purperal metritis in cattle

2. Puerperal Metritis in Bovines

3. • Postpartum period
• Postpartum problems
• Introduction of puerperal metritis
• Etiology
• Pathogenesis
• Clinical findings
• Dx
• Rx

4. Postpartum period
• The postpartum period is the time from parturition to complete
involution of the uterus. It can be divided into 3 periods.
 Puerperal period is the period from parturition until the
pituitary is responsive to GnRH (7-14 days).
 Intermediate period begins with the increasing sensitivity of
the pituitary to GnRH and lasts until the first ovulation (14-20
days).
 Post-ovulatory period is the time from the first ovulation until
involution is complete.
• 3-4 weeks period before and after calving (the transition period) is
crucial for the health and lactation of cow.

5. Postpartum problems
• Problems arise during the puerperal period/ after parturition are
called postpartum problems.
• One of the most important problem after parturition is Puerperal
Metritis. Other includes RFM, endometritis, pyometra, fatty liver
syndrome, milk fever and ketosis in bovines.
• They have same etiological factors, susceptibility and to some
extent treatment.
• Chances of uterine infection are at peak in this phase which further
affects the cyclicity of animal. Inflammation of the uterus slows
down the process of involution in the uterus and delays the onset of
activities of the ovaries leading to economic loss due to systemic
illness, loss of milk and marked drop in fertility.

6. Introduction of puerperal metritis
• It is an inflammation of all the layers of uterus which is
characterized by presence of watery, reddish brown vulvar
discharge. Uterus is filled with odorous, red – brown content mixed
with necrotic and putrefied tissues.
• This condition occurs within the few days (10-14 days) just after
calving in cattle.
• It results from contamination of the reproductive tract at
parturition. Clostridia is often involved but other pathogens are
E.coli, coliforms etc
• Puerperal metritis is associated with uterine atony or inertia, with or
without retained fetal membranes.
• Cows will be systemically ill and this disease can be life threatening.

7. Copious red brown discharge
from vulva in puerperal
metritis

8. Graph shows the chances of
metritis after parturition.
High chances are between 10 -
14 days of postpartum.

9. Impact
• Metritis is probably the most significant
postpartum economic disease in dairy cattle,
causing high losses because of longer days open
and involuntary culling rates. It causes severe
economic losses due to costs for treatment, milk
withdrawal, reduced reproductive performance
and premature culling

10. Etiology
• The uterus becomes a good environment for
growth of the bacteria immediately after
parturition as it becomes warm; fluid filled having
necrotic debris that facilitates the multiplication of
the pathogens. Different species of bacteria
isolated and cultured from postpartum uterus
include: E.coli, Corynobacterium, Actinomycosis,
Strep. cocciArcanobacterium pyogenes,
Fusobacterium necrophorum, Bacteroides species,
Staphylococcus species, M.haemolytica and many
other spp.

11. Cont….
• Among these, Arcanobacterium pyogenes,
coliforms and the Gram – negative anaerobes,
Fusobacterium and Bacteroides species are
commonly encountered

12. Pathogenesis
• In the non- involuted uterus bacteria colonize and produce
toxins which get absorbed and cause severe symptoms as
after parturition uterus becomes a favorable place for
microorganisms to colonize them . Puerperal metritis
generally starts with the establishment of the pathogenic
organism to the mucosa of uterus and then their
penetration through the epithelium and releasing of the
toxins. The immunity of the cow and the species and load
of the bacteria involved in the infection is critical
determinant for the establishment of the infection. The
load of pathogenic bacteria in the uterus disturbs the
normal defence mechanism of uterus and cause fatal
conditions in bovines.

13. Cont…..
After calving uterus of animals has damaged
epithelium with fluids and debris from tissues
that favors in the development of infection as
bacteria reside in this area and grow.
Bacterial load and virulence has a great influence
in the development of infection after parturition.

14. Cont…..
• Cows with difficult calving usually lost the ability
to control the uterine infections naturally.
Injuries during difficult calving and its
manipulation generally increase the risk to
puerperal metritis

15. Cont…..
• The normal phagocytosis by the uterine
leukocytes is reported to be severely affected in
conditions like difficult calving, retained fetal
membranes and puerperal metritis.
• When uterus of post partum is compromised the
pathogenic organisms gain advantages and can
lead to toxic puerperal metritis

16. Acute septic metritis

17. Signs and Symptoms
• Affected animal shows both local and general symptoms
General symptoms:
• Toxaemia , septicaemia, pyrexia and pyaemia most commonly
develop
• Hyperthermia followed by hypothermia
• Temperature of affected cow elevated to 41-42oC
• Rapid pulse rate ( upto 100/minute)
• Respiration elevated (60-70 times/min, in normal it is 15-20 times)
• Marked drop in milk production
• Anuria
• Rumen contraction reduced or may be absent
• Animal becomes anorexic and dehydrated; may often develop
toxaemic induced diarrhoea and may develop signs of shock and
death

18. Cont…..
Localized symptoms:
If infection penetrates to peritoneum then may
develop localized or generalized peritonitis
• The uterus contains large amount of serous, fetid,
reddish exudate, having degenerated fetal
membranes ; the exudate may discharged from
vagina by making frequent expulsive straining
efforts.
• This kind of movements cause acute discomfort to
the animal and at the same time favours to most
severe and continuous expulsive efforts.

19. Cont…..
• Cotyledons get swollen and often shows the
strong attachment of fetal membranes
• Deep congestion of vulva and vagina along with
swelling
• Inflammation and thickening of vaginal mucous
membrane and partial opening of cervix
• If quick Rx is not conducted then cow become
extremely lethargic, dehydrated and lying down
with ensuring death after few hours.

20. Dx of puerperal metritis
• Clinically persistent fever more than 38/39 for 2
days and no other abnormality storngly suggets
puerperal period
• Palpation in this case shows inflammation of all
the layers of uterus or sometimes uterus may be
friable in consistency
• Culture may be helpful sometimes but as cervical
swab is mostly contaminated so may give false
positive results

21. Cont….
• Culture will give presence of most imp.
peurperal metritis causing bacteria i.e.
A.pyogenes, group C streptococci, haemolytic
staph., coliforms and Gram-negative anaerobes,
particularly bacteroids spp.
• Blood tests usually not recommended
• Clinically corelation will lead to Dx

22. Cont…
Uterine palpation
• Uterine palpation per rectum is one of the most
frequently used method to diagnose peurperal
metritis. But it should be gentle as it may cause
injury to uterus because in acute case it is friable
in consistency

23. Cotn….
Vaginoscopy
• Visual inspection of the vaginal canal is done
using a sterile metal or transport barrel with a
light source to inspect the presence of pus or
abnormal discharge. Mucopurrulent , purrulent
and foul smelling discharge indicates that there
is uterine infection while clear mucus is normal
in color etc.
• Urine culture test is done to rule out UTI

24. Cont….
Ultrasonography
• US is used frequently used for the diagnosis of
metritis and this mostly depends on the volume,
nature and presence of fluid in uterus. It is
found that impaired involution of uterus plays
role in fluid accumulation and this co-relates
with the growth of bacteria causing uterine
infection

25. Ddx….
• Peuperal metritis must b differentially
diagnosed from left displacement of abomasum,
traumatic reticulopericarditis,pneumonia
because their symptoms generally match with
puerperal metritis and they also occur during the
peurperal period
• Also DDX from RFM and UTI or abcess etc

26. Treatment of puerperal metritis
• Success of its treatment depends on medical service , attention and
a quick medication
• First made cow calm and comfortable as early as possible by
keeping her warm as she should be provided with a very good
bedding that will keep her warm
• Try to remove fetal membranes with hand by applying very gentle
force but not insert hand in vagina and uterus as consistency of
uterus is friable and it contains septic fluid
• Any rupture may cause entry of bacteria and absorption of toxins
• If there is continuous and vigorous straining of cow then caudal
epidural anesthesia may be applied to slow down the straining
• Local anesthetic gives relief for short duration (1-2hrs)

27. Cont….
• If we use xylazine alone or in combination with other anesthetics it
can prolonged the effect and gives relief to cow from vigorous
straining
• Give injection of 50 I.U of oxytocin intravenously if the case is seen
within 2-3 days of parturition as it will cause contraction of the
uterus and expulsion of fluid and debris in the uterus

28. Systemic Rx…
• Toxaemia and septicaemia are best treated by systemic
administration of broad spectrum antibiotics and supportive
therapy.
• Flushing of uterus eith mild antiseptic solution
Systemic antibiotics
• Antimicrobial therapy includes use of penicillins along with
ceflosporines for several days until recovery occurs
• Different brands of these drugs are used like Brics 1g 1+1 inj for 5
days
• Excenel 100 ml for 5 days
• Nugmentin , clavet and Ax-clav @ 25-30ml I/M for 7 days
• Oxytetracycline ( oxyfer, oxtra LA , Nawacin) this is also used to
treat this disease

29. cont…
Selection of antimicrobials
• For acute puerperal metritis selection of
antimicrobials is very important. Most
organisms that cause septic puerperal metritis
are susceptible to penicillin, so it is the
antimicrobial of choice for the affected cow for
effective treatment

30. Rx…..
Non steroidal anti-inflammatory drugs:
• Ketoprofen: dose 3mg/kg b.w, I/M or I/V at 24 hrs interval.
Trade name: neoprofen15 ml vial containing ketoprofen 100mg/ml
• Meloxicam: dose 0.5 mg/ kg b.w at 24 hrs interval.
Trade name: Melonex (Intas) 15 ml & 30ml vial containing meloxicam
5mg/ml

31. Rx….
Antihistamines
e.g chlorpheniramine maleate and pheniramine
maleate
• Pheniramine maleate (avil)
Dose 5-10ml I/M
• Chlorpheniramine maleate (Codistin, Zeel etc)
Dose 30-50mg (total dose) i.e. 3-5ml I/M

32. Rx….
Glucocorticoid ( dexamethasone)
• It is used in severe condition to prevent from
septic shock
• Dose : 10-30 mg (total dose) or 5ml, I/M or I/V
every 24 hrs

33. Rx….
Fluid and electrolytes
• The intravenous infusion of large quantities of
fluid and electrolytes is necessary in the
management of septic puerperal metritis
• Large amount of isotonic fluids have been
practiced. Ringer lactate solution or a balanced
electrolyte solution must be given by I/V for
several hrs
• Glucose should be included in infusion fluids

34. Rx…
Benefits of fluid and electrolyte therapy
• For the correction of peripheral vasoconstriction
• For the restoration of acceptable pulse quality
• Return of urinary output
• For the restoration of cardiac output
• Dilution of toxins

35. Rx…
Vitamin B-complex along with liver extract
• it is given by I/M route for 3 days

36. Rx…
Removal of retained fetal membrane
• It should be done in a gentle way , if not possible
then leave it as it is beacause it may injure the
uterus may cause toxins as well as microbes
absorption

37. cont…
• The use of estrogen in case of acute puerperal
metritis is contraindicated as it will cause
increase uterine contraction an blood flow in the
uterus and lead to increase absorption of toxins
and will cause situation more complex

38. Rx….
Intrauterine medication:
• In case of acute puerperal metritis IU therapy is contraindicated as
it will not remove infection. OTC infusion by IU route will not
spread to all the layers of uterus.IU infusion of penicillines is also
ineffective as in early post-partum period there is mixed
environment in the uterus with bacteria. So penicillin resistant
bacteria will give protective shield to penicillin sensitive bacteria. So
IU therapy of these antimicrobials during first few days of
parturition is ineffective. When animal get back to its normal
condition like temp. normal , cessation of diarrhea and normal
appetite then IU therapy is effective

39. Rx….
Hormonal therapy
Rx with prostaglandins or its analogues is very
effective in evacuating the uterus by uterine
contaction when functional CL is present but it
is seen that in early parturition days the cow
have not a functional CL so their use is less
useful in early days. But around 30-40 days in
milk prostaglandins are useful in expulsion of
uterine fluids and debris and help the cow to
come in estrus

40. Rx…
Ozone therapy
• Ozone destroy the cell membrane of micro-
organisms and penetrates into nucleic acid
through the protein coat to kill bacteria. It helps
to treat uterine infections in cows suffering from
metritis and endometritis

41. Rx….
Miscellaneous drugs
• Calcium is used as it causes smooth contraction
of the uterine muscles
• Immediately after calving there is decline in
calcium level in high producing cows leading to
atonicity of muscles of uterus that cause RFM
and metritis so orally administration of calcium
is done to prevent from metritis chances

42. Prognosis
• Prognosis is guarded for future fertility as the cow
that has faced acute peurperal metritis may
develop lesions in reproductive tract like uterine
adhesions, ovario-bursal adhesions and closed
uterine tubes
• Other complications of it includes pneumonia,
polyarthritis and endocarditis.
• In cases where pyaemia develops there may be the
development of abcesses in liver, brain, lungs and
kidneys

43. References
• Arthur’s Veterinary Reproduction And
Obstetrics By David E Noakes.
• Defining postpartum uterine disease in cattle by
Martin Sheldon (Elsevier journal)
• Applied Veterinary Gynaecology And Obstetrics
By Pradeep Kumar.
• Treatment of postpartum metritis in dairy cows
by K.W.Pulfer & R.L., Riese (research article)