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L'inflammation génitale post-partum de la vache

Abstract : A routine bacterial contamination of the uterus at delivery is the rule in cattle, a unique feature among domesticated mammals. Calving stimulates activation of genital immunity in the cow. While post-partum inflammation can be regarded as physiological, its persistence beyond 21 days in milk (DIM) becomes pathological. The aim of this study was to describe in Holstein cows, uterine and cervical post-partum inflammation in a physiological and pathological context, using endometrial cytology as a gold standard. The first step was to validate cytological examination, as a reliable parameter. We found good inter- (ρc = 0.91, 95%CI, 0.89 - 0.94) and intra-operator (ρc = 0.88, 95%CI, 0.80 - 0.97) concurrence. However, samples taken at different sites of the uterus (cervix, uterine body, left and right horns) revealed the uneven distribution of inflammation in the female genital tract. The inflammatory status was not a reliable index of the bacterial colonization in the uterine lumen, as evidenced by conventional bacteriological techniques. Since neutrophils represented the predominant leukocyte subpopulation in genital specimens (median, 100%, interquartile range, 89 - 100%), the rate of neutrophils (% N; proportion of neutrophils among 200 cells counted) was used to characterize the inflammatory status of the cervix. Inflammation was then defined as pathological whenever the proportion of neutrophils in endometrial smears between 21 and 35 DIM exceeded ≥ 6%, since it was associated with a decreased pregnancy rate within 300 DIM (aHRs, 0.4; 95%CI, 0,2 - 0,7 ; P < 0,01). Furthermore, a proportion of neutrophils ≥ 1%, seven days or less prior to insemination, was associated with a decreased rate of success. Inflammation of the cervix was also associated with short (2%N threshold, seven days prior to insemination) and long term (5%N threshold between 21 and 35 DIM) reduction of reproductive performance. Since no endocervical inflammation was found in 31% of cows with endometrial inflammation, the cervix and uterus appeared as two separate compartments. The prevalence of pathological inflammation was high, ranging from 36 to 41% for the cervix and from 43 to 57% for the uterus, depending on the time of sampling. Finally, endocervical and endometrial inflammation appeared to have additive effects, since combined inflammations within 35 DIM reduced more than inflammation of a single compartment. We also investigated the kinetics of post-partum genital inflammation. The overall pattern is a decrease of %N in early post-partum (almost 20%N reduction between 21 and 35 DIM), followed by stabilization of the %N at a basal level until the breeding period. However, the study of individual profiles revealed peaks of inflammation (intense and fleeting) beyond 45 DIM. The kinetics of endometrial and endocervical %N appeared quite similar at any time. In the study of factors associated with inflammation, we failed to record a significant impact of sex steroids nor of energy supply to the cow, on the proportion of neutrophils in genital smears. The results of our cytological examinations were confronted with those of routine diagnostic techniques for endometritis commonly used: transrectal palpation, vaginal examination and uterine ultrasonography. Compared to cytological examination, the only reliable diagnostic criterion for genital inflammation was the observation of pus (mucopurulent or purulent discharge) following vaginal examination (Se = 56%, Sp = 88%, PPV = 85%, NPV = 63%). However, this method did not allow the diagnosis of subclinical forms, which represented over 40% of healthy looking cows. In conclusion, we suggest dropping the usual designation of uterine inflammation and to substitute the concept of genital inflammation, covering both uterine and/or cervical inflammation.
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Submitted on : Friday, May 6, 2011 - 3:50:06 PM
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Laure Deguillaume. L'inflammation génitale post-partum de la vache. Médecine vétérinaire et santé animale. AgroParisTech, 2010. Français. ⟨NNT : 2010AGPT0081⟩. ⟨pastel-00591104⟩

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