Cytological, Bacteriological and Antibiogram Studies for the Management of Uterine Infection in Repeat Breeder Bovines

Background: Repeat breeding syndrome (RBS) associated with sub-clinical uterine infection (UI) remains to be a major reproductive problem faced by Indian farmers. Present study documents its diagnosis, prevalent etiological agents, antibiogram pattern and efficacy of the treatment at field level. Methods: Seventy-eight RBS affected bovines were selected. The cervical mucous (CM) was collected for study of its characteristics, white-side test, endometrial cytology, microbial examination and antibiogram. The treatment protocol was developed and the animals’ response to the treatment was assessed. Result: The overall incidence of RBS was found to be 12.9% and the cases associated with uterine infection (RBS/UI+ve) and without uterine infection (RBS/UI-ve) were 44.87% and 55.13%, respectively. The mean scores of CM character, odour, pH and number of polymorphonuclear cells in RBS/UI +ve were 2.09±1.39, 1.14±0.12, 8.49±0.08 and 12.46±0.96, respectively, and differed significantly (P less than 0.05) from RBS/UI-ve cases. The microbial examination revealed the presence of gram negative bacilli, Trueperella spp., Pseudomonas spp., Staphylococcus spp., Escherichia coli and yeast infection. Antibiogram studies recorded the response of Tetracyclin as best (48.57%) followed by Cephalexin (22.86%), Chloramphenicol (20.0%) and Streptomycin (8.57%). The RBS/UI+ve cases were treated individually, on one-to-one basis, obeying antibiogram. The infection appeared to be considerably controlled and overall success rate was observed in the form of confirmed pregnancy in 71.43% cases. Thus, it was concluded that prompt diagnosis using endometrial cytology and antibiogram guided therapeutic approach may aid for effective management of RBS/UI +ve cases, under field conditions.

Progesterone Inhibits LPS-Induced Oxidative Stress Through Nrf2/Keap1 Pathway in Bovine Endometrial Epithelial Cells

Background Postpartum uterine infection can lead to endometrial inflammation and oxidative damage. Progesterone makes the animal more susceptible to uterine infection. Progesterone has been proved to play an anti-inflammatory role in inhibiting uterine innate immunity, and to reduce tissue oxidative damage. But the effect of progesterone on the oxidative damage of bovine endometrium has not been reported. The purpose of this study was to explore the effect and mechanism of progesterone (1, 3, and 5 ng/mL) on oxidative damage in primary bovine endometrial epithelial cells (BEEC) induced by lipopolysaccharide (LPS) from Escherichia coli. Results Compared with the LPS group, there were decreases (P < 0.05) in the levels of reactive oxygen and malondialdehyde, and increases (P < 0.05) in the activities of superoxide dismutase and catalase, and total antioxidant capacity in the cotreatment groups of progesterone and LPS. The cotreatment of LPS and P4 upregulated (P < 0.05) the mRNA abundance of antioxidant genes and the key protein levels in Nrf2/Keap1 pathway, and promoted the Nrf2 protein to enter the nucleus. The use of progesterone receptor antagonist mifepristone reversed the antioxidative effect of progesterone. Conclusions Progesterone protects BEEC from LPS-induced oxidative damage by activating Nrf2/Keap1 pathway through progesterone receptor.

Prevalence of Complications after Interval Postpartum Intrauterine Device Insertion

Background and Aim: Postpartum intrauterine device (PPIUD) is a reversible, long-term and effective technique of contraception. The intrauterine device (IUD) is inserted within 48 hours of delivery. The immediate insertion of an intrauterine device causes certain complications. The present study aimed to assess the prevalence of complications after Interval Postpartum Intrauterine Device Insertion. Materials and Methods: This cross-sectional study was carried out on 147 women who underwent postpartum IUD (PPIUD) insertions during from January 2021 to June 2021 at Gynecology department, Mufti Mehmood Memorial Teaching Hospital (MMMTH), Dera Ismail Khan and Muhammad Teaching Hospital Peshawar. All the women who delivered and showed willingness for PPIUCD insertion were enrolled and continuously follow-up for 4 to 6 weeks after delivery. Demographic, obstetric, and clinical parameters were recorded on pre-designed medical proforma. PPIUCD insertion after 6 weeks of delivery were followed-up for the evaluation of complications. Uterine infection, medical removal of IUD, IUD expulsion, perforation, and method discontinuation were the outcome variables. SPSS version 20 was used for data analysis. Results: Of the total deliveries, 147 women inserted the postpartum intrauterine contraceptive device (PPIUCD). Of the total, about 122 (83%) women returned for follow-up after 6 weeks. All the women underwent transvaginal insertion of intrauterine contraceptive devices. The PPIUCD insertion related complications with prevalence were uterine infection 26 (21.3%), overall method suspension 17 (13.9%), perforation 20 (16.4%), interceptive uterine device expulsions 25 (20.5%), and intrauterine device removal 32 (26.2%). The severe uterine infection was in 2 (1.7%) cases who were hospitalized. Conclusion: The postpartum intrauterine device cumulative expulsion rate was higher among women compared to the expulsion rate of insertions. The longer duration of bloody lochia flow and delivery intrauterine device insertions were the key risk factors for expulsion of PPIUCD. Women can safely utilize intrauterine contraceptive devices with low complications beyond four week. Keywords: Postpartum intrauterine device; Complications; Intrauterine device expulsion

Prostaglandin and antigestagen in pyometra bitches: vascular and stereological effect

Effects of conservative treatment on uterine blood flow and morphometric findings are still unknown in bitches. Thus, this study aimed to compare uterine changes of pyometra bitches subjected to distinct modes of treatment. Pyometra bitches were assigned to: OHE (ovariohysterectomy immediately after diagnosis), Aglepristone (days 1, 2 and 8) and Associative (aglepristone treatment coupled with cloprostenol for 7 days) groups. After 9 days, bitches were ovariohysterectomized. Before surgery, uterine area was measured ultrasonographically and the uterine artery Doppler velocimetry analyzed blood flow velocity and indexes. Uterine horns were classified according to resistance index (RI) as more compromised and less compromised. Endometrial vasculature was quantitatively evaluated by color flow Doppler. Blood samples were collected to determine nitric oxide (NO) concentrations. Histological uterine structures were quantified by stereology and VEGF-A (vascular endothelial growth factor) and eNOS were (endothelial nitric oxide synthase) immunohistochemically analyzed. Aglepristone and Associative groups had lower uterine area and vascularization, and higher blood flow velocity and indexes compared to OHE group. Less compromised horn of Associative group had higher blood flow velocity compared to OHE group. Aglepristone group presented lower inflammatory infiltrate and larger uterine stroma. Associative group had lower volume density and absolute surface of endometrial cysts and lower VEGF-A expression for glandular epithelium and stromal cells. Blood NO and e-NOS immunostaining were not different among groups. In conclusion, association between aglepristone and prostaglandin is more effective in decreasing uterine vascularization and modulating uterine blood flow. Moreover, associative therapy promotes marked morphological changes. Lay summary This research compared two medical protocols of treatment for uterine infection (pyometra) in bitches, using a hormone blocker (anti-progesterone aglepristone) solely or in association with a uterine contraction inducer (prostaglandin; associative therapy). After treatment, bitches were gonadectomized and a microscopic analysis of uterine blood vessel formation and uterine tissue elements were performed as well as uterine blood flow evaluation through Doppler ultrasonography. According to vascular resistance, uterine horns were additionally classified as more compromised and less compromised. Both treatment protocols led to reduction of uterine dimensions and vascularization, and higher blood flow compared to untreated bitches. Less compromised uterine horn of the associative treatment had higher blood flow compared to untreated bitches. The hormone blocker treatment had lower inflammatory cells and larger uterine histological structure, while associative treatment had less uterine pathological cysts and lower blood vessel formation. The associative therapy is effective in decreasing uterine vascularization and modulating uterine blood flow as well as reestablishing endometrium structure in bitches with uterine infection.

Cervical Ripening in the Outpatient Setting

Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.

Molecular characterization of extended-spectrum β-lactamase-producing Escherichia coli isolated from postpartum uterine infection in dairy cattle in India

Background and Aim: Selection and dissemination of plasmid-encoded extended-spectrum β-lactamase (ESBL) among Enterobacteriaceae confers resistance to beta-lactam antibiotics. The purpose of this study was to determine the prevalence and molecular characteristics of ESBL-producing organisms isolated from dairy cattle with a uterine infection. Materials and Methods: Bacterial isolates (n=62) were characterized by biochemical test for genus and species determination. Antimicrobial susceptibility tests were performed by Kirby–Bauer disk diffusion method using panel of antibiotics for initial screening of ESBL organism. Phenotypic confirmation of ESBL-suspected strains was done by combination disk method and double-disk method. Multiplex polymerase chain reaction (PCR) was carried out for phylogrouping of Escherichia coli isolates as well as for genotyping ESBL genes. Enterobacterial repetitive intergenic consensus-PCR method was used for genotypic characterization of isolates. Results: Antibiotic susceptibility profile of E. coli (n=40) isolates showed high rates of resistance for ampicillin (95.0%), cefpodoxime (97.5%), cefotaxime (87.5%), and ceftriaxone (70%). However, low rates of resistance were observed for cefoxitin (25%), amoxicillin/clavulanic acid (20%), ceftazidime (17.5%), gentamicin (10%), and ertapenem (7.5%). A total of 39/40 E. coli isolates were confirmed as ESBL with Epsilometer test as well as the genotypic method and 28 (70%) of them were multidrug-resistant. Genotype blaCTX-M was observed as a predominant beta-lactamase type with the preponderance of CTX-M Group 1. The following combinations were observed: blaTEM + blaCTX-M in 15 (36.2%) isolates, blaTEM / blaSHV in 8 (5.2%) isolates, and blaCTX-M / blaSHV in 6 (5.2%) isolates. The phylogenetic grouping of E. coli strains revealed the highest prevalence for B1 (22.0%) followed by A (20%). Conclusion: This report shows a high frequency of ESBL E. coli from cattle with postpartum uterine infections. These isolates showed reduced susceptibility to common antibiotics used for the treatment of uterine infections greater affecting the therapeutic outcome.

Pyometra Treatment by Histeropexy with Toggles Aplication in Mini Horse

Background: Brazil is an important horse breeder that creates about three million jobs and movements about R$16,15billions per year. Although, it is important to the horse breeding industry success that the animals reproductive performance be kept. The mare pregnancy loss causes abundant forfeitures to horse breeders, furthermore, the chronic pyometra is one of that causes. The chronic pyometra is an uncommon mare condition, clinical treatments are often ineffective, under those circumstances the hysterectomy, ovariohysterectomy and uteropexy are recommended. This report proposes to describe the chronic pyometra surgical treatments with the uteropexy technique in mini horses that do not respond to the clinical treatment. Case: A 14-year-old mini breed horse mare weighing 117 kg was sent to Veterinarian Hospital (HV) of the Paraná Federal University (UFPR), presenting dystocia background and intrauterine purulent secretion. The clinical treatment had been conducted, but not well succeeded. An hysteroscopy was conducted with a cervix rupture monitoring, uterine mucosa edematiated and crispy, presenting liquid and a high amount of purulent secretion in the uterus horn and body. The biopsy identified uteropexy. The post-surgical complications were minimums and 30 days after the procedure the laparoscopy was repeated with uterine healing monitoring, without adherences and the uterus were at horizontal position. The hysteroscopy was conducted where a small amount of purulent secretion was perceived. Ten days after the second laparoscopy the patient was discharged. Two years after the procedure, the animal responsible informed that there was not a relapse. Discussion: the mare pyometra occurrence is uncommon and emerges by nature protection false mechanisms. Any change or flaw in one of these protection mechanics barriers, may result in a reproductive change due to uterine infection, resulting in reduction of mare reproductive capacity. Probably this reports patients developed pyometra due to the cervix lesion it's presented made easier the uterus external microorganisms entrance, that predisposes an chronic uterine infection. As many authors report, the chronic pyometra clinical treatment is not always successful, also observed in the case reported, indicating then surgical treatment. There are many pyometra surgical treatments indications as: Wedge resection technique in case of cervix adherence, uteropexy technique, ovary-hysterectomy technique or hysterectomy. The ovary-hysterectomy and the hysterectomy was not conducted for being considered highly invasive. This case choice procedure was the uteropexy, which corresponds to fixing the broad ligament of the uterus to the abdominal wall, repositioning it horizontally, to obtain a better drainage and motility, since this is your anatomic position. In the report, the surgical technique was conducted satisfactorily, certifying the uterine elevation by laparoscopy in the postoperative and also by the responsible report, that the animal does not relapse in two years. The postoperative complications were not alarming, considering that it ceased 24h after the procedure. The conclusions present in this treatment show that the hysteropexy conducted by videosurgery with toggles application developed the necessary uterine elevation to the liquid drainage, that allows the mare to execute the uterine cleaning by the physiological form.Keywords: uterus, endometritis, uteropexy, uterine elevation.Histeropexia com aplicação de “toggles” para tratamentode piometra em mini horseDescritores: útero, edometrite, uteropexia, elevação uterina.

Cases of acquired uterine infection. (Atresia uteri aequisita)

Uterine infections usually occupy the inner orifice, owing their origin to some pathological processes leading to adhesive inflammation to the area of ​​the inner mouth; the process consists in the violation of the integrity of the tissue (ulcerative!) with the formation of a scar. Most often this happens after gangrene, after difficult labor, especially with the rough use of obstetric instruments, after which infectious diseases (diphtheria, smallpox, typhus, scarlet fever, measles), from non-rational means of caustic pointed out cases of atresia depending on senile atrophy of the genital organs, (which easily leads to the development of the ulcerative process); finally, some authors (Fritsch, Pozzi) point to one more ethiological moment of atresia after amputation of the vaginal part.

Experimentally Induced Endometritis Impairs the Developmental Capacity of Bovine Oocytes†

Uterine infection is associated with infertility in women and dairy cows, even after the resolution of infection. However, the mechanisms causing this persistent infertility are unclear. Here, we hypothesized that induced endometritis in non-lactating dairy cows would reduce the developmental competence of oocytes. Non-lactating Holstein cows received an intrauterine infusion of endometrial pathogenic bacteria (Escherichia coli and Trueperella pyogenes; n = 12) or vehicle control (n = 11) on day 2 of the estrous cycle. Bacterial infusion increased expression of endometrial inflammatory mediators, and a mucopurulent discharge in the vagina confirmed the establishment of endometritis. Oocytes were collected by transvaginal ultrasound-guided ovum pickup on days 2, 24, 45, and 66 following infusion and subjected to in vitro fertilization and embryo culture. Bacterial infusion resulted in fewer cleaved oocytes developing to morulae compared to vehicle-infused controls (30.7 versus 45.0%), with the greatest effect observed in oocytes collected on day 24. Development to morula was inversely correlated with endometrial expression of IL6 on day 6. The expression of genes associated with embryo quality did not differ significantly between morulae from bacteria-infused and control cows. Artificial insemination 130 days after intrauterine infusion resulted in normal, filamentous embryos that produced interferon tau 16 days after conception in both infusion groups. This model of experimentally induced uterine infection successfully resulted in endometritis and a reduction in the proportion of oocytes that developed to morulae following in vitro fertilization. In conclusion, endometritis reduced the capacity of oocytes to develop to morulae.