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856 Pyometra

• Antimicrobial therapy • Care should be taken to ensure the cervix is • The likelihood of the bitch becoming
○ Initiate antimicrobial therapy immediately open (e.g., flush on day 2 or 3 after initiation pregnant after appropriate medical treatment
VetBooks.ir ○ Continued antimicrobials are based on • Uterine rupture and leakage resulting in with optimal breeding management and in
of antiluteolytic treatment in cases of closed
during the subsequent estrus is high (>80%)
with broad-spectrum antibiotic (presump-
pyometra).
tion of E. coli infection).
cases with no ultrasonographic evidence of
culture and susceptibility, ideally from
sample of uterine contents obtained peritonitis has not been reported but should CEH.
be considered a risk.
transcervically (alternative is cranial PEARLS & CONSIDERATIONS
vaginal culture) until at least 14 days Possible Complications
after resolution of vaginal discharge. Retention of fluid in the uterus after 5 days of Comments
○ Initial empirical therapy: amoxicillin/ treatment is a poor prognostic sign for future • Any animal not intended for breeding should
clavulanic acid 12.5-25 mg/kg PO q 12h, fertility. Complete OHE should be performed be spayed.
cephalosporins (e.g., cephazolin 22 mg/kg in these cases. • Animals that have been medically treated
IV q 8h), and potentiated sulphonamides for pyometra should be bred the following
(care with renal function). Recommended Monitoring cycle; early ultrasonographic examination for
Surgical management: • Ultrasonography is the most important pregnancy (>21 days post LH surge) can
• Complete removal of ovaries, uterus, and tool in assessing response to medical treat- detect the recurrence of pyometra as early
entire cervix recommended in any animal ment. Significant reduction in uterine wall as possible and before systemic clinical signs
not intended for breeding, > 4 years old, thickness and absence of intraluminal fluid develop.
presents systemically ill, or has evidence of should be seen 5-7 days after initiation of
prior CEH changes in uterine wall. treatment. Prevention
• Prior medical stabilization often indicated • Hematologic parameters should return to • Do not treat females with a partial or
(p. 907) normal in about 7-15 days after treatment. complete uterus with exogenous progestins
○ If animal’s health is in critical condition, • Vaginal discharge should change from long-term and at high doses.
medical stabilization may be possible only purulent to serous and significantly reduce • Complete OHE if not intended for breeding
for a few hours before surgery is required. in volume over 5 days. • Because of potential familial predisposition,
○ If patient is in a more stable condition, • Clinical improvement in demeanor and do not breed female offspring from dams
surgery can be delayed 12-24 hours while appetite should be seen 48 hours after onset treated for pyometra.
medical treatment with aglepristone is of treatment in most cases.
given to aid in dilation of cervix and • Serum progesterone levels are difficult to Technician Tips
subsequent drainage of pus from uterus. interpret if aglepristone is used. If only PGF 2a It is important to remember that the uterus can
○ Presurgical treatment with aglepristone is used, reduction in serum progesterone is be extremely friable, and great care should be
facilitates patient stabilization before seen within 48 hours, and serum levels are taken during abdominal palpation.
surgery and reduces risk of uterine rupture < 2 ng/mL in 5-7 days. If treatment is
and leakage of pus during surgery. stopped before progesterone levels are Client Education
• It is important to monitor animal’s cardiac < 2 ng/mL, pyometra can recur. • Animals should be bred at a young age
(arrhythmia common), metabolic (acidosis • Medical treatment can result in shortened because the incidence of pyometra increases
common), and hydration status before, interestrous interval, which can adversely at > 4 years.
during, and after surgical procedure. affect a bitch’s fertility in the next estrus. • Breeding females should be spayed as soon as
• Great care must be taken when removing The subsequent estrus can be postponed with desired number of litters has been achieved.
uterus in a case of closed-cervix pyometra mibolerone treatment for 2-3 months starting • Animals should be bred when young (<4
because it can be very friable. Saline-soaked 1 month after end of pyometra treatment, years).
laparotomy sponges can help prevent leakage which ensures a minimal interestrous interval • Early ultrasonographic pregnancy exams
of purulent discharge into abdominal cavity. of 6 months. should be encouraged to detect recurrence
• Postoperatively, the animal should be of pyometra.
intensively monitored for signs of acid- PROGNOSIS & OUTCOME
base/electrolyte imbalances, dehydration, SUGGESTED READING
hypoglycemia, hypoproteinemia, and • At 1 month after the end of therapy, reduc- Krekeler N, et al: Pyometra. In Monnet E, editor:
anemia. IV fluids should be administered tion in ultrasonographic evidence of CEH Small animal soft tissue surgery, Ames, Iowa, 2013,
for a minimum of 24 hours after surgery is a good indicator of future fertility. Wiley Blackwell, pp 625-634.
or until bitch is eating or drinking ○ Bitches that respond to treatment within
• Pain management can include opioids: 5-7 days have a better prognosis in regards AUTHORS: Natali Krekeler, Dr. med. vet., PhD, DACT;
Fiona K. Hollinshead, BVSc, PhD, DACT
buprenorphine 0.01 mg/kg SQ q 8h or to future fertility than bitches that are EDITOR: Michelle A. Kutzler, DVM, PhD, DACT
morphine 0.1-0.2 mg/kg IV q 4-6h slow to respond.
Other therapy: • Case selection is critical to success and future
• Transcervical endoscopic catheterization and prognosis. Bitches < 4 years of age have a
flushing with warm saline and subsequent much better prognosis in regards to future
intrauterine instillation of 10-15 mcg/kg of fertility than bitches > 5 years of age.
dinoprost and 10 mg/kg of cefazolin has been
described.

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