Page 1005 - Small Animal Internal Medicine, 6th Edition

CHAPTER 55 Clinical Conditions of the Bitch and Queen 977

the source of hemorrhage, coagulation testing, and abdomi- spread, and E. coli is the most common causative organism
nal ultrasound assist in the diagnosis. Therapy with prosta- in both bitches and queens. Empirical selection of a broad-
VetBooks.ir glandins has not been substantiated. The preventive value of spectrum bactericidal antimicrobial (potentiated amoxicil-
lin such as ticarcillin, 15-25 mg/kg IV q8h, or cefazolin,
oxytocin given in the immediate postpartum period is also
unproven but not likely harmful. Laparotomy and ovariohys-
nurslings will be treated as well. Additional therapy consists
terectomy are curative. Histologic examination of the uterus 22 mg/kg IV q8-12h) must take into consideration that
is indicated to confirm the diagnosis. of IV fluid and electrolyte support as indicated and phar-
macologic uterine evacuation, either with synthetic pros-
Postpartum Endometritis taglandins (cloprostenol at 1-3 µg/kg q12-24h) or natural
Acute infection of the postpartum endometrium should be PGF 2α (0.1-0.2 mg/kg q 12-24h) for 3 to 5 days to effect.
suspected if lethargy, anorexia, decreased lactation, and poor Oxytocin is unlikely to promote effective uterine evacua-
mothering are reported and are accompanied by fever and tion when administered more than 24 hours postpartum.
malodorous vulvar discharge (Fig. 55.28). Endometritis is Nurslings should be hand-reared if the dam is seriously
serious and sometimes preceded by dystocia, contaminated sick or requires antibiotics contraindicated for neonates. An
obstetrical manipulations, or retained fetuses and/or placen- ovariohysterectomy may be indicated if the bitch’s condition
tae. Hematologic and biochemical changes often suggest
septicemia, systemic inflammation reaction, and endotox-
emia. Cytology of vulvar discharge is hemorrhagic to
purulent (Fig. 55.29). Ultrasound of the abdomen allows
evaluation of intrauterine contents and the uterine wall;
endometritis is characterized by thickened, corrugated
endometrium with echogenic fluid in the lumen (Fig. 55.30).
Postpartum metritis is best differentiated from the normal
postpartum uterine enlargement by a failure of normal pro-
gressive decrease in uterine lumen contents and horn width.
The canine uterus involutes and repairs for up to 16 weeks,
making the normal postpartum ultrasonographic appear-
ance challenging; serial evaluations (q24-48h) are helpful.
Retained fetuses and placentae can also be identified with
ultrasound.
A guarded cranial vaginal culture is likely representative
of intrauterine flora and should be submitted immediately
for both aerobic and anaerobic culture and sensitivities; this FIG 55.29
permits retrospective assessment of empirically selected Cytology of vulvar discharge in postpartum endometritis:
antibiotic therapy. Bacterial ascension from the lower numerous free and phagocytized bacteria, toxic neutrophils,
genitourinary tract is more common than hematogenous and macrophages.

+

+

+ 1.84 cm

FIG 55.30
FIG 55.28 Ultrasonographic appearance of postpartum endometritis.
Malodorous purulent to hemorrhagic vulvar discharge in Note the irregular hyperechoic endometrium and echogenic
postpartum endometritis. fluid content.