This document summarizes research on uterine infections in cattle. It discusses two main types of uterine infection: puerperal (occurring before uterine involution is complete) and post-puerperal (occurring after involution). For puerperal infections, it recommends rapid antibiotic treatment. For post-puerperal infections (endometritis), it discusses diagnosing via vaginoscopy or rectal palpation and treating with antibiotics or prostaglandins. Several studies are summarized that compared treatments, finding cloprostenol plus antibiotics improved uterine health more than antibiotics alone.

1. Carlos Antônio de Carvalho Fernandes
Med. Vet. PhD.
cacf@biotran.com.br
São Paulo - SP
07/04/2009

2. Uterine Infections
A major cause for reduced fertility in cattle (4-60%)
Average losses of $75.00/affected animal
Delay in conception
Increased cost of semen
Decreased milk production
Cost of medication
Cost of labor (treatment)

3. Uterine Infections
In cattle classified as:
Puerperal uterine infections (Metritis puerperalis)
Affect the uterus before the involution is completed
Normally before 21d post partum
Animals between 3rd and 4th week: evaluate through rectal palpation???
Post-puerperal uterine infections (Endometritis)
Occurs after completion of uterine involution
Normally starting from 4 weeks post calving

4. Uterine infections in cattle

5. Uterine infections in cattle
Volume of uterine cavity in cattle
1 days post calving=6 liters-9kg
30 days post calving=0.2 liters – 0.5kg

6. Practical aspects:
1
Define the type of infection
puerperal or post-puerperal
degree of uterine involution
time elapsed from calving

7. Practical aspects: 2
Define characteristics of microorganisms
present in the uterus
type of infection
mixed microorganisms or specific (possibility
of environmental resistance)
establish the most adequate choice of
antibiotic

8. Practical aspects: 3
Define the intensity of infection
Degree of uterine lesions
Average time of recovery
Treatment frequency
Associations (additional factors)
Selection of antibiotic (persistence in uterus)

9. Practical aspects: 4
Define treatment scheme/program
Verify the infection type
Local or parenteral
Adequate labor availability
Cost
Withdrawal time for milk

11. Puerperal uterine infections
Metritis Puerperalis
Occur during the involution phase
Acute character – require rapid intervention
Mixed bacterial flora (opportunistic)
Incidence varies from 6 to 40%
Predisposing factors:
- Placental retention
- Calving assistance
- Distocia
- Poor body condition at parturition

12. Puerperal uterine infections
Metritis Puerperalis
Symptoms:
- Vaginal discharge: purulent, sanguinolent, fetid
- Dried discharge contaminating perineal region and
base of tail
- Visible abdominal contractions when expulsing uterine
contents
- Hyperthermia, prostrate position, anorexia
- Digestive disorders (tympanus)
- Mortality (generally due to toxemia or bacteriaemia)

13. Puerperal uterine infections
Metritis Puerperalis
Main signs
- Enlarged uterus localized in
abdominal cavity
- Liquid, fetid contents of the
uterine cavity
- Thinned and fragile uterine wall
- In general, ovarian inactivity
- Leucocytosis

14. Treatment
Must be rapid and efficacious
- Number of bacteria is duplicating every 8
minutes
- Life threatening condition
- acute process
- high absorption capacity of the uterus
- absorption of both bacteria and toxins

15. Treatment
PUERPERAL
INFECTION
Excessive Delayed
Contamination involution
Antibiotics Prostaglandins

16. Treatment
Characteristics of antibiotics to be used
Broad spectrum of activity
Low possibility for bacterial resistance
Practicality of the treatment
Cost

17. Efficacy of the treatment of placental retention
with oxytetracycline HCl with or without
simultaneous administration of cloprostenol
(Fernandes, 1999)
Variable Oxytetracycline Oxyt+
HCl Cloprostenol
Number of animals 90 90
Infection at 30d post partum (%) 44.4 42.2
Degree of uterine involution* (%) 1.92 2.43
Interval calving-to-conception (d)* 78.4 54.1
Breeding period (d)* 131.3 111.7
Services/conception 2.41 2.03
* Significativo pelo teste de ‘t’ a 5% de probabilidade

18. Puerperal uterine infections
Metritis Puerperalis
Treatment
- Parenteral antibiotics
- Broad spectrum
- Low level of resistance
- Stimulation of uterine involution
- Sustain physiological parameters
- Re-evaluate after 15-30 days
Contraindications for infusions at this phase
- Large uterine volume
- Increased risk for a transfer of the uterine contents through oviducts
- Hyperaemia
- High capacity for re-absorption through endometrium

19. Carlos Antônio de Carvalho Fernandes
Eduardo Ramos de Oliveira
Bruno Fernandes Ludgero Alves
Ana Cristina Silva de Figueiredo
Marilu Martins Gioso

20. Treatment scheme in animals after detection of
calving problems
At 20 h 48 h post
Group Treatment N
pp 1st application
1 Nuflor IM2x 26 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV
Nuflor IM2x 20mg de Florfenicol IM/kg PV 20mg de Florfenicol IM/kg PV
2 28 + 0,530mg de Cloprostenol + 0,530mg de Cloprostenol
+Ciosin
3 Nuflor SC1x 27 40mg de Florfenicol SC/kg PV -
Nuflor SC1x 40mg de Florfenicol SC/kg PV
4 27 + 0,530mg de Cloprostenol
0,530mg de Cloprostenol
+Ciosin
5 Oxitetra IM1x 29 20mg de Oxitetraciclina IM/kg PV
Oxitetra IM1x 20mg de Oxitetraciclina IM/kg PV
6 28 + 0,530mg de Cloprostenol
0,530mg de Cloprostenol
+ Ciosin
TOTAL 165

21. Classification of uterine involution in cows treated with
antibiotics with or without cloprostenol (Fernandes et al., 2008)
Degree of involution:
1. Uterus located
completely in abdominal
cavity
2. Palpation possible apart
from the tips of uterine
horns
3. Palpation of more than
half of the uterine body
possible within the
abdominal cavity
4. Access to the complete
uterus in the abdominal
cavity
5. More than half of the
uterus located in the pelvic
cavity

22. Occurrence and average percentage of uterine infections and
characteristics of the infection in different groups of animals
evaluated between 25 and 35 days pp (Fernandes et al., 2008)
N and % of
animals with Grade 1 Grade 2 Grade 3
Group Treatment Type N
uterine No and % No and % No and %
infection
1 Nuflor IM2x 26 11 - 42,31 5 – 19,23 3 – 11,54 3 – 11,54
2 Nuflor IM2x +Ciosin 28 9 - 32,14 4 – 14,29 4 – 14,29 1 – 3,57
3 Nuflor SC1x 27 10 - 37,03 5 – 18,52 3 – 11,11 2 – 7,41
4 Nuflor SC1x +Ciosin 27 8 - 29,63 4 – 14,81 4 – 14,81 0 – 0,00
5 Oxitetra IM1x 29 11 - 37,93 4 – 13,79 4 – 13,79 3 – 10,34
6 Oxitetra IM1x + Ciosin 28 9 - 32,14 4 – 14,29 3 – 10,71 2 – 7,14
TOTAL 165 35,15 15,76 12,73 6,66
P> 0,05

23. Days post partum at first service, number of services
per conception and breeding period in animals in
different treatment groups (Fernandes et al., 2008)
Calving-to-1st Services/ Breeding
Group Treatment type No service interval
conception period (days)
(days)
1 Nuflor IM2x 26 75,32 + 19,87 3,27 + 1,11 169,29 + 45,76
2 Nuflor IM2x +Ciosin 28 62,45 + 19,62 2,91 + 0,99 148,63 + 39,97
3 Nuflor SC1x 27 66,27 + 16,66 2,96 + 0,86 157,33 + 41,18
4 Nuflor SC1x +Ciosin 27 56,19 + 14,09 2,48 + 0,83 135,49 + 35,64
5 Oxitetra IM1x 29 68,17 + 15,98 3,11 + 0,89 161,02 + 43,53
6 Oxitetra IM1x + Ciosin 28 60,83 + 16,37 2,92 + 0,93 149,24 + 44,60
TOTAL 165 65,08 + 17,47 2,96 + 0,98 154,56 + 42,01
P> 0,05

25. Post-puerperal uterine infections
Endometritis
Occur in cows after puerperal period when the
uterus completed its involution
Represent more chronic course
Rarely are life threatening
Predisposing factors:
- puerperal uterine infections
- nutritional deficiencies
- confinement (microbism)
- lack of proper hygiene at mating or AI
- presence of sexually transmissible diseases

26. Sequence of events associated with
uterine infections

27. Infecção uterina pós-
puerperal
Classification:
Grade 1 (catarrhal): opaque vaginal mucus with few strings or
flecks of pus
Grade 2 (muco-purulent): strings of mucus mixed with mucus
Grade 3 (purulent): discharge predominantly with purulent
character
Grade 4 (pyometra): Grade 3 infection with accumulation of
large quantities of purulent material in uterine cavity

28. Post-puerperal uterine infections
Endometritis
Sintomas principais:
Redução da fertilidade (retorno ao estro após
cobertura ou IA em intervalos regulares ou não);
Ciclos estrais irregulares (mais longos ou mais curtos)
ou normais
Anestro (infecções graves com destruição do
endométrio ou piometra com corpo lúteo persistente)
Contrações abdominais;
Sintomatologia sistêmica: rara (febre, taquicardia,
anorexia etc.).

29. Post-puerperal uterine infections
Endometritis

30. Post-puerperal uterine infections
Endometritis

31. Mucosal discharge

32. Comparative efficacy of tow methods for
diagnosis of uterine infections in cattle:
rectal palpation and vaginoscopy
Number of
Method Efficacy (%)
animals
Vaginoscopy 738 100
Rectal palpation 260 35,2

33. Post-puerperal uterine infections
Endometritis
Treatment:
- Antibiotic therapy
- Local x parenteral
- Additional treatments:
- prostaglandins
- Estrogens

34. Post-puerperal uterine infections
Endometritis
Treatment:
- Antibiotic therapy
- Local x parenteral
- For whom infusions are not suitable!!!
ADVANTAGES
Local: Parenteral:
•Lower Cost •Practicality of administration
•Less risk of WTD • Does not interfere with
uterine defenses???

35. “Recent” information
Actual conclusions
Estradiol does not have immunostimulatory properties
Progesterone is immunosuppressive
Facts
During estrogenic phase (heat) uterus is more
resistant to infections than during the luteal phase
Conclusions
Estradiol must have some immunostimulatory properties

36. Effects of prostaglandin
on uterine immunity
Prostaglandins have direct effect on the phagocytic activity
of endometrial immune cells
This efect is even stronger if the uterus is under the effect of
progesterone
Even in the absence of luteal tissue, prostaglandins remain
important for the function of uterine defence mechanisms
- Promote activation of the immune cells
- Increase chemotaxis
- Enhance diapedesis

37. Bruno Fernandes Ludgero Alves1; Eduardo Ramos e Oliveira1, Carlos
Antônio de Carvalho Fernandes2; Marilu Martins Gioso2

38. Efficacy of cloprostenol (Ciosin®) in the
treatment of uterine infections in cattle
Treatment scheme and number of animals in accordance with the
classification of the uterine infection and presence of ovarian activity (CL)
Group Ovarian Grade of Uterine Infection
Activity
(treatment) N Grade 1 Grade 2 Grade 3
(class)
Controle CL (+) 15 5 5 5
CL (-) 15 5 5 5
1 dose CL (+) 32 15 10 7
CL (-) 32 15 10 7
2 doses-24Horas Com CL 32 15 10 7
CL (-) 32 15 10 7
2 doses-48Horas CL (+) 32 15 10 7
CL (-) 32 15 10 7
Total 222 100 70 52

39. Average and percentage occurrence of different types of uterine
infections in animals with or without corpus luteum in accordance
with the characteristics of uterine discharge detected with
vaginoscopy (Alves et al., 2008)

40. Average and percentage occurrence of different types of uterine
infections in animals with or without corpus luteum in accordance
with the characteristics of uterine discharge detected with
vaginoscopy (Alves et al., 2008)

41. Eficiência média geral (Número e Percentual) dos tratamentos de infecção
uterina em animais com presença ou não de Corpo Lúteo (Alves et al 2008).
CL (+)
Group Development of the condition Improvement
(treatment) N Improvement Cure and cure
Control 15 2 (13,33%) a 2 (13,33%) a 4 (26,67%) a
1 dose 32 5 (15,62%) a 10 (31,25%) b 15 (46,88%) b
2 doses-24Horas 32 5 (18,75%) a 20 (65,62%) c 25 (71,88%) c
2 doses-48Horas 32 7 (21,85%) a 15 (46,87%) b 22 (68,75%) c
Total 111 19 (17,12%) 47 (42,34%) 66 (59,46%)
CL (-)
Group Development of the condition Improvement
(treatment) N Improvement Cure and cure
Control 15 2 (13,33%) a 1 (6,67%)a 3 (23,33%)a
1 dose 32 5 (15,63%) a 10 (31,25%)b 15 (46,87%)b
2 doses-24Horas 32 5 (15,63%) a 16 (50,00%)b 21 (65,63%)b
2 doses-48Horas 32 8 (25,00%) a 12 (37,50%)b 20 (62,50%)b
Total 111 20 (18,02%) 39 (35,14%) 60 (50,05%)

42. Average percentage of positive development (improvement and
cure) of the uterine infections in animals with or without CL,
independently from the type of treatment (Alves et al., 2008)

43. Carlos Antônio de Carvalho Fernandes2; Marilu Martins Gioso2;Bruno
Fernandes Ludgero Alves1; Eduardo Ramos e Oliveira1

44. Average efficacy (numeric and percentage) of the treatments
independently from the presence of CL
Group Development of the condition
Improvement
(treatment) N Improvement Cure
and Cure
1: Control 30 3a 3a 6 (20,00%)a
2: Preloban 64 9b 17b 26 (40,62%)b
3: Metricure 64 11b 30c 41 (64,06%)c
4: Preloban +
64 14b 36c 50 (78,12%)c
Metricure
Total 222 37 86 123

45. Average efficacy of evaluated treatment approaches
in cows with or without the presence of CL

46. Average interval treatment-to-conception
in different treatment groups in cows
with or without the presence of CL

47. “O sucesso nasce do querer.
Sempre que o homem aplicar a
determinação e a persistência
para um objetivo, ele vencerá os
obstáculos, e, se não atingir o
alvo, pelo menos fará coisas
admiráveis”.
José
José de Alencar
Carlos Antônio de Carvalho Fernandes
Med. Vet. D.Sc.
cacf@biotran.com.br