Acute metritis

• Cause: usually develops within 1 week of whelping (also abortion, mating, artificial insemination (AI) or normal estrus).
• Signs: vaginal discharge: sanguinous to purulent.
• Diagnosis: signs, imaging.
• Treatment: broad-spectrum antibiotics, supportive, follow-up hysterectomy.
• Prognosis: guarded depending on condition of bitch, potentially fatal if uterus ruptures.

• Vulval discharge: odiferous, sanguinous to purulent.
• Usually within 1 week of whelping (abortion, mating, artificial insemination (AI) or normal estrus).
• Anorexia.
• Depression.
• Tenesmus.
• Gastrointestinal signs.
• Agalactia and neglect of pups.

• Peritonitis following uterine rupture.

• Expensive with fluid therapy, and hysterectomy.

• Usually ascending bacterial infection: gram-negative, eg E. coli, Staphylococcus spp, Streptococcus spp and Corynebacterium spp.

General

• Poor uterine tone:
  • Hypocalcemia Primary maternal dystocia.
  • Dystocia Dystocia.
  • Large litters.

Specific

• Non-sterile manipulation of dystocia.
• Retained placentae Retention of fetal membranes and fetus /puppies.
• Fetal death.

• Uterine infection caused by:
  • E. coli Escherichia coli.
  • Proteus spp Proteus spp.
  • Staphylococcus spp Staphylococcus spp.
  • Streptococcus spp Streptococcus spp.
  • Other gram-negative and gram-positive vaginal commensals.

• Bacteria normally found in → uterus → proliferate in lochia → endotoxin release → :
  • Interference with ADH (see pyometra complex Pyometra ) → dehydration, uremia.
  • Pathogen chemotaxis → neutrophilia → pooling of neutrophils in uterus → left shift leukogram.

• Usually within 1 week of whelping (or other predisposing event).

• Vulval discharge.
• Agalactia.

• Usually develops within 1 week of whelping or abortion.
• Puppies restless and crying.
• Anorexia.
• Depression.
• Tenesmus.
• Agalactia and neglect of pups.

• Recent history of mating, AI or normal estrus.

• Vaginal discharge: sanguinous to purulent.

• Pyrexia.

• Abdominal pain/shock if peritonitis.

Hematology

• Elevated PCV Hematology: packed cell volume.
• Neutrophilia Hematology: leukocyte (WBC) and shift to left.

Biochemistry

• Elevated total protein Blood biochemistry: total protein.

Cytopathology

• Vaginal smears show cellular debris and mucus, clusters of endometrial cells, bacteria, hypersegmented and degenerate neutrophils.

Bacteriology

• Gram-negative bacteria.

Radiology

• Abdominal radiography Radiography: abdomen indicated:
  • Uterine enlargement.
  • Retained fetus.

Ultrasonography

• Uterine distension - may be flocculent material visible in uterus.

• Other systemic illness.
• Hypocalcemia Primary maternal dystocia.

• Mastitis Mastitis.

• Urinary tract infection Cystitis.

• May ultimately require ovariohysterectomy Ovariohysterectomy.
  Uterus may be friable and liable to rupture (particularly if receiving oxytocin) → peritoneal contamination.

• Broad-spectrum antibiotic Therapeutics: antimicrobial drug and fluid therapy Fluid therapy.

Restoration of uterine tone

• Calcium plus oxytocin Oxytocin : 0.5 iu/kg repeated in 1 hour or more often (maximum dose 40 iu); if no response then:
• Calcium Calcium borogluconate plus ergonovine : 0.2 mg/15 kg for 3 days.

Antibiotics

• Broad-spectrum antimicrobial Therapeutics: antimicrobial drug.
  Culture and sensitivity seldom if ever useful due to mixed population.
• Irrigation of uterus twice daily with oestrogen/antibacterial combination.
• Continuous therapy for 7-10 days with 2 antibiotics according to sensitivity.

Management of post-partum bitch

• Give puppies supplementary feeding until clinical response to therapy.

Fluid therapy

• 5% glucose Glucose with electrolyte replacement.

• Decreased fever.
• Improved demeanor.

Treatment

• Advise ovariohysterectomy if not breeding bitch.

• Guarded.
• Depends on condition of bitch.
• Potentially fatal following uterine rupture.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Watts J R & Wright P J (1995) Investigating uterine disease in the bitch: uterine cannulation for cytology, microbiology and hysteroscopy. JSAP 36 (5), 201-206 PubMed.

Other sources of information

• Magne M L (1986) Acute metritis in the bitch. In: Current Therapy in Theriogenology. 2nd edn. Morrow D A (ed). London: W B Saunders (a good review).