Pyometra in Queens
Common in intact queens, pyometra can also occur in ovariohysterectomized queens. It most often occurs in diestrus after ovulation has occurred without resulting pregnancy and progesterone levels remain high. Uropathogenic Escherichia coli are most commonly involved. Certain purebred cats are predisposed. Queens >5 to 7 years of age are most commonly affected.
Pyometra most often occurs in diestrus after ovulation has occurred without resulting pregnancy and progesterone levels remain high.
Clinical signs, which typically emerge within 4 weeks of estrus onset, are typically nonspecific (eg, lethargy, fever, anorexia). Hemopurulent discharge may be noted if the cervix is open. Queens with closed-cervix pyometra are usually the most clinically ill. Hematologic and biochemical changes are often mild or absent. Serum progesterone levels may be elevated. Abdominal radiographs may show a distended uterus but cannot differentiate pyometra from other conditions (eg, hydrometra, pregnancy). Abdominal ultrasonography is the most important tool for diagnosing pyometra in the queen. Ovariohysterectomy has traditionally been the treatment of choice for queens not intended for breeding. Medical management, which should only be attempted with careful monitoring, is generally indicated in young, healthy queens <3 years old intended for breeding. Options include prostaglandin F2α, dopamine agonists, and antiprogestins. Antimicrobial therapy should be instituted immediately. Supportive care is indicated for systemically ill cats. Queens intended for breeding should be mated in the first estrus after pyometra.
Global Commentary
In our clinical experience, we aim to treat with aglepristone (unavailable in the United States) whether faced with a pyometra, mucometra, hydrometra, or hematometra. An accurate diagnosis is essential, as pyometras have a more guarded prognosis. We use it in cats >5 years, especially those in which surgery and/or anesthesia pose a greater risk (eg, patients with serious cardiac disease). In queens with significant reproductive value, aglepristone is our first-choice treatment in order to continue breeding posttreatment. In fact, we experience an average of 70% pregnancy success in queens mated in the following estrus. In queens with reduced surgery risk, we still recommend medical treatment as the first line of action; those with a higher risk benefit from medical treatment before surgery to reduce morbidity and mortality.—Simón Martí Angulo, AVEPA, Universidad Alfonso X El, Clínica Veterinaria Plutos