SA Infertility - High Stakes Flashcards
what are high stakes problems
what are the clinical signs of pyometra
Canine and feline >6 years old
Very common and serious presentation
Typically within 4-8 weeks of a season or after exogenous estrogens/progestins
what are the clinical signs of pyometra
PU/PD
Vomiting
Anorexia
Depression
+/- vulva discharge
Pyrexia
+/- abdominal distention
what is the difference between open and closed pyometra
Is this a real distinction?
Cervix is closed then pus will build up
If cervix is more open then pus will drain out and more vulvovaginal discharge
Range of potential situations and not as clear cut
how is pyometra diagnosed
Symptoms
Hematology & biochemistry
US and/or radiography
what is seen on hematology and biochem with pyometra
Neutrophilia with left shift
+/- leukopenia, thrombocytopenia
Mild/moderate normocytic normochromic anemia
Hyperglobulinemia
Increased urea, creatinine
Hypoglycemia
what is seen on US with a pyometra
Normal uterus is hard to find
Look dorsal to bladder
Pyometra:
- Cystic endometrial hyperplasia
- Open pyometra
- Closed pyometra
how is pyometra managed
Bloods (urea/crea, hematology)
IV fluids
Systemic antibiotics
- Broad-spectrum, bactericidal antibiotics should be administered (potentiated amoxicillin usually first line of choice)
Usually treated surgically
- OVH
- Fluid, electrolyte, and acid-base imbalances should be corrected as quickly as possible, before ovariohysterectomy is performed
Reports of medical management
how is pyometra managed medically
Prostaglandins (cloprostenol)
- Open cervix (?)
- Induce uterine contractions
- Start with low dose, short term side effects
Alizin (Aglepristone)
- Progesterone antagonist
- Used alone
Uterine lavage
Antibiotics
- E coli, staphs and streps most common bacteria
- Balance between potential endotoxin release and issues around resistance (4-6 weeks)
what are the most common bacteria with pyometra
Bacteria from the normal vaginal flora or subclinical urinary tract infections are the most likely sources of uterine contamination
Escherichia coli is the most common bacterium isolated in cases of pyometra, although Staphylococcus, Streptococcus, Pseudomonas, Proteus spp, and other bacteria also have been recovered
when should medical management be considered when treating pyometra
Owners understand the risks of failure (rapid OVH)
Open pyometra?
No sign of systemic illness
- Renal compromise
- No CEH on scan (and follow up imaging)
With appropriate antibiotic therapy
Success rate >90% recover after 2 cycles, >50% go on to reproductive success
Used for breeding bitches
what does cystic endometrial hyperplasia predispose the bitch to
pyometra
what is cystic endometrial hyperplasia
Prolonged luteal phase
Uterine wall under alternating estrogen and progesterone influence
Becomes hyperplastic and cystic with time
Prone to pyometra
Often infertile
what breeds are predisposed to dystocia
bulldog
chihuahua
yorkie
what might be underlying causes of dystocia
maternal factors
- uterine inertia
fetal factors
- size
- orientation
describe the decision making in a dystocia case
describe the decision making in a dystocia case
