Pyometra, Canine - contd.
Pyometra usually necessitates immediate therapy. Those patients with a closed cervix may be more ill at the time of diagnosis. Intravenous fluids and antibiotics are routinely administered to patients that are severely ill, irrespective of the patency of the cervix. Potent antibiotics are given by injection, in combinations to target the most common bacterial pathogens. Supportive measures are customized for individual patient needs, according to the levels of shock, dehydration, electrolyte imbalance, organ dysfunction or cardiac arrhythmia. The patient is stabilized medically, if possible, to prepare for emergency ovariohysterectomy, or spay, to remove the infected uterus and the ovaries from the abdominal cavity. Most patients are released two to three days after uncomplicated surgery. Antibiotics are continued for seven to 10 days after most procedures.
While surgery is considered the treatment of choice for companion animals with pyometra, owners of valuable breeding animals may elect to treat pyometra medically. Stable patients may be given prostaglandin f2-alpha by injection for several consecutive days to dilate the cervix, stimulate uterine contractions and to decrease the blood progesterone level. The dog remains hospitalized for observation, monitoring for side effects of the prostaglandin or for worsening condition, and for continued antibiotic administration. Clinical improvement is expected within the first 48 hours of medical treatment. Surgery should be considered for patients that deteriorate. If purulent vaginal discharge persists seven days after conclusion of treatment, or if other parameters indicate ongoing infection or uterine enlargement, then repeating the treatment may be advised, provided that the patient remains physiologically stable.
Some veterinarians reserve attempted medical evacuation of the uterus for those patients with an open cervix. Cervical dilation is inconsistent with prostaglandin f2alpha, thus the drug may cause expulsion of infected materials into the abdominal cavity through the fallopian tubes, or direct uterine rupture if administered to patients with a closed cervix.
