CS: Vaginal and pre-putial discharge

Question 1

What are DDx that could be confused with pyometra?

Answer 1

Vaginitis
Cystitis
Pregnant and aborting

Question 2

What are the causes of pymotra? 4

Answer 2

Combination of:

bacterial infection
cystic endometrial hyperplasia
progesterone
open cervix

Question 3

What are the cons of OVH for pyometra?

Answer 3

Significant risk in clinically compromised and septic patient.
Low BP
Aspiration pneumonia
Cardiac arrythmia
Uterine friable
POST-SURGERY: wound infections, fistulous tracts, local swelling, haemorrhage

Question 4

Suggest an empiric AB therapy for pyometra.

Answer 4

Amocilicillin-calvulanate or a combination of a penicillin and a fluoroquinolone. Continue for 7-14d after resolution of signs (PE, lab and ultrasound findings)

Question 5

What are medical management options for pyometra?

Answer 5

IV FLUIDS - in combination, restores perfusion, corrects imbalances
PGF2A –> CL luteolysis, cervical relaxation and myometrial contractions
DOPAMINE AGONISTS (with prostaglandins) –> inhibits PRL production to reduce its luteotrophic effect
P4R ANTAGONISTS - but don’t stimulate myometrial contractions
EMPIRIC AB THERAPY - not best option or advised

Question 6

What is the mortality rate with pyometra?

Answer 6

About 5%, mostly due to secondary endotoxaemia and shock.

Question 7

What is best medical treatment option for pyometra?

Answer 7

combination of ABs, PGs and P4 antagonist with supportive treatment (also combination of ABs, PG, PRL inhibitor and supportive treatment)

Question 8

What are the goals of medical treatment of pyometra?

Answer 8

Reduce effects of P4
Relax cervis
Promote uterine contractility
Treat bacterial infection
Allow endometrial regeneration

Question 9

What should happen in the first estrous cycle of a bitch that is successfully treated for pyometra?

Answer 9

Breed - subsequent pregnancy has been suggested to be protective against recurrence of pyometra.

Question 10

What are the potential complications/ considerations of medically managing pyometra?

Answer 10

Drugs aren’t licensed for this use in UK
PG not licensed for dogs in UK
Small risk of uterine rupture (esp closed)
Significant risk of recurrence at next estrous (20%)
Significant risk of failure to resolve
Still require hospitalisation + intensive monitoring + supportive treatments
May not be cheaper than OVH
(Fertility not affected in cases which resolve)

Question 11

When will the KC not accept an application to register a litter?

Answer 11

• The dam has already whelped 4 litters
• The dam has already reached age of 8 years at date of whelping*
• The dam was under 1 year at the time of mating
• The offspring are the result of any mating between father and daughter, mother and son or brother and sister save in exceptional circumstances of for scientifically proven welfare reasons
• The dam has already had 2 litters delivered by c-section save for scientifically proven welfare reasons and this only normally provided the application is made prior to mating
• The dam was not resident at a UK address at the date of whelping

Question 12

What is the prognosis of pyometra if treated medically?

Answer 12

• Stage of diestrous may impact initial success of medical therapy (CL more sensitive to PGF2a with time – bitches treated in first 5 weeks of diestrous more likely to require retreatment)
• If treating medically, monitor frequently for changes and improvements. Clinical improvement is usually seen within 2-4 days after initiating treatment (P4 concentrations >0.5ng/ml are an indicator of ineffective luteolysis). If patient deteriorates, it is usually recommended to abandon medical therapy and proceed with OVH.