Evaluation of vaginoscopy for the diagnosis of clinical endometritis in dairy cows

Abstract

The objective of the study was to evaluate the visual assessment of vaginal discharge by vaginoscopy for the diagnosis of clinical endometritis (CE) in dairy cows. In an in vivo trial, inter- and intraobserver repeatability of vaginoscopic examination (VE) was determined and the effect of transrectal palpation and experience of the investigator evaluated. Holstein-Friesian cows (n=380) were examined by vaginoscopy between 21 and 27 d in milk by 3 investigators twice. Vaginal discharge was categorized on a 4-point classification system (0=clear mucus, 1=mucus containing flecks of pus, 2=discharge containing less than 50% pus, 3=discharge containing more than 50% pus). Cows with a vaginal discharge score (VDS) of 0 were classified as healthy, whereas cows with a VDS of 1 to 3 were classified as having CE. Vaginal discharge score on a scale from 0 to 3 has moderate intra- (Cohen's kappa coefficient, κ=0.55-0.60) and interobserver (κ=0.44) repeatability. The prevalence of CE was comparable between the 3 investigators (first VE: 42.6, 34.8, and 38.7; second VE 46.8, 36.9, and 43.7%). Transrectal palpation (relative risk=0.96-1.03) or experience of the investigator (relative risk=0.9-1.1) did not affect results of VE. In an in vitro trial, sensitivity and specificity of visual assessment were determined utilizing 33 images showing yellow and pink areas in certain percentages as a reference standard. Pus was represented by yellow areas and the mucosa, including clear mucus, by pink areas. These images were visually assessed by 30 investigators via PowerPoint presentation (experiment 1) and by 23 investigators via a simulated vaginal examination (experiment 2) utilizing the same 4-point classification system. Sensitivity was 99.6 and 96.3% and specificity was 96.7 and 90.1% in experiments 1 and 2, respectively. The results provide evidence that a visual assessment conducted by vaginoscopic examination is not perfect but can be considered a reasonable measurement of vaginal discharge and is a practical tool to distinguish healthy from diseased cows.

Diversity and health status specific fluctuations of intrauterine microbial communities in postpartum dairy cows

“…The vaginal discharge scoring system is based on large-scale studies which have shown, that the diagnosis of pus in the vaginal discharge is related to impaired fertility (LeBlanc et al, 2002). Vaginoscopic examination for the detection of pus in the vagina is not only widely accepted in science but also in veterinary practice to distinguish healthy from diseased cows (Leutert et al, 2012). The incidence of different VDS diagnosed in this study is in line with findings from other studies (Pleticha et al, 2009;Leutert et al, 2012;Wagener et al, 2014b).…”

“…of vaginal discharge usually diagnosed from day 21 to 26 postpartum (LeBlanc et al, 2002;Williams et al, 2005;Sheldon et al, 2009;Leutert et al, 2012). Monitoring changes in the bacterial composition of the uterine fluid before the appearance of clinical signs of a disease is crucial not only for a critical interpretation of clinical findings but also for the development of optimal prevention and intervention strategies (Madoz et al, 2014).…”

Dynamics of bacteriologic and cytologic changes in the uterus of postpartum dairy cows

“…Barlund et al [6] suggested that uterine cytology is the most reliable method for diagnosing CE in cattle. In veterinary practice, vaginoscopy, the Metricheck device, or the gloved hand are frequently used methods to diagnose CE [7][8][9]. In contrast to the clear definition of CE by Sheldon et al [2], the definition of subclinical endometritis (SE) is still under discussion.…”

63 Effect of Endometrial Biopsy on Uterine Health of Tropically Adapted Beef Cattle

“…Discharges can be collected and visually examined either by a gloved hand, the Metricheck® device or vaginoscopy (McDougall et al, 2007, Leutert et al, 2012. Based on the discharge characteristics (colour), the discharge obtained is given a score from 0 to 3 based on the amount of pus that the discharge contains.…”