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by Claire Duder, D.V.M.

Pyometra literally means "pus in the uterus". Pyometra is a serious, potentially life-threatening disorder, most commonly seen in the middle-aged diestrual (post-heat) bitch. Changes in the uterine lining, called cystic endometrial hyperplasia (CEH), due to the effects of the hormone progesterone, are thought to be the first stage in the development of pyometra. Bacteria (usually E. coli) entering through the cervix or the bloodstream multiply rapidly in the abnormal uterine lining, and the uterus quickly fills with pus. Clinical signs of pyometra may include depression, anorexia, abdominal distension, vomiting and diarrhea, and increased thirst and urination. A putrid vaginal discharge may or may not be present, depending on whether the cervix is open or closed. Diagnosis of pyometra is usually straightforward; any post-estral bitch (whether or not they were bred) who is not well should have a white blood cell count done, and an abdominal xray or ultrasound to visualize the uterus, even if there is no obvious discharge. Treatment of pyometra will involve either an emergency ovariohysterectomy (best for clode-cervix pyometras and older bitches no longer intended for breeding), or treatment with prostaglandins to stimulate emptying of the uterus (best for open-cervix pyometras in valuable breeding bitches). Fluid therapy and antibiotics will also be required. The only sure prevention of pyometra is spaying; obviously not an option in the brood bitch!

This excellent photograph above, submitted by Cat Angus, shows Hope's [Cat's Mastiff bitch] uterus, filled with pussy infection, at the time of spay for pyometra. The uterus should be about the size of a garden hose or a rope, or about the outside diameter of the fingerholes in the clamps (which are approximately 6" long) shown in the picture.

by dee dee Andersson

As Claire wrote above, pyometra is widely recognized as one of the most serious and dreaded infections that can occur in a valuable breeding bitch. Pyo means pus, metra means uterus, so it is literally pus in the uterus. As recently as 15 years ago when a bitch was confirmed with pyometra the only immediate and satisfactory resolution in order to save the bitch's life was to institute antibiotic and fluid therapies in order to stabilize and strengthen her and then surgery to remove the ovaries and uterus.

There are two types of pyometra, open and closed. Neither should ever be taken lightly. At the onset of any symptom the bitch should be taken to the veterinarian at once. Of the two forms, open pyometra is the least severe because the cervix is open and allows drainage of the pus. In some open pyometra cases the condition has been mistakenly diagnosed as an aberrant heat. The abnormal vaginal discharge is foul smelling, of creamy consistency and tomato soup in color (although it can begin as a greyish color before turning to soup hue).

The closed form has no avenue to drain since the cervix is not open, consequently the pus builds up inside the uterus, intensifying and spreading the infection until the bitch's life is in jeopardy. In the case of closed pyometra, because the uterus enlarges due to an accumulation of pus, there will be a pronounced swelling of the abdomen. Other signs of this infection are a noticeably increased thirst, increased urination, fever, extreme lethargy and overall weakness. When clinical blood work is performed it will reveal an elevated white blood cell count.

This picture is an excellent graphic to show the true tomato color
of the abnormal discharge produced by the infected uterus.

The condition has often been blamed on hormonal imbalances. It was once thought to occur only in older bitches who had irregular heat cycles, although mismate shots administered to abort ill conceived litters are also known to have caused pyometra. The infection will most often develop within weeks of going out of heat, whelping a litter, or after being bred and missing conception. The earlier pyometra is diagnosed and appropriate therapy begun, the better the chance of preserving the bitch's uterus.

This picture shows the uteus of a spayed Neo bitch
that got bred accidently. The vet estimated there were
13-14 puppies in this healthy uterus.

The treatment of choice is difficult for the bitch. My bitch was treated with high dosages of antibiotic and received two daily injections of prostaglandins for more than a week. The stinging shots are intended to cause hard uterine contractions to squeeze pus out of the uterus. Immediately after the shots are administered the bitch should be walked for at least 30 minutes, as this helps her endure the treatment with less discomfort. The treatment causes vomiting, and it can cause diarrhea.

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