Conditions of the Reproductive System (female)

Conditions of the female reproductive tract

- Vaginal disorders
- Uterine disorders
- Pregnancy-related disorders
- partition disorder (dystocia)
- Lactation disorders
- neoplasia (tumours)

What are many reproductive issues caused in females?

Hormones

What is pyometra?

An accumulation of pus within the uterus.

What condition is associated with pyometra?

Cystic endometrial hyperplasia.

What causes cystic endometrial hyperplasia?

Successive progesterone cycles.

What type of bacteria is commonly associated with pyometra infections?

E. coli.

During which phase does pyometra become infected?

Dioestrus.

What does 'Pyo' refer to in medical terminology?

Pus.

What does 'Metra' refer to in medical terminology?

Uterus.

What does the term 'pyometra' literally mean?

Pus in the uterus.

Cystic endometrial hyperplasia is..

Cysts will lie in the lining of the uterus

How does Cystic endometrial hyperplasia occur?

Occurs after multiple cycles when the animal has been exposed to progesterone more

What is a risk factor for pyometra in dogs?

Intact bitches (have a uterus)

What percentage of bitches with pyometra are nulliparous females?

75%

What is the mean age of dogs diagnosed with pyometra?

9.5 years

When is pyometra most often diagnosed in relation to the reproductive cycle?

2 weeks - 4 months after oestrus

Which breeds are predisposed to pyometra?

Golden retriever, rottweilers, collies, Bernese mountain dogs, Airedale terriers & Irish terriers

Nulliparous females are..

Ones that have not been bred

Clinical Signs of Pyometra

- Polydipsia
- Polyuria
- Anorexia
- Lethargy
- Vomiting
+/- purulent vulval discharge - don't always get it, cervix could be close to discharge wont come out

When is pyometra most commonly seen after oestrus?

4 - 8 weeks post-oestrus

What effect does progesterone have on the uterine wall?

Thickening of the uterine wall

What does progesterone increase in uterine glands?

Increased secretions from uterine glands

What happens to the cervix due to progesterone?

Closure of the cervix

How does progesterone affect uterine contractions if an animal is pregnant?

Decreased uterine contraction

What immune response effect does progesterone have?

Suppression of immune responses

Luteal phase

High progesterone during this phase

Creates a moist, humid environment which bacteria love

Pregnant during this phase

What hormone causes thickening of the uterine wall during the luteal phase?

Progesterone

What condition may result from the thickening of the uterine wall during the luteal phase?

Cystic endometrial hyperplasia

Cystic endometrial hyperplasia and which other condition are often presented together?

Pyometra

What is cystic endometrial hyperplasia characterized by?

Hyperplasia of the endometrium and abnormal proliferation and dilation of glands within the endometrium

What happens during oestrus regarding the uterus and bacteria?

It is normal to have contamination of the uterus by commensal bacteria from the vagina.

What is the ability of a normal uterus to handle bacterial contamination?

A normal uterus can clear the contamination.

What happens to the uterus with endometrial hyperplasia in terms of bacteria clearance?

It may find clearing the bacteria more difficult.

What factors contribute to the difficulty in clearing bacteria in a uterus with endometrial hyperplasia?

Closure of the cervix, increased glandular secretion, decreased uterine contractions

What condition develops when bacteria proliferate in a uterus with endometrial hyperplasia?

Pyometra

An unhealthy uterus..

Crevices in between cysts - bacteria get trapped - in a healthy uterus it would able to be cleared

Diagnoses of Pyometra

Clinical examination​ - Any vulval discharge, distended abdomen (due to increased pus within the uterus)
​
Blood sample​ - Elevates WBC count​
​
Ultrasonography​
​
Radiography

What is the first choice treatment for managing Pyometra?

Surgery

What surgical procedure is commonly performed for Pyometra?

Ovariohysterectomy

What should be done before performing surgery for Pyometra?

Stabilise the patient, provide IVFT, and administer antibiotics

What are the components of medical management for Pyometra?

Antibiotics, IVFT, and medications that open the cervix, increase uterine contractions, and promote luteolysis

What indicates that Pyometra can be treated medically?

The presence of vulval discharge (open Pyometra)

What can happen if Pyometra is not treated?

It could rupture, leak into the abdomen, and cause sepsis

What is pseudopregnancy?

A 'false pregnancy' - hormonally driven behaviour changes in a non-pregnant bitch.

When does pseudopregnancy typically occur?

2-3 months post-oestrus.

Which age group of bitches is most affected by pseudopregnancy?

Young to middle-aged bitches.

How does pseudopregnancy typically change with each season?

It often becomes worse after each season.

What hormonal change is associated with pseudopregnancy?

A rise in prolactin levels.

What happens to progesterone and prolactin levels during pseudopregnancy?

Progesterone levels decrease naturally while prolactin levels rise.

Clinical signs of a pseudopregnancy

- Mammary development + lactation of milk/clear brown fluid​
- Behaviour changes
- Abdominal distension​
- Polyphagia / anorexia​
- Polydipsia

What are the Behaviour changes seen in a pseudopregnancy?

Nesting behaviour​
Adopting objects​
Aggression / nervousness​
Depression​

What happens to progesterone levels during metoestrus in pseudopregnancy?

Progesterone levels fall.

What changes occur in prolactin during pseudopregnancy?

There is increased production of and sensitivity to prolactin.

What is one role of prolactin in pseudopregnancy?

Mammary gland development ready to feed pups.

What does prolactin promote in relation to maternal behavior?

It promotes maternal behavior.

What is another role of prolactin in pseudopregnancy?

Milk production.

What is the management approach for mild pseudopregnancy?

No action needed, will pass by themselves.

What is the management approach for severe pseudopregnancy?

Prevent prolactin release with cabergoline and provide sedation if aggressive.

What surgical procedure is recommended for severe pseudopregnancy once in anoestrus?

Ovariohysterectomy.

What is the function of cabergoline in the management of pseudopregnancy?

It is a dopamine receptor agonist that stops the production of prolactin.

What hormone is primarily involved in pseudopregnancy issues?

Prolactin.

What is the second most common tumor in mammals?

Mammary gland neoplasia

What percentage of all tumors does mammary gland neoplasia account for?

25-50%

What type of growth is mammary gland neoplasia?

Hormonally driven

How would you describe the consistency of mammary gland neoplasia?

Hard, not soft

What percentage of mammary gland neoplasia cases are benign?

Approximately 50%

Which breeds are commonly affected by mammary gland neoplasia?

Poodle, terriers, spaniels, Siamese cats

What is the average age at presentation for mammary gland neoplasia?

10-12 years old

At what age does the incidence of mammary gland neoplasia increase?

From 6 years

What is a risk factor for mammary gland neoplasia related to previous treatments?

Previous treatments for oestrus control, such as the use of progestogens, increase the likelihood of developing the tumor.

What is the risk of developing mammary gland neoplasia if neutered after 2.5 years old?

Neutering after 2.5 years old increases the risk of developing mammary gland neoplasia.

What is the risk of developing mammary gland neoplasia if neutered before the first season?

Neutering before the first season results in a 0.5% risk.

What is the risk of developing mammary gland neoplasia if neutered after the first season?

The risk increases to 8% if neutered after the first season.

How is obesity related to mammary gland neoplasia?

Obesity is linked with survival time after surgery for mammary gland neoplasia.

What is a history of pseudopregnancy considered in relation to mammary gland neoplasia?

A history of pseudopregnancy is a risk factor for developing mammary gland neoplasia.

Diagnoses of mammary gland neoplasia

- Physical examination _ history
- Thoracic radiography = Masticated or not, can develop in the lungs, clear x-ray could also mean that they have micro-mastocytes
- Ultrasound
- Blood analysis
- Fine-needle aspirate/Biopsy = seeing how nasty it is

Treatment of Mammary gland neoplasia

Surgical excision

Prognostic factors of mammary gland neoplasia

- Tumour growth rate = more harmful and nasty it can be
= any infiltration of nearby tissues?
- Inflammatory changes/ulceration of tissues
- metastasis - bad
- Size of tumour
- Timeliness of diagnosis
- Invade tissues = more nasty