1- Endometritis:

- Inflammation of the endometrium of the uterus.

- Infertility from the absence of suitable media due to the toxic influence of the exudates on the sperm and ovum.

-The possible causes of endometritis are:

-- Abnormal parturition; abortion dystocia, Fetotomy, and retention of placenta.

-- Delayed uterine involution.

-- Pneumo-vagina or wind sucking,

-- Following Coitus; infected semen or prepuce

-- Unhygienic births help.

-- Unhygienic instruments; treatment or insemination.

-- Vaginal or uterine prolapse.

-- Hormonal disturbance which influences the natural defensive mechanism of the female genitalia against the saprophytic and non-saprophytic microorganisms

-- Blood or endogenous infection from a septic focus in the body (clow or udder affection).

- Endometritis can be divided into four degrees as follows.

1- Chronic catarrhal endometritis (E1):

-- Failure of conception.

-- Regular estrus and mating with good fertile bull.

-- There is no abnormal vaginal discharge.

-- Estrous mucus is slightly increased and turbid.

-- Rectally, no abnormalities in the uterus.

-- The animal is typically a repeat breeder.

 

2- Chronic mucopurulent endometritis (E2):

-- Increased, milky, or cloudy mucus with pus flakes.

-- The abnormal discharge is seen on/off estrus.   

-- Rectally, the uterus is slightly enlarged, flabby, and thickened.  

-- The cervix is felt slightly larger and flabby.

-- Vaginally, the cervix is congested and enlarged.

-- It is commonly associated with chronic cervicitis.

-- The animal is a repeat breeder. 

Chronic endometritis in cow characterized by the presence of a hypoechoic inflammatory exudate contains a hyperechoic exfoliated cells and neutrophils inside the uterine lumen give it snow storm like appearance (notice the gray-black color of the inflammatory fluid)

Chronic endometritis in cow characterized by the presence of a hyperechoic masses inside the uterine lumen (notice the white color of the inflammatory aggregate)

 

3- Purulent endometritis (E3):

-- The inflammation is deeper,

-- Constant mucopurulent and purulent discharge.

-- The discharge is copious with bad odor.

-- Rectally, the uterus is large, thick, fluctuates, and hangs down or over the pelvic pubis.

-- The cervix is also enlarged and indurated.

-- Vaginally, enlarged, red, flabby, and widely opened cervix.

-- The Animal is a repeat breeder.

4- Pyometra (E4):

-- Collection of large amounts of pus in the uterus.

-- It will be associated with the persistence of the corpus luteum

-- The animal shows signs of anestrus.

- There are 2 types of pyometra:

- Diagnosis of endometritis:

-- History of repeat breeding,

-- Rectal examination with ultrasonography.

-- Vaginal examination.

◾Clinical endometritis in cows can be diagnosed by use of a vaginal discharge collection device or vaginoscopy or based on purulent discharge in the perineal area. The presence of more than 50% in the sample collected after 21 days after parturition can be used as a criterion to diagnose clinical endometritis.

◾ Subclinical endometritis in cows is diagnosed through the collection of a uterine lumen sample for cytologic evaluation using either cytobrush or cytotape techniques or uterine lavage. A threshold to characterize subclinical endometritis has been described: >18% PMNs in samples collected at 20–33 days after parturition or >10% PMNs in samples collected at 34–47 days after parturition.

- Because endometritis is a subclinical (no signs or symptoms) disease, diagnosis via a Metricheck™ device is necessary. A Metricheck™ device is a rubber diaphragm (similar to a small tennis ball cut in half) on the end of a stainless-steel rod, which is inserted into the cow’s vagina and used to collect a sample of discharge from the uterus. If pus is detected using this procedure, a cow is deemed to have endometritis ‘dirty’.

-- Whiteside test Cervical mucus: cervical mucus is collected aseptically and mixed with equal volume of 5 % NaOH in a test tube. The mixture is heated up to the boiling point and the intensity of color change is graded as Turbid (Normal), Light yellow (Mild endometritis), Yellow (Moderate endometritis), and Dark yellow (Severe endometritis).

-- Bacteriological examination from collected mucus.

-- Sensitivity test for suitable antibiotics.

- Prognosis of endometritis depends largely on

-- Duration of the disease,

-- Severity,

-- Extension of the lesion.

-- Kind of microorganism.

-- Prognosis is bad in C. pyogenes or E.coli.

- Treatment of endometritis:

1- Evacuation of the uterine contents by induction of estrous to dilate the cervix:

 - Cervix is opened by the I.M. injection of either by PGF2α, 25 mg, or Stilbesterol 30-50 mg.

- If the uterus contains dry pus, it will be liquefied by flushing the uterus with sod bicarbonate (3%) warmed solution then gentle massage to help in the evacuation.

2- Intra-uterine application of antibiotics. Several antimicrobial agents are absorbed from the uterus (tetracycline, penicillin, ampicillin and gentamicin). Cephapirin benzathine (500 mg, intrauterine, once; second treatment may be required in 7–14 days if clinical signs persist). 2-3 gm or sulfonamides repeated every 3 days for at least three successive treatments.

When appropriate, administer prostaglandin then administer intrauterine cephalosporin 4-6 days later. All treated cows require re-examination and possibly retreatment at 14-day intervals. Cows that fail to respond to these treatments have a poor prognosis regarding future fertility.

3- 2.0% intrauterine povidone-iodine intrauterine infusion (50-100 ml) seems to be a better option in treating severe clinical endometritis in dairy cows and in those who recover immediately from pyometra

4- Because intrauterine use of antiseptics may suppress the uterine defense mechanisms like phagocytosis, the use of intra uterine infusions in the postpartum cow is not recommended. Lugol’s iodine application must be given after rectal examination and be sure that the uterus returns to normal clinical condition.

5- Autologous plasma: Collect about 100 ml of blood from the estrus animal and separate the plasma. Administer 50 ml of plasma through intrauterine route on days 1, 2 and 3 of estrus.

6- Caslick operation or suturing the vagina in case of pneumo-vagina is recommended.

- The prophylactic measurements:

-- Good balanced ration. 

-- Hygienic birth and birth help.

-- Prophylactic antibiotic after birth.

-- Competing infectious disease.   

-- The animal never be mated or inseminated on the first two or three heats after recovery.

-- Sometimes a dose of antibiotics or Lugol’s solution is given 15-30 minutes after insemination.

2-Sclerotic metritis:

-  The endometrium and caruncles are destroyed.

-  Severe chronic metritis.

- The endometrium is converted into a thick dense layer of connective tissue with foci of infection and purulent exudation into the uterine cavity.

- On the rectal examination:

-- The uterus is felt cartilaginous, very hard in texture or dense fibers, enlarged than normal size  

-- Chronic exudates may be extruded from the uterus through a thickened indurated cervix.

-- Embedded CL in the ovary.

- The animal shows signs of:

-- Repeat breeding in the early stage,

-- Pyometra and anestrum lately.

- The animal is sterile and being slaughtered.

3- Perimetritis and Parametritis

- Inflammation of the outer coat of the uterus.

- Adhesions between the uterus and broad ligaments.

- The sequence of septic metritis:

-- Following perforation of the uterine wall with a catheter during irrigation of the uterus with irritant material.

-- Rough manipulation of the genitalia during rectal examination.

-- Diffuse peritonitis or tuberculosis.

-- Excessive bleeding after manual removal of CL or cyst.

- The lesion may vary from a few to large adhesion between the uterus, broad ligaments and the other structures.

- The adhesion may be diffuse or localized.

-  In some cases, abscess may be found

- In acute case, symptoms are:

-- Anorexia, arched back, fever and tenesmus. 

-- Pain at the time of urination or defection.

-- Rectal examination shows signs of pain.

- If the symptoms of acute stage pass without death of the animal, adhesion occurs and become chronic.

- Areas of infection become capsulated and abscesses are formed and can be felt on rectal examination.

- Prognosis varies with the severity of the condition.

-- Slight adhesion causes no disturbances and sometimes can be broken by the hand through the rectum.

-- In severe extensive adhesion, prognosis is unfavorable especially if the ovaries and oviducts are involved.

-- Treatment by antibiotics and sulfonamides may be useful

4- Abscess of the uterine wall:

- It is occasionally observed in the cow.

- It is usually round oval in shape and tense.  

- It occurs frequently as a consequence to:

-- Severe metritis,

-- Improper removal of retained placenta,

-- Improper use of pipettes or instruments.

- Rectally, the abscesses are easily palpated.

- They should be differentiated from tumors, cysts or hematoma.

- The general health of the animal is disturbed.

- The case may be fatal if the infection is extended and causes peritonitis.

- For treatment, systemic antibiotic is good value in early stage.

5- Tumors of the uterus:

- They are rare in the cow.

-  Mostly benign and occasionally malignant.

-  leiomyoma; fibroma; lipoma; adeno-carcinoma, and leucosis in cattle.

- Rectally, the tumor should be palpated easily.

- The animal should be discarded from breeding.