Dr. Saurabh Banerjee, Veterinary Assistant Surgeon, V.H. Pondi (Bachra), 
Baikunthpur District- Korea Chhattisgarh.
Dr. Kanchan Walwadkar, Assistant Professor Senior Scale, Department Of Veterinary Medicine C.V.Sc. and A.H., NDVSU Jabalpur Madhya Pradesh.

ABSTRACT:- Pyometra , a hormonally mediated acute or chronic polysystemic diestrul disorder is the most common genital disease in bitches and results in high mortality if remains untreated . The diagnosis of pyometra was made with correlating the history and clinical signs with the findings of abdominal palpation, radiography , and ultrasonography . The physiological , haematological and biochemical parameters were evaluated before and at the end of therapy. The clinical case therapy are of four types. The bitch was treated with natural PGF2α , and a lower dose of synthetic PGF2α (Cloprostenol), & Antiprogestins and Dopaminergic agonists ( Cabergoline), Along with broad spectrum antimicrobials and other suppotive therapy was given. OHE is the treatment of choice.

Keywords:- Pyometra, natural prostaglandin, synthetic prostaglandin, cabergoline Anti progestins .

List of abbreviations :- PCV = Packed cell volume, BUN = Blood urea nitogen .

“PYOMERTA “ literal meaning that is“pyo” means pus and “metra” means uterus accumulation of purulent material in the uterus , (Smith, 2006) . It is a diestrul disorder, is the most common genital disorder where a imbalance of estrogen and progesterone in combination with a secondry bacterial infection in order to maintain fertility or avoid the risk of surgery the medical treatment is advocated . Progesterone inhibits uterine contractions , responsible for the cervical closure , has negative effects on uterine immunity while protecting against infections and facilitating uterine secretions and cystic endometrial development . Therefore during the treatment of pyometra the effects of progesterone should be inhibited either directly by luteolysis using prostaglandins or indirectly either by using dopamine agonists which induces functional arrest anf finally luteolysis of CL , Through inhibition of prolactin or by using P4 receptor antagonists which prevents progesterone binding to it’s receptor . The most important hormone regulating the corpora lutea of Bitch is prolactin which is luteotrophic in nature.

Aetiology :- 1. E. coli 85-90% cases common in aged bitch more than 8 years , young are affacted by administration of Estrogen to manage mismating.

2. Staphylococcus, Streptococcus, klebsiella , pseudomonas, proteus .

Breed Predisposition :- Rough coated collies , Rottweillers , Golden Retrivers .

Parity :- Intact bitch with regular breeding and whelping develop endometrial hyperplasia and predisposes to endometrial hyperplasia pyometra complex, (CPC / CEH ).

Pathogenesis:- Rise of P4 in early estrus , non specific immune response , expression of TLR ( Toll like receptor) , it is required for embryo implantation and development however in in old intact bitches CEH (Result of pregnancies & exaggerated response of progesterone. It is the presence of E. Coli contamination from vagina & it’s property LPS . Increased immune response expression of TLR-2 & TLR-4 , Cytokines incresed, COX-2 increses, PGE2 & PGF2α increses , incread local inflammatory response. In Closed pyometra some of the risk factors such as rupture of uterus , peritonitis, toxemia , death can occur. If remains untreated.

Clinical Signs :- vaginal discharge ( in open cervix pyometra), lethargy , vomition, sometimes diarrhoea , distension of abdomen, Temp normal/ slightly elevated and sometimes subnormal in toxaemic bitches , polyuria, polydipsia.

Diagnosis:- Based on History ( old age , nullipara, intact, misallince ) , based on clinical signs , haematology biochemical analysis , analysis of C- reactive protein most important acute phase protein in canine indicative of inflammatory process, radiography , USG , Urine Analysis . In different tests starting from haematology shift to left regenerative neutrophilia, shift to left degenerative neutropenia, normocytic and normochromic anaemia due to toxic suppression of bone maarow, ALP Elevated, SGPT/ALT elevated, BUN & Creatinine ( produced by dehydration of creatine and deohosphorylation of phosphocreatine in muscles), TSP, Globuline elevated , PCV elevated , Globuline elevated, uraemia . Radiography reveals homogenous tubular opacity in caudoventral abdomen ( not recommended in pyometra) , USG reveals distension of uterus with anechoic or hyperechoic fluid, thickend and cystic endometrium, Urine analysis reveals hyposthenuria and isosthenuria ( means decresed specific gravity & normal specific gravity of urine ) normal sp. Gravity = 1.015- 1.045 , due to reduced renal medullary hypertonacity and renal tubular insensitivity to ADH Because of bacterial toxin liberation. Proteinuria.

Treatment :- Treatment of choice is OHE. But in order to maintain fertility or avoid the risk of surgery the medical treatment is adopted medical treatment consists of four types

1. PGF2α Combined with antibiotic and fluid :- It consists of natural and synthetic PGF2α

Dinoprost – 100-250mcg/kg Bw for 5-7 days

Cloprostenol- 10mcg/kg Bw

Amoxicillin + Potassium Clavulinate – 12.5-25mg/kg BW ORALLY

Second treatment may be required after 2 weeks. Before PGF2α adminitration atropin sulphate @ 0.02-0.04mg/kg is given in order to minimise the side effect withdrawl of feed and water is recommended , a short walk after PGF2α Administration it will facilitates early metabolism and excretion of end product of PGF2α.

EFFECTS:- Copius vaginal discharge for 2 days , change in quality of discharge , puruent to mucopurulent and then clear, luteolysis and uterine contraction is the outcome of treatment.

Antiprogestins :- Progesterone inhibits uterine contractions and responsible for the cervical closure , and has negative effects on uterine immunity and facilitates uterine secretions and cystic endometrial development that’s why it’s effect need to be inhibited. It compititively binds with progesterone receptor , not uterotonic .

1. ALGIPRISTONE ALONE :- 2 protocols first -5-6mg/kg BW s/c 12hrs interval , on day 1 , 3 mg/kg on day 2/3/4 and then 3 mg/kg BW every 4 days interval ( total 16 days ). Second one is 6 mg/kg Bw s/c on day 1 (12 hrs. interval) and 3mg/kg BW on day 2/3/4 .

2. ALGIPRISTONE ALONG WITH CLOPROSTENOL :- Algipristone – 10mg/kg and cloprostenol- 1 mcg/kg BW on day 3/4/5 /6/7 acts as ecbolic agent enhances uterine contraction.

3. SUCCESS RATE IN BOTH TREATMENT :- Dinoprost – 93%

Cloprostenol- 90%

Algipristone alone – 60%

Algipristone+ Cloprostenol- 85-90.

4. D2 agonist /PRL antagonist along with cloprostenol: - It is the most succesful treatment it causes fuctional arrest and finally luteolysis of CL. Ccabergoline and Bromocriptine are two D2 agonists , Cabergoline @ 5mcg/kg and Bromocriptine @ 10mcg/kg BW Orally is given and cloprostenol @ 1mcg/kg BW s/c for 7 days( B. JENA et.al).

Success Rate upto 100% , and low recurrence rate upto 29% .

5. SUPPORTIVE TREATMENT:- Fluid therapy depending upon degree of dehydration RL is given because metabolic acidosis develops in pyometra antihistamines , NSAIDs , antiemetic , anticholinergic should be given.