Page 524 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Reproductive system: 2.1 The female reproductive tr act 499

VetBooks.ir 2.109 inflammation. Some antibiotics (e.g. gentamicin
and amikacin) will require buffering with
sodium bicarbonate solution before being used
in the uterus. Infusion volumes of 50–200 ml
(larger volumes in older pluriparous mares) into
the uterus are adequate.
• Try and do no harm! Some therapies such as
chlorohexidine gluconate and undiluted iodine
solutions produce severe irritation to the
endometrium and have been associated with
uterine adhesions. Counterirritant therapy has
been used in the uterus of the mare successfully,
Fig. 2.109 Histopathology of an endometrial biopsy but it requires very careful use.
from a mare with chronic infiltrative endometritis that • Short cycle the mare with PGF α to bring the
2
subsequently responded to sexual rest and intrauterine mare back into oestrus. Oestrogens have been
therapy. Note the diffuse cellular inflammatory shown to have a positive influence on uterine
reaction (arrows). immune mechanisms.
• Administer 20 IU oxytocin i/v and/or remove
there is uterine intraluminal fluid. Endometrial biopsy uterine contents by lavage with sterile saline
often reveals chronic endometritis with focal or dif- (Hartmann’s or lactated Ringer’s solution is
fuse cellular inflammation (Fig. 2.109). best).
• 30 minutes later, infuse the uterus with
Management appropriate antibiotics (generally use systemic
Following the taking of an endometrial swab, ide- dose). Repeat the treatment for 3–5 days.
ally the mare should not be treated until the bacte- • It is important to correct any predisposing
rial culture and sensitivity results are known. Then conformational abnormalities (e.g. Caslick’s
an appropriate antibiotic should be infused into the vulvoplasty) or repair any damage to the external
uterus over 3–5 days under minimum contamina- barriers.
tion conditions. The perineum and vulva should be • Autologous plasma infusions into the uterus have
hygienically prepared, a sterile plastic insemination been used in mares with chronic endometritis
pipette inserted along the index finger through the both during treatment and 12–36 hours post
cervix into the uterus using a gloved hand, and the breeding.
sterile antibiotic infusion delivered into the uterus • Minimal-contamination techniques at breeding
via a sterile syringe. have been recommended in mares with chronic
There are few, if any, efficacy studies performed endometritis (p. 425).
to determine the best treatment for endometritis. In • Always maintain good hygiene during
addition, there are few products licensed for intra- examinations, treatments and breeding and use
uterine use or have licensed claims to treat endome- AI if possible.
tritis in the mare. However, some basic principles • Sexual rest, for up to 45 days, is particularly
should be followed whenever treating endometritis useful in severely affected cases.
in the mare: • Fungal and yeast infections in the uterus will
require prolonged intrauterine treatment
• Based on the causative agent/s cultured and with antimycotic drugs based on culture
their sensitivity pattern, select the best therapy and sensitivity results. Some cases have been
(Table 2.2). This may involve systemic and/or treated effectively with a saline and vinegar
intrauterine antibiotics. mixture or povidone–iodine and saline
• All intrauterine agents (including Hartmann’s solution. Recently, the addition of DMSO to
solution) cause some degree of intrauterine lavage fluids has been advocated as a way of