Puerperal metritis

From Cow
Postmortem specimen from a first calf heifer that died from puerperal metritis. Exposure of the endometrium shows delayed involution of the caruncles and discoloration due hydrogen sulfide production. There was a foul odor.
Chronic unilateral metritis in the right horn in a cow 40 to 50 postpartum. The left horn has involuted normally; the endometrium is clean. Note corpus luteum on the right ovary.

Puerperal (neonatal) metritis is an acute post-partum toxaemia that occurs in cows worldwide.

Cause

In all species, acute puerperal metritis occurs within the first 10–14 days postpartum. It results from contamination of the reproductive tract at parturition and often, but not invariably, follows complicated parturition. The causative organisms in cattle are most frequently the bacteria Escherichia coli and Arcanobacterium pyogenes. In some cases, gram-negative anaerobic bacteria such as Prevotella melaninogenica and Fusobacterium necrophorum may be involved.

Infections with Escherichia coli and Arcanobacterium pyogenes are associated with both metritis and purulent vaginal discharge[1].

Clinical signs

Acute signs of toxamia usually develop 10 - 14 days post-partum, characterised by acute depression, fever and inappetent. A fetid, watery uterine discharge is characteristic of the condition. Milk production is diminished, and nursing young may show signs of food deprivation.

Treatment

Some management strategies, such as shortening the 'dry period' and increasing dry matter intake during the periparturient period may help prevent puerperal metritis and subsequent fertility issues[2].

Systemic antimicrobial therapy, NSAIDs and fluid therapy greatly assist recovery.

Penicillins, enrofloxacin and ceftiofur are usually indicated as broad-spectrum antibiotics. Oxytetracycline, being bacteriostatic, may require high levels (11 mg/kg, bid) to maintain uterine tissue concentrations[3].

Drainage of the uterine content may be advantageous but should be attempted only after initiation of antimicrobial therapy; it should be done very carefully because the inflamed uterus may be friable, and manipulation of the uterus may result in bacteremia.

References

  1. LeBlanc SJ et al (2011) Reproductive tract defense and disease in postpartum dairy cows. Theriogenology 76(9):1610-1618
  2. Gumen A et al (2011) Dry period management and optimization of post-partum reproductive management in dairy cattle. Reprod Domest Anim 46(3):11-17
  3. Liu WB et al (2011) Strategy for the treatment of puerperal metritis and improvement of reproductive efficiency in cows with retained placenta. Acta Vet Hung 59(2):247-256