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: 1.8). 04/2008; 69(6):714-23. DOI: 10.1016/j.theriogenology.2007.12.005
Source: PubMed


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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    • "In addition to this, sometimes subclinical endometritis is traditionally characterized by inflammation of the endometrium in cow that impaire reproductive performance in the absence of signs of clinical endometritis (Cheong et al., 2011; Gilbert et al., 2005; Kasimanickam et al., 2004). There are different techniques for diagnosis of inflammatory processes of the endometrium, including ultrasonography (Barlund et al., 2008), culture of uterine fluids (Bretzlaff, 1987), uterine biopsy (Bonnett et al., 1991) and uterine cytology (Gilbert et al., 1998). Uterine cytology samples can be provided using flushing the uterine lumen (Gilbert et al., 2005) or by cytobrush technique (Kasimanickam et al., 2004). "

    Full-text · Article · Jan 2016 · Istanbul Universitesi Veteriner Fakultesi Dergisi
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    • "A harmless technique yielding a high number of well-preserved cells is indispensable for reliable cytologic results [12]. Subclinical endometritis commonly is diagnosed during the voluntary waiting period before insemination, usually from 21 to 64 DPP [2] [3] [8] [13]. However, diagnosing SCE at that time has two major disadvantages: (1) often, sampling interferes with routine management at the dairy farm (provoking extra handling of animals and hence extra labor); and (2) the percentage of PMNs present in the uterine lumen is a dynamic phenomenon [14], which makes it hard to predict the amount of PMNs that will be actually present at the moment the animal is inseminated, creating parameters for SCE diagnosis relatively erratic. "
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    ABSTRACT: The present article describes a study of the diagnosis of subclinical endometritis in dairy cows having two principal aims: first, to validate a novel technique for taking endometrial cytology samples to diagnose subclinical endometritis in dairy cows. Second, to compare the percentage of polymorphonuclear cells (PMNs) in cytology samples stained with Diff-Quik versus a specific staining method for PMNs, naphthol-AS-D-chloroacetate-esterase (CIAE). In the first experiment, Holstein-Friesian cows (n = 204) were used to take two cytology samples at the same time using the conventional cytobrush (CB) and the new cytotape (CT). Both devices were assembled within the same catheter allowing sampling at the same time, and approximately at the same location. Cytotape consisted of a 1.5-cm piece of paper tape rolled on the top of an insemination catheter covered with a double guard sheet. Parameters used to evaluate both methods were: PMNs percentage, total cellularity, quality of the smears, and red blood cell contamination. The concordance correlation coefficient analysis was used to assess agreement between continuous and Pearson chi-square tests for categorical variables. Agreement between the percentage of PMNs in both methods was good ρ = 0.84 (0.79, 0.87) with a minor standard error of 2%. Both methods yielded similar total cellularity (P = 0.62). Cytotape yielded better quality smears with more intact cells (P < 0.01) while samples that were taken by CB were more likely to be bloody (P < 0.01). Hence, CT and CB methods yielded smears with a similar PMNs percentage and a total number of cells, but CT provided smears with higher quality and significantly less blood contamination. For the second experiment, 114 duplicate cytology slides were stained using both Diff-Quik and CIAE. Agreement between PMNs percentage in both staining techniques was good ρc = 0.84 (0.78, 0.89) with a standard error of only 2%. Hence, Diff-Quik was confirmed as an easy, fast, and high-quality staining technique, which can be routinely used to stain endometrial cytology samples satisfactorily. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015 · Theriogenology
    • "It is unclear why the ENDO prevalence is highly variable between studies. Interestingly , it appears that studies conducted on a relatively small number of herds (<10 herds) reported quite high or low prevalence (Gilbert et al., 2005; Barlund et al., 2008; Dubuc et al., 2010a). However, studies conducted on a greater number of herds, such as 38 herds (Cheong et al., 2011) and 28 herds (the present study), reported a prevalence between 25 and 36%. "
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    ABSTRACT: The objectives of this observational study were to identify the optimal diagnostic criteria for purulent vaginal discharge (PVD) and cytological endometritis (ENDO) using vaginal discharge, endometrial cytology, and leukocyte esterase (LE) tests, and to quantify their effect on subsequent reproductive performance. Data generated from 1,099 untreated Holstein cows (28 herds) enrolled in a randomized clinical trial were used in this study. Cows were examined at 35 (±7) d in milk for PVD using vaginal discharge scoring and for ENDO using endometrial cytology and LE testing. Optimal combinations of diagnostic criteria were determined based on the lowest Akaike information criterion (AIC) to predict pregnancy status at first service. Once identified, these criteria were used to quantify the effect of PVD and ENDO on pregnancy risk at first service and on pregnancy hazard until 200 d in milk (survival analysis). Predicting ability of these diagnostic criteria was determined using area under the curve (AUC) values. The prevalence of PVD and ENDO was calculated as well as the agreement between endometrial cytology and LE. The optimal diagnostic criteria (lowest AIC) identified in this study were purulent vaginal discharge or worse (≥4), ≥6% polymorphonuclear leukocytes (PMNL) by endometrial cytology, and small amounts of leukocytes or worse (≥1) by LE testing. When using the combination of vaginal discharge and PMNL percentage as diagnostic tools (n = 1,099), the prevalences of PVD and ENDO were 17.1 and 36.2%, respectively. When using the combination of vaginal discharge and LE (n = 915), the prevalences of PVD and ENDO were 17.1 and 48.4%. The optimal strategies for predicting pregnancy status at first service were the use of LE only (AUC = 0.578) and PMNL percentage only (AUC = 0.575). Cows affected by PVD and ENDO had 0.36 and 0.32 times the odds, respectively, of being pregnant at first service when using PMNL percentage compared with that of unaffected cows; odds ratios were 0.33 and 0.69 for PVD and ENDO, respectively, when LE was used. Kappa value (agreement) of the pairwise comparison for the PMNL percentage and LE was 0.43. Vaginal discharge, endometrial cytology, and LE can be used to diagnose PVD and ENDO, and to predict pregnancy status at first service. The use of LE could be a good alternative to endometrial cytology for on-farm testing. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Dairy Science
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