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PubMed2000

Antibiotic regimens for endometritis after delivery.

BACKGROUND: Post-partum endometritis, which is more common after cesarean section, occurs when vaginal organisms invade the endometrial cavity during labour and delivery. Antibiotic treatment is warranted. OBJECTIVES: The effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's trials register and the Cochrane Controlled Trials Register. Date of last search: August 1999. SELECTION CRITERIA: Randomised trials of different antibiotic regimens for postpartum endometritis, after cesarean section or vaginal delivery, where outcomes of treatment failure or complications were reported were selected. DATA COLLECTION AND ANALYSIS: Data were abstracted independently by the reviewers. Comparisons were made between different types of antibiotic regimen, based on type of antibiotic and duration and route of administration. Summary relative risks were calculated. MAIN RESULTS: Forty-one trials were included. Overall the studies were methodologically poor. In the intent-to-treat analysis, fifteen studies comparing clindamycin and an aminoglycoside with another regimen showed more treatment failures with another regimen (relative risk (RR) 1.37; 95% confidence interval (CI) 1.10 - 1.70). Failures of those regimens with poor activity against penicillin resistant anaerobic bacteria were more likely (RR 1.73; 95% CI 1.14 - 2.63). In four studies that compared continued oral antibiotic therapy after intravenous therapy, no differences were found in recurrent endometritis or other outcomes. There was no evidence of difference in incidence of allergic reactions. Cephalosporins were associated with less diarrhea. REVIEWER'S CONCLUSIONS: The combination of gentamicin and clindamyin is appropriate for the treatment of endometritis. Regimens with activity against penicillin resistant anaerobic bacteria are better than those without. There is no evidence that any one regimen is associated with fewer side effects. Once uncomplicated endometritis has clinically improved with intravenous therapy, oral therapy is not needed.

Anti-Bacterial Agents↗

PubMed2003

Risk factors for postpartum endometritis and the effect of endometritis on reproductive performance in dairy cows in Korea.

The objectives of this study were to determine the risk factors for postpartum endometritis by evaluating several reproductive factors in individual cows, and to determine the effect of endometritis on the subsequent reproductive performance in dairy herds in Korea. The data, including health status, parity and body condition score (BCS) of cows, and calving date, were collected from 320 cows in eight dairy herds calving from January 2001 to October 2002. We used logistic regression to evaluate the effects of these factors on endometritis. A stepwise procedure, used to obtain the appropriate model with alpha=0.05, revealed that retained placenta, metabolic disorders and parity are the important risk factors for endometritis. The mean intervals from calving to first service and conception were prolonged (P<0.01) by 23 and 36 days, respectively, in the endometritis group compared to the non-endometritis group. The first service conception rate was lower (P<0.05) in the endometritis group (47.6%) than in the non-endometritis group (62.6%). The number of services per conception was higher (P<0.05) in the endometritis group (1.9) than in the non-endometritis group (1.6). We conclude that retained placenta, metabolic disorders and cow parity are strongly correlated with the development of postpartum endometritis, which decreases reproductive performance in dairy herds in Korea.

Animals↗

PubMed2002

Endometritis: the clinical-pathologic syndrome.

OBJECTIVE: The purpose of this study was to evaluate histologically proved endometritis as a clinical syndrome that is distinct from laparoscopically confirmed salpingitis. STUDY DESIGN: This was a cross-sectional study of 152 women in an urban hospital with a suspected pelvic inflammatory disease. All women provided a standardized medical history and underwent physical examination, endometrial biopsy, and laparoscopy. We defined endometritis by the presence of plasma cells in endometrial stroma and neutrophils in the endometrial epithelium. RESULTS: Of 152 women who were enrolled, 43 women had neither endometritis nor salpingitis; 26 women had endometritis alone without salpingitis, and 83 women had salpingitis. Those women with endometritis alone more often had douched recently, had a current intrauterine device, and were in menstrual cycle day 1 to 7, compared with women with no endometritis or salpingitis (P =.007,.04,.005, respectively) or women with acute salpingitis (P =.03,.01,.02, respectively). Infection with Neisseria gonorrhoeae and/or Chlamydia trachomatis was found more frequently in women with endometritis alone than in women with no endometritis or salpingitis (P <.001) and less frequently than in women with salpingitis (P =.05). Lower quadrant, adnexal, cervical motion, rebound tenderness, peritonitis, tenderness score, fever, and laboratory abnormalities that indicated inflammation and detection of gonorrheal or chlamydial infection were significantly less common in women with endometritis alone than in women with salpingitis but were somewhat more common in women with endometritis alone than among women with no salpingitis or endometritis. CONCLUSION: Among women with suspected pelvic inflammatory disease, the histopathologic manifestations of endometritis were associated with clinical manifestations, infection, and specific risk factors that were intermediate in frequency between women with salpingitis and women with neither endometritis nor salpingitis.

Biopsy↗

PubMed2005

Endometritis treatment with a PGF2alpha analog does not improve reproductive performance in a large dairy herd in Argentina.

In Argentina, most dairy cows with endometritis are treated with prostaglandin (PGF(2alpha) or its analogs) and insemination is withheld until there are no signs of endometritis. The objective of the present study was to evaluate if this method of managing endometritis enhances reproductive performance. Three experiments were conducted over 4 years in a large farm in the west of Buenos Aires province. In Experiment 1, half of the cows diagnosed with endometritis (>1.5-fold difference in diameter of uterine horns, as determined by rectal palpation) received standard endometritis management (treatment with tiaprost, a PGF(2alpha) analog, rectal palpation every 20 days, and withholding of AI until endometritis apparently resolved) and the other half was untreated, with AI at the first estrus after the voluntary waiting period. Untreated cows were inseminated and conceived 20 days earlier than treated cows, and the pregnancy rate by Day 90 postpartum was higher in the untreated group. In Experiment 2, cows with endometritis were divided into four groups according to the severity of symptoms; within each group, cows were allocated to treatment or control, as in Experiment 1. Although first service conception rate decreased as endometritis severity increased, reproductive performance in treated versus control cows was similar to that of Experiment 1 (with no interaction due to degree of endometritis). Re-evaluation of the treated cow (to confirm uterine "normality") may have been responsible for the delay in conception in both experiments. The objective of Experiment 3 was to determine the effects of tiaprost treatment on clinically normal postpartum cows (no evidence of endometritis). Tiaprost treatment reduced the interval from calving to conception in multiparous cows, but it delayed conception and reduced the conception rate in primiparous cows. In conclusion, treatment with tiaprost impaired reproductive performance in primiparous cows (in the absence of endometritis). Furthermore, the standard treatment for endometritis (treatment with a prostaglandin analog and withholding insemination until clinical signs abated) impaired reproductive performance and increased costs.

Animals↗

PubMed2002

Relationship between postpartum changes in 13, 14-dihydro-15-keto-PGF2alpha concentrations in Holstein cows and their susceptibility to endometritis.

Uterine infections (i.e., endometritis) can have a major economic impact on dairy production. Identifying cows that are susceptible to endometritis and improving the diagnosis of endometritis could lead to a reduction in the impact of such infections. Thus, we used Holstein cows to determine whether postpartum changes in 13, 14-dihydro-15-keto-PGF2alpha (PGFM), a metabolite of PGF2alpha, could be used to identify cows that are susceptible to endometritis and to improve the diagnosis of endometritis. Cows were assigned to three treatments. 1) Control (n = 10) had no clinical or bacteriological signs of endometritis during the study. 2) Treated (n = 11) developed endometritis spontaneously and were treated i.m. with 25 mg of PGF2alpha immediately after clinical diagnosis (d 17.6 +/- 0.8 postpartum; mean +/- SEM). 3) Untreated (n = 10) developed endometritis spontaneously and were not treated after diagnosis (d 20.0 +/- 0.5). Examinations of external and internal genitalia and bacteriological data were used to diagnose endometritis. From d 0 (calving) until approximately d 63 postpartum, jugular blood was collected three times weekly. Progesterone and PGFM were quantified in plasma. For PGFM, the treatment x day interaction was significant (P < 0.01). Overall PGFM profiles for Control and Treated differed (P < 0.05), but the Untreated profile did not differ from either Control or Treated. To better understand the interaction, PGFM data from d 0 to 35 postpartum were partitioned into consecutive 7-d periods, and d-36 and greater data were partitioned into one period. Effects of treatment, day, and the treatment x day interaction were then evaluated within period. Except for the d-15 to -21 period, PGFM was greater (P < 0.03) in Control than in Treated and Untreated. In Treated and Untreated, PGFM increased during the d-15 to -21 period. For progesterone, treatment did not affect the profiles, but day was significant (P < 0.001). Progesterone concentrations were basal from d 0 until approximately d 12, and they generally increased after d 12. Onset of endometritis was associated with increased progesterone concentrations. Treatment did not affect the interval from calving to first detected estrus (29.5 +/- 4.9 d) or from calving to AI (73.3 +/- 8.7 d). We conclude that PGFM measures have the potential to be used to identify cows that are more likely to develop endometritis and that PGFM may aid in the diagnosis of endometritis.

Animals↗

PubMed2005

[Influence of time of initiation of a prostaglandin F2alpha protocol in dairy cows with puerperal endometritis].

A field trial was conducted to elucidate the effect of the time of initiation of a repeated PGF2alpha-application in a 14 day interval for treatment of endometritis in dairy cows. On a commercial dairy farm in Brandenburg, Germany, a total of 494 dairy cows were examined by rectal palpation and adspection for signs of endometritis (vaginal discharge, enlarged uterus) between day 20 to 26 post partum (dpp). We performed two further examinations by rectal palpation and external adspection to monitor the puerperal phase (34.-40. dpp, 55.-61. dpp). All cows with symptoms of an endometritis were treated with PGF2alpha (0.15 mg R-Cloprostenol, Preloban, Intervet Deutschland GmbH Unterschleissheim) twice in a 14-day interval. In the group "Early" (n = 146) the first injection of Cloprostenol was administered at time of the 1st examination. In the group "Late" (n = 129) an identical treatment was administered in cows with endometritis, however it was started 14 days later (34.-40. dpp). The incidence of endometritis was 57.7% in the group "Early" and 53.5% in the group "Late" at the first time of examination. The 1st service conception rates for treated cows were 34% in the group "Early" vs. 37% in the group "Late". In the group "Early" differences were found in days open between treated cows with endometritis and untreated controls without symptoms of endometritis (99.1 d vs. 110.8 d, p > 0.05). In the group "Late", days open for treated (106.8 d) and untreated cows (108.0 d) were similar. The severity of endometritis influenced the percentage of cows pregnant at 200 dpp. Regarding cows with a severe endometritis (E2 and E3) the percentage of pregnant cows 200 dpp was higher in the group treated early (E2: 78.4%; E3: 80.0%) than in the group with the late initiation of the treatment (E2: 68.6%; E3: 54.5%, p < 0.05). Cows with a moderate endometritis (E1) had a similar percentage of pregnant cows (200 dpp) as the untreated cows without endometritis. It is concluded that application of PGF2alpha in the 4th and 6th week post partum in a 14 day interval in cases of severe endometritis is more effective than the application of the same treatment two weeks later.

Animals↗

PubMedDate not supplied

Detection of chronic endometritis at fluid hysteroscopy.

STUDY OBJECTIVE: Chronic endometritis is a subtle condition that is difficult to detect; however, it may cause abnormal uterine bleeding and infertility. Few data exist about the appearance of chronic endometritis at fluid hysteroscopy and about the value of diagnostic fluid hysteroscopy in the detection of this condition. In our experience, at fluid hysteroscopy chronic endometritis is characterized by consistent association of stromal edema and either focal or diffuse hyperemia; in some cases, this finding is associated with endometrial micropolyps (less than 1 mm in size). This study attempted to describe diagnostic criteria for chronic endometritis at fluid hysteroscopy and assess the diagnostic accuracy of fluid hysteroscopy in the detection of this condition. DESIGN: Retrospective Study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Nine hundred-ten women in whom hysteroscopy was indicated. INTERVENTIONS: Fluid hysteroscopy followed by endometrial biopsy. MEASUREMENTS AND MAIN RESULTS: Sensitivity, specificity, positive and negative predictive values, and accuracy of fluid hysteroscopy in the detection of chronic endometritis, based on the association of edema; hyperemia; and, if present, micropolyps were calculated. Based on the presence of hyperemia and edema, chronic endometritis was diagnosed in 158 patients (17.4%); in 61 patients (6.7%), micropolyps also were present. Histology confirmed the diagnosis in 101 patients (63.9% of positive cases at hysteroscopy) and was positive in 9 additional cases not detected by hysteroscopy. Chronic endometritis at histology was found in approximately 30% of infertile women and 35% of cases related to abnormal uterine bleeding. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for chronic endometritis based on detection of only hyperemia and edema were 91.8%, 92.9%, 63.9%, and 98.8%, respectively; the diagnostic accuracy was 92.7 %. The combination of hyperemia, edema, and micropolyps had sensitivity, specificity, and positive and negative predictive values of 55.4%, 99.9%, 98.4%, 94.5%, respectively, with a diagnostic accuracy of 93.4%. CONCLUSIONS: Fluid hysteroscopy is very reliable in diagnosing no inflammation, while detection of micropolyps is a very reliable sign of inflammation. When performing hysteroscopy for abnormal uterine bleeding or infertility, signs of chronic endometritis should always be sought.

Biopsy↗

PubMed2005

Prevalence of endometritis and its effects on reproductive performance of dairy cows.

Hostein cows (n=141) in five commercial dairy herds in central New York were examined for endometritis by examination of endometrial aspirates for presence of inflammatory cells, principally neutrophils, by endometrial cytology at 40-60 days postpartum. The prevalence of cytologically-diagnosed endometritis was 53%; within herds the prevalence varied from 37 to 74% (P=0.02). There was excellent agreement between two examiners (Kappa=0.864; P<0.0001). Parity did not influence prevalence of endometritis (P=0.53). Cytologically diagnosed endometritis was associated with profoundly impaired reproductive performance; Kaplan-Meier survival analysis revealed lower overall pregnancy rate (P<0.0001). Median days open was 206 for cows with endometritis and 118 for cows free of the condition. Overall, 76% of cows in this study became pregnant by 300 days postpartum; 63% of cows with endometritis and 89% of cows without endometritis were confirmed pregnant by 300 days postpartum (P<0.003). (For these two groups, 69, and 90% respectively, became pregnant during the duration of the study). Pregnancy to first service percentage was lower (11 versus 36%; P=0.001) for cows with than without endometritis, and these cows required more services before 50% became pregnant (3 versus 2; P=0.006). In a second study using 22 cows in a university-owned herd, the prevalence of cytological evidence of inflammation was 100% at 2 weeks postpartum, and dropped to 89, 58, and 41% at 4, 6, and 8 weeks, respectively. Endometritis diagnosed by endometrial cytology late in the voluntary waiting period was highly prevalent and exerted a profoundly detrimental effect on subsequent reproductive performance, making this condition potentially extremely costly to the North American dairy industry.

Animals↗

PubMed1978

Endometritis and infertility.

Endometrial biopsy is an essential tool in the evaluation of the infertile couple. Among the various causes of infertility which may be elucidated by such a biopsy, endometritis plays a significant role. In this review endometritis has been subdivided into three distinct pathologic entities: acute, chronic, and fibrotic. Detailed histologic features are discussed separately for each of these varieties. Most of the acute inflammations of the endometrium are cauased by bacteria. They are usually of short duration, respond well to treatment, and only rarely are associated with long-standing infertility. Chronic endometritis, on the other hand, can be caused by a variety of agents such as bacteria, viruses, and parasites. However, in the majority of cases with chronic endometritis the etiology cannot be determined and these are then considered nonspecific. Tuberculous endometritis, which is discussed under the heading of chronic endometritis, constitutes a common cause of infertility in certain countries but much less so in the United States. Other less common conditions such as mycoplasma infection and cytomegalic virus infection, have also been associated with reproductive failure. However, chronic endometritis, especially the most common so-called nonspecific type, is a relatively uncommon cause of infertility. The syndrome of intrauterine adhesions or synechiae has been classified here as fibrotic endometritis because of the pathogenesis and histopathology of this lesion. This entity is commonly associated with infertility and may constitute the end result of a long-standing inflammatory process in the endometrium. The diagnosis of endometritis is not a simple one and necessitates close cooperation between the clinician and pathologist. Pertinent clinical and detailed histopathologic data have to be exchanged between the treating physician and pathologist, especially in cases of infertility, in order for the patient to have benefit from the examination of endometrial tissue obtained.

Acute Disease↗

PubMed1998

Chronic plasma cell endometritis in hysterectomy specimens of HIV-infected women: a retrospective analysis.

OBJECTIVE: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients. METHODS: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surgical indication, and history of gonadotropin-releasing hormone (GnRH) use. Cases were evaluated for the presence of plasma cells and assigned a grade between 0 and 3. RESULTS: Indications included cervical dysplasia (4), carcinoma in situ (2), abnormal uterine bleeding (3), and adnexal mass (3). Some degree of abnormal uterine bleeding occurred in all cases. Plasma cell endometritis was twice as common in HIV-infected women compared to HIV-negative specimens (11/11 versus 11/22) (P < 0.05). Plasma cell endometritis was also of a higher grade in specimens from HIV-infected women than in controls (P = 0.001). CONCLUSION: Chronic endometritis was common and of a higher grade among HIV-infected women requiring hysterectomy in our series. Diagnosis and treatment of endometritis should be considered in HIV-infected women with uterine bleeding and/or tenderness. We speculate that antiretroviral and/or antimicrobial treatment for endometritis may effectively treat endometritis and eliminate the need for surgery in some HIV-infected women. We suggest that consideration and treatment of endometritis in HIV-1 infected women being evaluated for possible hysterectomy has the potential to reduce costs and morbidity for patients and providers who may be exposed during surgical procedures.

Adult↗

PubMed1995

Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum.

OBJECTIVE: To determine if asymptomatic antenatal colonization of the chorioamnion with Ureaplasma urealyticum is a risk factor for the development of post-cesarean delivery endometritis. METHODS: The chorioamnion was cultured at cesarean delivery for aerobic and anaerobic bacteria, mycoplasmas, Chlamydia trachomatis, and Trichomonas vaginalis in 575 singleton gestations with intact membranes. Culture results were compared with the clinical outcome. Postoperative endometritis was defined as a temperature of 38C with uterine tenderness and without other nonpelvic sources of fever. RESULTS: Fifty-eight (10%) of the 575 women developed endometritis. Women with spontaneous labor developed endometritis twice as often as those delivered for medical or obstetric indications (17 versus 8%, P = .002). Endometritis occurred in 28% of women with U urealyticum present in the chorioamnion at cesarean delivery, compared with only 8.4% if the culture was negative and 8.8% if only bacteria other than U urealyticum were isolated (P < .001). Gestational age less than 34 weeks, spontaneous labor, and a vertical uterine incision were all associated with endometritis (P < or = .002). Regression analysis controlling for gestational age and incision type revealed a threefold increased risk of endometritis if the chorioamnion was colonized with U urealyticum at cesarean (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.1-8.3) and an eightfold risk (OR 7.7, 95% CI 1.9-31.5) in women in whom the onset of labor was spontaneous. CONCLUSION: Colonization of the chorioamnion with U urealyticum in women with intact membranes being delivered by cesarean is a significant, independent predictor of subsequent endometritis.

Amnion↗

PubMed2004

The antimicrobial treatment of subacute endometritis: a proof of concept study.

OBJECTIVE: Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for endometritis. STUDY DESIGN: A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute endometritis and to determine the treatment effect on endometritis resolution. RESULTS: After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic endometritis (38% vs 4%), all P<.001. In women with prior pelvic inflammatory disease (PID), endometritis was present in 43% with and 28% without current Chlamydia trachomatis or Neisseria gonorrhoeae. In women without prior PID, endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae (P=.002 for trend). CONCLUSIONS: In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic endometritis. Prior PID is additive with current cervical infection as a risk for endometritis.

Adult↗

PubMed2005

Effect of presence of clinical and subclinical endometritis at the initiation of Presynch-Ovsynch program on the first service pregnancy in dairy cows.

The present study examined the effect of presence of clinical or subclinical endometritis at the initiation of Presynch-Ovsynch estrous synchronization program on the first service pregnancy rate in dairy cows. Lactating Holstein cows (N=275) were given a thorough reproductive examination at 32-38 days in milk, 3 days prior to the scheduled start of Presynch-Ovsynch program. Based on the reproductive exam findings the cows were diagnosed and classified into three groups as clinical endometritis, subclinical endometritis and normal. All cows received two set-up injections of 25mg PGF(2alpha) (Lutalyse((R)), Pfizer Animal Health, New York, NY, USA) i.m., 14 days apart starting at 35-42 days in milk (DIM). All cows received 75microg of GnRH (Cystorelin, Merial, Iselin, NJ, USA) i.m. 14 days after the second pre-synchronization injection of PGF(2alpha), followed by a third injection of 25mg PGF(2alpha) i.m. 7 days later. Cows received a second injection of 75microg of GnRH i.m. 54h after the third PGF(2alpha), and received timed artificial insemination at the time of the second GnRH injection or 24h later. Multivariate logistic regression was used to analyze the odds of pregnancy at the first service. Variables included in the model were endometritis status (clinical endometritis, subclinical endometritis and normal), farm (two), presence of corpus luteum (CL, yes or no), timing of second GnRH in relation to AI (0 or 24h), sire fertility (bulls with greater compared with lesser estimated relative conception rates), parity (primiparous and multiparous) and their interactions. Of all variable included in the model, cows with corpus letuem (OR=1.83 versus OR=1.00; P=0.05) 3 days prior to the scheduled start of Presynch-Ovsynch program and primiparous cows (OR=1.00 versus OR=0.55; P=0.04) had increased odds of becoming pregnant at the first service. No differences were found in the odds of first service pregnancy among clinical, subclinical endometritis and normal cows (P>0.1). In summary, presence of clinical or subclinical endometritis at the initiation of Presynch-Ovsynch estrous synchronization program does not harm the first service pregnancy rate in dairy cows.

Animals↗

PubMed2006

Association between endometritis diagnosis using a novel intravaginal device and reproductive performance in dairy cattle.

Endometritis reduces reproductive performance in dairy cattle. Diagnosis of endometritis is undertaken using a variety of techniques including vaginoscopy, manual examination, cytology and ultrasonography. The current studies compared a novel test device ("metricheck") that is inserted into the vagina with vaginoscopy and then examined the relationship between the metricheck test score at 35 days before the start of the seasonal breeding programme and subsequent reproductive performance. Cows (n = 191; Study 1) with a history of a peripartum disease were examined by both vaginoscopy and the metricheck device and any material viewed within the vagina (using vaginoscopy) or retrieved (by the metricheck device) was scored on a 0 (no material) to 5 (grossly purulent and with an odour) scale. Within each herd the order of examination was randomized with sequentially presented pairs of cows. All cows (n = 2793; Study 2) from nine herds were examined and scored using the metricheck device 35 days before the start of the seasonal breeding programme. All cows were pregnancy tested to determine date of conception. In Study 1, more cows were defined as infected (i.e. score > 1) following metricheck than vaginoscopic examination (60% versus 43%, respectively; P < 0.05) and the level of agreement between the two tests was moderate (kappa = 0.45). The metricheck device had a higher sensitivity, but lower specificity, than vaginoscopy. Endometritis (i.e. score > 1) was detected in 21.2% of cows examined in Study 2. The prevalence of endometritis varied among herds, declined with time postpartum (P < 0.05) and was higher in cows recorded as having a peripartum disease (P < 0.01). Cows diagnosed with endometritis were at higher risk of not being detected in oestrus before the start of breeding (P < 0.01), took longer to be inseminated after the start of the seasonal breeding programme (P < 0.01), had a lower first service conception rate (P < 0.01), had lower 56-day and final pregnancy rates (P < 0.05) and took longer to conceive than cows without endometritis (P < 0.05). It is concluded that examination with the metricheck device is more sensitive in detecting endometritis than vaginoscopy. Diagnosis of endometritis with the metricheck device was associated with poorer subsequent reproductive performance.

Animals↗

PubMed2004

Endometrial cytology and ultrasonography for the detection of subclinical endometritis in postpartum dairy cows.

The objectives of the study were to validate the use of endometrial cytology (EC) and ultrasonography (US) to diagnose subclinical endometritis in clinically normal postpartum dairy cows, and to measure the impact of subclinical endometritis on reproductive performance. Holstein cows from two dairy farms were examined at Visit 1 (V1) at 20-33 days in milk (DIM), and clinically normal cows (n = 228), based on the absence of abnormal discharge on external inspection and vaginoscopy, were selected. The reproductive tract of selected cows was evaluated by transrectal palpation, US and EC. All cows in the study were re-examined at Visit 2 (V2) at 34-47 DIM (2 weeks after V1) and were subsequently followed for a minimum of 8 months (until pregnant or culled). Survival analysis was used to derive a case definition of subclinical endometritis, based on factors associated with decreased relative pregnancy rate. Positive EC at V1 (>18% polymorphonuclear leukocytes; PMN) or fluid in uterus at V1 (FIU1) were associated with a significant reduction in the relative pregnancy rate and identified cows with subclinical endometritis. Similarly, a positive EC (>10% PMN) at V2 or fluid in the uterus at V2 (FIU2), identified cows with subclinical endometritis. Cows with subclinical endometritis at V1 and at V2 had a relative pregnancy rate of 41 and 51% (hazard ratio for pregnancy of 0.59 and 0.49), respectively, compared to cows without subclinical endometritis. Given EC or US findings, no diagnostic criteria based on transrectal palpation of the uterus had predictive value for risk of pregnancy. In conclusion, subclinical endometritis, diagnosed by EC or US, was associated with reduced relative pregnancy rate.

Animals↗

PubMed1997

Oral contraception and the recognition of endometritis.

OBJECTIVE: Oral contraceptive use has been associated with a lower risk of symptomatic pelvic inflammatory disease but a higher risk of chlamydial cervicitis. To explain these seemingly contradictory findings, we asked whether oral contraceptive use was more common among women with unrecognized endometritis than among women with recognized endometritis. STUDY DESIGN: A multicenter case-control study was performed. Women without signs of pelvic inflammatory disease were ascertained through contact tracing of partners with sexually transmitted diseases or through presentation with cervicitis. Women with symptomatic pelvic inflammatory disease met a set of standard clinical criteria. We compared the 43 cases without signs of pelvic inflammatory disease but with endometritis ("unrecognized endometritis") with the 111 controls with recognized pelvic inflammatory disease and endometritis ("recognized endometritis"). RESULTS: Women with unrecognized endometritis were 4.3 times (95% confidence interval 1.6 to 11.7) more likely than women with recognized endometritis to use oral contraceptives. CONCLUSION: Future studies need to fully characterize the risks and benefits of oral contraceptives in relation to sexually transmitted diseases.

Adult↗

PubMed2003

Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis.

OBJECTIVE: To determine if extended spectrum prophylactic antibiotic treatment (with efficacy against Ureaplasma urealyticum) reduces post-cesarean delivery clinical endometritis. METHODS: After cord clamping at cesarean delivery, subjects received prophylaxis with cefotetan. Subjects were then simultaneously randomized (double blind) to receive doxycyline plus azithromycin versus placebo. Post-cesarean delivery endometritis was defined clinically as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever. RESULTS: A total of 597 women were enrolled, 301 in the doxycycline/azithromycin group and 296 in the placebo group. The study population was 56% black, 25.5 +/- 6.2 years of age, and 43% nulliparous. The groups were similar (P >.05) for black race, parity, maternal age, and most risk factors for post-cesarean delivery endometritis. The frequency of post-cesarean delivery endometritis (16.9% versus 24.7%, P =.020), wound infections (0.8% versus 3.6%, P =.030), and a combination of these two outcomes (19.0% versus 27.8%, P =.019) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group. The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis (24.9% versus 12.5%, P =.042) and frequency of classic uterine incision (7.6% versus 12.5%, P =.048). Adjusting for these factors did not alter the risk ratio for post-cesarean delivery endometritis in the active versus placebo-treated group (relative risk 0.65, 95% confidence interval 0.43, 0.98). Length of stay was longer in the placebo group overall (104 +/- 56 versus 95 +/- 32 hours, P =.016) and among women with endometritis (146 +/- 52 versus 127 +/- 46 hours, P =.047). CONCLUSION: Extended spectrum prophylactic antibiotic treatment (with presumed efficacy against U urealyticum) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post-cesarean delivery endometritis and wound infections.

Adult↗

PubMed2003

Histologic endometritis in asymptomatic human immunodeficiency virus-infected women: characterization and effect of antimicrobial therapy.

OBJECTIVE: To estimate the prevalence, risk factors, clinical symptoms and signs, and response to antimicrobial therapy of histologic endometritis in human immunodeficiency virus (HIV)-infected women without clinical salpingitis. METHODS: This was a cross-sectional study of 42 HIV-infected women enrolled from a single clinic. Subjects underwent standardized history, examination, and laboratory determinations, including endometrial biopsy. Women with suspected pelvic inflammatory disease were excluded. All women were given antibiotics and repeat evaluation in 5-7 weeks. Histologic endometritis was defined by at least one stromal plasma cell per 120x field and five or more surface polymorphonuclear leukocytes per 400x field. Chi-square and Fisher exact tests were used as appropriate. RESULTS: Histologic endometritis was present among 16 (38%) of 42 evaluable HIV-infected women, none of whom had Chlamydia trachomatis or Neisseria gonorrhoeae. Douching three or more times per month, history of ectopic pregnancy, and two or more prior urinary tract infections were associated with endometritis, as was elevated erythrocyte sedimentation rate (P < or = .05). Physical examination findings and mean CD4+ lymphocyte count were similar among those with and without endometritis. In the nine HIV-infected women with a repeat biopsy, endometritis decreased from four (44%) to two (22%) after treatment (P = .30). CONCLUSION: The prevalence of histologic endometritis in HIV-infected women was high despite few examination findings and no demonstrated pathogens. Endometritis in HIV-infected women might be related to pathogens not evaluated, to prior infection, or to reduced immunity from HIV.

Adult↗