Clinical Research - Cystic Endometria Hyperplasia

Question 1

What is Cystic Endometrial Hyperplasia?

Answer 1

A progressive disease that affects the lining of the uterus

Long elaborate answer:

Cystic endometrial hyperplasia (CEH) is a disease that affects the uterus of breeding bitches [1]. In CEH bitches, inflammation of the lining of the uterus that occurs after mating appears to impact fertility by reducing the uterine vasodilatory (artery widening) response to mating and delaying clearance of uterine fluid as a result of decreased uterine contractions when compared to normal bitches. These responses function to aid the transport of spermatozoa and remove excess and dead spermatozoa, bacteria and other contaminants that enter the uterus at the time of mating [2]. Recently, a substantially larger influx of neutrophils was documented in bitches with endometrial hyperplasia compared with normal bitches, and this appeared to reduce fertility [3]. In that study the reduction in fertility appeared to be partially alleviated by the post-insemination administration of systemic antibiotic, potentially providing some evidence that the condition is associated with bacterial persistence within the uterus. Within Guide Dogs, diagnosis of CEH is on ultrasound examination which is usually prompted either by a failure to conceive or upon finding a large number of neutrophils or bacteria on a vaginal cytology smear. These bitches then receive antibiotic treatment after all future matings.

Question 2

When is Cystic Endometrial Hyperplasia seen?

Answer 2

After mating

Question 3

What are the effects of CEH? (2)

Answer 3

• Reduced uterine vasodilatory effects
  
  • Reduces time of sperm movement out of the uterus after mating.
• Uterine contractions are reduced with CEH compared to normal bitches.

Question 4

What are the signs of CEH? (3)

Answer 4

Inflammation,

Reduced fertility,

Large numbers of bacteria or neutrophils in vaginal smear

Question 5

What can we give post mating to alleviate reduced ferility?

Answer 5

Antibiotic administration post-mating appears to alleviate reduction in fertility

• Condition associated with bacteria.
• Bacterial persistence in the uterus affecting fertility. 4 day use of antibiotics to reduce persistence bacteria.
• Diagnosed historically when the bitch fails to conceive
• Does not go away

Question 6

How can CEH be diagnosed? (3)

Answer 6

• large numbers of bacteria or neutrophils in vaginal smear
• Ultrasound examination after a failed conception
• Diagnosed historically when the bitch fails to conceive

Question 7

What is this?

Answer 7

Normal uterus

Question 8

What is this?

Answer 8

CEH affected uterus with one cyst.

Question 9

What is this?

Answer 9

CEH affected uterus with two cysts close to one another

Question 10

What is this?

Answer 10

CEH affected uterus with one cyst

Question 11

Is treatment with antibiotic post mating effective for bitches with cystic endometrial hyperplasia?

Answer 11

• Fertility of bitches with CEH is impaired
• Pregnancy rates are improved with post-mating antibiotic treatment
• Litter sizes remain lower than healthy controls

Question 12

What else might be beneficial to reduce the effects of CEH?

Answer 12

Rotuine U/S screen prior to mating

Question 13

Can routine ultrasound screening of ALL bitches help the breeding programme?

Answer 13

• 16 previously undiagnosed but CEH affected bitches were identified and all became pregnant.
• Recommend routine examination for all breeding bitches prior to mating commencing when the bitch is being mated around 3 years of age.

Question 14

What is the most common abnormalities in the bitch vagina? (4)

Answer 14

Vaginal strictures or bands. Fault in the formation of the vagina. Congenital abnormality in the bitch.

Question 15

What is the effect of vaginal strictures or bands?

Answer 15

Lead to difficulties achieving a mating and difficulties during whelping