Prevalence of subclinical endometritis in dairy cows that recovered after treatment of clinical endometritis with cephapirin and PGF2α

In dairy herds, the prevalence of postpartum uterine diseases ranges from 3% to 40%, with a median of 10% [14,22,32]. In recent years, uterine diseases have been deeply reconsidered and redefined; according to the current understanding, there are four clinical or subclinical forms of bovine uterine inflammation: metritis, clinical endometritis (CE), subclinical endometritis (SE) and pyometra [28,32].

Clinical endometritis diagnosed in some countries according to its main clinical sign – purulent vaginal discharge – is one of the most common uterine disease (10–20%) during the late postpartum and service periods [8,22,25]. This form of uterine disease is defined by inflammation caused by bacteria, is limited to the endometrium, and is diagnosed by an increased diameter of the uterine horns and the presence of purulent or mucopurulent vaginal discharge beyond the third week postpartum [9,32]. Due to its detrimental effects on fertilization and conception, clinical endometritis has a significant impact on bovine fertility [4,23].

The treatment of CE with intrauterine application of antibiotics or antimicrobials, as well as systemic administration of PGF2α, has been described in the literature and is widespread in routine practice as a main therapy option [6,7,10,16,17,27,33]. The effects of prostaglandins on reproductive performance were inconsistent [3,7,9,15,23], however they are still used for treatment and prevention of endometritis.

Clinical trials describing the effects of CE treatment have mainly focused on clinical cure rates, bacteriological findings and reproductive performance, whereas the prevalence of subclinical endometritis (SE) as a consequence of clinical uterine disease and its treatment has not been sufficiently evaluated. In recent decades, a high prevalence of SE - up to 70% - and its negative impact on reproductive performance in dairy cows has been demonstrated [1,14,18,19]. SE is an inflammation of the endometrium that results in a significant reduction in fertility in the absence of clinical signs beyond 42 days postpartum. The presence of over 5% polymorphonuclear neutrophils (PMNs) in endometrial samples obtained using transcervical cytobrush cytology is recommended as the main method of diagnosis [34]. Currently, there is no valid, evidence-based treatment method for this uterine disease. The lack of successful treatment, as well as the lack of cow-side diagnosis, are the main reasons that the current awareness of this disease in practice is still low.

Generally, CE and SE are thought to be independent diseases occurring separately, but may also be considered interrelated pathologies. The establishment of full uterine health postpartum and during the service period depends on uterine involution, regeneration of the endometrium and uterine immune defense mechanisms, whereas pathological cases also depend on the treatment methods of clinical endometritis [21,28,32,34]. The aims of our study were to evaluate (1) the prevalence of SE in clinically cured cows after treatment of CE with uterine cephapirin infusion or with systemic application of PGF2α and after self-healing, (2) the prevalence of SE in clinically cured cows in relation to the type of vaginal discharge.

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