Introduction

• Uterine infections are a frequent disorder during the postpartum period.
• 20-40% of dairy cattle may develop one or more uterine diseases during lactation. In addition to the animal welfare implications of uterine disease, it also results in economic loss, due to:
  • Decreased milk yield.
  • Impaired fertility.
  • Premature culling.
  • Death.
• The three principal postpartum uterine infections are metritis, endometritis and pyometra.
• Prolonged calving, twins, dystocia, and retained fetal membranes (RFM) are often implicated as predisposing factors for uterine infection.
• Although metritis, endometritis, pyometra and retained fetal membranes are distinct clinical condition, they do share common etiologies and treatments and also predispose to one another, Together, these conditions result in significant infertility problems for the cattle industry.
• Dairy cattle seem to be more susceptible than beef cattle or are more likely to be presented for examination on an individual or herd basis. The reasons for this may include:
  • Due to the pressures of lactation, dairy cattle body systems are under increased stress and are thus more likely to be in a state of negative energy balance and/or immunocompromised.
  • Dairy cattle are more intensively housed, than beef cattle, and are, therefore more likely to be exposed to pathogenic strains of bacteria.
  • Dairy cattle are observed more closely than beef cattle, and so it is more likely that issues will be picked up by the stock person.
• The proportion of cattle developing uterine disease varies greatly, even between what outwardly appear to be similar farms in the same geographical region. Milk production, hygiene, and other specific farm management factors should be evaluated.

Pathophysiology

Defining uterine infections

Diagnosis

Treatment

Further Reading

Publications

Refereed Papers

• Recent references from PubMed and VetMedResource.
• Ghasemi F, Gonzalez-Cano P, Griebel P & Palmer C (2012) Proinflammatory cytokine gene expression in endometrial cytobrush samples harvested from cows with and without subclinical endometritis. Theriogenology 78, 1538–1547 PubMed.
• Machado V, Knauer W, Bicalho M et al (2012) A novel diagnostic technique to determine uterine health of Holstein cows at 35 days postpartum. J Dairy Sci 95, 1349–1357 PubMed.
• Santos T, Gilbert R & Bicalho R (2011) Metagenomic analysis of the uterine bacterial microbiota in healthy and metritic postpartum dairy cows. J Dairy Sci 94, 291–302 PubMed.
• Dubuc J, Duffield T, Leslie K, Walton J & LeBlanc S (2011) Randomized clinical trial of antibiotic and prostaglandin treatments for uterine health and reproductive performance in dairy cows. J Dairy Sci 94, 1325–1338 PubMed.
• Wittrock J, Proudfoot K, Weary D & von Keyserlingk M (2011) Metritis affects milk production and cull rate of Holstein multiparous and primiparous dairy cows differently. J Dairy Sci 94, 2408–2412 PubMed.
• Cheong S, Nydam D, Galvão K, Crosier B & Gilbert R (2011) Cow-level and herd-level risk factors for subclinical endometritis in lactating Holstein cows. J Dairy Sci 94, 762–770 PubMed.
• Bicalho R, Machado V, Bicalho M et al (2010) Molecular and epidemiological characterization of bovine intrauterine Escherichia coli. J Dairy Sci 93, 5818–5830 PubMed.
• Dubuc J, Duffield T, Leslie K, Walton J & LeBlanc S (2010) Definitions and diagnosis of postpartum endometritis in dairy cows. J Dairy Sci 93, 5225–5233 PubMed.
• Sheldon I, Price S, Cronin J, Gilbert R & Gladsby J (2009) Mechanisms of infertility associated with clinical and subclinical endometritis in high producing dairy cattle. Reprod Domest Anim 44 (3), 1–9 PubMed.
• Galvão K, Frajblat M, Brittin S et al (2009) Effect of prostaglandin F2α on subclinical endometritis and fertility in dairy cows. J Dairy Sci 92, 4906–4913 PubMed.
• Galvão K, Greco L, Vilela J, Sá Filho M & Santos J (2009) Effect of intrauterine infusion of ceftiofur on uterine health and fertility in dairy cows. J Dairy Sci 92, 1532–1542 PubMed.
• Sheldon I, Cronin J, Goetze L, Donofrio G & Schuberth H (2009) Defining postpartum uterine disease and the mechanisms of infection and immunity in the female reproductive tract in cattle. Biol Reprod 81, 1025–1032 PubMed.
• Rutigliano H, Lima F, Cerri R et al (2008) Effects of method of presynchronization and source of selenium on uterine health and reproduction in dairy cows. J Dairy Sci 91, 3323–3336 PubMed.
• LeBlanc S (2008) Postpartum uterine disease and dairy herd reproductive performance: a review. Vet J 176, 102–114 PubMed.
• Hill J & Gilbert R (2008) Reduced quality of bovine embryos cultured in media conditioned by exposure to an inflamed endometrium. Aust Vet J 86, 312–316 PubMed.
• Sheldon I, Williams E, Miller A, Nash D & Herath S (2008) Uterine diseases in cattle after parturition. Vet J 176, 115–121 VetMedResource.
• Barlund C, Carruthers T, Waldner C & Palmer C (2008) A comparison of diagnostic techniques for postpartum endometritis in dairy cattle. Theriogenology 69, 1516–1530 PubMed.
• Gilbert R, Santos N, Galvão K, Brittin S & Roman H (2007) The relationship between postpartum uterine bacteria and subclinical endometritis. J Dairy Sci 90 (1), 469 (Abstract) ResearchGate.
• Williams E, Fischer D, Noakes D et al (2007) The relationship between uterine pathogen growth density and ovarian function in the postpartum dairy cow. Theriogenology 68, 549–559 PubMed.
• Huzzey J, Veira D, Weary D & von Kerserlingk M (2007) Prepartum behaviour and dry matter intake identify cows at risk for metritis. J Dairy Sci 90, 3220–3233 PubMed.
• MacDougall S, Macaulay R & Compton C (2007) Association between endometritis diagnosis using a novel intravaginal device and reproductive performance in dairy cattle. Anim Reprod Sci 99, 9–23 PubMed.
• Kasimanickam R, Cornwell J & Nebel R (2006) Effect of presence of clinical and subclinical endometritis at the initiation of Presynch–Ovsynch program on the first service pregnancy in dairy cows. Anim Reprod Sci 95, 214–223 PubMed.
• Hendricks K, Bartolome J, Melendez P, Risco C & Archbald L (2006) Effect of repeated administration of PGF2α in the early post partum period on the prevalence of clinical endometritis and probability of pregnancy at first insemination in lactating dairy cows. Theriogenology 65, 1454–1464 PubMed.
• Hammon D, Evjen I, Dhiman T, Goff J & Walters J (2006) Neutrophil function and energy status in Holstein cows with uterine health disorders. Vet Immunol Immunopathol 113, 21–29 PubMed.
• Herath S, Dobson H, Bryant C & Sheldon I (2006) Use of the cow as a large animal model of uterine infection and immunity. J Reprod Immunol 69, 13–22 PubMed.
• Sheldon I, Lewis G, LeBlanc S & Gilbert R (2006) Defining postpartum uterine disease in cattle. Theriogenology 65, 1516–1530 PubMed.
• Chenault J, McAllister J, Chester T & Dame K (2005) Efficacy of ceftiofur hydrochloride sterile suspension administered parenterally for the treatment of acute postpartum metritis in dairy cows. JAVMA 224, 1634–1639 PubMed.
• Urton G, von Keyserlingk M & Weary D (2005) Feeding behaviour identifies dairy cows at risk for metritis. J Dairy Sci 88, 2843–2849 PubMed.
• Gilbert R, Shin S, Guard C, Erb H & Frajblat M (2005) Prevalence of endometritis and its effects on reproductive performance of dairy cows. Theriogenology 64, 879–1888 VetMedResource.
• Kasimanickam R, Duffield T, Foster R et al (2005) The effect of a single administration of cephapirin or cloprostenol on the reproductive performance of dairy cows with subclinical endometritis. Theriogenology 63, 818–830 PubMed.
• Kasimanickam R, Duffield T, Foster R et al (2005) A comparison of the cytobrush and uterine lavage techniques to evaluate endometrial cytology in clinically normal postpartum dairy cows. Can Vet J 46, 255–259 PubMed.
• Williams E, Fischer D, Pfeiffer D et al (2005) Clinical evaluation of postpartum vaginal mucus reflects uterine bacterial infection and the immune response in cattle. Theriogenology 63, 102–117 PubMed.
• Kasimanickam R, Duffield T, Foster R et al (2004) Endometrial cytology and ultrasonography for the detection of subclinical endometritis in postpartum dairy cows. Theriogenology 62, 9–23 PubMed.
• Sheldon I, Rycroft A & Zhou C (2004) Association between postpartum pyrexia and uterine bacterial infection in dairy cattle. Vet Rec 154, 289–293 PubMed.
• Melendez P, McHale J, Bartolome J, Archbald L & Donovan G (2004) Uterine involution and fertility of Holstein cows subsequent to early postpartum PGF2α treatment for acute puerperal metritis. J Dairy Sci 87, 3238–3246 PubMed.
• Overton M, Sischo W & Reynolds J (2003) Evaluation of effect of estradiol cypionate administered prophylactically to postparturient dairy cows at high risk for metritis. JAVMA 223, 846–851 PubMed.
• Sheldon I, Noakes D, Rycroft A & Dobson H (2002) Effect of postpartum manual examination of the vagina on bacterial contamination in cows. Vet Rec 15, 531–534 PubMed.
• Smith B & Risco C (2002) Therapeutic and management options for postpartum metritis in dairy cattle. Comp Cont Educ Pract Vet 24, S92–S100.
• Okker H, Schmitt E, Vos P, Scherpenisse P, Bergwerff A & Jonker F (2002) Pharmacokinetics of ceftiofur in plasma and uterine secretions and tissues after subcutaneous postpartum administration in lactating dairy cows. J Vet Pharmacol Ther 25, 33–38 PubMed.
• Smith B & Risco C (2002) Predisposing factors and potential causes of postpartum metritis in dairy cattle. Comp Cont Educ Pract Vet 24, S74–S80.
• LeBlanc S, Duffield T, Leslie K et al (2002) The effect of treatment of clinical endometritis on reproductive performance in dairy cows. J Dairy Sci 85, 2237–2249 PubMed.
• Sheldon I, Noakes D, Rycroft A et al (2002) Influence of uterine bacterial contamination after parturition on ovarian dominant follicle selection and follicle growth and function in cattle. Reproduction 123, 837–845 PubMed.
• Mateus L, Lopes da Costa L, Bernardo F & Robalo Silva J (2002) Influence of puerperal uterine infection on uterine involution and postpartum ovarian activity in dairy cows. Reprod Domest Anim 37, 31–35 PubMed.
• LeBlanc S, Duffield T, Leslie K et al (2002) Defining and diagnosing postpartum clinical endometritis and its impact on reproductive performance in dairy cows. J Dairy Sci 85, 2223–2236 PubMed. 
• Dohmen M, Joop K, Sturk A, Bols P & Lohuis J (2000) Relationship between intra-uterine bacterial contamination, endotoxin levels and the development of endometritis in postpartum cows with dystocia or retained placenta. Theriogenology 54, 1019–1032 VetMedResource.
• Østergaard S & Gröhn Y (1999) Effect of diseases on test day milk yield and body weight of dairy cows from Danish research herds. J Dairy Sci 82, 1188–1201 PubMed.
• BonDurant R (1999) Inflammation in the bovine reproductive tract. J Dairy Sci 82 (2), 101–110 VetMedResource.
• Sheldon I & Noakes D (1998) Comparison of three treatments for bovine endometritis. Vet Rec 142, 575–591 PubMed.
• Lewis G (1997) Health problems of the postpartum cow, uterine health and disorders. J Dairy Sci 80, 984–994.
• Peters A & Laven R (1996) Treatment of bovine retained placenta and its effects. Vet Rec 139, 535–539.
• Cohen R, Bernstein M & Ziv G (1995) Isolation and antimicrobial susceptibility of Actinomyces pyogenes recovered from the uterus of dairy cows with retained fetal membranes and postparturient endometritis. Theriogenology 43, 1389–1397 PubMed.
• Pugh D, Lowder M & Wenzel J (1994) Retrospective analysis of the management of 78 cases of postpartum metritis in the cow. Theriogenology 42, 455–463 PubMed.
• Gilbert R & Schwark W (1992) Pharmacologic considerations in the management of peripartum conditions in the cow. Vet Clin North Am Food Anim Pract 8, 29–56 PubMed.
• Noakes D, Wallace L & Smith G (1991) Bacterial flora of the uterus of cows after calving on two hygienically contrasting farms. Vet Rec 128, 440–442 PubMed.
• Gröhn Y, Erb H, McCulloch C & Saloniemi H (1990) Epidemiology of reproductive disorders in dairy cattle: associations among host characteristics, disease and production. J Dairy Sci 8, 25–39 PubMed.
• Noakes D, Wallace L & Smith G (1990) Pyometra in a Friesian heifer: bacteriological and endometrial changes. Vet Rec 126, 509 PubMed.
• Burton M, Dziuk H, Fahning M & Zemjanis R (1990) Effects of oestradiol cypionate on spontaneous and oxytocin-stimulated postpartum myometrial activity in the cow. Br Vet J 146, 309–315 PubMed.
• Nakao T, Moriyoshi M & Kawata K (1988) Effect of postpartum intrauterine treatment with 2% polyvinylpyrrolidone-iodine solution on reproductive efficiency in cows. Theriogenology 30, 1033–1043 PubMed.
• Peter A & Bosu W (1988) Relationship of uterine infections and folliculogenesis in dairy cows during early puerperium. Theriogenology 30, 1045–1051 PubMed.
• Markusfeld O (1987) Periparturient traits in seven high dairy herds. Incidence rates, association with parity, and interrelationships among traits. J Dairy Sci 70, 158–166 PubMed.
• Peter A & Bosu W (1987) Effects of intrauterine infection on the function of the corpora lutea formed after first postpartum ovulations in dairy cows. Theriogenology 27, 593–609 PubMed.
• Paisley L, Micklesen W & Anderson P (1986) Mechanisms and therapy for retained membranes and uterine infections of cows: a review. Theriogenology 25, 353–381 PubMed.
• Manns J, Nkuuhe J & Bristol F (1985) Prostaglandin concentrations in uterine fluid of cows with pyometra. Can J Comp Med 49, 436–438 PubMed.
• Dohoo I (1984) A retrospective evaluation of postbreeding infusions in dairy cattle. Can J Comp Med 48, 6–9 PubMed.
• Bretzlaff K, Ott R, Koritz G, Bevill R, Gustafsson B & Davis L (1983) Distribution of oxytetracycline in genital tract tissues of postpartum cows given the drug by intravenous and intrauterine routes. Am J Vet Res 44, 764–769 PubMed.
• Ott R & Gustafsson B (1981) Use of prostaglandins for the treatment of bovine pyometra and postpartum infections: a review. Comp Cont Educ Pract Vet 3, S184–S187.
• Gustafsson B & Ott R (1981) Current trends in the treatment of genital infections in large animals. Comp Cont Educ Pract Vet 3, 147–S151.
• Black W, MacKay A, Doig P & Claxton M (1979) A study of drug residues in milk following intrauterine infusion of antibacterial drugs in lactating cows. Can Vet J 20, 354–357 PubMed.

Other sources of information

• Risco C, Youngquist R, Shore M (2007) Postpartum uterine infections. In: Current Therapy in Large Animal Theriogenology. Eds: Youngquist R S & Threlfall W R. 2nd edn. WB Saunders, USA. pp 339–344.
• Noakes D, Parkinson T, England G & Arthur G (2002) Arthur’s Veterinary Reproduction and Obstetrics. 8th edn. Elsevier Science. pp 399–408.
• Frazer G (2001) Hormonal therapy in the postpartum cow days 1 to 10. Fact or fiction? In: Proceedings of the Annual Meeting of the Society for Theriogenology. pp 161–183.
• Mortimer R, Farin P & Stevens R (1997) Reproductive examination of the non-pregnant cow. In: Current Therapy in Large Animal Theriogenology. Ed: Youngquist R S.WB Saunders, USA. pp 268–275.
• Olson J, Bretzlaff K, Mortimer R & Ball L (1986) The metritis–pyometra complex. In: Current Therapy in Theriogenology. Ed: Morrow D A. 2nd edn. WB Saunders, USA. pp 227–236.

Organisation(s)

• RUMA Responsible Use of Medicines in Agriculture Alliance. Website: https://www.ruma.org.uk.