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| + | [[Image:Endometritis.jpg|thumb|right|150px|Endometritis,Copyright RVC 2008]] |
| − | ==Introduction==
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| − | [[Image:Endometritis.jpg|thumb|right|200px|Endometritis,Copyright RVC 2008]] | |
| − | Endometritis is an '''infection of the uterine endometrium'''.
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| − | Endometritis is a common cause of '''poor fertility''' in the mare. It occurs following '''uterine contamination''' during '''covering''', [[Artificial Insemination - Anatomy & Physiology|artificial insemination]], '''reproductive examination''', [[Parturition Behaviour - Mare|'''parturition''']] and as a result of '''poor conformation'''.
| + | * Infection of the uterine endometrium |
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| − | ==Types of Endometritis== | + | === Treatment === |
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| − | #Venereal Infectious Endometritis
| + | * Antibiotics (intrauterine or systemic) |
| − | #Non-venereal Infectious Endometritis
| + | * Antibacterials |
| − | #Persistent Post-mating Endometritis
| + | * Prostaglandin analogues |
| − | #Chronic Degenerative Endometritis
| + | * Oestradiol Benzoate |
| − | #Chronic Infectious Endometritis
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| − | ===Venereal Infectious Endometritis===
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| − | Three major pathogens cause venereal endometritis in the mare:
| + | The potential consequences of this [[Healing and Repair - Pathology#Repair in the Genital Tract|condition]] vary according to the timing and species involved. |
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| − | * [[Taylorella equigenitalis|''Taylorella equigenitalis'']] - causing the '''notifiable''' Contagious Equine Metritis (CEM)
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| − | * [[Klebsiella|''Klebsiella pneumoniae'']] - tests can be performed to identify capsule types 1, 2 and 5 which are sexually transmitted
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| − | * [[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']] - there is no available test to differentiate strains so all must be treated as pathogenic
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| − | 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. All three bacteria '''prevent conception'''.
| + | [[Category:Reproductive Disorders]][[Category:Parturition]] |
| − | | + | [[Category:To Do - Clinical]][[Category:Reproductive Diseases - Cattle]] |
| − | [[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.
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| − | Detailed guidelines on the diagnosis, treatment and prevention of all these infections can be found in the [http://codes.hblb.org.uk/|Codes of Practice] which are followed by Thoroughbred breeders in the UK.
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| − | ===Non-venereal Infectious Endometritis===
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| − | This occurs following infection during '''covering''', '''reproductive examination''' or '''foaling'''. The mare will normally present with a history of '''infertility''' or '''early embryonic death''' and '''short cycles'''. There may also be evidence of '''vaginal discharge'''. Infection may be caused by:
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| − | * Bacterial Infection - [[Streptococcus zooepidemicus|''Streptococcus zooepidemicus'']], [[Escherichia coli|''Escherichia coli'']] or [[Staphylococcus aureus|''Staphylococcus aureus'']]
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| − | * Fungal Infection
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| − | ===Persistent Post-mating Endometritis===
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| − | This is more common in '''older''' and '''multiparous mares'''. They present with a history of short cycling and often an vaginal discharge approximately two weeks post-cover.
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| − | A '''transient inflammatory response''' is '''normal''' in the mare post-cover, however a normal immunological response is mounted and the infection cleared before the embryo exits the fallopian tube. In the cases of persistent post-mating endometritis the '''inflammation persists longer than 72-96 hours''' so that when the embryo enters the uterus the '''environment''' is still '''unsuitable for embryonic development''', resulting in '''early embryonic death'''.
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| − | ===Chronic Degenerative Endometritis===
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| − | Chronic degenerative endometritis ''aka'' '''endometriosis''' is '''degenerative change''' that occurs in '''older mares''' or following '''repeated inflammation''' of the uterus. If the condition is severe it may result in delayed clearance of the uterus post-cover. Definitive diagnosis can only be achieved by '''biopsy''', which will show degenerative change of the uterus '''histologically'''.
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| − | ===Chronic Infectious Endometritis===
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| − | Normally an underlying '''conformational condition''' such as [[Pneumovagina - Horses|'''pneumovagina''']] predisposes the mare to chronic infectious endometritis. Definitive diagnosis is again by '''biopsy''' which should show '''infiltration of the endometrium with [[lymphocytes]] and [[Plasma Cells|plasma cells]]'''. Infection may be:
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| − | * Bacterial - [[Streptococcus zooepidemicus|''Streptococcus zooepidemicus'']], [[Escherichia coli|''Escherichia coli'']]
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| − | * Fungal - more common if there is a history of multiply intra-uterine antibiotic treatments
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| − | 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 using Caslicks procedure.
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| − | ==Diagnosis==
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| − | * '''Clinical examination''' may reveal '''vulval discharge''' or '''matted tail hairs'''.
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| − | * '''Vaginal''' '''examination''' should identify any '''discharge''' and '''increased vascularity''' of the tissue. Conformational abnormalities resulting in e.g. pneumovagina and urovagina may be evident.
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| − | * '''Ultrasound''' examination of the uterus - '''more than 2 cm of fluid with abnormal character''' suggests endometritis.
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| − | * '''Clitoral''' and '''endometrial swabs''' should be taken for '''culture and sensitivity'''. Clitoral swabs should be taken if a chronic venereal infection is suspected. Guarded endometrial swabs should be taken during oestrus to identify either acute venereal infections or the causative organism of other endometrial infections and evidence of inflammation. A high level of neutrophils is indicative of endometritis. The mare should be confirmed as not pregnant before taking an endometrial swab.
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| − | * '''Uterine flush''' - the uterus should be flushed with 100mls of fluid which can then be examined '''cytologically''' for evidence of inflammatory cells and bacteria.
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| − | * '''Endometrial endoscopy''' can be performed to visualise and assess the endometrium.
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| − | *''' Uterine biopsy''' - this should be performed after all other tests have failed to reach a diagnosis or to '''definitively diagnose''' endometriosis or chronic infectious endometritis. A single sample should be representative if the uterus feels normal on palpation. If an abnormality is detected on examination per rectum then samples should be taken from both normal and abnormal sites.
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| − | ==Treatment==
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| − | A combination of multiple therapies should be used to collectively resolve the inflammation within the uterus and treat existing infections:
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| − | '''(1) Uterine lavage''' with copious amounts of fluid. This is beneficial because it:
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| − | :removes contaminants such as bacteria and purulent material
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| − | :stimulates uterine contractions to aid clearance
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| − | :causes mechanical irritation to the endometrium aiding healthy neutrophil recruitment
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| − | '''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.
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| − | '''(2) 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.
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| − | '''(3) Administration of ecbolics''' to stimulate uterine contractility and clearance of infection - oxytocin and prostaglandin analogues
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| − | '''(4) Hormonal therapy'''- Oestradiol Benzoate and PG can be used to aid the clearance of infection. They are more effective during oestrus.
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| − | In the cases of venereal infections additional treatment may be required:
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| − | :'''Acute infections''': Repeated antibiotic clitoral irrigation and reintroduction of normal flora. A clitorectomy may be considered.
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| − | :'''Chronic/carrier infections''': Repeated clorhexidine clitoral irrigation and reintroduction of normal flora.
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| − | ==Management of Susceptible Mares==
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| − | (1) '''Identify''' problem mare
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| − | (2) Plan a '''single insemination''' using a stallion with high fertility rates approximately '''1-2 days prior to ovulation'''. Semen extender may be delivered intra-uterine before cover.
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| − | (3) '''Ultrasound the uterus''' in the first '''12 hours''' post-cover. The character and volume of fluid present should be assessed.
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| − | (4) '''Remove uterine contaminants via lavage and antibiotic infusion'''. Administer oxytocin 8 hours after treatment.
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| − | (5) '''Repeat ultrasound''' examination after '''24 hours'''.
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| − | Treatments should not be repeated if possible as this may introduce infection.
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| − | ==Prevention==
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| − | * Employment of strict hygiene measures during breeding, reproductive examinations and parturition
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| − | * Adherence to the [http://codes.hblb.org.uk/| Codes of Practice]
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| − | * Surgical correction of any existing conformational abnormalities
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| − | ==Prognosis==
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| − | 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.
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| − | {{Learning
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| − | |flashcards = [[Equine Reproduction and Stud Medicine Q&A 12]]
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| − | ==References==
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| − | [http://codes.hblb.org.uk/| '''Codes of Practice'''] (2011) ''Horserace Betting Levy Board (HBLB)''
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| − | Pycock, JF (1997) '''Self-Assessment Colour Review Equine Reproduction and Stud Medicine''' ''Manson''
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| − | Pycock, JF (2004) '''Pre-breeding checks for mares''' ''In Practice 2004 26: 78-85''
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| − | Ricketts, S (1987) '''Vaginal discharge in the mare''' ''In Practice 1987 9: 117-123''
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| − | RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''
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| − | {{review}}
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| − | {{OpenPages}}
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| − | [[Category:Reproductive Disorders]][[Category:Uterus - Pathology]] | |
| − | [[Category:Reproductive Diseases - Horse]] | |
| − | [[Category:Expert Review - Horse]] | |
