A comparison of diagnostic techniques for postpartum endometritis in dairy cattle.

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4, Canada.
Theriogenology (Impact Factor: 2.08). 04/2008; 69(6):714-23. DOI: 10.1016/j.theriogenology.2007.12.005
Source: PubMed

ABSTRACT Holstein cows (n=221) from eight commercial dairy herds were examined for endometritis between 28 and 41 days postpartum using 5 diagnostic techniques: (1) vaginoscopy; (2) ultrasonographic assessment of uterine fluid volume; (3) ultrasonographic assessment of endometrial thickness; (4) endometrial cytology collected by cytobrush; and (5) endometrial cytology collected by uterine lavage. Concordance correlation was used to evaluate the reliability of cytobrush and lavage cytology. Cytobrush cytology was found to have the greatest intraobserver repeatability (cytobrush, rho(c)=0.85 versus lavage, rho(c)=0.76) and was chosen as the reference diagnostic test. Pregnancy data at 150 days postpartum was available for 189 cows. Survival analysis was used to determine the lowest percentage of polymorphonuclear cells associated with time to pregnancy. The sensitivity and specificity of the diagnostic techniques was determined using pregnancy status at 150 days and cytobrush cytology as the diagnostic standards. The risk of non-pregnancy at 150 days was 1.9 times higher in cows with more than 8% PMNs identified using cytobrush cytology than in cows with less than 8% PMNs (P=0.04). Twenty-one cows of 189 cows (11.1%) had >8% PMNs and were considered to be positive for endometritis. Cows with endometritis had a 17.9% lower first service conception rate (P=0.03) and a 24-day increase in median days open (P=0.04). The sensitivities of all five diagnostic tests relative to 150-day pregnancy status ranged from 7.1 to 14.3% and the specificities from 84.0 to 93.3%. Relative to cytobrush cytology, the respective sensitivity and specificity values are as follows: vaginoscopy (53.9%, 95.4%); lavage cytology (92.3%, 93.9%); ultrasonographic assessment of uterine fluid (30.8%, 92.8%); and ultrasonographic assessment of endometrial thickness (3.9%, 89.2%). Endometritis impaired reproductive performance. Cytobrush cytology was the most reliable method of diagnosing endometritis in cattle.

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    ABSTRACT: The objectives of this study were to assess the efficacy of antibiotic treatment for preventing postpartum uterine disease among cows at high risk of uterine disease, and to assess the efficacy of PGF(2α) for treating cytological endometritis (CYTO) and purulent vaginal discharge (PVD). A total of 2,178 Holstein cows in 6 herds were enrolled in a randomized clinical trial. Within 24h after parturition, cows were classified at being at high risk of uterine disease (HRUD; n=1,017) if they had twins, dystocia, or retained placenta. All remaining cows were classified as being at low risk of uterine disease (LRUD; n=1,161). Cows in the HRUD group were randomly allocated in a factorial design to receive ceftiofur crystalline free acid (CCFA) at 24h after parturition or be untreated, and to receive dinoprost (PGF(2α)) at 35 and 49 (±3) days in milk (DIM) or to be untreated. Cows in LRUD were randomly allocated to receive PGF(2α) at 35 and 49 (±3) DIM or to be untreated. Serum progesterone was measured at 21, 35, 49, and 63 (±3) DIM. Cows were examined at 35 (±3; exam 1) and 56 (±3; exam 2) DIM for CYTO (by cytobrush device; ≥6% polymorphonuclear cells in endometrial cytology) and for PVD (by Metricheck device; mucopurulent or purulent vaginal discharge). Statistical analyses were performed using multivariable logistic regression models accounting for herd clustering. Treatment with CCFA in HRUD cows was not associated with the probability of metritis overall, but interactions occurred such that CCFA decreased the incidence of metritis among HRUD cows that did not have retained placenta and among cows of parity ≥2. Treatment with CCFA in HRUD cows decreased the probability of PVD at exam 1. Treatment with PGF(2α) did not affect the probability of cure of CYTO or PVD irrespective of progesterone concentration at the time of treatment. Among cows affected by CYTO or PVD at exam 1, 66 and 63%, respectively, had spontaneously cured at exam 2. Cows persistently affected at exam 2 had an increased time to pregnancy and were more likely to have both CYTO and PVD at exam 1. Administration of PGF(2α) at both 5 and 7 wk postpartum did not mitigate the effects of CYTO or PVD on reproductive performance. Clinical approaches to treatment of chronic postpartum reproductive tract infection and inflammation should be reassessed.
    Journal of Dairy Science 03/2011; 94(3):1325-38. · 2.57 Impact Factor
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    ABSTRACT: The objective was to compare three diagnostic approaches for intrauterine infection and inflammation: scoring of vaginal contents; quantification of percentage of nucleated cells that were polymorphonuclear leukocytes (PMN) following endometrial cytology; and intra-uterine bacteriology. Dairy cows (n = 303) were examined twice, Days 28 (D28) and 42 (D42), where Day 0 = day of calving. Associations between gross vaginal inflammation scores, uterine cytology, and bacteriology, and subsequent reproductive performance were examined using multivariable models. There was fair agreement at D28 (Kappa = 0.29), but only slight agreement at D42 (Kappa < 0.15), between PMN% and gross vaginal inflammation score. Cows were categorized as having PMN% in the highest quartile (H), or not (L), at both D28 and D42; therefore, cows were categorized as PMNLL, PMNLH, PMNHL, or PMNHH. Cows in the highest PMN% quartile at both time periods were slower to conceive (P < 0.001) than those in all other quartiles (mean ± SEM 32.2 ± 2.3, 37.0 ± 5.3, 40.8 ± 4.1, and 55.3 ± 7.3 d from start of breeding to conception for PMNLL, PMNLH, PMNHL, and PMNHH PMN% cows, respectively). Milk yield was greater (P = 0.001) in cows in the lower quartiles for PMN% at D28 and D42 (i.e., PMNLL) than those in the PMNHH and PMNHL categories, with PMNLH intermediate (P = 0.001). We concluded that PMN% was a better predictor of reproductive performance than either intra-uterine bacteriology or gross vaginal inflammation score. Cows in the highest quartile for PMN% at both D28 and D42 had lower pregnancy rates, took longer to conceive, and had a lower milk yield than those in the lower PMN% categories.
    Theriogenology 07/2011; 76(2):229-40. · 2.08 Impact Factor
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    ABSTRACT: The objectives of this study were to assess the clinical and metabolic risk factors for clinical endometritis, the likelihood for having a normal vaginal discharge during postpartum, and the effects of endometritis on milk yield, reproductive efficiency, and metabolic status in Holstein cows. The study was conducted in a commercial dairy herd (Cordoba, Argentina) where 303 Holstein cows were enrolled. Cows were body condition scored (1 to 5) and tail bled on -14, 7, 21, 31, 41, and 50 d relative to parturition. Cows having a vaginal discharge with presence of pus between 21 and 41 d postpartum (dpp) were diagnosed as having clinical endometritis. Plasma blood samples were analyzed for nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), and blood urea nitrogen using commercial kits and insulin-like growth factor 1, insulin, and leptin by RIA. Data were analyzed with PROC MIXED, PROC GENMOD, and PROC PHREG of SAS (SAS Institute Inc., Cary, NC). Abnormal calving and puerperal metritis increased the risk for endometritis [adjusted odds ratio (AOR) = 2.21 for both]. High prepartum NEFA and high postpartum BHBA increased the risk for endometritis (AOR = 1.003 and 1.001, respectively), whereas high prepartum blood urea nitrogen reduced it (AOR = 0.853). Cut-offs of 456.6 μM NEFA and 402.5 μM BHBA had sensitivities of 0.69 and 0.58, and specificities of 0.88 and 0.86, respectively. The likelihood for having normal vaginal discharge increased with time (∼1% × dpp) and with normal calving. Cows with endometritis had higher milk yield than normal herdmates (27.8 ± 0.9 vs. 25.7 ± 0.4 kg/d), lower risk for pregnancy by 100 dpp (AOR = 0.10), higher nonpregnancy risk by 200 dpp (AOR = 2.87), and higher risk for culling than normal cows (AOR = 2.28). Cows with endometritis had a lower hazard rate (0.44) for pregnancy and had approximately 70 d longer calving-to-conception intervals. Finally, endometritis had no effect on metabolic hormones. In conclusion, the risk for clinical endometritis increases with abnormal calving and puerperal metritis, as prepartum NEFA and postpartum BHBA concentrations increase. Prepartum NEFA and postpartum BHBA could be useful for the prediction of endometritis. Last, clinical endometritis has detrimental effects on reproductive efficiency, as affected cows take longer to get pregnant and are at higher risk for culling.
    Journal of Dairy Science 11/2012; · 2.57 Impact Factor

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