Post-partum Conditions

Cattle Diseases

Post-partum Conditions in Cattle

Includes the following conditions: Metritis, Endometritis, Pyometra

Metritis

Metritis, simply put, is inflammation of the uterus. Acute puerperal metritis is relatively uncommon and is defined as acute inflammatory changes in the endometrium, myometrium and peritoneal (outer) layers of the uterus within 10 days of calving (Sheldon et al., 2006). It is either due to an excessive bacterial challenge (often associated with RFM, infectious abortion, dystocia which required assistance or dirty calving equipment) or due to a reduced ability of the cow’s defence mechanism to clear infection (concurrent disease such as milk fever or dystocia) (Bruun et al., 2002; Fleischer et al., 2001; Sheldon et al., 2006). Should the bacteria load become too great, toxins produced can lead to toxaemia, septicaemia  and shock, with the condition rapidly progressing in severity.  This can be fatal unless cows are rapidly and intensively treated by a veterinary surgeon.

Cows with metritis will appear dull, may be pyrexic or have a sub-normal temperature, anorexic and dehydrated and may have a foul-smelling vaginal discharge.

Click here to read about the treatment of metritis

Endometritis

It is good practice to examine all cows 14 – 28 days after calving for signs of post-partum conditions

The most common form of uterine inflammation is a chronic form that is often called endometritis (also known as “whites” or “dirty cows”). Endometritis is defined as inflammation of the endometrium only and is seen from 3 weeks after calving and up to three months of lactation when various levels of uterine discharge can be observed, particularly when the cow is in heat and the uterine cervix opens up. Whilst the affected cows are seldom severely ill as a result of endometritis, the condition is considered important as it results in poor conception rates and prolongs the inter-calving intervals. The incidence of endometritis varies, but in a recent study, sub-clinical endometritis was found in 26% of cattle in a herd (Carneiro et al., 2014), although it can vary with season with highest incidence in winter (Sheldon et al., 2004).

The causes of endometritis are similar to those that increase the incidence of retained placenta in a herd, including retained placenta itself, poor calving hygiene, difficult or abnormal calvings, overfat cows and calves born dead. Excessive weight loss after calving (negative energy balance) has also been associated with dirty cows, and indeed, the risk factors for endometritis are hypocalcaemia, RFM, high triacylglycerol and NEFA (Roche, 2006).

Uterine bacterial contamination affects fertility due to disruption of the normal endocrine control (hypothalamic-pituitary axis) of ovarian activity, disruption of follicular development and prevention of establishment of pregnancy by the presence of pathogenic organisms in the uterus (Sheldon et al., 2004). Cows with uterine disease may take longer to get pregnant, are less likely to conceive and thus are more likely to be repeat breeders and are 1.7 times more likely to be culled for reproductive failure (Fourichon et al., 2000; Gilbert et al., 2005; LeBlanc et al., 2002). Duboc et al. (2011) found yield reductions in multiparous, but not primiparous cows of 753 litres per lactation due to retained placenta and 259 litres due to metritis. The direct and indirect cost of uterine disease have been estimated at 192 Euros per cow (Sheldon et al. 2008).

Cows with endometritis usually have an obvious vaginal discharge, although this is not always the case and some cases may be missed by the farmer, which is why a post-partum check of ALL cows at 2-3 weeks after calving is a good practice on problem farms, while checking all problem cows (dead calf, assisted calving, milk fever, twins) should be done on all farms. The severity of endometritis can be graded based on the vaginal discharge smell, character (amount of pus and or mucus) and the uterine and cervical diameter (Sheldon et al., 2004). It has been reported that the presence of a foul smell correlates well with the growth density of bacteria and levels of acute phase proteins which indicate inflammation (Williams et al., 2005). This may aid in decision making as regards to treatment and also the prognosis and requirement for re-examination by a veterinary surgeon as more severe cases are less likely to resume normal ovarian function (Mateus et al., 2003).

Click here to read about the treatment of endometritis

Pyometra

Pyometra is defined as an accumulation of pus in the uterus and by the persistence of a functional corpus luteum (Sheldon et al., 2004). Pyometra is often due to chronic endometritis with the normal cycling of the cow disrupted by the presence of infection in the uterus. Affected cows do not appear ill but may be presented as not seen in heat. There will be an obviously enlarged, doughy uterus, which may potentially be mistaken as a pregnancy but if ultrasound scanned will show a content of pus rather than foetus and foetal fluids.

Click here to read about the treatment of pyometra

Preventing and Controlling Post-partum Infections

To minimise infection calving pens should be kept as clean as possible with fresh bedding. Also if calving assistance is needed this should be carried out hygienically.

The control of post-partum infection focuses on the main causes of the condition. Controlling the incidence of retained placenta will have a direct effect on the levels of endometritis. Improved hygiene in calving boxes and calving assistance are also likely to reduce the occurrence of endometritis- especially in herds where hygiene has been poor.

Equally important risk factors for endometritis are hypocalcaemia, RFM, high triacylglycerol and NEFA, therefore, ensuring correct nutritional management both pre and post-calving is important (Roche, 2006). Ensure cows are not over fat at the time of calving and that excessive weight isn’t lost in the pre or post-calving period (Blowey, 1999).

Vitamin E or prostaglandin injections could be used on a short-term basis as part of a concentrated effort to improve the situation in the herd, once all other management changes have been exhausted. The use of some homeopathic remedies such as series of varied treatments with Lachesis compositum (Lachesis), Carduus compositum (Carduus), and Traumeel LT (Traumeel) as prophylaxis to prevent of endometritis has shown to be ineffective (Arlt et al., 2009).

Treating Post-partum Conditions

Treating Metritis

Cows with acute metritis should be seen by a veterinary surgeon. They require treatment with antibiotics, non-steroidal anti-inflammatories (NSAIDS) to counter pain, inflammation and bacterial endotoxins and fluid therapy (either oral or intra-venous).  Cows should be nursed carefully in a well bedded box with special care taken that she does not develop mastitis. The prognosis for cows with metritis must be guarded. Systemic treatment with antimicrobials has been reported to be as effective as combined systemic and local antimicrobial therapy in these cases (Drillich et al., 2001). Recently ampicillin has been shown to be as effective as ceftiofur in treating metritis, reducing the need for critically important antibiotics (Lima et al., 2014).

Treating Endometritis

It has been shown that early treatment of endometritis leads to better conception rates and shorter calving intervals in herds that suffer from the condition. Treatment success rates are higher for mild cases compared to more severe cases and those with a foul-smelling odour (Sheldon et al., 2004). Intra-uterine pessaries (either antibiotic or herbal) are a common treatment for the condition. If intra-uterine antimicrobials are to be used it should be considered that at less than 30 days post-partum, penicillin may be rendered ineffective due to the presence of bacteria which produce penicillinase (Sheldon et al., 2004). Both oxytetracycline and cephalosporins are broad spectrum antibiotics and effective in the uterine environment and should be considered as the drugs of choice (Sheldon et al., 2004). Use of cephapirin in cows with endometritis 3-6 weeks before breeding has been shown to improve fertility (McDougall, 2001). Alternatively, uterine infusions with 2% povidone iodine have shown to be an effective non-antibiotic alternative (Mido et al., 2015).

In some cases, prostaglandin (PGF) injections may prove useful. The effectiveness of PGF improves if there is a corpus luteum present and, although it may help in cases without a corpus luteum due to its direct effect on the myometrium, there may be some later impacts on pregnancy rate (Blowey, 1999; LeBlanc et al., 2002). There appears to be no advantage to using intra-uterine cephalosporin rather than prostaglandin in terms of subsequent reproductive performance (Kasimanickam et al., 2006; Laven, 2003)

Gentle flushing of large quantities (several litres) of warmed saline into the uterus and subsequent siphoning may help remove some of the uterine content, although this has not been extensively validated (Sheldon et al., 2004). Administration of a variety of antiseptic solutions has been reported, although the success is not well documented and may be counterproductive in some cases (Brooks, 2000; Sheldon et al., 2004).

There appears to be no clear protocol for treatment of endometritis (LeBlanc et al., 2002) and treatment should probably be assessed on an individual basis by the farm’s veterinary surgeon and reserved for those cows with more severe clinical signs more than 4 weeks after calving.

Treating Pyometra

Treatment of pyometra is best achieved by a veterinary surgeon administering prostaglandin, which allows the cow to ‘open up’ and discharge the infected material (Blowey, 1999). It should always be verified that the cows is not pregnant before giving prostaglandin, as a pregnant cow will abort.

Post-partum Conditions and Welfare

Metritis is a painful condition (Stojkov et al., 2015) and therefore preventative steps should be taken in order to minimise incidence. However, there are no major welfare considerations associated with the chronic condition itself, but high culling rates for “barren” cows due to chronic metritis should be avoided by improved control and therapy. High culling rates for endometritis may reflect on suboptimal hygiene and health in the periparturient period.

Good Practice Based on Current Knowledge

Routine fertility visits are very useful and can be used to diagnose endometritis early. Ideally routine fertility monitoring should be part of the Herd Health Plan

• Any cow that is sick immediately after calving should be seen as soon as possible by a veterinary surgeon
• All cows should be examined 14-28 days after calving by a veterinary surgeon and cows with endometritis should be treated immediately
• Record carefully all cases of postpartum disease, noting details about the cow’s other symptoms or problems
• Assess the situation after each calving season and decide whether there is a clear underlying cause for the occurrence of endometritis in the herd
• Avoid over fat cows at calving (condition score 2.5-3 at drying off and at calving)
• Prevent clinical and subclinical milk fever
• Maintain good calving box and calving assistance hygiene
• Avoid excessive weight loss in cows after calving