Equis ISSN 2398-2977

Uterus: lavage

Contributor(s): Reed G Holyoak, Philippa O'Brien, Jonathan Pycock

Introduction

  • Uterine lavage is an important treatment option for mares with delayed uterine clearance who are susceptible to persistent mating-induced endometritis   Uterus: endometritis - bacterial  and other similar uterine pathologies.
  • The aim of treatment should be to assist the uterus to physically clear the normal inflammatory by-products of the response to breeding and/or infection. Since within 4 h of mating the spermatozoa necessary for fertilization are present within the oviduct, and since the embryo does not descend into the uterus for about 5 ½-6 ½ days, mares may be treated safely from 4 h after mating, until 3 days from ovulation, providing non-irritant therapy is used.
  • However, progesterone concentrations rise rapidly following ovulation in the mare and it is preferable to avoid treatment involving uterine interference beyond 2 days after ovulation.
  • Both coitus and artificial insemination can be a source of uterine contamination; it is well known that spermatozoa themselves are responsible for initiating a marked inflammatory response. This is why susceptible mares should only be bred once per cycle and close to ovulation, regardless of whether natural mating or artificial insemination is used.
  • The successful management of susceptible mares should logically require some form of post-mating therapy such as intra-uterine antibiotic infusion, uterine lavage and intravenous or intramuscular oxytocin; these may be used alone or in combination.
  • The emphasis should be on treatment in relation to breeding and not ovulation.
  • Too often in the past veterinarians have waited until ovulation before treating these mares. By then there has usually been a large accumulation of fluid and the bacteria are in a logarithmic phase of growth.
  • It is mainly the infusion of semen into the uterus that causes an inflammatory reaction    →   a persistent endometritis in susceptible mares. Ideally these mares will only be bred once, but if repeated mating is necessary, uterine lavage should be performed after each mating.

Uses

  • The removal of accumulated uterine fluid, potential pathogens and inflammatory debris which may interfere with neutrophil function and the efficacy of antibiotics.
  • Stimulation of uterine contractility.
  • Recruitment of fresh neutrophils through mechanical irritation of the endometrium.
  • Large-volume lavage is also used for treatment of retained fetal membranes in post-partum mares   Placenta: retained  .
  • Low-volume uterine lavage may be used to a diagnostic tool to identify bacterial and fungal uterine pathogens. 50-100 ml sterile saline is infused via a uterine catheter or pipette, and the fluid recovered may be submitted for culture and cytological examination.
  • During the process of embryo transfer, uterine lavage is used to recover embryos from donor mares   Embryo Transfer  .

Advantages

  • Large volume lavage is beneficial in many cases, particularly in the mare with a relatively large (>2 cm depth) accumulation of fluid after breeding.
  • The cervix is dilated by the passing of the catheter assisting fluid removal.
  • If the fluid which has accumulated in the uterus is high in neutrophils, and other debris, the fluid infused can better flush this material out than ecbolic agents such as oxytocin   Oxytocin  alone.

Disadvantages

  • The process is time-consuming and there is the possibility of further contamination of the uterus by passage of a lavage catheter.

Requirements

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Preparation

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Procedure

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Aftercare

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prognosis

  • A safe technique to perform.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Ferris R A, Frisbie D D & McCue P M (2014) Use of mesenchymal stem cells or autologous conditioned serum to modulate the inflammatory response to spermatozoa in mares. Theriogenology 82 (1), 36-42 PubMed.
  • Cocchia N et al (2012) Comparison of the cytobrush, cottonswab and low-volume uterine flush techniqes to evaluate endometrial cytology for diagnosing endometritis in chronically infertile mares. Theriogenology 77 (1), 89-98 PubMed.
  • LeBland M M & Casey R C (2009) Clinical and subclinical endomtetirits in the mare: both treats to fertility. Repro Dom Anim 44 Suppl 3, 10-22 PubMed.
  • Knutti B, Pycock J F, van der Weijden G C & Kupfer U (2000) The influence of early postbreeding uterine lavage on pregnancy rate in mares with intrauterine fluid accumulations after breeding. Equine Vet Educ 12 (5), 267-270 VetMedResource.

Other sources of information

  • Troedsson M H T (2011)Endometritis.In:Equine Reproduction. 2nd edn. Eds: McKinnon A O, Squires E L, Vaala W E & Varner D D. Wiley-Blackwell. pp 2608-2619.


ADDED