Arvind Sharma

Assistant Professor

Deptt. Of Surgery & Radiology

DGCN COVAS, CSK HPKV, Palampur

Canine Pyometra Complex accumulation of purulent material within the uterus.

cystic endometrial hyperplasia-pyometra complex.

Potentially a life threatening condition

Develops during diestrus.

Diagnosis gets delayed and unrecognized until anestrous.

Pathophysiology of CPC develops during diestrus

high and prolonged ovarian production ofprogesterone

Fluid accumulates in the endometrial glands

Uterine drainage is hindered by progesteroneinhibition of myometrial contractility.

Abnormal uterine environment allows bacterialcolonization to cause Pyometra.

Administration of estrogen increases the risk ofPyometra during diestrus.

CPC- Pathophysiology contd… Estrogen increases the number of uterine progesterone

receptors

Leukocyte response to bacteria is inhibited in progesterone – primed uterus- E. coli

Open or close d cervix pyometra

dehydration and toxemia ensues.

Compression and over distension of the uterus -peritonitis

Torsion of the distended uterus may also occur.

CPC- Concurrent abnormalities Hypoglycemia

Prerenal azotemia

Hepatocellular injury

Anemia

Coagulation deficits

Cardiac arrhythmias

Diagnosis of CPC Signalment: older intact bitches (6 to 11 years) , Nullipara bitches

History: several weeks (4-8 weeks) after estrus

purulent or bloody vaginal discharge.

abdominal distention, fever, partial to complete anorexia, lethargy, polyuria, polydipsia, vomiting, diarrhea and weight loss.

Closed Pyometra - vomiting and diarrhea.

Physical examination findings

Dehydration ,endotoxaemia or septicemia may be in shock, hypothermic and moribund. Fever is infrequent.

Diagnostic imaging:

Ultrasonography - uterine contents; determine uterine wall thickness and irregularities.

Radiographic confirmation of Pyometra may not be possible until 41 to 43 days after ovulation.

Caution….. Never perform a transabdominal percutaneous

puncture to aspirate the uterine contents.

Leakage of the pus in the abdominal cavity usually occurs leading to a usually fatal peritonitis.

Treatment of CPC Medical treatment: prostaglandin therapy (PGF2α) - inappropriate for critically

ill patients ,evacuation is neither immediate nor incomplete.

Medical therapy with antibiotics for 2-3 weeks and with PGF2α or preferably Aglepristone combined with Cloprostenol should be considered only for metabolically stable, valuable, breeding animals.

Medical therapy is most appropriate for animals with an open Pyometra.

Expect Pyometra to recur in 20% cases during subsequent estrus cycles.

Doses: PGF2α 0.1-0.25mg/kg SC, qd or bid for 3-5 days Aglepristone 10mg/kg SC on days 1,3,8 and 15 Cloprostenol 1µg/kg SC, days 3 and 8.

Surgical treatment of CPC Ovariohysterectomy should not be delayed

Morbidity and mortality are associated with concurrent metabolic abnormalities and organ dysfunction.

Hydration, electrolyte and acid base imbalances should be corrected before surgery.

Ovariohysterectomy should be performed invariably by mid ventral approach of the abdomen. Flank approach must be avoided due to chances of rupture of the already friable pus filled uterus during manipulation and evacuation between the flank muscles. Do not use spay hook to locate or exteriorize the uterus as it may tear the uterus.

Do not correct uterine torsion because this will release bacteria and toxins.

Exteriorized pus filled uterus

Post- operative follow up Closely monitor the patients for 24-48 hours for sepsis

and shock, dehydration and electrolyte/acid-base imbalances.

Fluid therapy should be continued post operatively until the animal is drinking and feeding normally.

Stump Pyometra may occur.

Prognosis following surgery is good

- if abdominal contamination is avoided

- shock and sepsis are controlled

- renal damage reversed by fluid therapy and bacterial antigen elimination.

Thank You