Metritis

Metritis refers to bacterial infection of all the layers of the uterus. It is always associated with systemic illness; although this can range from mild (reduction in appetite and milk yield) to very severe and potentially fatal. Severe or puerperal metritis typically occurs in the first few days after calving (within 2-4 days after parturition.)and is usually secondary to severe calving problems that have resulted in damage to the reproductive tract and introduction of bacteria during the assisted calving. It is often accompanied by retained fetal membranes, but can occur without; the presence of membranes is not the cause of the metritis.

Predisposing factors :

• Dystocia

• Twin births

• Retention of fetal membranes

• Prolonged traction and damage of birth canal

• Unsanitary calving condition

Under such conditions, the chances of invasion of the uterus and

multiplication of large number of pathogenic bacteria get increased

Etiology :

1. Corynebacterium pyogenes (Now, Actinomyces pyogenes) - Most

important bacteria.

2. Streptococci (group C).

3. Staphylococci (haemolytic).

4. Coliform bacteria: E. coli, Proteus and Enterabacter spp.

5. Gram-negative anaebrobes (Bacteriodes & fusobacterium spp.)

6. Gram-positive anaerobes (Clostridrium spp.) rarely.

These bacteria get colonised in the non-involuted uterus, some of

which are producing toxins which are absorbed and cause severe

symptoms

Pathogenesis :

Failure of normal involution combined with retention of the foeta l membranes and infection of the uterus with a mixed bacterial flora resulting in acute metritis and severe toxaemia. There is diffuse necrosis and oedema of the mucosa and wall of the uterus. There is marked accumulation of foul-smelling fluidin the uterus, and thereby enlargement of the uterus. Absorption of toxins cause in severe toxaemia.

Clinical Findings

Cows with puerperal metritis have a fetid vaginal discharge and a high temperature initially, which can rapidly drop away to become sub-normal. Less severe cases usually occur later in the first and second week after calving. These cows will show reduced appetite and milk yield,  may have a high temperature but will have a fetid, bloody vaginal discharge.

Symptoms:

• The septic puerperal metritis exclusively occurs during puerperal period i.e. within 2-4 days after parturition.

• Affected animals show both local and general symptoms.

General symptoms:

• Depression

• Anorexia

• Hyperthermia followed by hypothermia

• Tachycardia (96-120 beats/min)

• Respiration ra te high (60-72 times / min, normal 15-20 times / min)

• Cool skin and extremities

• Foul-smelling diarrhoea

• Dehydration because the affected cow does not drink normally

• Anuria

• Congested mucosa with an increased capillary refill time

• Muscular weakness, leading to recumbency

• Marked drop in milk production

• Rumen contraction reduced or absent

• Septic shock and death

Localized symptoms:

• Large quantities of foul-smelling, dark brown to red fluid containing pieces of degenerating foetal membranes comes out from the uterus through the vagina.

• Frequent straining.

Puerperal metritis must be differentiated from pneumonia, traumatic

reticulitis, left side displacement of the abomasum because their

general symptoms are likely to match with the puerperal metritis

and they also occur during puerperial period.

Differential diagnosis

Puerperal metritis must be differentiated from pneumonia, traumatic reticulitis, left side displacement of the abomasum because their general symptoms are likely to match with the puerperal metritis and they also occur during puerperial period. 

Treatment

1.. Non steroidal anti-inflammatory drugs FLUNIXIN  (1 ml to 25 kg body weight)or

Meloxicam : Dose 0.5 mg/kg b.w. at 24 hours interval.

2. (Prostaglandin F2-alpha )(3 ml)

3. Antimicrobial therapy (ceftiofur)

4. Antihistamines ego Chlorpheniramine maleate and pheniramine maleate. Pheniramine maleate (Avil) Dose 5-10 ml.

5. Glucocorticoid (Dexamethasone) should be used in severe case

to prevent septic shock. Dose -10-30 mg (total dose) or 5 ml. I/M or I/V every 24 hours.

6. Fluid and electrolytes :- The intravenous infusion of large quantities of fluids and electrolytes is essential in the management of septic puerperal metritis. Large volume of isotonic fluids have been standard practiced. Lactate Ringer's solution or a balanced electrolyte mixture must be given by IV infusion over several hours. Glucose should be included in the infusion fluids.

Benefits of Fluid and electrolytes

Correction of peripheral vasoconstriction.

• Restoration of an acceptable pulse quality

• Return of urinary output.

• Restoration of cardiac out put.

• Dilution of toxins.

(6) If the cow is continually straining, caudal epidural anaesthesia can be used; gives temporary relief for 1-2 hours and sometimes .It will break the cycle and stop the straining.

The use of oestrogen is contraindicated in cases of acute puerperal metritis because oestrogens increase the contraction and blood flow in the uterus thereby increasing the absorption of bacterial toxins and thus, the case becomes more severe.

Remove the retained foetal membranes by very gentle external traction, if possible otherwise leave it as it is.The hand should not be entered in the vagina and uterus to remove the placenta. Because the uterus in this condition is friable, it may result in severe damage and also predispose to the absorption of toxins and making the case more severe.

(8) Vitamin B-complex with liver extract : intramuscular for three days.

Prognosis:

 The prognosis for subsequent fertility should always be guarded, because cows that have suffered a severe puerperal metritis very often develop lesions such as ovario-bursal adhesions, uterine adhesions and occluded uterine tubes.