Endometritis in Mare

Question 1

what is a subfertile mare?

Answer 1

• “problem mare”
• not pregnant after repeated matings
• cannot carry a pregnancy to term
• has known reproductive pathology
• behavioral issues that affect reproduction

Question 2

what causes subfertility?

Answer 2

• breeding management
• conformational defects
• susceptibility to endometritis (inflamed environment)

Question 3

types of endometritis

Answer 3

• infectious endometritis
• Post-mating induced endometritis (PMIE)
• sexually transmitted diseases
  
  • contagious equine metritis (CEM)

Question 4

what mares get endometritis?

Answer 4

ALL MARES

act of mating causes profound inflammation

Question 5

what type of defenses does the mare uterus have to resist infection?

Answer 5

• myometrial contractions
  
  • move sperm
  • get rid of bad stuff (dead sperm, debris, fluid, old PMNs)
• clearance through the cervix and lymphatics
• inflammatory response- PMNs
• physical barriers
  
  • perineum, vestibule, cervix

Question 6

causative agents of acute infectious endometritis

Answer 6

• Streptococcus equi spp zooepidemicus
• E. coli
• Pseudomonas aeruginiosa
• Klebsiella pneumonia
• fungal organisms

Question 7

chronic infectious endometritis

Answer 7

• multiple episodes of uterine infection
• failed tx
• may involve multiple organisms

Question 8

post-mating induced endometritis

Answer 8

• prior to breeding
  
  • minimal inflammation
• after breeding
  
  • acute inflammatory response to sperm (antigens)
• poor ability to clear inflammation
• often non-infectious

Question 9

what does a mare with poor clearance look like?

Answer 9

• middle-aged or aged
• pluriparous
• pendulous uterus
  
  • poor contractililty
• perineal defects

not in all mares

Question 10

“atypical” susceptible mare

Answer 10

• middle-aged
• maiden
• cervical incompetence during estrus

Question 11

mucus production in mare with endometritis

Answer 11

• excessive in endometritis
• produced by endometrial ciliated cells
  
  • protective

Question 12

biofilm

Answer 12

• heterogenous mix of bacteria
  
  • suppoted in ECM
  • normal flora/protective
  • Pseudomonas, E.coli
• properties of bacteria can change with conditions
  
  • can result in disease (dental caries)
  • abx resistance

Question 13

“positive” uterine culture

Answer 13

• pure growth
• many colonies
• associated inflammation
• Streptococcus zooepidemicus, E. coli, Klebsiella pneumoniae, P. aeruginosa, fungal species

Question 14

methods for uterine cytology

Answer 14

• uterine swab
• uterine cytology brush
• uterine biopsy

Question 15

low volume uterine lavage

Answer 15

• infuse small volume sterile saline (150-250 mL)
• recover with rectal massage
  
  • oxytocin IV
• examine fluid character
• centrifuge effluent
  
  • culture
  • cytology

Question 16

interpretation of results of uterine cytology and lavage

Answer 16

• traditional cytology
  
  • 5 PMN’s/hpf
  • degenerate cells
  • bacteria (Streptococcus)
  • fungal organisms
• low volume lavage
  
  • presence of PMN’s
  • debris in fluid
  • mucus strands
  • E. coli culture
  • fungal culture

Question 17

detection of fungal infections

Answer 17

• culture
  
  • 4-7 days
  • aerobic cultures miss most
• cytology
  
  • brush best
• biopsy
• PCR

Question 18

cervical examination

Answer 18

• digital examination
  
  • full thickness tears
  • “divets”
  • adhesions
• visual examination
  
  • discharge

Question 19

hysteroscopy

Answer 19

• visualization of uterine lumen
• localized abnormalities of the endometrium
• visually-guided procedures
  
  • deep horn insemination
  • biopsy
  • laser procedures

Question 20

oviductal patency

Answer 20

• barren mares
• oviductal blockage
  
  • plugs
  • salpingitis adhesions
• laparoscopic evaluation
  
  • flush
  • prostaglandin E

Question 21

tx of mare endometritis

Answer 21

• correct anatomic defects
• reduce contamination during breeding
• breed close to ovulation
• uterine lavage: 4-8 hrs after breeding (up to 12-18hrs)
  
  • prior to ovulation
  • should be cloudy if bred

Question 22

ecbolic agents

Answer 22

• induce uterine contractions
• Oxytocin
• Cloprostenol

Question 23

antimicrobial agents

Answer 23

• culture and sensitivity
• intrauterine
  
  • once daily infusion
  • endometrial penetration
  • cost effective
• systemic
  
  • multi-dose/day
  • endometrial penetration
  • expensive