Endometritis Research Articles

Causes and Management of Uterine Perforation- A Review

Uterine perforation is an intrauterine problem that can occur with any therapy. It is a rare but possibly dangerous consequence of uterine manipulation, evacuation of retained products of conception or pregnancy termination (TOP), hysteroscopic treatments, and coil implantation. Injury to blood arteries or viscera, such as the bladder or the intestine, might be related. Severe bleeding or infection may ensue if not discovered at the time of surgery; nevertheless, the most majority of uterine drilling is subclinical and safe without treatment, with no substantial long-term damage. Perforation can be caused by cervical stenosis during trans-cervical operations or by a reduction in myometrial wall strength during pregnancy or menopause. Uterine abnormalities, infection, recent pregnancy, and postmenopause are all factors that raise the chance of uterine perforation. The treatment of uterine perforation is determined by the operation and the equipment employed. Admission to the hospital, intravenous antibiotics, and close supervision are required following a uterine perforation and any accompanying injuries. In this paper, we overview common causes and updated management of uterine perforation. Data was collected during a period of 6 months searching Pubmed, EPISCO, Web of science data bases to include studies with relative topics.

Greater Reproductive Performance in Holstein Dairy Cows with Moderate Length of Anogenital Distance at First Service Postpartum

BACKGROUND: Previous studies have indicated negative association of anogenital distance (AGD) with fertility in dairy cows; however, the mechanism of inverse relationship is not completely understood. In this regard, postpartum uterine infections and their corresponding risk factors could diminish fertility of cows, yet there has been no research exploring the relationship between AGD and postpartum disorders. OBJECTIVES: The aim of this study was to investigate the relationship between AGD and postpartum reproductive performance in dairy cows. METHODS: AGD of Holstein dairy cows of a commercial dairy herd (n = 290) was measured at the first postpartum examination (days 28 to 32 postpartum) in millimeter. Cows were classified into three categories based on AGD length, including short anogenital distance (20% of cows with lowest values), intermediate anogenital distance (60% of cows with moderate values) and long AGD (20% of cows with highest values). Additionally, data of postpartum reproductive variables were retrieved form herd database. Dara were analysed using SAS software version 9.4.RESULTS: Rate of dystocia, twinning, retention of fetal membranes, puerperal metritis and clinical endometritis, calf birth weight and days to first service did not differ among the various AGD categories (P > 0.05). However, proportion of male offspring was lower in short AGD cows than intermediate and long AGD cows (P < 0.05). Furthermore, first service conception rate was greater in intermediate anogenital distance group than short and long anogenital distance groups (P < 0.05). CONCLUSIONS: In conclusion, the present study showed suboptimal first postpartum conception rate in cows with minimal and maximal length of anogenital distance and indicated that this inferior fertility was not mediated through alteration in rate of postpartum reproductive disorders.

Perinatal Data of Refugee Women from the Gynaecology Department of Charité University Hospital Berlin Compared with German Federal Analysis.

Introduction The aim of this study was to record the perinatal data of refugee women at Charité Hospital, Berlin, and to evaluate possible differences in pre-, peri- and postnatal outcomes compared with indigenous women. Material and Methods All pregnant women who gave birth in the period from 1 January 2014 to 30 September 2017 and were registered at least once in the hospital as “refugee” were included in the analysis. The data recorded from the refugee women were compared with the perinatal data of the German Federal obstetric analysis for the year 2016, which was published by the IQTIG (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen [Institute for Quality Assurance and Transparency in Healthcare]). Results The analysis comprised 907 refugee women and 928 infants (21 twin pregnancies). Pregnant refugee women were significantly younger than the pregnant women from the Federal analysis (birth before the age of 30: 66 vs. 41%, p < 0.001, RR: 1.6, 95% CI: 62.9 – 69.2). They had a history both of more pregnancies (≥ 3 pregnancies: 29.4 vs. 13.4%, p < 0.001, RR: 2.2, 95% CI: 26.4 – 32.5) and of more miscarriages (> 2 miscarriages: 9.7 vs. 5.9%, p < 0.001, RR: 1.6, 95% CI: 7.9 – 11.8) and more often had a history of suffering from psychological stress (11.1 vs. 4.1%, p < 0.001, RR: 2.70, 95% CI: 9.2 – 13.4). There were more premature births (10.3 vs. 3.0%, p < 0.001, RR: 3.36, 95% CI: 8.4 – 12.4), post-term pregnancies (8.5 vs. 0.5%, p < 0.001, RR: 15.4, 95% CI: 6.7 – 10.5), and cases of postpartum anaemia (28.7 vs. 22.0%, p < 0.001, RR: 1.30, 95% CI: 25.7 – 31.7) and puerperal endometritis (1 vs. 0.2%, p = 0.006, RR: 4.3, 95% CI: 0.5 – 1.9) compared with the Federal analysis. The neonatal outcome showed an increased rate of hypotrophy (11 vs. 7%, p < 0.001, RR: 1.6, 95% CI: 9.1 – 13.2), more stillbirths (0.7 vs. 0.2%, p = 0.006, RR: 3, 95% CI: 0.2 – 1.4) and increased congenital malformations (2.8 vs. 0.4%, p < 0.001, RR: 3, 95% CI: 0.2 – 1.4). Conclusion Both refugee women and their infants showed significant differences. Despite the average younger age of the pregnant refugee women, the rates of premature birth and stillbirth and congenital malformations were significantly more frequent. More intensive antenatal screening with differentiated foetal organ diagnostics including psychosomatic care could contribute to early identification and prompt diagnosis. As regards the postpartum anaemia and puerperal endometritis, which occur more often in refugee women, midwife engagement and an improvement in the living situation in homes and accommodation facilities could be of great importance.

Standardizing abortion research outcomes (STAR): Results from an international consensus development study

ObjectiveTo develop a minimum data set, known as a core outcome set, for future abortion randomized controlled trials. Study designWe extracted outcomes from quantitative and qualitative systematic reviews of abortion studies to assess using a modified Delphi method. Via email, we invited researchers, clinicians, patients, and healthcare organization representatives with expertise in abortion to rate the importance of the outcomes on a 9-point Likert scale. After 2 rounds, we used descriptive analyses to determine which outcomes met the predefined consensus criteria. We finalized the core outcome set during a series of consensus development meetings. ResultsWe entered 42 outcomes, organized in 15 domains, into the Delphi survey. Two-hundred eighteen of 251 invitees (87%) provided responses (203 complete responses) for round 1 and 118 of 218 (42%) completed round2. Sixteen experts participated in the development meetings. The final outcome set includes 15 outcomes: 10 outcomes apply to all abortion trials (successful abortion, ongoing pregnancy, death, hemorrhage, uterine infection, hospitalization, surgical intervention, pain, gastrointestinal symptoms, and patients’ experience of abortion); 2 outcomes apply to only surgical abortion trials (uterine perforation and cervical injury), one applies only to medical abortion trials (uterine rupture); and 2 apply to trials evaluating abortions with anesthesia (over-sedation/respiratory depression and local anesthetic systemic toxicity). ConclusionUsing robust consensus science methods we have developed a core outcome set for future abortion research. ImplicationsStandardized outcomes in abortion research could decrease heterogeneity among trials and improve the quality of systematic reviews and clinical guidelines. Researchers should select, collect, and report these core outcomes in future abortion trials. Journal editors should advocate for core outcome set reporting.

"Association of High Risk Factors and Hearing Impairment in Infants-A Hospital Based Study".

The aim of the study was to find the association of various risk factors with permanent hearing impairment in infants. Acase-control study was designed on 420 infants with permanent hearing impairment and normal hearing. The case control ratio was 1:1. Alternate sampling method was used for selecting the control group. Review of medical records and parent interview was done to collect the information of risk factors. Family history(adj. OR 7.5; 95% CI 3, 14; P = 0.000), Consanguinity (adj. OR: 4; 95% CI 2,4; P = 0.000), intra uterine infection (adj. OR 18, 95% CI: 2.3-126.5, P = 0.000), post natal infection (adj. OR 3, 95% CI: 1.3-5, P = 0.004), low Apgar score (adj.OR: 4.6, 95% CI: 1.3-15), craniofacial anomaly (OR-4.6, 95% CI: 1.4-9.5, P = 0.005) and low birth weight (adj. OR: 2.3, 95% CI: 1.2-3.8) were significantly associated with hearing impairment. Among the risk factors, intra uterine infection was having highest significant association with permanent hearing impairment. This is followed by family history, low Apgar score, craniofacial anomaly, consanguinity, post natal infection and low birth weight.

Levofloxacin or gonadotropin releasing hormone agonist treatment decreases intrauterine microbial colonization in human endometriosis

ObjectiveWe examined the hypothesis that antibiotic treatment with or without gonadotropin releasing hormone agonist (GnRHa) may decrease intrauterine infection with consequent decrease in tissue inflammation, cell proliferation and angiogenesis in human endometriosis. Study designThis is a prospective non-randomized observational study. Endometrial/endometriotic samples were collected during surgery from 53 women with endometriosis and 47 control women who were treated with levofloxacin (LVFX, 500 mg, once per os) or GnRHa (1.88 mg/IM for 3 months) before surgery. Endometrial samples were analyzed by broad-range polymerase-chain reaction (PCR) amplification of bacteria targeting V5-V6 region of 16S rRNA gene. Immunohistochemical analysis was performed using antibodies against CD138 (Syndecan-1, a marker of plasma cells), CD68 (marker of macrophages), Ki-67 (cell proliferation marker), and CD31 (vascular cells marker). Results16S rDNA metagenome assay indicated that treatment with either of LVFX or GnRHa + LVFX significantly decreased some components of major bacterial genera comparing to untreated group. In women with endometriosis, treatment with either of LVFX or GnRHa + LVFX significantly decreased Gardnerella, Prevotella, Acidibactor, Atopobium, Megasphaera, and Bradyrhizobium (p < 0.05 for each) comparing to untreated group. Cochran-Mantel-Haenszel test indicated that occurrence rate of chronic endometritis was significantly decreased after GnRHa + LVFX treatment comparing to GnRHa treatment group (p = 0.041). These findings were coincided with significantly decreased CD68-stained macrophage infiltration, Ki-67- stained cell proliferation and CD31-stained micro-vessel density in endometria and endometriotic lesions with histology proven improvement in the morphological appearance of ovarian endometrioma. ConclusionsThese findings suggest that clinical administration of a broad-spectrum antibiotic with or without GnRHa may be effective in improving uterine infection with decrease of tissue inflammation, cell proliferation, and angiogenesis in human endometriosis.

CORRELATION BETWEEN EXCLUSIVE BREASTFEEDING IN GROUP OF EARLY INITIATION OF BREASTFEEDING ON THE DURATION OF LACTATIONAL AMENORRHEA

Introduction: Based on data from "Survei Demografi dan Kesehatan Indonesia" (SDKI) in 2012, about four percent of births occurred 18 months apart, and six percent were less than two years apart, about 75 percent occurred at least three years apart. WHO’s recommendation for birth spacing is at least 24 months. A gestation interval of fewer than six months can increase maternal mortality due to premature rupture of the amniotic sac, anemia, and puerperal endometritis. The Lactational Amenorrhea Method is a natural and easy method of contraception. The LAM method is one of the contraceptive methods with a success rate of 98 percent. One of the importance of contraception, such as LAM, is to adjust the optimal birth spacing. Purpose: This study aims to determine the correlation between exclusive breastfeeding in a group of early initiation of breastfeeding on the duration of lactational amenorrhea. Method: This study is an observational analytic study with a retrospective cohort study design. A simple random sampling technique is used for the sampling method. The collection of data on the history of breastfeeding and the duration of amenorrhea was collected from the main research results by doing interviews with respondents. Results: The results of statistical tests with Spearman correlation showed that the P-value obtained is 0.005. This value is less than p (0.05), which means a significant correlation between exclusive breastfeeding and the duration of lactational amenorrhea. Conclusion: There is a significant correlation between exclusive breastfeeding in the early initiation of the breastfeeding group and the duration of lactation amenorrhea.

Placental complications among Iraqi Pregnant Women with Placenta Accreta

Background: Placenta accreta is an abnormal attachment of the placenta to the myometrium. It is the most common reason for an emergency postpartum hysterectomy, which is a major cause of maternal morbidity and mortality. If placenta accreta has been detected or suspected prior to birth, the best time to deliver is about (34-35) weeks, with a multidisciplinary team strategy to prevent complications during birth such as uterine infection, massive vaginal bleeding, uterine wall rupture, and uterine inversion secondary due to tried manual placenta removal.Aims of the study: To assess placenta complications for pregnant women with placenta accreta and to assess the obstetrical history of pregnant women with placenta accreta.Methodology: This study was conducted at Maternity wards in Baghdad City's. The study sample consists of (410) pregnant women diagnosed with placenta accreta out of 58,600 cesarean sections. Retrospective study for last three years ago, of January /2018 to December/ 2020, The data collected of patient records in the Statistical Department of the hospitals.Results: The results of the study showed that all women suffer of the adherence of the placenta to the uterine wall at a rate of (100%). The study found (45.6%) of women needing from 4 to 5 pints of blood, the amount of blood transferred to the mother after childbirth. Also, about (52.7%) was noticed to be a critical cesarean delivery requires a multidisciplinary surgeon.Conclusion: women diagnosed with placenta accreta suffer of adhesion placenta to the uterine wall and need a blood transfusion during the delivery process, as well as the need to provide a multidisciplinary surgeon because some women have the adhesion extended to the organs adjacent to the uterus.Recommendations: Increase awareness of women regarding the complications of placenta accreta, Encourage women to commit to prenatal visits and early diagnosis is important to minimize complications.

Medical abortion offered in pharmacy versus clinic-based settings: A systematic review

ObjectiveExpanding access to medical abortion through pharmacies is a potential strategy to promote safe abortion care. To compare the effectiveness and safety of medical abortion offered in pharmacy settings with clinic-based medical abortion. Study designWe searched multiple databases and the gray literature through November 2020. No language restrictions were applied. We included randomized and nonrandomized comparative studies. We applied standard risk of bias tools to each included study and used GRADE methodology to assess certainty of evidence. The primary outcomes were completion of abortion without additional intervention, need for blood transfusion, and presence of uterine or systemic infection within 30 days of medical abortion. ResultsOur search yielded 2030 studies. One prospective cohort study from Nepal met inclusion criteria. This study collected data on 605 women obtaining medical abortion rom either a clinic or pharmacy, and was judged to have low risk of bias for our primary outcome. For women who received medical abortion in a pharmacy compared to a clinic there was probably little or no difference in complete abortion rates (adjusted risk difference 1.5%; 95% confidence interval [CI] −0.8 to 3.8, 1 study, 600 participants; low certainty of evidence). No cases of blood transfusion were reported in the study and a composite outcome comprised mainly of infection complications showed little or no difference between settings (adjusted risk difference 0.8; 95% CI −1.0 to 2.8, 1 study, 600 participants; very low certainty of evidence). ConclusionEvidence from just one nonrandomized study provides low certainty evidence that the effectiveness of medical abortion is probably not different between the pharmacy or clinic setting. ImplicationsProvision of medical abortions through pharmacy-based models of care may improve access to safe abortion. Comparative studies examining each model of care and outcomes on safety, effectiveness, and patient experience are needed.

Chronic Uterine Infection Caused by Fetal Retention and Treatment by Unilateral Ovariohysterectomy in a Dog

A four-year-old Anatolian Shepherd bitch was brought to our clinic with an intermittent purulent-hemorrhagic vaginal discharge complaint with no general symptoms for six months following the last parturition. There were no signs of mass or lesion on the vaginal wall during physical examination. Anechogenic uterine content, hyperechoic structures freely floating in the lumen, and suspicious fetal tissue remnants were detected by ultrasonography in only the left uterine horn. Hematological parameters revealed the chronic uterine infection. The unilateral ovariohysterectomy operation was performed for the more affected left horn to maintain the patient’s fertility. Two fetal bone remnants were detected in the reddish infectious uterine content at the postsurgical uterine incision. Throughout the postoperative five months, vaginal discharge or any general signs of complication were not observed. We thought that the last fetus might have undergone uterine retention and autolysis in the following weeks, which caused the chronic uterine infection. Obstetrical controls are well-advised in all parturitions to reveal any fetal remnant cases/complications and to have a normal postpartum process.

Genotype by heat stress interactions for production and functional traits in dairy cows from an across-generation perspective

The aim of this study was to analyze time-lagged heat stress (HS) effects during late gestation on genetic co(variance) components in dairy cattle across generations for production, female fertility, and health traits. The data set for production and female fertility traits considered 162,492 Holstein Friesian cows from calving years 2003 to 2012, kept in medium-sized family farms. The health data set included 69,986 cows from calving years 2008 to 2016, kept in participating large-scale co-operator herds. Production traits were milk yield (MKG), fat percentage (fat%), and somatic cell score (SCS) from the first official test-day in first lactation. Female fertility traits were the nonreturn rate after 56 d (NRR56) in heifers and the interval from calving to first insemination (ICFI) in first-parity cows. Health traits included clinical mastitis (MAST), digital dermatitis (DD), and endometritis (EM) in the early lactation period in first-parity cows. Meteorological data included temperature and humidity from public weather stations in closest herd distance. The HS indicator was the temperature-humidity index (THI) during dams' late gestation, also defined as in utero HS. For the genetic analyses of production, female fertility, and health traits in the offspring generation, a sire-maternal grandsire random regression model with Legendre polynomials of order 3 for the production and of order 2 for the fertility and health traits on prenatal THI, was applied. All statistical models additionally considered a random maternal effect. THI from late gestation (i.e., prenatal climate conditions), influenced genetic parameter estimates in the offspring generation. For MKG, heritabilities and additive genetic variances decreased in a wave-like pattern with increasing THI. Especially for THI >58, the decrease was very obvious with a minimal heritability of 0.08. For fat% and SCS, heritabilities increased slightly subjected to prenatal HS conditions at THI >67. The ICFI heritabilities differed marginally across THI [heritability (h2) = 0.02-0.04]. For NRR56, MAST, and DD, curves for heritabilities and genetic variances were U-shaped, with largest estimates at the extreme ends of the THI scale. For EM, heritability increased from THI 25 (h2 = 0.13) to THI 71 (h2 = 0.39). The trait-specific alterations of genetic parameters along the THI gradient indicate pronounced genetic differentiation due to intrauterine HS for NRR56, MAST, DD, and EM, but decreasing genetic variation for MKG and ICFI. Genetic correlations smaller than 0.80 for NRR56, MAST, DD, and EM between THI 65 with corresponding traits at remaining THI indicated genotype by environment interactions. The lowest genetic correlations were identified when considering the most distant THI. For MKG, fat%, SCS, and ICFI, genetic correlations throughout were larger than 0.80, disproving concerns for any genotype by environment interactions. Variations in genetic (co)variance components across prenatal THI may be due to epigenetic modifications in the offspring genome, triggered by in utero HS. Epigenetic modifications have a persistent effect on phenotypic responses, even for traits recorded late in life. However, it is imperative to infer the underlying epigenetic mechanisms in ongoing molecular experiments.

Potential Benefits to Dairy Cow Welfare of Using a Ceftiofur-Ketoprofen Combination Drug for the Treatment of Inflammatory Disease Associated with Pyrexia: A Field Clinical Trial on Acute Puerperal Metritis.

Simple SummarySome diseases of dairy cows require the use of an antimicrobial and an anti-inflammatory drug in association to be fully cured and relieve pain. However, pharmacological treatments in cattle are subject to strict regulations and restrictions, and cow handling is not always easy and safe. For these reasons, only the antimicrobial is often administered, thus not fully applying the appropriate therapeutic protocol. This study investigated whether the use of a drug combining ceftiofur and ketoprofen in a single injection instead of ceftiofur alone can improve the healing and welfare of dairy cows affected by a pyretic inflammatory disease, such as acute puerperal metritis. The results show that the variation in the physiological parameters was similar between the two treatment groups, and daily activity and milk yield did not differ from healthy cows. However, affected cows that were treated with the combined drug seemed to be more likely to become pregnant within 120 days in milk than those that received the antimicrobial alone, having an estimated number of days open more similar to that of the healthy cows.This study aimed at investigating the benefits of using a drug combining ceftiofur and ketoprofen in a single injection on dairy cow welfare in the case of inflammatory disease with pyrexia, such as acute puerperal metritis (APM). Cows of an Italian dairy farm were examined between 5 and 14 days of calving: those with APM were randomly treated either with combined ceftiofur–ketoprofen (CD) or ceftiofur alone (C), starting from Day 0, and an equal number of healthy cows served as a control (CTR). Clinical examination and blood sampling were performed until Day 7 in each group according to specific schedules. Daily cow activity was recorded until Day 14 and daily milk production until Day 30. Additional data on fertility were collected until 120 days in milk (DIM). Data of 20 cows per group were analyzed. Body temperature and haptoglobin concentration dropped between Day 0 and 4 in both CD and C, approaching the level of CTR. The cure rate at Day 7 (body temperature < 39.0 °C) was 65 (CD) and 55% (C), without statistical difference. Neither cow activity nor milk production differed among the three groups. Reproductive performances in both CD and C were similar to CTR, but CD cows were 2.8 times more likely to be pregnant within 120 DIM than C, becoming pregnant about 14 days sooner. Both treatments (CD and C) have been effective in bringing the cows back to health conditions (CTR), and further studies would be needed to confirm the positive effect observed for CD on days open of the affected cows.

Incidence, clinical patterns, and risk factors of postpartum uterine diseases in dairy cows from high-altitude tropical herds

The cow's uterus sustains bacterial contamination and active inflammation after calving as part of the normal physiological process of uterine involution. Although the definition, incidence, and risk factors for postpartum uterine diseases (PUD) have been documented in annual calving systems with high-producing cows on total mixed ration, the literature contains little information for other production systems. The objective of this study was to quantify the incidence risk and factors associated with metritis, clinical endometritis, and cytological endometritis in high-altitude tropical dairy herds in a pasture-based system. A total of 248 cows from 5 commercial dairy herds in northern Antioquia, Colombia, were enrolled in this prospective observational longitudinal cohort study. Data collection and PUD diagnosis were performed at d 0, 3, 10, 17, 24, 31, 38, 45, and 52 (±1) after parturition. Between 60 and 70 d, cows were systematically enrolled in a synchronization protocol, and herds were visited monthly for pregnancy diagnosis until 180 ±15 d. The multivariable logistic regression model of variables associated with PUD occurrence included (a) parity, season of calving, transition diet, and body condition score at calving; (b) blood calcium, phosphorus, and magnesium concentrations, and milk urea nitrogen, β-hydroxybutyrate and fat-to-protein ratio; and (c) dystocia, retained placenta, and delayed uterine involution. The incidences of puerperal metritis, clinical metritis (MET), clinical endometritis (CE), and cytological endometritis (CYTO) were 2.8, 25, 29, and 26%, respectively. Retained placenta and dystocia were associated with MET, and MET was associated with CE. Low blood calcium concentration at calving was associated with CYTO. Overall, 51.2% of the cows suffered at least 1 category of PUD during the first 60 d postpartum (DPP). However, cows also suffered from different consecutive clinical events of PUD (MET, CE, and CYTO) during the follow-up period (0 to 180 ±15 DPP). These events could be grouped into 4 types (which were referred to as "clinical patterns") based on interactions between MET, CE, and CYTO.

Emphysematous hepatic abscess and pyometra, both caused by Burkholderia cepacia, in a bitch

AbstractA thirteen‐year‐old female intact mixed dog was presented to the emergency service with a history of vomiting and apathy. The bitch was under treatment of prednisone for chronic cough. The patient was depressed and showed abdominal pain. Abdominal radiographs revealed an increased liver size, a rounded structure of gas opacity located within the liver and a soft tissue opacity mass in the caudal abdomen. The ultrasonographic findings of the abdomen were consistent with emphysematous hepatic abscess (HA), vacuolar hepatopathy, focal peritonitis and pyometra. Surgical drainage, lavage and omentalisation of the liver abscess were performed, followed by an ovariohysterectomy. Twelve hours after surgery, the patient died due to the suspected multiple organ failure. Culture of the abscess and uterine fluid revealed presence of Burkholderia cepacia. To the authors’ knowledge, this report represented the first description of HA presumably caused by the haematogeneous spread of Burkholderia cepacia from a uterine infection.

Uterine necrosis, infection, and subinvolution: complications observed after combined application of modified B-Lynch suture and vascular ligation.

Compression sutures are primarily used to treat atonic postpartum hemorrhage. We herein describe three cases of selective arterial ligation combined with B-Lynch or modified B-Lynch suture for the treatment of intractable postpartum hemorrhage unresponsive to available conservative interventions. Three pregnant women underwent a cesarean section for a macrosomic fetus, fetal distress, and oligohydramnios, respectively. All three women developed intractable postpartum hemorrhage due to uterine atony with no chance of embolization therapy. B-Lynch or modified B-Lynch suture and additional selective arterial ligation were performed using braided absorbable suture. The first woman developed postoperative hematometra and infection without response to drainage and antibiotic therapy. Although laparoscopic exploration was performed to loosen the suture line and drain the hematometra and pyometra, the necrosis and infection could not be controlled. Subtotal hysterectomy was therefore conducted, and the necrotic uterine adnexa was removed. The other two women developed subinvolution of the uterus resulting in prolonged menstruation and amenorrhea, although the uterus was preserved and the bleeding was controlled. Modified B-Lynch suture combined with vascular ligation is an invaluable technique for women with severe intractable postpartum hemorrhage. However, it can lead to serious complications such as uterine necrosis, infection, and subinvolution.

Effect of oral calcium administration on metabolic status and uterine health of dairy cows with reduced postpartum rumination and eating time

BackgroundHypocalcemia has detrimental effects on health and performance of dairy cows. As hypocalcemic cows show reduced feed intake, we hypothesized that cows with reduced combined rumination and eating time (CRET) may benefit from Ca supplementation. The objective was to evaluate the effect of postpartum oral Ca administration on metabolic status (Calcium [Ca], fatty acids [FA], and β-Hydroxybutyrate [BHB] serum concentrations) and incidence of puerperal metritis (PM) in dairy cows with reduced postpartum CRET. Cows in an organic-certified dairy, diagnosed with reduced CRET (< 489 min/d; n = 88) during the first day postpartum were assigned into 1 of 2 treatments: i) Calcium administration (CA; n = 45) that received 1 Ca oral capsule (Bovikalc bolus, Boehringer Ingelheim, St. Joseph, MO) containing CaCl2 and CaSO4 (43 g of Ca) once per day, for 3 consecutive days, starting at d 1 postpartum; and ii) Control (CON; n = 43) that did not receive oral Ca. A convenience group consisting of cows with CRET ≥489 min/d was used for comparison and did not receive oral Ca (NOR; n = 96).ResultsAt day 1 postpartum cows with reduced CRET had lower Ca serum concentrations (CA = 2.08 mmol/L; CON = 2.06 mmol/L) compared with NOR cows (2.17 mmol/L). Calcium concentrations at d 3, 5, and 12 postpartum were not different among the three groups. Serum FA concentrations at d 1, 3 and 5 postpartum were higher in both CA and CON cows compared with NOR. At d 12, only CA cows had higher FA concentrations than NOR cows. Serum BHB concentrations at d 3 were highest in CA, with no difference between CON and NOR. At d 5, BHB concentrations were higher in CA, followed by CON, and NOR. No effect was observed for Ca administration on incidence of PM and reproductive performance. CON cows had lower survival at 30 DIM (86.5%) than NOR cows (97.9%).ConclusionsThe use of remote sensor technology identified cows with reduced rumination and eating time that had lower postpartum serum concentrations of calcium and altered metabolic status. However, oral calcium administration to cows with reduced CRET did not affect incidence of metabolic disorders nor reproductive health and subsequent pregnancy. Although survival at 30 days postpartum was lower for non-Ca supplemented cows, the identification of effective interventions in cows with reduced CRET requires further consideration.

Evaluación de la eficacia clínica de tres protocolos antibióticos en yeguas diagnosticadas con endometritis bacteriana

La endometritis bacteriana es una de las causas más comunes de falla reproductiva en yeguas, generalmente asociada a agentes bacterianos como Streptococcus equi, Echerichia coli, Enterococcus spp, Klebsiella sp., entre otros. De manera común se utilizan terapias antimicrobianas a base de fármacos betalactámicos y aminoglucósidos infiltrados a nivel uterino o en terapia sistémica. Para el presente estudio se tiene como objetivo principal evaluar la eficacia clínica de tres protocolos antibióticos en yeguas con diagnóstico de endometritis bacteriana y verificar su desempeño reproductivo postratamiento. La muestra se realizó con 90 yeguas diagnosticadas con infección uterina. Mediante examen clínico reproductivo, vaginoscopia y ecografía. Se tomaron muestras de cultivo uterino por medio de hisopado, a su vez se realizó antibiograma. Las yeguas fueron divididas en tres grupos de tratamiento antibiótico asignados según el resultado del antibiograma: penicilina G procaínica (n=4), ceftiofur (n=10) y gentamicina (n=20). Posteriormente se evaluó la eficacia clínica y el desempeño reproductivo de las yeguas. De las tratadas con penicilina, 75% (3/4) se recuperaron y dos quedaron gestantes; de las tratadas con gentamicina, 75% (15/20) se recuperaron y 8 quedaron gestantes; en tanto que de las tratadas con ceftiofur, 70% (7/10) se recuperaron y a 5 se le confirmó gestación. Se concluye no hubo diferencias clínicas o reproductivas postratamiento por efecto del tipo de antibiótico empleado.

Dinamics of Group B Streptococcus and Enterococcus faecalis associated with genital tract infections of dairy cows from two farms of county Iași

Abstract: The involution of the postpartum bovine uterus is accompanied by bacterial invasion. Studies show that most, if not all, bovine uteri are bacterially contaminated in the immediate postpartum period. The culture at this time will usually produce a wide range of bacteria, including Actinomyces pyogenes, Streptococcus spp., Staphylococcus spp. and Clostridium spp., Coliforms and Gram-negative anaerobes.&#x0D; The research is part of a larger study that aimed to isolate and identify potentially pathogenic bacteria from uterine secretions and their role in postpartum infections. To isolate and identify the uterine flora, swabs (n=160) were collected from the lumen of 32 dairy cattle, between 3 to &gt;21 DIM. Bacterial microflora has been monitored for 5 weeks. The samples were passed through all stages of the microbiological examination and the results revealed the presence of the species Streptococcus agalactiae and Enterococcus faecalis.&#x0D; At the first examination Streptococcus agalactiae and Enterococcus faecalis were isolated in 8 (25%) of 32 samples, and Streptococcus agalactiae in monoculture was isolated in 4 (12,5%) of 32 samples. At the second and third examination the number of Streptococcus agalactiae in monoculture decreased. At 21 days after parturition Streptococcus agalactiae and Enterococcus faecalis were isolated in 11 (34,38%) of 32 samples and Streptococcus agalactiae in monoculture was found in 9 (28,12%) of cows. The presence of these bacterial species with pathogenic potential for cattle and humans, highlights a possible zoonotic risk.&#x0D; Keywords: Dairy cows; Group B Streptococcus; Enterococcus faecalis, Uterine infection

Prostaglandin and antigestagen in pyometra bitches: vascular and stereological effect.

SummaryEffects of conservative treatment on uterine blood flow and morphometric findings are still unknown in bitches. Thus, this study aimed to compare uterine changes of pyometra bitches subjected to distinct modes of treatment. Pyometra bitches were assigned to: OHE (ovariohysterectomy immediately after diagnosis), Aglepristone (days 1, 2 and 8) and Associative (aglepristone treatment coupled with cloprostenol for 7 days) groups. After 9 days, bitches were ovariohysterectomized. Before surgery, uterine area was measured ultrasonographically and the uterine artery Doppler velocimetry analyzed blood flow velocity and indexes. Uterine horns were classified according to resistance index (RI) as more compromised and less compromised. Endometrial vasculature was quantitatively evaluated by color flow Doppler. Blood samples were collected to determine nitric oxide (NO) concentrations. Histological uterine structures were quantified by stereology and VEGF-A (vascular endothelial growth factor) and eNOS were (endothelial nitric oxide synthase) immunohistochemically analyzed. Aglepristone and Associative groups had lower uterine area and vascularization, and higher blood flow velocity and indexes compared to OHE group. Less compromised horn of Associative group had higher blood flow velocity compared to OHE group. Aglepristone group presented lower inflammatory infiltrate and larger uterine stroma. Associative group had lower volume density and absolute surface of endometrial cysts and lower VEGF-A expression for glandular epithelium and stromal cells. Blood NO and e-NOS immunostaining were not different among groups. In conclusion, association between aglepristone and prostaglandin is more effective in decreasing uterine vascularization and modulating uterine blood flow. Moreover, associative therapy promotes marked morphological changes.Lay summaryThis research compared two medical protocols of treatment for uterine infection (pyometra) in bitches, using a hormone blocker (anti-progesterone aglepristone) solely or in association with a uterine contraction inducer (prostaglandin; associative therapy). After treatment, bitches were gonadectomized and a microscopic analysis of uterine blood vessel formation and uterine tissue elements were performed as well as uterine blood flow evaluation through Doppler ultrasonography. According to vascular resistance, uterine horns were additionally classified as more compromised and less compromised. Both treatment protocols led to reduction of uterine dimensions and vascularization, and higher blood flow compared to untreated bitches. Less compromised uterine horn of the associative treatment had higher blood flow compared to untreated bitches. The hormone blocker treatment had lower inflammatory cells and larger uterine histological structure, while associative treatment had less uterine pathological cysts and lower blood vessel formation. The associative therapy is effective in decreasing uterine vascularization and modulating uterine blood flow as well as reestablishing endometrium structure in bitches with uterine infection.

Beta-endorphin inhibits the inflammatory response of bovine endometrial cells through δ opioid receptor in vitro

Postpartum uterine infections are common reproductive diseases in postpartum cows. Evidence has shown that plasma β-endorphins increase during bovine uterine inflammation. However, the effect of β-endorphins on the inflammatory response in bovine endometrium has not been clarified. The aim of this study was to investigate the effect of β-endorphins on the inflammatory response of bovine endometrial epithelial and stromal cells, and to explore the possible mechanism. The cells were treated with E. coli lipopolysaccharide (LPS) to simulate inflammation, which was characterized by the significant activation of NF-κB signaling pathway and the increased gene expression of the downstream proinflammatory cytokines (approximately 1.2- to 15-fold increase, P < 0.05). By using Western blot and qPCR techniques, we found that β-endorphins inhibited the key protein expression of NF-κB pathway, and the gene expressions of TNF, IL1B, IL6, CXCL8, nitric oxide synthase 2, and prostaglandin-endoperoxide synthase 2 (P < 0.05). The co-treatment of β-endorphins and opioid antagonists showed that the anti-inflammatory effect of β-endorphins could be blocked (P < 0.05) by non-selective opioid antagonist naloxone or δ opioid receptor antagonist ICI 154129, but not the μ opioid receptor antagonist CTAP (P > 0.05). In conclusion, β-endorphins may inhibit the inflammatory response of bovine endometrial epithelial and stromal cells through δ opioid receptor.