PROGESTERONE RECEPTOR BLOCKER IN THE TREATMENT OF CLOSED PYOMETRA IN A BITCH

Pratyush Kumar1, S.N. Shukla2, Apra Sahi and Abhishek Bisen3
1M.V.Sc. Student, 2Associate Professor, 3Ph.D. Scholar, Department of Veterinary Gynaecology and Obstetrics; College of Veterinary Science and Animal Husbandry; NDVSU; Jabalpur – 482001 (M.P.), India. [Received: 03.3.2018; Accepted: 04.9.2018] {DOI 10.29005/IJCP.2018.10.2.137-138}

A five years old Pomeranian bitch was presented to the clinics with the history of anorexia, dullness, vomition
and a highly distended abdomen. A closed pyometra was diagnosed based on medical history, clinical examination and laboratory findings. Medical management of the condition with Mifepristone and Misoprostol with supportive therapy was done for 8 days. Pus discharge from vagina started gradually on day 3 of treatment. On ultrasonographic examination pus pockets were still detected on day 7. Hence, Dinoprost tromethamine was used for next 7 days with recommended dosage which lead to complete reduction in uterine lumen and absence of visible discharge by day 14 of the treatment. Administration of dinoprost tromethamine in combination with mifepristone can be used effectively in the treatment of pyometra in bitches.
Keywords: Closed pyometra, Mifepristone, Misoprostol, Dinoprost, Bitch.

Pyometra is a reproductive disorder of diestrual bitch which affects nearly one fourth of all female dogs before they reach ten years of age (Egenvall et al., 2001). By definition it is the accumulation of pus within the uterine lumen, typically occurring during or immediately following a period of progesterone dominance (Noakes et al.,
2009). Progesterone receptor blockers (Mifepristone) have been used as treatment for closed pyometra in canines (Fieni, 2006). Its use in combination with prostaglandin has therapeutic possibilities with a high success
rate for treatment of pyometra (Shah et al., 2016).

Case history and Diagnosis
A five years old female Pomeranian dog was presented at TVCC, College of Veterinary Science and Animal Husbandry, Jabalpur with the history of anorexia, dullness, frequent vomition, dehydration, distended abdomen, polydipsia and polyuria. Clinically no vaginal discharge was found.Haemato-biochemical examination
revealed high value of TLC (32.18×103/μl), Neutrophils (76.86%), ALT (54.81 U/L), ALP (154.71 U/L), BUN (39.78 mg/dl) and Creatinine (2.06 mg/dl). A tentative diagnosis of closed pyometra was made based on the
above symptoms and laboratory investigation. However, presence of large anechoic pus pockets in the region of uterus by ultrasonographic examination was confirmatory diagnosis for closed pyometra (Fig.1).

Treatment and Discussion
The ailing dog was subjected to intravenous fluid therapy, antibiotics (ceftriaxone plus tazobactum @ 15-25 mg/kg
b.wt. I/V for 7 days), tab. Mifepristone @ 3 mg/kg orally twice daily on day 1, 2 and 8 and tab. Misoprostol @ 5 mcg/kg intravaginally twice daily from day 3 to 7 along with supportive treatment. Pus discharge started from vagina gradually from third day of treatment may be due to opening of cervix. Mifepristone proves to be safe and
efficient drug for opening cervical canal in dogs with closed pyometra as also reported by Shah et al. (2016). The values of haematobiochemical parameters were decreased as compared to that of before start of treatment.
Ultrasonographic examination on day 8 of treatment revealed decreased in endometrial thickness, total lumen diameter and pus content of uterine horns. However, pus discharge was not completely disappeared after the treatment. Thus, dinoprost tromethamine was used at progressively increasing dose @ 50-200 mcg/kg subcutaneously once daily for 7 days (50 mcg/kg on day 1, 100 mcg/kg on day 2, 150 mcg/kg on day 3 and 200 mcg/kg on day 4 to 7) along with supportive treatment that
consists of anti-emetic, anti-cholinergic drug as well as oral calcium supplement and immune stimulants etc. All haematobiochemical parameters returns to normal (TLC-13.65×103/μl, Neutrophils- 68.75%, ALT-24.28 U/L, ALP-115.85 U/L, BUN-06- 25 mg/dl and Creatinine-1.06 mg/dl) post
treatment and no abnormality in uterine horn was observed in ultrasonographic examination (Fig.2). The dog was recovered completely after therapy without any further complications and recurrence upto two months.

References
Egenvall, A., Hagman, R., Bonnet, B., Hedhammar, A., Olsson, P. and Lagerstedt, A. (2001). Breed risk of
pyometra in insured dogs in Sweden. J. Vet. Int. Med., 15: 530-538.

Fieni, F. (2006). Clinical evaluation of the use of aglepristone, with or without cloprostenol, to treat cystic endometrial hyperplasia-pyometra complex in bitches. Theriogenology, 66: 1550-1556.

Noakes, D.E., Parkinson T.J. and England G.C.W. (2009). Arthur’s Veterinary Reproduction and Obstetrics. 9th edn., Published by Saunders Elsevier, Edinburgh, U.K. Pp. 658.

Shah, M., Pande, N., Shah, I., Agrawal, R., Sharma, U. and Ghuman, S. (2016). Treatment of Pyometra in female dogs using Prostaglandin F2α ± Antiprogestin (Mifepristone). Ind. J. Anim. Rep., 37(1): 23-26.

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