Defining clinical diagnosis and treatment of puerperal metritis in dairy cows: A scoping review

Abstract

Although puerperal metritis (PM) is a common infectious disease in dairy cattle, there are currently discrepancies between clinical case definitions within and between available peer-reviewed literature and on-farms practices. The inconsistent use of PM criteria across studies and on-farms practices can result in disparities related to recommendations for treating cows, affecting judicious use of antimicrobials. The objective of this study was to systematically review the peer-reviewed literature for clinical signs used for case definition of PM. The criteria used included local (e.g., vaginal discharge) and systemic clinical signs of infection (e.g., fever, drop in milk). The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews protocols were used to screen commonly used databases. Following this protocol, one reviewer screened title and abstract for eligibility (n = 2,096), followed by full-text screening of selected articles (n = 396) by 2 reviewers to confirm eligible articles (n = 174). The most frequently cited reference article (37.5%) for the definition of PM was published in 2006, followed by articles published between 1998 and 2009 (13%). In 40.2% of articles, no reference was provided for definition of PM; vaginal discharge was described in terms of color, odor, and viscosity when related to the PM definition. Terms used for description of vaginal discharge color were red-brown (61.4%), red (5.1%), brown (8.6%), chocolate (4%), white (1.7%), yellow (0.5%), pink (5.7%), or gray (0.5%); vaginal discharge color was not reported in 24.1% articles. The vaginal discharge odor was described as fetid (75.8%), putrid (5.1%), foul (10.3%), or other (5.7%; e.g., abnormal, malodorous, odoriferous); odor was not mentioned in 7.4% of articles. The vaginal discharge viscosity was described as watery (74.1%), purulent (27%), mucopu-rulent (8.6%), thin (4%), serous (2.8%), or abnormal (2.3%) and was not mentioned in 11.5% of articles. Fever was included in 59.7% of articles as a criterion for PM diagnosis. The most used rectal temperature threshold was ≥39.5°C (56.8%), followed by ≥39.2°C (2.8%). Approaches used for vaginal discharge evaluation included rectal palpation (37.3%), intravaginal exploration with a gloved hand (18.4%), Metricheck (9.8%), or speculum (5.7%); and in 28.7% of articles, diagnostic tools used were not mentioned. Many of the color and odor vaginal discharge descriptions observed in the literature, used synonymous words to describe the same vaginal discharge sample, highlighting a lack of terminology consensus that could result in disagreements, especially due to the subjective character of these clinical evaluations of vaginal discharge color and odor. Although select consensus articles are available, it is common for studies to disregard a reference when defining PM cases. Furthermore, our findings highlight the need for a robust and clear consensus on criteria and terminology used to diagnose PM.

Nonpuerperal chronic endometritis with pyometra causing systemic illness in a production sow

“…Metritis is defined as inflammation of all layers of the uterus. 9,10,16,17 In cows, metritis is characterized by malodorous fluid and myometrial edema, occurring within 2-3 weeks after calving, and usually does not cause systemic disease. Systemically affected cows with metritis are usually termed as having septic and/or toxic metritis, which has different treatments and implications than a metritis localized to the uterus.…”

Systemic antibiotic treatment of cows with metritis early postpartum does not change the progression of uterine disease or the uterine microbiome at 1 month postpartum

“…Metritis (uterine infection after calving) can have a profound negative effect on the health and productivity of postpartum dairy cows causing fever, fetid uterine discharge, loss of appetite, and reduced milk production during early lactation [1][2][3][4]. Approximately one-third of postpartum dairy cows develop metritis within one week after calving [5][6][7] and nearly 50% of all deaths on farms occur within one month postpartum due to metritis or other complications that originate during calving [8]. Cows with metritis may fail to completely recover from the disease and develop chronic in ammation of the uterus (clinical or subclinical endometritis) that can last for several months [7,9,10].…”

WGS of intrauterine E. coli from cows with early postpartum uterine infection reveals a non-uterine specific genotype and virulence factors

“…The pathophysiology of the disease is complex with limited studies that generate information to allow causal inferences about the disease ( 6 ). Part of this challenge includes a lack of consensus on the criteria and terminology used for clinical disease diagnosis in research studies, as recently demonstrated in a scoping review (ScR) ( 7 ). Although inconsistencies in the clinical definition of metritis exist, the aforementioned ScR identified that most studies defined metritis as a fetid, red-brown watery discharge with or without systemic signs of disease based on the work of Sheldon et al ( 2 ).…”