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Metritis-laminitis-septicemia complex
Introduction
- Cause:
- Sequelae to retained placenta or any gross contamination of the uterus during foaling.
- Severe bacterial infection in the myometrium → systemic bacterial +/- toxin absorption, septicemia and systemic inflammatory response syndrome (SIRS) → sepsis-associated laminitis.
- Parturition abnormality, including retained placenta, especially in draft breeds.
- Signs: increased vulval discharge, severe systemic illness and endotoxemia, laminitis, occasionally death.
- Diagnosis: history, clinical examination, vaginal examination, clinical pathology, foot radiographs.
- Treatment: includes therapy for retained placenta Placenta: retained, uterine lavage, systemic antibiotics, NSAIDs, IV fluid therapy and acute laminitis treatment Foot: laminitis.
- Prognosis: guarded.
Presenting signs
- Post-parturient broodmare.
- Parturition abnormality.
- Retained placenta.
- Severe illness.
- Vulval discharge.
- Septicemia/toxemia.
- Increased digital pulse(s).
- Laminitic stance and lameness.
- Draft breed.
Acute presentation
- See Presenting signs above.
Geographic incidence
- Worldwide.
Age predisposition
- Adults.
Breed/Species predisposition
- Heavy horse breeds.
Cost considerations
- Treatment.
- Loss of mare.
Special risks
- Increased anesthetic risk due to endotoxemia if require general anesthesia for another reason.
Pathogenesis
Etiology
- Delayed uterine involution Uterus: delayed involution.
- Severe bacterial infection including anaerobes, eg Bacteroides fragilis Bacteroides fragilis.
- Rapid multiplication and/or death of Gram-negative bacteria results in endotoxin release.
- Bacteria and/or toxins are absorbed through compromised uterine wall into the circulation.
- Toxins initiate a systemic inflammatory response syndrome (SIRS) Systemic inflammatory response syndrome.
- Bacteria result in sepsis.
- The feet are one of the end organs affected by SIRS, resulting in sepsis-associated laminitis.
Predisposing factors
General
- Uterine delayed involution Uterus: delayed involution.
- Dystocia Reproduction: dystocia.
Specific
- Retained placenta Placenta: retained.
- Draft breeds.
Pathophysiology
- Sequel to retained placenta or any gross contamination of the uterus during foaling, eg dystocia Reproduction: dystocia.
- Infection of endometrial, myometrial and occasionally serosal layers → septicemia and SIRS with possible secondary consequences, eg laminitis Foot: laminitis.
- Gross contamination of the uterus at foaling +/or retained placenta → delayed uterine involution, increased autolysis of the placenta and severe bacterial infection.
- The uterine wall becomes thin and friable → disruption of the endometrial barrier → allows myometrial +/- serosal infection.
- The toxic metritis allows absorption of bacteria and bacterial toxins → subsequent septicemia/endotoxemia + SIRS → laminitis.
- Death can occur in severe cases.
Timecourse
- 12-24 h onwards.
Epidemiology
- Adult post-parturient mares.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Belknap J et al (2012) Sepsis-related laminitis. Equine Vet J 44 (6), 738-740 PubMed.
- Crabtree J (2012) Peripartum problems in mares 2. Postpartum problems. In Pract 34 (8), 462-471 VetMedResource.