Volume 8 | Issue 1 Article 5

1945 Metritis and Pyometra Harvey Price Iowa State College

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Recommended Citation Price, Harvey (1945) "Metritis and Pyometra," Iowa State University Veterinarian: Vol. 8 : Iss. 1 , Article 5. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol8/iss1/5

This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. Metritis and Pyometra Methods of diagnosis and treatment

Harvey Price, '46

HE value of dairy and beef cows de­ ing with histories of breeding T pends upon their ability to reproduce trouble. Other agents include the Proto­ healthy, viable calves at regular intervals. zoa, Trichomonas fetus and Vibrio fetus, Since pregnancy is the greatest burden of the Staphylococci, Streptococci, mycotic reproduction, a healthy genital system is organisms, Corynebacterium, Necrophor­ essential to realizing this value. The us bacillus, and other bacteria. Except for anatomical location of the bovine external trichomoniasis, Vibrio infection and bru­ genitalia plus the frequent insanitary cellosis, metritis and pyometra may be husbandry in many dairies subjects this considered as relatively noncontagious. important system to infection. Most other uterine infections are intro­ Invading pathogens find conditions well duced by attendants at parturition or as suited to rapid growth. If pregnancy is mentioned above through improper hus­ not terminated by this infection it is quite bandry practices. Trichomoniasis is chiefly likely that parturition and labor will so transmitted from infected bulls to non­ weaken the that the existing infec­ infected cows and heifers, but may also tion will appear in a more virulent form. be transmitted mechanically. From these, According to Williams,1 parturition and other bulls become infected and the cycle the puerperium supply the greatest mor­ is continued. tality of any period in the breeding fe­ Metritis and are closely re­ male's life. lated and the former is seldom present Sterility without the latter also being present in some degree. When the uterus is the site In cases of metritis not ending fatally of the infection the disease progresses the result is sterility. This may be either caudally and usually involves all of the temporary or permanent. Metritis is an . Metritis may develop into a rap­ inflammation of the uterus. Often qualify­ idly fatal septicemia or into a chronic ing prefixes are used to indicate the exact form ending in sterility. Since the former seat of infection such as pyometra, an ac­ usually ends in the death of the animal cumulation of in the uterus; endome­ before veterinary assistance is sought, the tritis, an inflammation of the endome­ chronic type is most frequently encoun­ trium; and perimetritis, an inflammation tered. of the peritoneal coat of the uterus. Niel­ Diagnosis son? describes pyometritis as an endo­ metritis of the third degree. There is no The accurate diagnosis of chronic me­ specific etiological agent responsible for tritis depends largely upon an accurate metritis and pyometra. Brucella abortus history and a careful clinical examination is recognized as a major cause of metritis, of the reproductive system, including rec­ abortion, and sterility, but since brucel­ tal palpation and examination with the losis is a subject in itself it will not be speculum. Accurate histories are difficult discussed here. Suffice it to say that it to obtain, especially if the owner has re­ should not be overlooked when examin- sorted to home treatment at the last par-

20 The Veterinary Student turition. If there was a history of retained the catheter with the other, palpating the placenta at the last parturition there may instrument at all times. Should this meth­ have been much damage to the uterine od fail the procedure should be repeated mucosa and caruncles. If the damage was during estrum. Gould et aU use epidural extensive pregnancy is impossible or pre­ anesthesia to facilitate this manipulation. maturely terminated due to insufficient Since complete anesthesia causes balloon­ nutrition to the developing embryo. In ing of the rectum and difficult manipula­ such cases clinical examination is unsatis­ tion, do not carry anesthesia too far. factory without a complete history. Rarely does atresia playa part in prevent­ ing passage of the catheter. Examination Once a catheter is passed, warm physio­ Upon examination of the genital tract logical saline is used to douche the uterus the symptoms may be marked or very and the character of the return flow is slight. A purulent discharge, when pres­ noted. When little pus is in the return flow ent in the , usually comes from the it may have come from the cervical canal, uterus or the cervical canal. The vaginal but when the amount of pus is extensive speculum is useful to determine the origin it indicates much damage to the endom­ of the discharge. The cervix frequently trium. The future breeding value of such shows much inflammation and induration. cows is questionable. In some cases the cervix may be enlarged to the size of the fist or larger, exposing Rectal Palpation the first or second cervical folds. For Rectal palpation should always be prac­ closer inspection or digital examination ticed when examining for metritis. En­ the cervix may be retracted with two largements of the cervix and sclerosis of pairE'. of uterine forceps. The forceps are the corpora uterinum and cornua are placed on either side of the os uteri ex­ easily recognized. The detection of adhe­ ternum. Steady traction will present the sions of the uterus to other organs indi­ cervix in the except in animals ac­ cates a prior severe metritis and peritoni­ customed to constant pasturing in which tis. Also the presence of a mummified fe­ the tubular organs are more firmly at­ tus and pyometra is diagnosed rectally. tached. Once the cervix is retracted as far Pyometra may be confused with preg­ as possible the vulva can be spread by nancy. Rowson and Spriggs~ suggest these applying lateral pressure on the forceps differential points. handles. With the cervix fixed in such 1. In pyometra there is no fremitus in

Smnme1',1945 21 of the rectal examination. In all cases of equipped with a rubber bulb material can metritis and pyometra bacterial cultures be aspirated from the os uteri externum. should be made as the prognosis and If the quantity of secretion is not suffi­ treatment depends upon the causative cient, a small amount of sterile saline may agent. The technique for obtaining sam­ be used to wash the cervical orifice and ples is described below. the resulting admixture aspirated for At this time it is well to consider tricho­ diagnostic purposes. A cotton swab may moniasis as a cause of metritis and pyo­ be used instead of the pipette if preferred. metra. Early investigations of this disease If the material is to be examined immedi­ were conducted by Emmerson,5 and Mc­ ately no preservative is necessary, but if Nutt, Walsh and Murray.') Classification the material is to be sent to a laboratory of trichomoniasis as a venereal disease it should be preserved by refrigeration has been established without doubt. during transit. Because of the periodic According to the British Ministry of appearance of T. fetus several days prior Agriculture7 trichomoniasis may be sus­ to estrus, Hammond and BartlettH recom­ pected when: mend examination at that time. They also a. Several cows and heifers are re­ recommend the examination of recently turned to service. Estrum may recur bred virgin heifers in herds where T. fetus in three weeks, but usually the in­ is suspected. The best time to examine terval is six, nine or twelve weeks. such heifers is twelve to nineteen days b. Abortions occur early in pregnancy, after breeding or if estrum returns the commonly between the sixth and six­ examination should be a few days prior teenth week. In trichomoniasis abor­ to the next anticipated estrum. tion rarely occurs in the second half Material For Diagnosis of pregnancy. The material from aborted feti best c. and pyometra are as­ suited for examination is obtained from sociated with anestrus. the fetal stomach, membranes, and mucus d. or cervicitis are noted. around the tongue. Other material suited Abortions may not be observed or sus­ to examination can be obtained from the pected and the only symptom is failure following abortion. to conceive. In other cases the cow is be­ Emmerson!} reports the fluid under the lieved to be pregnant from two to four skin of the aborted fetus as providing suit­ months when a clear discharge is seen able material for examination. coming from the vulva. To examine the material, a hanging Generally a few days after the infec­ drop or wet slide is prepared. Some work­ tion there may be some discharge at the ers add one drop of a 1% eosin solu­ vulva, but this is often overlooked by the tion to the preparation to better outline caretaker or is passed off as something of the protozoa. The slide is first examined no importance. White streaked pus is under low power. Once the trichomonads characteristic of trichomoniasis, however, are found the high dry objective is used secondary infection frequently alters this to definitely identify them as T. fetus. until it is not diagnostic. "Rasp" vaginitis, Wenrich and Emmerson1o describe T. when present, is suggestive, but not fetus as a spindle shaped or pyriform pro­ diagnostic of T. fetus infection. tozoan 10 to 25 microns in length and one­ third to two-fifths as wide as it is long, Laboratory Diagnosis bearing three anterior flagella as long or If the above clinical symptoms fail to be somewhat longer than the body, and a diagnostic, microscopic and cultural meth­ posterior flagellum which constitutes the ods may be resorted to. To obtain samples marginal filament of the undulating mem­ for this purpose the following technique brane. The posterior flagellum is about as is suggested. Clean the external genitalia long as the anterior flagella. Within the with soap and water, then insert a sterile undulating membrane a secondary fila­ vaginal speculum. With a sterile pipette ment parallels the marginal filament. The

22 The Veterinary Student dorsal undulating membrane usually has with 12 ounces of 2 or 3 percent Lugol's tour or five undulations. In the live speci­ solution. This treatment is repeated 2-3 men the movements of the anterior fla­ times a week until the discharge stops. gella are seen as rapid forward extensions If a corpus luteum is present it should be and energetic backward thrusts. The expressed. In some instances bismuth movement of the undulating membrane subnitrate 2 parts and iodoform 1 part in with the flagellar movements causes a 12 ounces of mineral oil can be substi­ counter-clockwise rotation and an inter­ tuted for the above treatment. Lindquist mittent. locomotion. For more details of points out that the flavor of iodoform is morphology reference should be made to often detected for as long as two weeks the work of the above authors. in the milk of cows so treated, therefore, judgment is needed in the use of this drug Cultural Methods around dairies. Sulfonamides are useful Cultural methods are seldom practiced in acute metritis due to streptococcic or although some cases have been diagnosed staphylococcic infections. For the former by this means when other methods failed. sulfanilamide is recommended, and for Serological diagnosis is of limted value the latter sulfathiazole is the drug of since a negative test is not always indi­ choice. The dose of either is 1-1 % gr. per cative of freedom from infection. The pound of body weight divided into three serological test is useful to indicate herd daily doses and continued for two to five infection and not infection in individuals. days. When the discharge has ceased and It must be remembered that positive diag­ the estrus cycle has become normal, it is nosis of trichomoniasis depends upon generally thought to be safe to breed finding the organism. All else is only sug­ these treated animals. gestive as similar symptoms may be due to other infections. Pyometra The prognosis in most cases of metritis In treating pyometra, regardless of the and pyometra with regard to the life of cause, the aims are first, to induce the the animal is good. However, if bacterio­ regression of the corpus luteum, second, logical findings show the causative or­ to dilate the os uteri and third, to produce ganism to be the necrophorus bacillus, prolonged contraction of the uterus and corynebacteruim or mycotic organisms, expel the pus. Rowson suggests three or if acute septic metritis develops the possible ways to accomplish these aims: prognosis is guarded. Chiversll reports one case of necrotic metritis in which five 1. By use of the two way catheter and or six inches of the gravid horn had ne­ douche plus massage of the uterus crosed. This case ended fatally five or six through the rectal wall. days after parturition. 2. By expression of the corpus luteum. Chronic metritis, pyometra, and tricho­ 3. By hormone therapy. moniasis often respond to treatment to the extent that subsequent pregnancies The advantages of the first method are are carried to term. The economy of keep­ tew and the disadvantages many. Passing ing mediocre cows which fail to repro­ 2. uterine catheter in the cow is always a duce regularly has not been demon­ tedious job. This method presents the strated. It would seem that, except for danger of puncturing the rectum or peri­ those cows of outstanding pedigree, toneal cavity. In such cases fatal infec­ treatment beyond preparing for slaugh­ tions are the rule. Most antiseptics intro­ ter is not advisable. duced in this manner are ineffective in the presence of the purulent exudate in Treatment the uterus. The flaccid uterus is not easily The treatment of cervicitis and metri­ emptied of its contents by siphoning and tis has changed but little since Albrecht­ any additional material introduced may sen's time. A catheter is introduced as cause rupture of the weakened organ. described above and the uterus douched Introduction of instruments into the

Summer, 1945 23- uterus is always done at the risk of intro­ three treatments. A week after estrus re­ ducing more infection. turns the uterus is again irrigated, but Method two presents no real advan­ the lactic acid is left out of the iodine so­ tages. In some extreme cases of pyome­ lution. Treated animals are considered tra the ovary can not be palpated. Other safe to breed when the discharge has disadvantages include danger of ruptur­ stopped and two normal estrus cycles ing the rectal wall and danger of severe have elapsed. Chances for conception in or fatal hemorrhage when the deeply em­ such animals are considered fair if the bedded corpus luteum is expressed. If pathological changes to the the corpus is not enucleated the desired have not been too great. result~, are not obtained for several days. Metritis, due to retained placenta, is Since the object is to get the animal back being treated at Iowa State College by a into breeding condition any of these in­ combination of sulfanilamide and stil­ juries defeat the purpose. bestrol. 60 to 90 gms. of sulfanilamide are placed into the uterus and the cap­ Hormone Therapy sules opened to aid in distribution. 25 Hormone therapy presents several dis­ tc- 35 mg. of Stilbestrol are given intra­ tinct advantages over the other two muscularly simultaneously and again in methods. Stilbestrol is the drug generally 48 hours. used. It is easily administered and can be repeated as necessary. There is no Trichomoniasis danger of infection or hemorrhage and if 'I'richomoniasis in the adult female is used with proper judgment there is no frequently self-limiting. Cows which have dangel' of damage to the ovaries. Hor­ aborted or failed to conceive seem to mone therapy approaches the aims as set produce a local immunity to T. fetus and out above. The natural hormone func­ if given two to three estrus periods of tions include increased cellular activity sexual rest successfully resist further in­ of the tubular genitalia, sensitization of vasion. If such animals are then bred to the uterus to the oxytocic principle of Cl. disease free bull they often calve nor­ the posterior pituitary causing contrac­ mally. Garlick, Bartlett and Hammond tions of the uterine musculature, dilation attempted to produce passive immunity of the os uteri and regression of the cor­ with negative results. Attempts to dem­ pus luteum. It is not always desirable to onstrate an active immunity failed. Ham­ conclude treatment with one or more in­ mond and Bartlett suggest a local tissue jectiom: of a hormone substance. After immunity in the vagina. If this is true of the cervix is dilated and the purulent ma­ that tissue it may be assumed that a like terial is evacuated rectal massage of the reaction occurs in the uterus. uterus may be useful in restoring the tonus of that organ. Rowson and Spriggs Prevention administer 20-25 mg. of Stilbestrol intra­ Metritis and pyometra are best pre­ muscularly and one week later irrigate vented by applying the principles of live­ the uterus with a 1: 500 aqueous iodine stock sanitation. Williams says that this solution. Their results show that pus ap­ must begin by raising healthy calves. pears within 24 hours after injection and This can be done only in a healthy uterus. continues until the uterus is empty, Cows should be provided clean quarters however, in very large pyometras a sec­ at parturition. When conditions are such ond injection may be necessary. Pyo­ that cows can be observed at all times no metra due to trichomoniasis is treated better place can be provided than the pas­ in Great Britain with aqueous iodine so­ ture. In dystocia the veterinarian must lution 1: 2000 plus 30 minims of lactic alway~. use sterile instruments and wash acid to each 12 ounces of solution. The the arms and hands thoroughly before at­ uterus is irrigated weekly until estrus tempting delivery. Attendants should be occurs spontaneously and the discharge advised of the danger of infection in at­ stops. This generally requires two or tempting home remedies. When the pla-

24 The Veterinary Student centa is retained a return trip 24-48 hours USDA Farm Science Notes dated April later may be necessary. If at that time 10, 1944, warns flock-owners of the dan­ the placenta is not easily detached the ger to from infected with use of sulfanilamide and stilbestrol may Taenia avis by pointing to a recent inci­ be resorted to. dent in which 164 sheep out of 429 were Sanitation condemned by federal meat inspectors on account of the presence of tapeworm cysts Pyometra due to trichomoniasis can in their flesh and various organs, acquired be prevented by a strict program of sani­ from ingesting worm eggs scattered about tation and a careful breeding program. the pasture by dogs. Proof of the source Virgin heifers should be mated only to of the cysts was furnished by investiga­ young bulls which have not previously tions of Parasitologist Benjamin Schwartz been exposed to trichomoniasis. Older of the BAI. Anthelmintic treatment of the cows showing signs of infection should suspected removed a complete tape­ be removed from the breeding herd and worm. The incident has importance to given a rest of two to six months. Each veterinarians by warning that the pres­ cow in an infected herd should be given ence of dogs on ground inhabited by sheep a thorough physical examination before is not a matter to be overlooked. breeding. The bull used for older cows should be free from infection and not used on young females. Infected bulls should be removed from the herd. By fol­ E. R. Quortrup, D.V.M., of Fish and lowing these simple rules breeding effi­ Wildlife Service, USDI, described two ciency can be improved in most infected outbreaks of botulism in mink on fur herds. ranches. The one was due to mixing the REFERENCES meat of a calf that had died from pneu­ 1. Williams. W. L. The diseases of the genital or­ monia with wholesome meat as mink feed, gans of domestic animals. 3rd ed. and the other outbreak from feeding frozen 2. Rowson. L. E. A .. Spriggs. D. N. The diagnosis and treatment of pyometra in cattle. Vet. Rec. blocks of horse meat shipped from Idaho 54 :309. 1942. to Utah which obviously was toxic when 3. Albrechtsen. J. The sterility of cows. its causes and treatment. 1920. frozen. The losses were 200 mink out of 4. Gould. G. N .. Hignett. S. L .. Steel-Bodger. H. W. 5,000 in the second instance and 461 mink Suggested technique to be employed in pregnancy out of an approximate 500 in the first out­ diagnosis and the treatment of in the bovine. Vet. Rec. 54 :69-73. 1942. break. 5. Emmerson. M. A. Trichomoniasis in cattle. A pre­ liminary report. J. A. V. M. A. 81 :636-640. 1932. 6. Walsh. F. E.. McNutt. S. H .• Murray. C. Tricho­ A raw material essential to the manu­ monas bovis infection in cattle. Cornell Vet. 24 :60- 74. 1943. facture of insulin, used in the treatment 7. The British Ministry of Agriculture. Bovine tricho­ of diabetes, has been given dollar-and­ moniasis in Great Britain. Vet. Rec. 54 :421-424. 1942. cent ceiling prices by the OPA recently. 8. Hammond. D. M .. Bartlett. D. E. Pattern of fluctu­ The OPA said that "insufficient quanti­ ations in the number of Trichomonas fetus occur­ ties of these glands were moving to the ring in the bovine vagina during initial infections. correlation with time of exposure and with subse­ pharmaceutical trade because some pack­ quent estrual cycles. Am. J. of Vet. Res. 6:91-95. 1945. ing and slaughtering houses had low 9. Emmerson. M. A. Iowa State College. Personal 'freeze' prices and found it unprofitable communication. to perform the separate function of re­ 10. Wenrich. D. H .. Emmerson. M. A Studies on the morphology of Trichomonas fetus (Riedmuller) moving the gland from tankage material." (Protozoa. flagellatal from American cows. J. of The prices for the glands, trimmed and Morphology 55: No.1. 1933. free of fat and other tissue, individually 11. Chivers. W. H. Iowa State College. Personal com­ munication. frozen and packed, £.o.b. at the packing 12. Lindquist. H. G. Iodoform flavor in milk. J. Milk plant are: Tech. 5: 334. 1942. 13. Garlick. G. G.. Bartlett. D. E .. Hammond. D. M. Hog pancreas glands ...... 12c per lb. Attempts to demonstrate passive immunity in bo­ Calf pancreas glands ...... 28c per lb. vine trichomoniasis. Am. J. of Vet. Res. 5:14. 1944. Beef pancreas glands ...... 16c per lb.

Summer, 1945 2.5