Treatment of Uterine Infections and Associated Endometritis in Mares--A Comparative Study.
Uterine infection and associated endometritis is the most common cause of infertility in broodmares, the most important being persistent mating induced endometritis (PMIE) and post-breeding metritis (PMB). PMIE and PBM occur as sequelae to poor uterine defense mechanism in infertile mares (Hughes, 1993) and account for major causes of conception failure in broodmare practice. The recorded incidence of PMIE is about 15% in breeding mares (Traub-Dargatz et al., 1991; Newcombe, 1997; Zent et al.,1998). Uterine infection is inevitable during breeding and foaling in mares and resolves within 72 hours post-breeding and 10-15 days post-foaling in post-partum mares (Ricketts and Mackintosh, 1987; Card, 1997). Young maiden mares are resistant to uterine infections owing to effective cellular and humoral immunological uterine defense mechanisms (Hughes, 1993; Hurtgen, 2006). However, old pleuriparous mares are unable to overcome these uterine infections, due to inadequate uterine defense mechanisms and poor conformation, leading to accumulation of uterine fluids and subsequent development of endometritis associated with oedema and thickness of uterine wall (Hurtgen, 2006; Lu and Morresey, 2006). Mares affected are usually the best performing proven mares and therefore huge effort, manpower and money are required to manage and treat such conditions year after year (Relias, 2001).
Therapeutic management of equine endometritis is of utmost importance and involves adoption of necessary measures to achieve rapid uterine clearance, potentiating uterine cellular and humoral defense mechanisms and effective antibiotic therapy to clear invading uterine pathogens (Causey, 2006). Uterine lavage with isotonic saline removes uterine pathogens, debris and inflammatory exudates, and improve luminal phagocytic activity against pathogens (Asbury, 1984a; Troedsson et al., 1995). Oxytocin (Cadario et al., 1999a, b), Prostaglandin and its analogues (Combs et al., 1996) are of additional advantage to induce evacuation of uterine contents and there by enhance therapeutic effect of antibiotics against uterine pathogens.
Evacuation of uterine inflammatory exudates is primary requirement to obtain success through local and parenteral antibiotic therapy in infertile mares (Causey, 2006). Uterine ecbolics, luteolytic agents, uterine lavage and/or plasma infusion are recommended prior to selection of antibiotic therapy in equine endometritis (Bermudz et al., 1995; Zent et al., 1998; Causey, 2006). The use of antibiotics during treatment should be guided by microbiological investigations and in vitro sensitivity patterns of isolated uterine pathogens from affected mares (Bermudz et al., 1995; Zent et al., 1998). Further, management of perineal disconformation, foaling wounds over perineum and vulvo-vaginal region should be attempted prior to therapeutic antibiotic approach in recurrent and persistent equine endometritis (Hurtgen, 2006; McCue, 2008).
Therapeutic management of equine endometritis with Oxytocin was initially reported by Allen (1991) and was considered to promote uterine drainage and strengthen uterine defense mechanism (Allen, 1991; Pycock and Newcombe, 1996). Oxytocin induces high amplitude uterine contractions of approximately 30 minutes duration (LeBlanc, 2008). Repeated administration of Oxytocin is required due to its 6.8 minute half-life (Paccamonti et al., 1999; Troedsson et al., 1995). Nie et al. (2002) proposed that Oxytocin should be repeated every 6 hours, while Hurtgen (2006) found that in refractory cases it may be repeated after an interval of 2 hours. Causey (2006) recorded that a single dose of Oxytocin can successfully treat around one third of uterine infections in subfertile mares. Housing of mares susceptible to uterine infection in vicinity of breeding stallions induces endogenous release of Oxytocin and assists in clearance of uterine exudates (Madill et al., 2002).
Prostaglandin and its Analogues
PG[F.sub.2[alpha]] causes weaker uterine contractions than Oxytocin and is less effective in evacuating uterine exudates; though myometrial contractions may last longer than Oxytocin for about 5 hours (Cadario et al.,1995; LeBlanc, 1997). PG[F.sub.2[alpha]] enhances uterine immune defense mechanism and induces uterine lymphocytic proliferation in infertile mares (Lewis, 2004) as well as neutrophil chemotaxis and phagocytosis (Kelly et al., 2001; Seals et al., 2003). Cloprostenol is particularly useful in cases with excessive uterine oedema post-ovulation which does not resolve with Oxytocin or other prostaglandin analogues. This is due to sustained uterine contractions caused by action of Cloprostenol (Combs et al., 2006). Cloprostenol is frequently administrated in therapeutic doses of 250 [micro]g IM at interval of 24 hours, but higher and more frequent doses should be avoided (Brendemuehl, 2000; Nie et al., 2002). Fenprostalene, another Prostaglandin analogue was used by Combs et al. (1996) to study its effect on clearance of radiocolloid from uterus of mare and was found inferior to both PG[F.sub.2[alpha]] and Cloprostenol.
Uterine lavage with sterile, isotonic saline promotes evacuation of uterine exudates consisting of cellular debris, phagocyozed bacteria and phagocytes and enhances uterine phagocytosis and circulation (Asbury 1984a; Troedsson et al., 1995). Early drainage of uterine debris and inflammatory exudates by uterine lavage often helps uterine inflammation to subside early (Knutti et al., 2000). Troedsson et al. (1995) observed that saline uterine lavage was as effective as penicillin in reducing Streptococcus population from uterine lumen. Administration of uterine lavage increased conception rates in infertile mares when used in combination plasma infusion and Oxytocin therapy (Asbury, 1984 b; Knutti et al., 2000).
Intrauterine antibiotics along with parenterel antibiotic therapy are often advocated in equine persistent endometritis. Further, pre-treatment with uterine ecbolics increases therapeutic efficacy of antibiotic treatment in endometritis mares (Pycock and Newcombe, 1996). Persistent uterine infection with highly pathogenic organisms such as Klebsiella, Pseudomonas and Taylorella warrants preference for intrauterine antibiotics over parenteral antibiotic therapy (Watson, 1997; Hughes et al., 1966). Further, minimum inhibitory concentration (MIC) is more rapidly achieved with intrauterine administration of antibiotics as compared to systemic antibiotic therapy (Bowen et al., 1984; Spensley et al., 1986). Indiscriminate use of antibiotics in post-partum equine endometritis favors establishment of fungal uterine infection along with growth of resistant bacteria populations in uterine lumen (Davis and Abbitt, 1977; Ricketts, 1997) and thus such approach should not be adopted in treating uterine infections. Therapeutic management of equine endometritis should involve consideration of infusion vehicle (saline or buffer), volume of vehicle (at least 50 ml) and adequate therapeutic dose of local and/or parenterel antibiotic therapy (Asbury and Lyle, 1993; Brinsko, 1996; Troedsson, 1996; Causey, 2006).
Post-breeding antibiotic therapy prevents establishment of uterine infection and ensures conception in chronically infected mares.
Different workers have reported different treatment protocols for successful therapeutic management of uterine infections in mares, but the reports continue to be equivocal. Present study was therefore attempted to strengthen the existing body of knowledge on therapeutic aspects of equine endometritis along with evaluation of post-treatment fertility with the objective to evaluate therapeutic efficiency of three different treatment regimens in uterine infection in subfertile mares.
Materials and Methods
Mares stationed at Equine Breeding Stud-EBS (an equine breeding establishment of Remount Veterinary Corps of Indian Army, Hisar) constituted the experimental animals for the present investigation.
The ultrasonographic studies were performed at the EBS by means of a portable ultrasound machine. The samples collected at the breeding stud were processed for uterine cytology in the departmental laboratory and for uterine culture and antibiotic sensitivity in the College Central Laboratory.
The animals were screened on 1st day by per-rectal examination and uterine ultrasonography and uterine flush samples were collected. The flush samples were processed for uterine cytology, uterine culture and ABST (Nafis et al., 2015). Mares declared as having uterine infections by any two of the diagnostic techniques were considered positive for uterine infections and associated endometritis. The results of diagnostic tools used were read independent of mares` history. As such twenty one (21) mares with uterine infections and associated endometritis were identified. These endometritis mares were categorized into three treatments (Group I, II and III) of seven mares each. Group I mares were treated with saline uterine lavage (500 ml) + PG[F.sub.2[alpha]] (10 mg, IM) + intrauterine antibiotic infusion (based on in-vitro ABST). Uterine lavage and PG[F.sub.2[alpha]] was given on day 0 of treatment and intrauterine antibiotics were infused on 3rd day and continued for 3-5 consecutive days or till complete clearance of uterine infection. Few mares evidenced severe sweating following PG[F.sub.2[alpha]] administration. They were given Pheniramine maleate (10 ml, IM). Group II mares were treated with saline uterine lavage (500 ml) + Cloprostenol (250 [micro]g, IM) + intrauterine antibiotic infusion (based on in vitro ABST). Uterine lavage and Cloprostenol was given on day 0 of treatment and intrauterine antibiotics were infused on 3rd day and continued for 3-5 consecutive days or till complete clearance of uterine infection. The mares of group III were treated with saline uterine lavage (500 ml) + Oxytocin (60 IU, IM) + intrauterine antibiotic infusion (based on in vitro ABST). Uterine lavage and Oxytocin was given on day 0 of the treatment. Three doses of Oxytocin (20 IU each) were given to mares after 2 hour intervals. Intrauterine antibiotics were administered from 3rd day of treatment and continued for 3-5 consecutive days or till complete clearance of uterine infection. Besides the twenty one endometritis mares, 6 normal mares were also identified on the basis of history and the aforesaid diagnostic techniques and were assigned to Group IV. These mares were treated with uterine lavage (500 ml) + a single dose of intrauterine penicillin (5 x 106 IU). The intrauterine penicillin was administered in order to negate any chances of seeding infections during lavage procedure in this group. Group IV served as a control group against which the results of groups I, II and III were compared besides being compared amongst themselves.
Therapeutic efficacy of three different treatment regimens was evaluated and compared on the basis of resumption of utero-ovarian function and post-treatment fertility. The utero-ovarian function was evaluated in terms of post-treatment correction of uterine exudates/uterine infection, uterine luminal and wall morphology (edema and thickness) as evidenced by ultrasonographic examination conducted between 7-10th days after completion of treatment protocol. Absence of uterine fluid and wall thickness was interpreted as resolution of infection and treatment was deemed as effective. In case of persistence of uterine fluid after treatment as found by ultrasonography, the treatment was recorded as ineffective. The post-treatment fertility was evaluated by onset of estrus, resumption of normal estrous cycle duration and conception status after first three AIs. All mares were teased daily in the morning with vasectomised stallion for estrus detection, which was later confirmed by recto-vaginal examination and ultrasound for evidence of graffian follicle (>30 mm diameter) and cervical relaxation. Mares in true estrus were subjected to AI and conception was recorded between 20-30th days post-insemination by ultrasonography upto three consecutive estrus cycles.
Collection of Samples
Uterine flush samples were collected for three procedures viz uterine cytology, uterine culture and ABST. Uterine flushings from experimental mares (Group I, II, III and IV) were collected by low volume flush technique (LeBlanc, 2008; Card et al., 2004; Ball et al., 1988a) using two way Foley`s catheter (Bard Urological Georgia, USA; no. 24) and sterilized phosphate buffer saline-PBS (pH, 7.2). A disposable Foley`s catheter with a sterile metal stillete and covered in sanitary sheath was introduced per vaginum with lubricated hand covered with sterilized glove. Cervix was opened with digital pressure to introduce the catheter beyond the cervix into uterus. Mares with tightly closed cervix that could not yield to digital pressure were administered a single dose of PG[F.sub.2[alpha]] (5-10 mg IM) and were sampled after 36 hours of PG[F.sub.2[alpha]] administration. Uterine flushings were collected just after initial clinical examination. Sterile PBS (100 ml) was infused into the uterus through Foley's catheter using sterile disposable intravenous set. The uterus was manipulated per rectum to distribute the PBS into both uterine horns and then the PBS (60-80 ml) was recovered in sterile glass test tube by gravitational flow assisted by per rectal manipulation of uterine horns. The tubes were immediately capped to prevent contamination.
The uterine sample that was recovered after low volume uterine flush was divided into two parts (20 ml each) inside a safety cabinet (laminar flow) so as to prevent contamination by ambient factors. The two samples were then separately processed, one for uterine cytology and other for uterine microbiology (culture and sensitivity). The portion of flush sample that was selected for microbiological examination was necessarily dispensed into sterile disposable centrifuge tube (conical bottom, centrifuge tube). The test tubes containing the uterine sample were placed inside a thermos flask containing mixture of ice and common salt and taken to laboratory for immediate processing for cytological and microbiological examinations. If processing was delayed due to some reason, samples were necessarily stored in refrigeration.
In Vitro Antibiotic Sensitivity Test
The in vitro antibiotic sensitivity test (ABST) was performed in order to determine the specific antibacterial and antifungal agents that would be specifically active against particular isolates of bacterial of fungal pathogens obtained from infected mares. The sensitivity or otherwise of a total 12 antibacterial and 6 antifungal antibiotics was evaluated. Antibiotics selected for this purpose were all reportedly used by different equine practitioners via intrauterine route for treatment of uterine infections. The pattern of sensitivity of various bacterial isolates to different antibiotics was studied by single disc diffusion method (Ellner, 1978) using commercially available discs (Hi Media laboratories Pvt. Ltd. Mumbai). Antibiotic discs of different concentrations were used (Penicillin-G: 100 units; Streptomycin: 10[micro]g; Tetracycline: 30[micro]g; Ampicillin: 10[micro]g; Gentamicin: 10[micro]g; Ciprofloxacin: 5[micro]g; Ceftriaxone: 30[micro]g; Cephalexin: 30[micro]g; Chloramphenicol: 30[micro]g; Cefuroxime: 30[micro]g; Norfloxacin: 10[micro]g; Co-trimoxazole 25[micro]g).
In vitro sensitivity of fungal isolates to different antibiotics was carried out by disc diffusion method according to recommendations described in M44-A guidelines (NCCLS, 2004). Sensitivity was evaluated against following antibiotic discs. Ketoconazole: 10ug; Itraconazole: 10ug; Clotrimazole: 10[micro]g; Fluconazole: 10[micro]g; Amphotericin: 100 units and Nystatin 100 units. Sabouraud`s dextrose agar (SDA) medium was used for the test. The plates were then incubated at 30 [+ or -] 20C for 24-120 hours. The isolates were classified as resistant or sensitive to a particular antibiotic based on diameter of zone of inhibition (Pfaller et al., 2004).
Procedure of Uterine Lavage
Mares were restrained in trevis and vulva and perineum cleaned with 2% solution of Savlon (a) and disinfected by 5% solution of Povidone-Iodine and rectified spirit. 500 ml of sterile NSS was infused into the uterus using two way Foley`s catheter connected to a disposable intravenous set and uterine contents were then flushed out after thorough rectal massage of uterine horns and uterine body to ensure complete recovery of infused saline. The lavage was recovered under gravitational flow assisted by per-rectal manipulation of uterine horns to collect maximum volume of infused saline.
Intrauterine Infusion of Antibiotics
Mares positive for uterine infections were treated with intrauterine administration of antibacterial or antifungal agents in a suitable vehicle, based on in vitro sensitivity of uterine pathogens. Intrauterine antibiotic infusions were performed using sterile plastic intrauterine insemination catheter for mares. Mare was restrained in a stock and vulva and perineum cleaned with with 2% solution of Chlorhexidine (Savlon (a)) and subsequently disinfected by 5% solution of Povidone-Iodine (Cipladine (b)) and rectified spirit to prevent external contamination. The sterile plastic catheter was introduced per vaginum beyond mid cervix with hand covered with sterlized rubber glove. The required antibiotic solution prepared after proper dilution and/or buffering (minimum 100 ml volume) was infused into uterus with the help of disposable plastic syringe (60 ml) and catheter was removed after intrauterine infusion.
The treatment protocol followed and therapeutic response obtained in different treatment groups are shown in tables 1. It can be observed that treatment regimen instituted in Group I mares was successful in clearing the uterine exudates and associated uterine infection in four out of seven mares (57.14%). Treatment protocol applied to group II mares was successful in five out of seven cases (71.4%). In case of group III, five out of six mares (83.33%) could be identified as treated for uterine infections at the time of post-treatment examination. It is thus clear that therapeutic regimen adopted in Group III (saline lavage + Oxytocin + intrauterine antibiotic infusion) was most effective in clearance of uterine luminal exudates and associated uterine infection, followed by protocol instituted in Group II (saline lavage + Cloprostenol + intrauterine antibiotic infusion). The treatment regimen followed for Group I (saline lavage + PG[F.sub.2[alpha]] + intrauterine antibiotic infusion) was found to be least effective in clearance of uterine exudates and uterine infection.
Six out of seven mares treated with assigned therapeutic regimen of Group I resumed estrous cycle (85.71%) and two out of these six mares (28.57%) conceived after AI (one mare at 2nd AI and one mare at 3rd AI). One out of 7 infertile mares failed to resume estrous cycle (14.29%). Of the Group II mares six out of seven resumed estrous cycles (85.71%) and four out of these six mares (57.14%) conceived after AI (two mares at 1st AI and two mares at 2nd AI). One out of 7 infertile mares of this group failed to resume estrous cycle following the treatment (14.29%). Out of the seven mares of treatment group III, one mare died in accident during the treatment period. Four mares out of the remaining 6 infertile mares treated with assigned therapeutic regimen of Group III resumed estrous cycle (66.66%) and two out of these four mares (33.33%) conceived after AI (one mare at 1st AI and one mare at 2nd AI). Two out of these six mares failed to resume estrous cycle following treatment (33.33%). All the 6 mares of Group IV exhibited estrous cycle (100%) and conceived after AI. (two at 1st AI, three at 2nd AI and one mare at 3rd AI). The results of post-treatment fertility for the infertile mares (Group I, II, III) and control mares (Group IV) are represented in Table 2. It is clear from the table that treatment regimen followed for Groups I and II gave the best results for resumption of estrous cycle in treated mares, but higher pregnancy rates (57.14%) were recorded for the treatment protocol followed for Group II. As such the treatment regimen comprised of uterine lavage + Cloprostenol + intrauterine antibiotic infusion was the most effective treatment in the management of uterine infections in endometritis mares.
Four mares out of 7 infected mares (Group I) cleared uterine exudates and associated uterine infection (57.14%) with therapeutic regime involving PG[F.sub.2[alpha]]. PG[F.sub.2[alpha]] induces uterine contractions; however, uterine clearance is considerably slow, with contractions lasting for approximately 5 hours (Combs et al., 1996; Troedsson et al., 1995a). Five mares out of 7 infertile mares (Group II) cleared persistent uterine infection (71.4%) with treatment regimen involving Cloprostenol. This slightly superior therapeutic response with Cloprostenol than PG[F.sub.2[alpha]] can be ascribed to prolonged uterine contractions induced by this synthetic Prostaglandin analogue (Troedsson et al., 1995a; Brendemuehl, 2002). Six out of 7 infertile mares (Group III) responded to therapeutic regimen involving Oxytocin (83.33%) and therapeutic response closely resembles with reported observation of clearance of uterine infection with Oxytocin along with intrauterine antibiotics (72%) than Oxytocin alone (63%) in infertile mares (Pycock and Newcombe, 1996). Further superior response with Oxytocin than PG[F.sub.2[alpha]] and Cloprostenol in clearance of uterine exudates could be attributed to induction of uterine contractions of higher amplitude (for 30 minutes) by Oxytocin (LeBlanc, 2008). Further, PG[F.sub.2[alpha]] is secreted in response to Oxytocin stimulation of the multiparous uterus, owing to neurological sequelae from repeated mechanical stretch (Rigby et al., 2001; DeLille et al., 1998). This may also explain the superior results obtained in group III (Oxytocin treated) compared to groups I and II with respect to proportion of uterine fluid free mares observed on ultrasonography after completion of treatment.
It may be noted that in mares, uterine contractility may be beneficial in reducing fluid volume but not for reducing bacterial quantity (Nikolakopoulos and Watson, 1999). Thus mares declared treated (no intrauterine fluid accumulation) after they were evaluated by post-treatment ultrasonography may necessarily not perform better when evaluated for post-treatment fertility.
Six out of seven infertile mares (Group I) responded to therapeutic regimen involving PG[F.sub.2[alpha]] by exhibiting estrus and cyclic ovarian activity within 7-10 days post-treatment. Further 2 mares out of 6 mares bred by AI conceived. PG[F.sub.2[alpha]] besides being a prompt luteolytic agent, also induces stimulation of uterine cellular immune function, uterine phagocytic activity along with prolonged uterine contractions that aid in clearance of uterine exudates (Lewis, 2004; Hirsbrunner et al., 2003; Nakao et al., 1997; Kelly et al., 2001; Seals et al., 2003). The lower fertility of Group I mares seems to be due to chronic infertility during last two to three breeding seasons and thereby continued hormonal variations along with utero-ovarian dysfunction. The fact that results of clinical trials of PG[F.sub.2[alpha]] for treatment of clinical endometritis in absence of an active corpus luteum are inconsistent (LeBlanc et al., 2002; Steffan et al., 1984; Sheldon and Noakes, 1998) could also explain why animals treated prostaglandins exhibited varied results.
Six out of 7 infertile mares (Group II) responded to therapeutic regimen involving Cloprostenol by exhibiting estrus and cyclic ovarian activity within 7-10 days post-treatment and four out of them conceived. Recorded therapeutic effect of Cloprostenol following uterine lavage in resumption of ovarian cyclic function is consequential to clearance of uterine infection with prolonged stimulation of uterine contractions (Troedsson et al., 1995a; Brendemuehl, 2002) as well as its effective therapeutic response in chronic endometritis with uterine lymphatic stasis (Brendemuehl, 2002). Further, Combs et al. (1996) observed that radiocolloid was not cleared consistently in mares after PG[F.sub.2[alpha]] treatment, while Cloprostenol consistently caused the most rapid clearance of radiocolloid. Administration of Cloprostenol also causes a sustained increase in intrauterine pressure (Goddard and Allen, 1985). The prolonged uterine contractions and possibility that Cloprostenol has a higher binding affinity for prostaglandin receptors in myometrium (Josimovich, 1973) likely contribute to its better performance.
Four out of six infertile mares (Group III) responded to therapeutic regimen involving Oxytocin by exhibiting estrus and cyclic ovarian activity within 7 -10 days post-treatment. Further, two out of these four mares bred by AI conceived. Therapeutic response both in terms of resumption of cyclic ovarian function and occurrence of estrus as well as fertility following three consecutive inseminations were indicative of synergistic effect of uterine lavage and Oxytocin in evacuation of uterine exudate along with associated uterine infection. Oxytocin induces high amplitude uterine contractions, consistent in duration as well as in its ecbolic effect (LeBlanc, 2008).
In conclusion, it may be stated that therapeutic regimen involving saline uterine lavage + Cloprostenol + intrauterine antibiotic infusion is recommended as first preference treatment owing to the superior post-treatment fertility achieved with this treatment protocol. However, treatment regimen involving saline uterine lavage + oxytocin + intrauterine antibiotic infusion may be recommended where clearance of uterine exudates is the primary objective. This treatment regimen may also be recommended as a second preference treatment in management of infections in endometritis mares.
Sincere thanks to the administration of EBS-Hisar for providing us the mares and assistance in terms of manpower. Special thanks are due to Lt. Col (Dr) A H Haldar and Lt. Col (Dr) J Taneja for their valuable cooperation. Dr Anshu Sharma, Sr. Scientist and Incharge of College Central Laboratory deserves a special mention for all the help and cooperation.
Allen, W. E. (1991). Investigations into the use of exogenous Oxytocin for promoting uterine drainage in mares susceptible to endometritis. Vet. Rec, 128: 593-94.
Al-Bagdadi, F.K., Eilts, B.E., Richardson, G.F. (2004). Scanning Electron Microscopy of endometrium of mares infused with Gentamicin. Microsc Microanal. 10: 280-85.
Asbury, A.C. (1984). Pathogenesis and diagnosis of uterine infection in mares. In: Proceedings of Western States Vet. Conf. 13: 9-14.
Asbury, A.C. (1984a). Post-breeding treatment of mares utilizing techniques that improve uterine defenses against bacteria. Proceedings of American Association of Equine Practitioners. 30: 349-56.
Asbury, A.C. (1984b). Uterine defense mechanisms in the mare: the use of intrauterine plasma in management of endometritis. Theriogenology. 21: 387-93.
Asbury, A.C. and Lye, S.K. (1993). Infectious causes of infertility. In: McKinnon AO, Voss JL. (Eds.), Equine Reproduction. Lea and Febiger, Malvern, PA. USA. p. 381-91.
Ball, S.A., Shin, S.J., Patten, V.H., Lein, D.H., Woods, G.L. (1988a). Use of low-volume uterine flush for microbiological and cytological examination of mare`s endometrium. Theriogenology 29: 1269-83.
Brendemuehl, J.P. (2000). Influence of Cloprostenol, PG[F.sub.2[alpha]] and Oxytocin administered in the immediate post-ovulatory period on corpora luteal formation and function in the mare. In: Proceedings of the society for Theriogenology Annual Conference, San Antonio, TX, USA. p. 267.
Brendemuehl, J.P. (2002). Effect of Oxytocin and Cloprostenol on luteal formation, function and pregnancy rates in mares. Theriogenology. 58: 623-26.
Brhrendt-Adam, C.Y., Adams, M.H., Simpson, K.S., McDowell, K.J. (2000). Effect of steroids on endometrial Oxytocin mRNA production. J. Reprod. Fertil. 56: 297-304.
Brinsko, S.P. (1996). Treatment of infectious infertility. In: Proceedings of the Society for Theriogenology, Mare Reproduction Symposium, Kansas City, MO. p. 150-55.
Brown, M.P., Embertson, R.M., Gromwell, R.R., Beal, C, Mayhew, I.G., Curry, S.H. (1984). Amikacin sulfate in mares: pharmacokinetics and body fluid and endometrial concentrations after repeated intramuscular administration. Am. J. Vet. Res. 45: 1610-13.
Cadario, M.E., Merritt, A.M., Archibald, L.F., Tatcher, W.W., LeBlanc, M.M. (1999a). Changes in intrauterine pressure after Oxytocin administration in reproductively normal mares and in those with a delay in uterine clearance. Theriogenology. 51: 1017-25.
Cadario, M.E., Tatcher, M.D., LeBlanc, M.M. (1995). Relationship between prostaglandin and uterine clearance of radiocolloid in the mare. Biol. Reprod. Mono., Series I; p. 495-500.
Cadario, M.E., Tatcher, W.W., Klapstein, E., Merrit, A.M., Archbald, L F., Tatcher, MJ., LeBlanc, M.M. (1999b). Dynamics of prostaglandin secretion, intrauterine fluid, and uterine clearance in reproductively normal mares and mares with delayed uterine clearance. Theriogenology, 52: 1181-92.
Campbell, M.L.H. and England, G.C.W. (2002). A comparison of the ecbolic efficacy of intravenous and intrauterine Oxytocin treatments. Theriogenology. 58: 473-77. Card, C. (1997). Current therapy in large animal Theriogenology. Youngquist RS. (Editor) 1st edition. WB Saunders Co. p. 151-53.
Card, C.E., Carley, S.D., Green, J., Chirino-Trejo, M. (2004). Endometrial cytology in mares bred with frozen semen. In: Proceedings of the 50th Annual Convention of American Association of Equine Practitioners. p. 431-33.
Causey, R.C. (2006). Making sense of equine uterine infections: The many faces of physical clearance. The Vet. J. 172: 405-21.
Combs, G.B., LeBlanc, M. M., Neuwirth, L. and Trans, T.Q. (1996). Effects of PG[F.sub.2][alpha], Cloprostenol and Fenprostalene on uterine clearance of radio-colloid in mare. Theriogenol. 45: 1449-55.
Davis, L.E. and Abbitt, B. (1977). Clinical pharmacology of antibacterial drugs in the uterus of the mare. J. Am. Vet. Med. Assoc. 170: 204-07.
Dascanio, J., Ley, W. and Schweizer, C. (2000). How to diagnose and treat fungal endometritis. In: Proceedings of Annual Convention of American Association of Equine Practitioners. 46: 316-18.
DeLille, A., Silvers, M., Cadario, M. et al. (1998). Interaction of xylazine, acepromazine, and Oxytocin on intrauterine pressure in normal mares and those exhibiting a delay in uterine clearance. In: Proceedings of the 7th International Symposium of Equine Reproduction. Pretoria, South Africa. p. 373-79.
Ellner, P.D. (1978). Current procedures in clinical bacteriology. 2nd edition. Charles C Thomas, Illinois; USA. Ginther, O.J. (1985). Embryonic loss in mares: incidence, time of occurrence and hormonal involvement. Theriogenol. 23: 77.
Goddard, P.J. and Allen, W.E. (1985). Genital tract pressures in mares II, changes induced by Oxytocin and PG[F.sub.2][alpha]. Theriogenol. 24: 35-44.
Henry, M., Vandelplassche, M. and Bouters, R. (1982). A comparison of bacteriological, cytological and histological findings for evaluating of endometritis in mare. Vlams Diergeneeskunding Tijdschrift., l. 51: 498-512. (Vet. Bull.1983, Abstract no. 53:3488.).
Hirsbrunner, G., Knutti, B., Kupfer, U., Burkhardt, H., Steiner, A. (2003). Effect of PGE2, DL-Cloprostenol, and PGE2 in combination with D-Cloprostenol on uterine mobility during dioestrus in experimental cows. Animl Reprod Sci. 79: 17-32.
Hughes, J.P. (1993). Equine endometritis: John P Hughes International workshop. Eq. Vet. J. 25: 184.
Hughes, J.P., Loy, R.G., Asbury, A.C. and Burd. H.E. (1966). Occurrence of Pseudomonas in the reproductive tract of mares and its effect on fertility. The Cornell Vet.. 56: 595-10.
Hurtgen, J.P. (2006). Pathogenesis and treatment of endometritis in the mare; A review. Theriogenol. 66: 560-66.
Josimovich, J.B. (1973). Mechanism of smooth muscle contractility. In: Josimovich JB (Editor), Uterine contraction-Side effects of steroidal contraceptives. New York: John Wiley and Sons; p. 194-201.
Kelly, R.W., King, A.E. and Critchley, H.O. (2001). Cytokine control in human endometrium. Reprod. 121: 3-19.
Knutti, B., Pycock, J.F., van-de-Weijden, G. C. and Kupfer, U. (2000). The influence of early post-breeding uterine lavage on pregnancy rate in mares with intrauterine fluid accumulation after breeding. Eq. Vety. Educ. 12: 267-70.
LeBlanc, M.M. (1997). Effects of Oxytocin, Prostaglandin and Phenylbutazone on Uterine clearance of Radio-colloid. Pferdeheilkunde. 13: 483-85.
LeBlanc, M.M. (2008). When to refer an infertile mare to a theriogenologist. Theriogenol. 70: 421-29.
LeBlanc, S.J., Duffield, T.F., Leslie, K.E., Bateman, K.G., Keefe, G.P., Walton, J.S. et al. (2002). The effect of treatment of clinical endometritis on reproductive performance of dairy cows. J. Dairy Sci. 85: 2237-49.
Lewis, G.S. (2004). Steroidal regulation of uterine immune defenses. J. Anim. Reprod. Sci. 82: 281-94.
Lu, K.G. and Morresey, P.R. (2006). Reproductive tract infections in horses. Vety. Clin. Eq. 22: 519-52.
Madill, S., Troedsson, M.H.T., Santschi, E.M. and Malone, E.D. (2002). Dose-response effect of intramuscular Oxytocin treatment on myometrial contraction of reproductively normal mares during oestrus. Theriogenol. 58: 479-81.
McCue, P.M. (2008). The problem mare: management philosophy, diagnostic procedures, and the therapeutic options. J. Eq. Vet. Sci. 28: 619-26.
McKinnon, A.O. and Voss, J.L. (1993). Equine reproduction. Blackwell Publishing, Lea and Febgier; State Avenue. USA. p. 50.
Nafis, I A, Pandey, A.K. and Sharma, L.M. (2015). Different approaches to diagnose uterine pathology in mare: A review. Accepted for publication in Theriogenology Insight (Dec. 2015 issue).
Nakao, T., Gamal, A., Osawa, T., Nakada, K., Moriyoshi, M. Kawata, K. (1997). Postpartum plasma PGF metabolite profile in cows with dystokia and/or retained placenta, and effect of Fenprostalene on uterine involution and reproductive performance. J .Vety. Med. Sci. 59: 791-94.
Newcombe, J.R. (1997). The effect of incidence and depth of intra-uterine fluid in early dioestrus on pregnancy rate in mares. Pferdeheilkunde. 13: 545.
Nie, G.J., Jhonson, K.E., Wenzel, J.G.W. and Braden, T. D. (2002). Effect of pre-ovulatory ecbolics on luteal function and fertility. Theriogenol. 58: 461-63.
Nikolakopoulos, E. and Watson, E.D. (1999). Uterine contractility is necessary for the clearance of intrauterine fluid but not bacteria after bacterial infusion in the mare. Theriogenol. 52: 413-23.
NCCLS (2004). Reference method for antifungal disc diffusion susceptibility testing of yeast: approved guidelines. NCCLA document M44. National Committee for Clinical Laboratory Standards, Wayne.
Paccamonti, D.L., Pycock, J.F., Taverne, M.A., Bevers, M., van-der- Weijden, G.C., Gutjahr, S., Schams, D., Blouin, D. (1999). PGFM response to exogenous Oxytocin and determination of half-life of Oxytocin in non-pregnant mares. Eq. Vet. J. 31: 285-88.
Pfaller M.A. et al. (2004). Evaluation of NCCLS M44-P disc diffusion method for determining susceptibilities of 276 clinical isolates of Cryptococcus neoformans to fluconazole. J. Clin. Microbiol. 42: 380-83.
Pycock, J.F. and Newcombe, J.R. (1996). Assessment of the effect of three treatments to remove intrauterine fluid on pregnancy rate in the mare. Vet. Rec. 138: 320-23.
Rickets, S.W. and Mackintosh, M.E. (1987). Role of anaerobic bacteria in equine endometritis. J. Reprod. Fertil. 35: 343-51.
Ricketts, S.W. (1997). Treatment of equine endometritis with intrauterine irrigations of Ceftiofur sodium: A comparison with mares treated in a similar manner with a mixture of sodium benzylpenicillin, neomycin sulfate, polymixin B sulfate and furaltadone hydrochloride. Pferdeheilkunde 13: 486-89.
Rigby, S.L., Barhoumi, R. and Burghardt, R.C. et al. (2001). Mares with delayed uterine clearance have an intrinsic defect in myometrial function. Biol. Reprod. 65: 740-47.
Seals, R.C, Wulster-Radcliffe, M.C., Lewis, G.S. (2003). Uterine response to infectious bacteria in estrous cyclic ewes. Am. J. Reprod. Immunol. 49: 269-78.
Sheldon, I.M. and Noakes, D.E. (1998). Comparison of three treatments for bovine endometritis. Vet. Rec. 142: 575-79.
Steffan, J., Adrimanga, S. and Thibier, M. (1984). Treatment of metritis with antibiotics or PG[F.sub.2][alpha] and influence of ovarian cyclicity in dairy cows. Am. J. Vet. Res. 45: 1090-94.
Spensley, M.S., Baggot, J.D., Wilson, W.D., Hietala, S.K. and Mihalyi, J.E. (1986). pharmacokinetics and endometrial tissue concentrations of Tricarcillin given to the horse by intravenous and intrauterine routes. Am. J. Vet. Res. 47: 2587-90.
Traub-Dargatz, J.L., Salman, M.D. and Voss, J.L. (1991). Medical problems of adult horses, as ranked by equine practitioners. J. Am. Vety. Med. Assoc. 198: 1745-47.
Troedsson, M.H.T., Liu, I.K.M., Ing, M. and Pascoe J. (1995a). Smooth muscle electrical activity in the oviduct and the effect of Oxytocin, PG[F.sub.2][alpha] and PG[E.sub.2] on the myometrium and oviduct of cycling mares. Biology of Reproduction Monograph series I: Equine Reprod. p. 439-52.
Troedsson, M.H.T. (1996). Treatment strategies in mares with endometritis. In: Proceedings of the Society for Theriogenology, Mare Reproduction Symposium, Kansas City, MO. p. 40-50.
Troedsson, M.H.T., Scott, M.A. and Liu, I.K.M. (1995). Comparative treatment of mares susceptible to chronic uterine infection. Am. J. Vet. Res. 56: 468-72.
Watson, E. D. (1997). Swabbing protocols in screening for contagious equine metritis. Vet. Rec. 140: 268-71.
Watson, E. D., Thomassen, R., Nikolakopoulos, E. (2003). Association of uterine oedema with follicle wave around the onset of breeding season in pony mares. Theriogenol. 59: 1181-87.
Widders, P.R., Warner, S., Huntington, J.P. (1995). Immunization of mares to control endometritis caused by Streptococcus zooepidimicus. Res. Vet. Sci. 58: 75-81.
Zent, W.W., Troedsson, M.T.H. and Xue, J.L. (1998). Post-breeding uterine fluid accumulation in normal population of thoroughbred mares: A field study. In: Proceed. Amer. Assoc. Equine Pract. 44: 64-65.
Nafis Ibni Assad (1), N.S. Bugalia (2) and R.K. Chandolia (2)
Department of Veterinary Gynaecology and Obstetrics
College of Veterinary Science
Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS)
Hisar - 125004 (Haryana)
(1.) Resesrch Scholar and Corresponding author.
(a) - Brand of ITC Ltd., Kolkata
(b) - Brand of Cipla Ltd., Mumbai
Table 1: Treatment protocol and its therapeutic response of different groups Treatment regimen besides uterine lavage (500 ml NSS) Sr. Ecbolic Intrauterine Reference no agent antibiotic for antibiotic Treatment group I (n=7) 1 PG[F.sub.2[alpha]] (10 mg IM) Penicillin Causey (5-10x106 IU) (2006) 2 PG[F.sub.2[alpha]] (10 mg IM) Fluconazole Dascanio and (100 mg) Ley (2000) 3 PG[F.sub.2[alpha]] (10 mg IM) Chloramphenicol McKinnon and (2-3 g) Voss (1993) 4 PG[F.sub.2[alpha]] (10 mg IM) Cefalexin Causey (4.0 g) (2006) 5 PG[F.sub.2[alpha]] (10 mg IM) Penicillin Causey (5-10x106 IU) (2006) 6 PG[F.sub.2[alpha]] (10 mg IM) Penicillin Causey (5-10x106 IU) (2006) 7 PG[F.sub.2[alpha]] (10 mg IM) Penicillin Causey (5-10x106 IU) (2006) Treatment group II (n=7) 1 Cloprostenol Penicillin Causey (250 [micro]g IM) (5-10x106 IU) (2006) 2 Cloprostenol Cefalexin Causey (250 [micro]g IM) (4.0 g) (2006) 3 Cloprostenol Cefalexin Causey (250 [micro]g IM) (4.0 g) (2006) 4 Cloprostenol Penicillin Causey (250 [micro]g IM) (5-10x106 IU) (2006) 5 Cloprostenol Chloramphenicol McKinnon and (250 [micro]g IM) (2-3 g) Voss (1993) 6 Cloprostenol Ciprofloxacin Al-Bagdadi et al. (250 [micro]g IM) (2-3 g) (2004) 7 Cloprostenol Cefalexin Causey (250 [micro]g IM) (4.0 g) (2006) Treatment group III (n=7) 1 Oxytocin Ciprofloxacin Al-Bagdadi et al. (60 IU, IM) (2-3 g) (2004) 2 Oxytocin Chloramphenicol McKinnon and (60 IU, IM) (2-3 g) Voss (1993) 3 Oxytocin Penicillin Causey (60 IU, IM) (5-10x106 IU) (2006) 4 Oxytocin Chloramphenicol McKinnon and (60 IU, IM) (2-3 g) Voss (1993) 5 Oxytocin Cefalexin Causey (60 IU, IM) (4.0 g) (2006) 6 Oxytocin Chloramphenicol McKinnon and (60 IU, IM) (2-3 g) Voss (1993) 7 Oxytocin Ciprofloxacin Al-Bagdadi et al. (60 IU, IM) (2-3 g) (2004) Post-treatment therapeutic response by ultrasonographic examination Sr. Ultrasound observation of Post- no uterus treatment uterine infection 1 Small amount of echogenic uterine Positive exudates along with non-echogenic exudates. Uterine wall compact 2 No echogenic or non-echogenic Negative exudates in uterine lumen. Normal uterine wall thickness. Uterine cavity hardly appreciable. 3 Some amount of echogenic uterine Positive exudates in left uterine horn. 4 Uterine wall thickening along with Positive some echogenic uterine exudates 5 Small amount of non-echogenic uterine Negative exudates present. Uterine wall compact. Probably mare in estrus. 6 No uterine exudates seen, normal Negative uterine wall thickness 7 Compact uterine wall lining without Negative any exudates in uterine lumen. 1 No echogenic or non-echogenic Negative uterine exudates seen. Normal uterine wall thickness 2 Uterus contains non-echogenic fluid Positive with spacklings of echogenic material. 3 Small amount of non-echogenic uterine Negative fluids present. Wall lining compact. 4 No uterine wall thickening seen, Negative no uterine exudates appreciated. 5 Echogenic uterine exudates Positive present inside right horn. Uterine wall lining little edematous. 6 Normal uterine wall thickness Negative without uterine exudates. 7 Compact uterine wall lining, Negative no uterine exudates seen. 1 Compact uterine wall lining without Negative uterine exudates. 2 No uterine exudates were seen. Negative Normal uterine wall thickness recorded. 3 Examination not done. Died of accident 4 No uterine wall thickening seen. Negative No uterine exudates were recorded. 5 Small amount of echogenic exudates Positive along with non-echoic exudates in the uterine lumen. 6 No uterine exudates seen, normal Negative uterine wall lining present. 7 No echogenic or non-echogenic Negative uterine exudates were seen. Normal uterine wall lining. Table 2: Post-treatment fertility of infertile and fertile mares (Group I, II, III and IV) Pregnant mares (%) Treatment group Cycling Non-cycling mares (%) mares (%) 1st AI 2nd AI 3rd AI Group I 6 (85.71) 1 (14.29) 0 (00.00) 1 (14.28) 1 (14.28) Group II 6 (85.71) 1 (14.29) 2 (28.57) 2 (28.57) 0 (00.00) Group III 4 (66.66) 2 (33.33) 1 (16.66) 1 (16.66) 0 (00.00) Group IV 6 (100) 0 (00.00) 2 (33.33) 3 (50.00) 1 (16.66) Non Treatment group pregnant Total mares (%) Group I 2 (28.57) 4 (57.14) Group II 4 (57.14) 2 (28.57) Group III 2 (33.33) 2 (33.33) Group IV 6 (100) 0 (00.00)
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||Clinical Article|
|Author:||Assad, Nafis Ibni; Bugalia, N.S.; Chandolia, R.K.|
|Date:||Jan 1, 2017|
|Previous Article:||Management of Digital Flexor Tendon Sheath Tenosynovitis in a Mare.|
|Next Article:||Bilateral Conjuctival Habronemiasis with Blepharoconjunctivitis in a Marwari horse.|