Endometritis Research Articles

Decidual Natural Killer Cells Are Essential for a Successful Pregnancy (Review)

Pregnancy is a complex physiological process involving several interconnected systems. Many researchers were concerned that the formation of a fetus with different genetic components may contradict the normal state of immunity, which attempts to reject and fight foreign bodies. This piqued the interest of biologists and immunologists, who set out to discover the immune system’s composition and mode of response in the uterus. According to several studies, natural killer (NK) cells are present in a significant percentage that differs from what is seen in peripheral blood. As a result, several scientific studies have been conducted on uterine NK cells, investigating their types, characteristics, receptors, secretions, and interactions with the surrounding environment. Research has also indicated the capacity of uterine NK cells to strike a balance between eradicating uterine infections and effectively contributing to different phases of pregnancy. Various studies have shown that NK cell activity is intimately related to the success or failure of pregnancy. In this review, we describe the uterine NK cell subtypes; decidual (dNK) cells and endometrial NK cells (eNK) cells and their important role during different phases of pregnancy.

Therapeutic effects of silver nanoparticles on Escherichia coli-induced endometritis in rats

Background Silver nanoparticles (AgO-NPs) have shown antimicrobial effects against a broad spectrum of microorganisms.Objectives To assess the antimicrobial effects of AgO-NPs prepared using an eco-friendly green method against multidrug-resistant Escherichia coli in vivo after inducing endometritis in rats.Materials and methods In female mice, LD50 of AgO-NPs was determined, followed by a chronic toxicity in female rats by oral administration of 0, 20, 30, and 40 mg of AgO-NPs daily for 4 weeks. The induced endometritis model in female rats was performed by inoculating two doses of E. coli (100 μl of 10×105 CFU) intravaginally. Seven days later, vaginal swabs were stained with Wright stain to confirm the development of endometritis and used to re-isolate the inoculated microorganism. Two doses of 100 μl containing 10 mg AgO-NPs were inoculated intravaginally. Estradiol, progesterone, liver and kidney functions, oxidants and antioxidants, and zinc were measured in collected blood samples of chronic toxicity and induced endometritis model.Results and conclusion LD50 of AgO-NPs was 800 mg/kg body weight (BW). The use of 40 (1 : 20 LD50), 30 (1 : 26.67 LD50), and 20 (1 : 40 LD50) mg/kg BW during the chronic toxicity experiment was safe as indicated by blood biochemical analyses. The chronic toxicity experiment resulted in normal liver and kidney functions, oxidant–antioxidant status, acute-phase proteins, and ovarian hormones. The green method-synthesized AgO-NPs showed efficacy against E. coli-induced endometritis, and rats responded to the treatment as indicated by the uterine cytology and the clinical analysis with mild adverse effects on both liver and kidney. In conclusion, AgO-NPs showed treatment of experimental uterine infections induced by E. coli in rats and were safe for longer administration in concentrations lower than 50 mg/kg BW.

THE IMPACTS OF UNPLANNED PREGNANCY ON ADOLESCENCE: A LITERATURE REVIEW

Background: Pregnant adolescents (age 10-19) are at risk for complications of pregnancy and childbirth such as eclampsia and puerperal endometritis, which is one of the major causes of maternal death in the world. Unsafe abortions pose the same health risks (WHO 2018). Unwanted pregnancies reported by women in the 15-19 age group are twice as high (16%) as in the 20-24 age group (8%) (IDHS, 2017). Objective: The literature review’s purpose was to analyse the impact of pregnancy on adolescents through scientific evidence from research results of several researchers. Methods: The study was conducted with a literature review design, where the data used were secondary data from articles that examined adolescents with problems with unplanned pregnancies or adolescents who experienced early marriage due to unplanned pregnancies. The framework used to search for articles used PICOS. The article was limited to empirical studies of the last 5 years. Search through Google Scholar database, e-resource, Science Direct and Pubmed. Keywords and Boolean operators used were impacts and unplanned pregnancy and teen. Keywords adjusted to Medical Subject Heading (MeSH), obtained a sample of 22 reviewed articles. Result: The search results obtained 22 articles and it had similarities, namely 8 articles discussing physical impacts, 11 articles discussing psychological impacts, 15 articles discussing social impacts and 7 articles discussing economic impacts. Through this review, the physical impact results were premature birth, anemia and hypertension during pregnancy, attempted abortion, psychological impact in the form of feelings of fear, depression, guilt and disappointment with oneself, social impact in the form of dropping out of school, community stigma because it was considered a problem group, not getting support from the environment and the economic impact was difficulty finding work so that it was difficult to meet daily needs. Conclusion: Adolescents who decide to maintain their pregnancy is the best decision, but the significant impact that adolescents will experience makes them at high risk for physical disorders.

Intrauterine infection effects on fetal heart rate variability : evaluation in an experimental sheep model

Intra uterine infection can lead to serious complications for the fetus and it’s detection is a major concern during labor. Currents methods for fetal surveillance during intrapartum are imperfect and new tools need to be developed. Analysis of fetal heart rate variability (HRV) seems to be an interesting option. The objective of this study was to evaluate acute intra uterine infection effects on fetal heart rate variability, using an experimental sheep model.

Maternal and neonatal outcomes following waterbirth: a cohort study of 17 530 waterbirths and 17 530 propensity score-matched land births.

Investigate maternal and neonatal outcomes following waterbirth. Retrospective cohort study, with propensity score matching to address confounding. Community births, United States. Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n = 17 530 each), propensity score-matched on >80 demographic and pregnancy risk covariables. Logistic regression models compared outcomes between the matched waterbirth and land birth groups. Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 mL, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death. Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (adjusted odds ratio [aOR] 0.56, 95% CI 0.31-1.0), and maternal or neonatal hospitalisation in the first 6 weeks (aOR 0.87, 95% CI 0.81-0.92 and aOR 0.95, 95% CI 0.90-0.99, respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (aOR 1.25, 95% CI 1.05-1.48) (but not hospitalisation for infection) and umbilical cord avulsion (aOR 1.57, 95% CI 1.37-1.82). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. New study demonstrates #waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. @TheUpliftLab @BovbjergMarit @31415926abc @NICHD_NIH.

The Role of Uterine Infection in Pregnancy Outcome: A Case Report

Summary It was believed in the past that only the lower genital tract is inhabited by microorganisms, and the cervix was considered as a perfect barrier against the ascension of microbes. Nowadays, many studies using new sequencing technologies examining microbiomes with low biomass show that the microorganisms are gradually changing from the lower to the upper genital tract with decreasing bacterial abundance and increasing bacterial diversity. It is well documented that the endometrium is a non-sterile area, and in healthy women, the Lactobacillus spp. is the dominant flora. Lactobacillus - as a dominant endometrial microbiome, has a crucial role in implantation, early pregnancy development. It is also essential for a good pregnancy outcome. Non-Lactobacillus-dominant microbiome is associated with poor reproductive outcomes (recurrent implantation failure, recurrent miscarriages, outgoing pregnancy). This association is evidence of its significance for reproductive health. We present a case of unsuccessful first pregnancy with concurrent bacterial endometrial infection. A definitive antibiotic treatment resulted in a successful full-term second pregnancy. We present the influence of pathogenic microorganisms on uterine function and pregnancy development, current possibilities for diagnosis and treatment.

Associations between Circulating IGF-1 Concentrations, Disease Status and the Leukocyte Transcriptome in Early Lactation Dairy Cows

Peripartum dairy cows commonly experience negative energy balance (EB) and immunosuppression together with high incidences of infectious and metabolic disease. This study investigated mechanisms linking EB status with immune defense in early lactation. Data were collected from multiparous Holstein cows from six herds and leukocyte transcriptomes were analyzed using RNA sequencing. Global gene expression was related to circulating IGF-1 (as a biomarker for EB) by subdividing animals into three groups, defined as IGF-1 LOW (<35 ng/mL, n = 35), MODERATE (35–100 ng/mL, n = 92) or HIGH (>100 ng/mL, n = 43) at 14 ± 4 days in milk (DIM). Differentially expressed genes between groups were identified using CLC Genomics Workbench V21, followed by cluster and KEGG pathway analysis, focusing on the comparison between LOW and HIGH IGF-1 cows. LOW cows were older and had significantly lower dry matter intakes and EB values, whereas HIGH cows produced more milk. During the first 35 DIM, 63% of LOW cows had more than one health problem vs. 26% HIGH cows, including more with clinical mastitis and uterine infections. Gene expression analysis indicated that leukocytes in LOW cows switched energy metabolism from oxidative phosphorylation to aerobic glycolysis (PGM, LDH, and PDK4). Many antimicrobial peptides were up-regulated in LOW cows (e.g., PTX3, DMBT1, S100A8, and S100A9) together with genes associated with inflammation, platelet activation and the complement cascade. HIGH cows had greater expression of genes regulating T and B cell function and the cytoskeleton. Overall, results suggested an ongoing cycle of poor EB and higher infection rates in LOW IGF-1 cows which was reflected in altered leukocyte functionality and reduced milk production.

Study of antibiotics and symbiotic effects on sperm quality using the CASA system

The objective of the current work was to study in vitro sperm quality after antibiotics and symbiotic administration and to evaluate treatment administered before insemination with the aim of reducing artificial insemination failures in goats. This experimental study was carried out at the Animal Reproduction Biotechnology Laboratory (Blida, Algeria). Semen analysis was performed using the Computer-assisted sperm analysis system. In the first experimental approach, we used the antibiotics most commonly administered in the veterinary field for the treatment of subclinical endometritis. A total of eight antibiotics were studied. Each antibiotic tested was co-incubated with frozen goat semen brought from the Centre for Artificial Insemination and Genetic Improvement. For the second experimental approach, we incubated semen with a symbiotic (Symbiovéba). Finally, we selected two antibiotics among those used, namely colistin and cotrimoxazole, and these were co-incubated with the symbiotic and the semen, to examine possible combinations of antibiotics with symbiotics in the treatment and prevention of uterine infections (broad spectrum synergistic activity). Antibiotics have been shown to have a detrimental effect on the sperm cell, by decreasing sperm motility. The average value calculated on all antibiotics was 18% (as opposed to initial motility of 78% in the control group), with an alteration of the linear speed that would have a negative impact on fertilization. On the other hand, symbiotics had a beneficial effect on spermatozoa motility and vitality. The combination of the symbiotic and colistin proved to be very promising. In conclusion, the use of symbiotics in the treatment of subclinical endometriosis at the time of goat insemination is beneficial, and requires greater attention in future research.

Assessing South African medical interns' experience and confidence in managing obstetric emergencies.

Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. To describe the self-perceived readiness of medical interns completing their training to manage obstetric emergencies, based on the Essential Steps in the Management of Obstetric Emergencies modules in the Health Professions Council of South Africa's internship logbook. This cross-sectional descriptive study assessed medical interns in the last 3 months of their training, using a self-administered online questionnaire. Data collection took place between October and December 2019. Cluster sampling of interns at training facilities throughout SA resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Most interns had experience with and confidence in the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy-related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications for and contraindications to assisted deliveries, and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy-related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section (CS), only 28.6% had performed uterine compression suture for uterine atony at CS. Additionally, there was a statistically significant variation in scores between training hospitals. An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.

Human cytomegalovirus inhibits the proliferation and invasion of extravillous cytotrophoblasts via Hippo-YAP pathway

BackgroundHuman cytomegalovirus (HCMV) infection in utero is very common during pregnancy, which can lead to adverse outcomes in both pregnancy and progeny, but its pathogenesis has not been fully clarified. The decrease of extravillous cytotrophoblasts (EVT) invasion is an essential pathophysiological process of some pregnancy complications. Hippo-YAP signaling pathway plays an important role in regulating cell proliferation and apoptosis. However, whether YAP is involved in HCMV uterine infection remains to be studied.MethodsThe primary EVT was cultured and infected by the HCMV strain AD169 virus in vitro. Immunofluorescence staining of HCMVpp65 antigen was conducted afterward to confirm the establishment of an infection model. The optimal virus infection dose was determined by the EVT proliferation status in vitro. Real-time PCR was performed to examine the mRNA level of major genes involved in the Hippo pathway in EVT after HCMV infection. The effect of HCMV on the expression of YAP protein in EVT was evaluated by Immunofluorescence staining and Western blot. An in vitro cell invasion assay was carried out to analyze the influence of HCMV on EVT invasion. The changes of EVT invasion was accessed by establishing YAP silencing and over-expression models using YAP1 specific siRNA and plasmid pcDH.ResultsThe optimal HCMV infection dose was 282.5TCID50/ml. Compared to the control group, the infection of HCMV significantly reduced the mRNA expression of Mst1, Mst2, SAV, Lats1, Lats2, Mob1, YAP1, TAZ, TEAD1-4 genes and YAP protein expression in the Hippo-YAP pathway. HCMV infection also decreased the EVT invasion. In non-infected EVT, the number of transmembrane EVT cells was significantly reduced when YAP1 gene was silenced, while it was significantly increased when YAP1 gene was over-expressed. In the HCMV-infected EVT, the number of transmembrane EVT cells significantly increased when over-expressed and eventually recovered to the level of NC.ConclusionsHCMV may decrease EVT invasion by inhibiting the expression of mRNA and protein of YAP in the Hippo-YAP signaling pathway. HCMV eventually reduces the invasion ability of EVT by inhibiting multiple genes in the Hippo-YAP signaling pathway, especially inhibiting YAP which serves as the downstream effector.

Genomic loci and genetic parameters for uterine diseases in first-parity Holstein cows and associations with milk production and fertility

Based on the clinical stage (e.g., vaginal discharge) and bacterial species, several forms of uterine diseases (UD) exist and can be classified as different traits [i.e., different stages of endometritis (EM) and metritis (MET)], which may differ in their genetic background and causal physiological mechanisms. Consequently, the present study aimed to study (1) the effect of UD on 305-d lactation and fertility, (2) the estimation of heritabilities for UD traits using pedigree- and SNP-based relationships, and (3) genome-wide associations to detect significant SNP markers and to infer candidate genes for UD traits. The data set contained herd manager and veterinarian recorded UD traits of 14,810 first-lactating genotyped Holstein cows from 63 large-scale contract herds. Binary defined UD traits (healthy or diseased) according to the clinical stage were endometritis catarrhalis (EM I), endometritis mucopurulenta (EM II), endometritis purulenta (EM III), pyometra (EM IV), endometritis (EM_SOD; superordinate diagnosis = no specific clinical stage defined), and MET. The binary defined trait UDall included all EM and MET diagnoses. The prevalence of UDall was 26.7%. The effect of UD on 305-d lactation and fertility was estimated via linear and generalized linear mixed models. We applied linear single-trait animal models and threshold models to estimate pedigree- and SNP-based heritabilities for UD traits, and bivariate linear models for genetic correlation estimations between UDall with 305-d lactation and fertility traits. A diagnosis for UDall had significant unfavorable effects on the female fertility traits calving interval, interval from calving to first service, days open, and nonreturn rate after 90 d, but was unrelated to 305-d lactation records for production traits milk yield, protein yield, and fat yield. Heritabilities for UDall and EM stages were close to zero, displaying maximal values of 0.05 for pedigree and 0.07 for SNP-based relationship matrices. For MET, pedigree- and SNP-based heritabilities were <0.001 and 0.07, respectively. Genetic correlations ranged from 0.20 to 0.31 between UDall with 305-d milk, protein, and fat yield, and from 0.17 to 0.40 with fertility traits. The GWAS revealed 5 SNP on bovine chromosomes (BTA) 1, 8, 10, 23 for UDall, 5 SNP on BTA 26 for EM I, 1 SNP on BTA 19 for EM II, 4 SNP on BTA 2, 18, 20, 25 for EM III, and 4 SNP on BTA 4, 16, 20 for EM IV above the significance threshold. For EM_SOD, we identified 15 significantly associated SNP on 4 chromosomes, and 4 significant SNP on BTA 3, 20, 22, 28 for MET. Marker associations for UD traits were annotated to 24 potential candidate genes using the ENSEMBL database. Six of these genes were previously reported to be involved in uterine defense mechanisms or in endometritis. Further detected genes contribute to immune response mechanisms during bacterial infections. Different SNP significantly influenced different UD stages, explaining the inter-individual variations in clinical severity of uterine infections.

Hyperthermia alters interleukin-6 production in response to lipopolysaccharide via endoplasmic reticulum stress in bovine endometrial cells.

In the postpartum period, cows experience the uterine bacterial infection and develop the endometritis. To eliminate bacteria and recover from endometritis, endometrial epithelial and stromal cells secrete the cytokine and chemokine, such as interleukin 6 (IL-6), IL-8, and monocyte chemotactic protein 1 (MCP1), to recruit immune cells. Moreover, the symptom of endometritis is prolonged in summer and we have recently indicated that hyperthermia suppresses and enhances the IL-6 production in response to lipopolysaccharide (LPS) challenge in endometrial epithelial and stromal cells, respectively. However, the mechanisms for the opposite reaction of IL-6 secretion in response to LPS challenge in both types of endometrial cells under hyperthermia conditions were still unclear. To reveal these mechanisms, both types of endometrial cells were cultured with LPS under the control (38.5°C) or hyperthermia (40.5°C) conditions and comprehensively analyzed differential gene expressions of them by RNA-seq. In addition, based on these results, we examined the effect of endoplasmic reticulum (ER) stress on the IL-6 production in both types of endometrial cells cultured with LPS under hyperthermia conditions. In comprehensive analysis, hyperthermia induced the ER stress in the endometrial stromal cells but not in the endometrial epithelial cells. Actually, we confirmed that hyperthermia increased the gene expression of BiP, ATF4, and sXBP1 and protein expression of BiP and phosphorylated inositol requiring 1, ER stress marker, in the endometrial stromal cells but not in the endometrial epithelial cells. Moreover, in the endometrial stromal cells exposed to LPS, activation and inhibition of ER stress enhanced the IL-6 production under control conditions and suppressed it under hyperthermia conditions, respectively. In this study, we could uncover the one of causes for the disruption of IL-6 production in response to LPS challenge in the endometrial cells under hyperthermia conditions. This finding might be a clue for the improvement of the symptom of endometritis in cows during summer.

Supplemental materials - Defining clinical diagnosis and treatment of puerperal metritis in dairy cows: A scoping review

Supplemental materials - Defining clinical diagnosis and treatment of puerperal metritis in dairy cows: A scoping review

Endometrial Microbiome and Women’s Reproductive Health – Review of the Problem Endometrial Microbiome and Reproductive Health

Currently, unlike in the past, the endometrial cavity is not considered to be sterile. The endometrium is supposed to be dominated by Lactobacilli, but also their deficiency can be found in the reproductive tract of asymptomatic healthy women. Sometimes the endometrial microbiome is dominated by various pathological microorganisms, and this can lead to various conditions as chronic endometritis, chorioamnionitis and preterm birth. Their presence causes uterine inflammation and infection, release of pro-inflammatory molecules, uterine contractions, disruption of cervical barrier, premature rupture of membranes. Uterine dysbiosis is associated with recurrent implantation failure and recurrent miscarriages. As the microbiome is important for maintaining immunological homeostasis at the level of gastrointestinal tract Lactobacilli may play a similar function at the level of uterus. The lactobacillus-dominated uterine microbiome is of great importance for maintaining a hostile uterine microenvironment, embryo implantation, early pregnancy development and normal pregnancy outcome.

Prevalence of Complications after Interval Postpartum Intrauterine Device Insertion

Background and Aim: Postpartum intrauterine device (PPIUD) is a reversible, long-term and effective technique of contraception. The intrauterine device (IUD) is inserted within 48 hours of delivery. The immediate insertion of an intrauterine device causes certain complications. The present study aimed to assess the prevalence of complications after Interval Postpartum Intrauterine Device Insertion. Materials and Methods: This cross-sectional study was carried out on 147 women who underwent postpartum IUD (PPIUD) insertions during from January 2021 to June 2021 at Gynecology department, Mufti Mehmood Memorial Teaching Hospital (MMMTH), Dera Ismail Khan and Muhammad Teaching Hospital Peshawar. All the women who delivered and showed willingness for PPIUCD insertion were enrolled and continuously follow-up for 4 to 6 weeks after delivery. Demographic, obstetric, and clinical parameters were recorded on pre-designed medical proforma. PPIUCD insertion after 6 weeks of delivery were followed-up for the evaluation of complications. Uterine infection, medical removal of IUD, IUD expulsion, perforation, and method discontinuation were the outcome variables. SPSS version 20 was used for data analysis. Results: Of the total deliveries, 147 women inserted the postpartum intrauterine contraceptive device (PPIUCD). Of the total, about 122 (83%) women returned for follow-up after 6 weeks. All the women underwent transvaginal insertion of intrauterine contraceptive devices. The PPIUCD insertion related complications with prevalence were uterine infection 26 (21.3%), overall method suspension 17 (13.9%), perforation 20 (16.4%), interceptive uterine device expulsions 25 (20.5%), and intrauterine device removal 32 (26.2%). The severe uterine infection was in 2 (1.7%) cases who were hospitalized. Conclusion: The postpartum intrauterine device cumulative expulsion rate was higher among women compared to the expulsion rate of insertions. The longer duration of bloody lochia flow and delivery intrauterine device insertions were the key risk factors for expulsion of PPIUCD. Women can safely utilize intrauterine contraceptive devices with low complications beyond four week. Keywords: Postpartum intrauterine device; Complications; Intrauterine device expulsion

Premature rupture of membranes

Prenatal (premature) rupture of membranes (PROM) is defined as rupture of fetal membranes before the onset of labor or regular uterine contractions. PROM can lead to serious complications such as uterine cavity infection, umbilical cord compression, oligohydramnios, fetal malpresentation, umbilical cord prolapse, preterm delivery, fetal asphyxia and death. Initial evaluation of all term pregnancies with suspected PROM should include confirmation of membrane rupture and assessment of maternal and fetal well-being. Immediate initiation of labor is recommended in term pregnant women with PROM. Compared with expectant management, induction of labor is associated with a reduction in maternal and possibly neonatal infection and lower treatment costs without an increase in cesarean delivery. Induction with oxytocin is recommended. Oxytocin is as effective as prostaglandins, easier to titrate and may be less expensive depending on the preparation. Balloon catheter use is not recommended for cervical ripening in PROM.

Fertility-Preserving Management of Uterine Arteriovenous Malformation in a 16-Year-Old Female

Arteriovenous malformations (AVM) are abnormal connections between arteries and veins without a capillary bed, creating high- and low-flow areas that are prone to bleeding. Uterine AVMs can be congenital or acquired with an incidence of 0.1%. Acquired cases are usually caused by uterine instrumentation, trauma, infection, or gestational trophoblastic disease. Patients typically present with sudden onset of heavy vaginal bleeding. Diagnosis is made using angiography, ultrasound, computerized tomography, or magnetic resonance imaging. After patients are stabilized, management depends on their desire for future fertility and may include hysterectomy or endovascular embolization.We present the case of a 16-year-old G1P0010 female with recurrent vaginal bleeding caused by a uterine AVM. To preserve the patient’s fertility, a selective embolization approach was employed using microcoils and gel foam. This case highlights a unique treatment option for uterine AVMs in patients who desire fertility preservation. Additionally, we review the diagnostic imaging and treatment options for uterine AVMs.

Whole-Genome Sequencing-Based Characterization of a Listeria monocytogenes Strain from an Aborted Water Buffalo in Southern Italy.

Listeria monocytogenes is a Gram-positive pathogen causing life-threatening infections both in humans and animals. In livestock farms, it can persist for a long time and primarily causes uterine infections and encephalitis in farmed animals. Whole genome sequencing (WGS) is currently becoming the best method for molecular typing of this pathogen due to its high discriminatory power and efficiency of characterization. This study describes the WGS-based characterization of an L. monocytogenes strain from an aborted water buffalo fetus in southern Italy. The strain under study was classified as molecular serogroup IVb, phylogenetic lineage I, MLST sequence type 6, Clonal Complex 6, and cgMLST type CT3331, sublineage 6. Molecular analysis indicated the presence of 61 virulence genes and 4 antibiotic resistance genes. Phylogenetic analysis, including all the publicly available European L. monocytogenes serogroup IVb isolates, indicated that our strain clusterized with all the other CC6 strains and that different CCs were variably distributed within countries and isolation sources. This study contributes to the current understanding of the genetic diversity of L. monocytogenes from animal sources and highlights how the WGS strategy can provide insights into the pathogenic potential of this microorganism, acting as an important tool for epidemiological studies.

Treatment practices after calving-related events on 45 dairy farms in California

Retained fetal membranes (RFM), dystocia, and twinning are common postpartum events that increase the risk of metritis, impair reproductive performance, and contribute to antimicrobial use on dairies. The overall objective of this study was to describe treatment decisions after RFM, severe dystocia (cesarean section and fetotomy), nonsevere dystocia (nonmechanical and mechanical assistance to extract the calf), and twinning. A total of 44 dairies from California's San Joaquin Valley (39 Holstein and 6 Jersey or crossbreed herds) with 450 to 9,500 lactating cows were enrolled in this study. Researchers visited each dairy once to observe cow-side fresh cow health evaluations and to interview health evaluators and maternity workers, using a standardized survey tool. The survey included questions about antimicrobial (class, dose, and duration) and nonantimicrobial therapies for calving-related events. Antimicrobial therapy was used in all 44 dairies to treat RFM at 24 (n = 23), 48 (n = 10), or 72 h (n = 5) after calving, or when puerperal metritis signs were observed (n = 6). Antimicrobial therapy was used after all severe dystocia cases, and after nonsevere dystocia (n = 27) and twinning (n = 15). Ceftiofur products were the most common antimicrobial class; they were used to treat RFM cases (n = 29), nonsevere dystocia (n = 13), and twinning (n = 10). Supportive therapy for calving-related events included nonantimicrobial intrauterine treatments, nonsteroidal antiinflammatory drugs, oxytocin, i.v. calcium, or oral drenches. Our study highlights opportunities to reduce extra-label use of antimicrobials in postpartum cows affected with RFM, and the need for education and outreach efforts on judicious use of antimicrobials. Furthermore, antimicrobial treatment choices differed largely across dairies, indicating a need to reach consensus and promote standardized practices within the industry.

POST-PARTUM SUB-CLINICAL ENDOMETRITIS IN DAIRY COWS: INCIDENCE AND DIAGNOSIS

Post-partum uterine infections such as metritis, clinical endometritis and sub-clinical endometritis, are the most common cause for decreased productivity and fertility in dairy cows. Being the least severe form of endometritis, sub-clinical endometritis (SCE) is defined as the superficial inflammation of endometrium with no signs of systemic illness and characterized by an increase in number of polymorphonuclear cells (PMNCs) inside the uterine lumen. The impact of sub-clinical endometritis on fertility of dairy cows is well known probably due to absence of any clinical signs and thus, difficulty in diagnosis and treatment. Different techniques such as endometrial cytology, uterine biopsy, biochemical analysis of uterine fluid, and measurement of acute phase proteins and inflammatory markers have been employed for the diagnosis of SCE. Doppler and B-mode ultrasonography of middle uterine arteries and uterus have also been used to diagnose the inflammation via assessment of uterine perfusion, respectively. Among all methods, endometrial cytology via cytotape is one of the most advanced and frequently employed methods for diagnosis of cytological endometritis based on the fact that proportion of PMNCs increase during uterine inflammation. The review focuses mainly on current status of incidence and diagnosis of post-partum sub-clinical endometritis in dairy cows.