Ultrasonic evaluation of the reproductive tract of the mare; principles, equipment, and techniques

Ultrasound scanners have the potential of becoming as important for examination of the reproductive tract of mares, as x-ray machines are for examination of the legs. The principles of ultrasonography are based on the abilities of various tissues and fluid-filled structures to either reflect or propagate high frequency sound waves. A sound beam is emitted from an intrarectal, hand-held transducer. The proportion of the beam that is reflected (echoed) is received by the transducer, converted to electrical impulses, and displayed on a screen as moving images. Liquid-filled structures do not reflect sound waves and appear black on the screen. At the other extreme, dense tissues reflect much of the beam and appear white. Other tissues are seen in various shades of the gray-scale, depending upon their echogenicity (ability to reflect sound waves). Certain tissue formations may cause the sound waves to bend (refract), bounce back and forth (reverberate), or to become weakened (attenuated) or entirely blocked. Therefore artifacts may appear on the screen and must be appreciated by the ultrasonographer. The resolving power of the equipment is dependent upon the frequency of the sound waves measured in megahertz (MHz) units. A 5 MHz transducer is more suitable for examining the reproductive tract of mares than the generally available 3 or 3.5 MHz transducer.

Preparation for intrarectal ultrasound examination is similar to preparation for rectal examination, but there are other considerations, such as protection of the equipment and management of external lighting. A linear-array transducer is hand-held and is generally oriented in the sagittal plane with respect to the mare's body. The images of the cervix and uterine body are therefore longitudinally oriented, and those of the uterine horns are cross-sectional. With sector scanners, however, the sound beam generally travels transversely with respect to the mare's body and images of the cervix and uterine body are cross-sectional and images of the horns are longitudinal or oblique. The availability of ultrasound instruments for examination of the reproductive tract should provide additional encouragement for veterinarians to be as knowledgeable as possible about reproductive anatomy and pathology. The ability to study “living,” detailed, sequential, sectional views of the organs demands a more detailed working knowledge of anatomy than that required for rectal palpation.     

Quantitation of the immunoglobulins in reproductive tract secretions of the mare

IgG, IgA, IgM and albumin concentrations were measured in serum, follicular fluid and oviductal, uterine and intestinal secretions of the horse. Follicular protein concentrations were found to be dependent on serum concentration and molecular size. Of the immunoglobulins only IgG was detectable in oviductal secretions, but IgG:albumin ratios did not differ significantly from those in serum. IgG, IgA and IgM were measured in uterine secretions, with IgG predominant. Serum transudation into uterine secretions was minimal. In intestinal secretions, IgA levels were slightly higher than IgG, with albumin and IgM at low levels. In five mares with histories of chronic metritis, IgG, IgA and albumin concentrations were significantly elevated in uterine secretions.     

Immunohistological studies of the local immune system in the reproductive tract of the mare

The immunoperoxidase technique was adapted for the identification of free immunoglobulin and immunoglobulin producing cells in equine tissues. Staining specific for free IgG, IgA and IgM was detected at all levels of the reproductive tract, and secretory component staining was present in the uterine epithelium but not in the oviduct, cervix or vagina. Immunoglobulin producing cells were present at all levels of the tract, with IgG and IgA cells at equivalent concentrations, but with fewer IgM cells. There was no cyclical trend in free immunoglobulin staining, or plasma cell numbers. IgG and IgM plasma cell numbers declined from uterus to vagina, as did epithelial staining, and the ratio of IgG:IgA cells declined from oviduct to vagina.     

REVIEW paper: mare reproductive loss syndrome

An epidemic of early fetal loss (EFL), late fetal loss (LFL), fibrinous pericarditis, and unilateral uveitis which occurred during the spring of 2001, are together now known as the mare reproductive loss syndrome (MRLS). A similar epidemic with less intensity was reported during the same period of time from southern Ohio, West Virginia, and Tennessee. The same syndrome with lesser intensity recurred in 2002. The estimated economic loss from the syndrome in 2001 and 2002 together was approximately $500 million. Both EFL and LFL were characterized by the absence of specific clinical signs in aborting mares. Nonhemolytic Streptococcus spp. and Actinobacillus spp. accounted for 65% of the organisms isolated from fetuses submitted for a postmortem during the MRLS period in 2001 and 2002. The pathologic findings in fetoplacental units of LFL included bronchopneumonia and funisitis, and there were no findings in EFL. Epidemiologic studies conducted in 2001 suggested an association between the presences of eastern tent caterpillars (ETC) in pastures with MRLS. Experimental studies in pregnant mares by exposure to ETC, or administration by stomach tube or with feed material, reproduced EFL and LFL. Similar experimental studies in mouse, rats, and goats with ETC were unsuccessful. Currently, 2 hypotheses are proposed for MRLS. One hypothesis proposes that an ETC-related toxin with secondary opportunistic bacterial invasion of the fetus leads to MRLS. The second hypothesis suggests that a breach of gastrointestinal mucosal integrity by hairs of ETC leads to a bacteremia and results in MRLS. In 2004, a similar equine abortion storm was reported from Australia and caterpillar exposure was identified as a risk factor for the abortion. In 2006, the syndrome was observed in Florida and New Jersey.     

Recent advances in reproductive endocrinology of the mare

The recent development of radioimmunoassay techniques to determine changes in blood hormone levels has increased our understanding of the endocrinology of the oestrous cycle and pregnancy in the mare. This review describes recent findings concerning the endocrine basis and treatment of some common types of infertility.

Further evidence supporting the concept that prostaglandin F2∝ is the uterine luteolysin in the mare is discussed. Persistent corpus luteum is now recognized as an important cause of infertility, which may be treated by uterine distension or prostaglandin; recommendations for avoiding treatment failures are presented.

The clinical significance of recent findings on the effectiveness of HCG in hastening ovulation, and on the increase in anti-HCG antibodies after repeated injections of this hormone are also discussed.

Although antibiotics successfully control the specific pathogen causing contagious equine metritis, the treatment of common opportunistic organisms with antibiotics appears to give indifferent results. The increased understanding of the role of sex steroids in susceptibility to uterine infection seems likely to lead to improved methods of control.

Although stimulation of folliculogenesis and ovulation in seasonally acyclic mares is possible using extracts of equine pituitary glands, this treatment is impractical on a clinical scale. Gonadotrophin-releasing-hormone provides a more physiological method of stimulation, and results of recent experiments using this hormone are reviewed.

In the pregnant mare, recent studies have shown that the “pregnancy signal” to the mare may be the production of oestrogens from the developing blastocyst from Day 14. Measurement of PMSG as an aid to pregnancy diagnosis is evaluated, and the use of progesterone supplementation to prevent abortion is discussed.     

The irritancy of chlorhexidine gluconate in the genital tract of the mare

Uterine irrigation was carried out in eight Welsh pony mares using 50 ml of chlorhexidine gluconate solution diluted to give active ingredient concentrations of 0.25 per cent to 2 per cent. Treatment was repeated up to twice in mares showing no adverse effects and irritancy of treatment judged on clinical symptoms and uterine biopsy. Results indicated the inadvisability of using a higher concentration than 0.25 per cent. Three daily applications of a diluted surgical scub solution containing 2 per cent chlorhexidine gluconate to the penis of an arab stallion failed to produce symptoms or irritation. An in vitro minimum inhibitory concentration test performed with the contagious equine metritis organism confirmed its high sensitivity to both chlorhexidine gluconate preparations.     

Interaction of Tritrichomonas foetus with the reproductive tract of experimentally infected female BALB/c mice: ultrastructural evaluation

The interaction of Tritrichomonas foetus with its host is a complex process that involves colonisation, attachment and persistence. The goal of the present study was to describe the interaction of T. foetus with the genital tract using a model of non-oestrogenised female BALB/c mice which had been intravaginally infected with a suspension of T. foetus during oestrus. Animals were sacrificed after 10 weeks and the uteri fixed and processed for light and electron microscopy. Ultrastructural analysis showed that the attached protozoa interacted with the mucosa through a somal projection. With an amorphous secretion at the protozoa-host cell interface. There was no direct contact between the protozoal plasma membrane and the epithelial cell membrane. Our results demonstrated the participation of an active phagocytosis and the destruction of T. foetus by eosinophils.     

Theory of ammonia toxicity as the mechanism of abortion in the mare reproductive loss syndrome

In late April/early May of 2001, for the equine industry in Kentucky, a previously unknown factor led to the loss of up to 40% of the new pregnancies (20-60 days) for that year, with a following significant number of late abortions and ill new born foals. In addition, encephalopathy, ocular lesions, pericarditis, laminitis, and other diseases were suspected to be associated with the syndrome. This occurrence was known as the mare reproductive loss syndrome (MRLS). On examination of the weather data, this period was seen to have an unusual pattern of severe late spring frost. Acute changes in the pasture diet affected the horses gut microflora, allowing the overgrowth of opportunistic pathogens and resulting in the excessive absorption of nitrogen and ammonia from the large bowel. Clinical blood chemistries from the horses on pasture at this time showed abnormally high levels of blood urea nitrogen (BUN). Elevated blood ammonia levels were found in mares and newborn foals affected with MRLS. Ammonia is metabolically one of the most toxic substances to the body. It is present naturally as a breakdown product of nitrogen turnover. If the body nitrogen balance is disturbed for any reason, with nitrogen accumulation exceeding the body's ability to excrete it as urea (BUN), ammonia will accumulate in toxic levels. Ammonia toxicity can cause all the symptoms that were observed in the horses exhibiting MRLS.     

Immunity in the female sheep reproductive tract

Immune surveillance in the female reproductive tract is dependent on the interplay of many factors that include the expression of pattern recognition receptors on epithelial cells, resident leukocyte populations and hormones, none of which are uniform. The lower reproductive tract must accommodate the presence of commensal organisms whereas the upper reproductive tract is sterile. However, the upper female reproductive tract has its own immunological challenge in that it must tolerate the presence of a semi-allogeneic fetus if pregnancy is to succeed. So, immune activation and effector mechanisms to control pathogens may be qualitatively and quantitatively different along the reproductive tract. Our knowledge of innate and adaptive immunity in the sheep is less comprehensive than that of human or mouse. Nevertheless, comparative studies suggest that there are likely to be conserved innate immune sensory mechanisms (e.g. Toll-like receptors) and defence mechanisms (anti-proteases, defensins) that combine to limit infection in its early stages while shaping the adaptive response that leads to immunological memory and long-term protection. There are many pathogens that target the reproductive tract, and in particular the placenta, where specialised immunoregulatory mechanisms are operational. Among such pathogens are bacteria belonging to the genera Chlamydia/Chlamydophila that chronically infect the reproductive tracts of sheep and humans and ultimately cause disease through inflammation and tissue damage. An understanding of the immunological microenvironment of the reproductive tract is important for the design of novel control strategies to control chlamydial disease.     

Inflammation in the bovine female reproductive tract

Inflammation of the reproductive tract of a cow occurs when the physical and functional barriers to contamination are breached or specific infection occurs. Commonly, contamination occurs at parturition and to a lesser extent at estrus. Uterine contamination following calving is common, but most healthy cows are able to clear the uterus of bacteria in the first 2 to 3 wk after calving. Persistent infections are more likely to be caused by Actinomyces pyogenes. Specific venereal infections tend to be more host-adapted and produce a lower grade inflammation. Nonspecific bacterial contamination of the endometrium generally induces a neutrophilic influx into the stratum compactum and uterine lumen. Neutrophils phagocytize bacteria with the aid of opsonins in the uterine fluid. Mast cells and eosinophils may also contribute to the inflammatory reaction, which may damage the surface epithelium and release vasoactive substances that allow leakage of serum antibodies into the uterine secretions. Specific antibodies of immunoglobulin (Ig) isotype A, M, G1, and G2 in uterine secretions have been described. In model species, the immune capability of the uterus is influenced by steroid hormones, especially estradiol, which increases secretory component and both IgA and IgG content in uterine secretions and increases the activity of antigen-presenting cells in the uterus. Similar cyclic fluctuations in immune components have been described for cows, including changes in the population of subsurface cytotoxic and helper T cells and changes in the expression of major histocompatibility II antigen on surface cells.     

Distribution of cytosolic oestrogen and progesterone receptors in the genital tract of the mare

The distribution of oestrogen and progesterone receptors in the equine genital tract was investigated by means of a modified dextran-coated charcoal method on samples collected from the vagina, the cervix and the uterus of 30 healthy adult Polish mares, divided into two groups on the basis of their serum progesterone levels. The concentrations of oestrogen and progesterone receptors were significantly (P<0·05) lower in the vagina and the cervix than in the uterus, in agreement with data from human beings, cattle and pigs, which showed that the highest concentrations of oestrogen and progesterone receptors were localised respectively in the body and in the horns of the uterus.     

Sperm interaction with the female reproductive tract

Sperm transit in the female tract is a critical event for the success of fertilization. From their deposition in the vagina to final migration in the oviduct, sperm pass through the different compartments of the genital tract in which they encounter different environments. The cervix and the uterotubal junction (UTJ) are two barriers with different relative importance according to the species. The protein composition, the degree of glycosylation and the hydration of the cervical mucus change during the oestrous cycle. Several sperm surface proteins are associated with their migration through the cervical mucus and the UTJ. Data regarding the interaction of sperm with secretions of the epithelial tissue lining the different compartments of the female genital tract during the sperm transit are reviewed, with a particular emphasis on the migration of sperm through the cervix.     

Female caudal reproductive tract abnormalities

The report by McCarthy and coworkers (McCarthy et al. 2021) in this issue describes a case of vaginal septum with pyometra in a 10-week-old Westphalian filly foal. This is an interesting case report which evokes thought about the developmental abnormalities of the caudal female reproductive and urogenital tracts and their pathophysiology. Such anomalies are rare, reflected by the limited number of cases reported in the literature involving mares/fillies with uterine, cervical, vaginal and hymenal abnormalities.     

Videoendoscopic evaluation of the mare's uterus: III. Findings in the pregnant mare.

During a 5-year period 65 Pony and 20 Thoroughbred pregnant mares were subjected to videoendoscopic hysteroscopy from 10 to 266 days of gestation. The aims of these examinations were to 1) observe foetal and placental development in vivo (60 Pony and 10 Thoroughbred mares); 2) eliminate one of unicornuate twin conceptuses (9 Thoroughbred mares); 3) recover embryonic foetal and placental tissues non-surgically for experimental purposes (47 Pony mares); 4) induce focal separation of the placenta in late gestation as an experimental model of placentitis (5 pony mares and 1 Thoroughbred mare). It was possible to view the embryo and all constituent extra-embryonic membranes of the conceptus between Days 10 and 87 of gestation without having to perforate the allantochorion. This allowed study of physiological processes such as the coordinated uterine contractions responsible for conceptus motility between Days 7 and 17, active foetal movements, which began as early as Day 34, and invasion of chorionic girdle cells into the endometrium, which occurred between Days 34 and 38. From Day 90, vision of the foetus was reduced or prevented by the increased thickness of the allantochorion. Transendoscopic recovery of the conceptus was successful in all of 10 mares under 30 days of gestation, whereas only 10 of 18 attempts between Days 30 and 45 produced the conceptus without resorting to uterine lavage after initial rupture of the allantochorion. All 9 attempts to eliminate one of unilateral twin conceptuses were unsuccessful and the technique was abandoned as clinically unsuitable. Nevertheless, 9 of 22 (41%) single conceptuses remained viable after one or more hysteroscopic examinations.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of phytoestrogens on the reproductive tract

Environmental estrogens may be derived from plants (phytoestrogens), pharmaceuticals or synthetic compounds. They exert estrogenic and/or potentially antiestrogenic effects on farm animals, wildlife and humans. Exposure to these compounds results in some abnormalities in the reproductive tract, changes in the estrous cycle, and possibly protection against the development of hormone-dependent cancer. The data obtained from animal studies suggest that the timing of exposure to phytoestrogens is important, and neonatal exposure causes the most pronounced effects.