are followed by Thoroughbred breeders in the UK.  

===Non-venereal Infectious Endometritis===

===Non-venereal Infectious Endometritis===

===Chronic Infectious Endometritis===

===Chronic Infectious Endometritis===

Normally an underlying condition such as pneumovagina predisposes the mare to chronic infectious endometritis. Infection Diagnosis is again by biopsy which should show infiltration of the endometrium with lymphocytes and plasma cells. Infection may be:

Normally an underlying conformational condition such as pneumovagina predisposes the mare to chronic infectious endometritis. Infection Diagnosis is again by biopsy which should show infiltration of the endometrium with lymphocytes and plasma cells. Infection may be:

* Bacterial - [[Streptococcus zooepidemicus|''Streptococcus zooepidemicus'']], [[Escherichia coli|''Escherichia coli'']]

* Bacterial - [[Streptococcus zooepidemicus|''Streptococcus zooepidemicus'']], [[Escherichia coli|''Escherichia coli'']]

* Fungal  - more common if there is a history of multiply intra-uterine antibiotic treaments

* Fungal  - more common if there is a history of multiply intra-uterine antibiotic treaments

Prognosis is guarded.

Prognosis is guarded due to the chronic nature of the infection and the anatomical faults predisposing to infection. Surgical correction of the conformational abnormalities may be attempted.

==Diagnosis==

==Diagnosis==

* Clinical examination may reveal vulval discharge or matted tail hairs

* Clinical examination may reveal vulval discharge or matted tail hairs.

* Vaginal examination should identify any discharge and increased vascularity of the tissue. Conformational abnormalities such as pneumovagina and urovagina may be evident.

* Vaginal examination should identify any discharge and increased vascularity of the tissue. Conformational abnormalities such as pneumovagina and urovagina may be evident.

* Ultrasound examination of the uterus - more than 2 cm of fluid with abnormal character suggests endometritis

* Ultrasound examination of the uterus - more than 2 cm of fluid with abnormal character suggests endometritis.

* Clitoral and endometrial swabs should be taken for culture and sensitivity. Clitoral swabs should be taken if a chronic venereal infection is suspected. Endometrial swabs should be taken during oestrus to identify and acute venereal infection or identify the causative organism of other endometrial infections

* Clitoral and endometrial swabs should be taken for culture and sensitivity. Clitoral swabs should be taken if a chronic venereal infection is suspected. Endometrial swabs should be taken during oestrus to identify either acute venereal infection or the causative organism of other endometrial infections.

* Uterine flush

* Uterine flush - the uterus should be flushed with 100mls of fluid which can then be examined cytologically.

* Uterine biopsy

* Uterine biopsy - this should be performed after all other tests have failed to reach a diagnosis or to definitively diagnose endometriosis.

==Treatment==

==Treatment==

* Uterine lavage with copious amounts of saline or lactated ringers solution

* Uterine lavage with copious amounts of fluid. This is beneficial because it:

* Antibiotics (intrauterine or systemic)

* Administration of ecbolics - oxytocin and prostaglandin analogues

 

* Hormonal therapy - Oestradiol Benzoate and PG

 

 

2-3 litres of saline or lactated ringers solution should be administered using a uterine flushing catheter and then drained back into the bag and inspected. Dilute Povidone iodine can also be used as a cheap alternative.

* Antibiotics (intrauterine or systemic) - antibiotic type should be guided by culture and sensitivity and activity of the drug in the uterus where possible. The length of the treatment should be proportional to the severity of infection.

* Administration of ecbolics to stimulate uterine contractility and clearance of infection - oxytocin and prostaglandin analogues

* Hormonal therapy - Oestradiol Benzoate and PG can be used to aid the clearance of infection. They are more effective during oestrus.

 

 

==Management of Susceptible Mares==

==Management of Susceptible Mares==

==Prognosis==

==Prognosis==

The potential consequences of this [[Healing and Repair - Pathology#Repair in the Genital Tract|condition]] vary according to the timing and species involved.

The prognosis of this [[Healing and Repair - Pathology#Repair in the Genital Tract|condition]] vary according to the type, severity and chronicity of the infection and the age of the mare.

=Cattle Endometritis=

=Cattle Endometritis=

===Aetiology===

===Aetiology===