Contributors: Mushtaq Memon

 Species: Canine   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading

Introduction

  • 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.

Presenting Signs

  • 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.

Acute Presentation

  • Peritonitis following uterine rupture.

Cost Considerations

  • Expensive with fluid therapy, and hysterectomy.

Special Risks

Uterus may be easily damaged - care with hysterectomy.

Pathogenesis

Etiology

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

Predisposing Factors

General

Specific

Pathophysiology

  • 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.

Timecourse

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

Diagnosis

Presenting Problems

  • Vulval discharge.
  • Agalactia.

Client History

  • 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.

Clinical Signs

  • Vaginal discharge: sanguinous to purulent.
  • Pyrexia.
  • Abdominal pain/shock if peritonitis.

Diagnostic Investigation

Hematology

Biochemistry

Cytopathology

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

Bacteriology

  • Gram-negative bacteria.

Radiology

Ultrasonography

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

Differential Diagnosis

Treatment

Initial Symptomatic Treatment

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

Standard Treatment

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.

Monitoring

  • Decreased fever.
  • Improved demeanor.

Subsequent Management

Treatment

Allowing one normal estrus before mating if breeding bitch probably not required due to the spacing of ovulatory periods in this species.
  • Advise ovariohysterectomy if not breeding bitch.

Outcomes

Prognosis

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

Expected Response to Treatment

Reasons for Treatment Failure

Further Reading

Publications

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).

Other Sources of Information