This article was #16 in PDmag's Top 25 most-well read articles in 2010. Jump to the article here.

Summary: A panel of four industry experts – Doug Hammon of Pfizer Dairy Veterinary Operations, Cory Meyers of Mid-Maryland Dairy Veterinarians, Ray Nebel of Select Sires and Carlos Risco of the University of Florida – shared their thoughts on metritis. Topics included the detection, prevention and treatment of this fertility disease.

Because this article was so popular, we asked the author, Josh Hushon, to get in contact with panel members for a follow-up question:

Q. Why are producers becoming more interested in understanding metritis and how to minimize its effect?
A. Undeniably, metritis is a costly transitional disease that can impact performance well into lactation. More importantly, the incidence of metritits is a measure of the effectiveness of transitional management. Producers continue to recognize the impact the transition period has on the lactational performance of the dairy cow. Healthy calvings and smooth transitions into milk production are critical drivers of lactation performance. A high or increasing rate of metritis indicates a problem in transitional management, and producers who see this on their dairy should work with a veterinarian to do an assessment of their transition program. Improving transitional management will have a positive impact on profit margins through decreased costs associated with the incidence of metritis and other metabolic diseases, while also improving revenues through greater herd performance.
—Dr. Cory Meyers, partner and practitioner, Mid-Maryland Dairy Veterinarians

A. I think our industry as a whole has been paying more attention to fresh cow management over the past 10 to 15 years, and that renewed focus has included metritis. Metritis is typically the result of a transition failure, and looking at incidence rates can provide insight into a how a dairy’s transition program is performing. A high incidence of metritis is most likely associated with other fresh cow diseases which may indicate a greater problem on the dairy. Additionally, the economic data showing that an average cost for a case of metritis is around $350 has encouraged veterinarians and producers alike to take a closer look at incidence rates of this disease. As we’ve learned more about this disease, we’ve begun to better understand the impacts it can have on reproductive performance and recognized the need to identify and better manage high risk cows.
—Dr. Doug Hammon, senior manager, Pfizer Dairy Veterinary Operations

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3 open minutes with Doug Maddox and Gary Genske: http://bit.ly/PDTop25_24
3 open minutes with David Martosko of HumaneWatch: http://bit.ly/PDTop25_25

ARTICLE

Metritis is not a disease that can be prevented. But by knowing the risk factors and aggressively managing fresh cows, producers can limit the effects. Our panel of experts has a wide background in working with fresh cows and reproductive challenges on farms, and they share their insights and recommendations on limiting the effects of this fertility killer.

Panel:
Dr. Doug Hammon – senior manager, Pfizer Animal Health Veterinary Operations
Dr. Cory Meyers – partner and practitioner with Mid-Maryland Dairy Veterinarians
Dr. Ray Nebel – vice president of Technical Services, Select Sires
Dr. Carlos Risco – professor of Food Animal Reproduction and Medicine Service, University of Florida College of Veterinary Medicine

MEYERS: Average incidence rate for the majority of my herds is below 10 percent. I have seen a greater incidence of metritis in herds under-feeding protein, over-feeding energy, and overcrowding pens.

NEBEL: The incidence of metritis varies significantly across herds, but most herds would be in the 8 to 25 percent range. Difficult and assisted calvings which have a high association with retained placentas are the risk factors we see most commonly.

RISCO: I have seen incidence rates as high as 25 percent and as low as 15 percent in herds as part of clinical and research work. It’s important to understand that metritis is in all herds at some level; it cannot be completely eradicated.

What do you advise producers to look for when they are identifying at-risk cows?
HAMMON: Risk factors for metritis can be divided into two categories: 1) factors that reduce dry matter intake prior to calving, and 2) calving abnormalities including dystocia, retained placenta, twinning and stillbirth.

MEYERS: My main focus is prevention. If a fresh cow problem exists, we will implement more intensive management, such as daily or every-other-day fresh cow checks including temperature, palpation and so forth. Overcrowding is a common metritis precursor causing a greater incidence of stillbirths and creating a dirtier environment that results in higher bacterial levels that can be transferred to the uterus. Additionally, co-mingling heifers with mature cows in an overcrowded environment will result in a higher incidence of metritis in the heifers.

NEBEL: Cows most commonly at risk are ones that have a short pre-fresh period, which can happen for any number of reasons. Fat cows and thin cows have a high prevalence of metritis, as well as cows with reduced appetite.

RISCO: Producers should work with their veterinarians and nutritionists to find sub-clinical ketosis, as well as identify and monitor cows that have experienced dystocia, retained placenta, stillbirth or twins. Producers also should watch for drops in milk production and cows that look sick.

What routine fresh cow protocols do you recommend?
HAMMON: I advise producers to develop specific protocols with input from their veterinarian. However, daily fresh cow screening programs aimed at assessing appetite, udder fill or milk production, attitude and uterine discharge for the first 10 days after calving, will help with early identification of metritis.

MEYERS: Daily milk weights and observation provide a wealth of information about the cow. I recommend this daily observation for the first two weeks in milk and a palpation during the second week. If we observe a decline in milk, or lack of an increase, and see a lack of rumen fill, poor appetite, higher respiratory rates and/or a uterine discharge, we will temp the cow, palpate, test for ketosis and fill the rumen with a drench mix.

NEBEL: Fresh cow protocols can vary, but we like to see individual daily observations for alertness, fever, appetite, manure status and odor. A record system must be in place so that cows are not missed, especially on weekends. The temping of cows is overrated because many times the whole cow is overlooked before it is too late.

RISCO: First, look at daily milk production for the first 21 days. Fresh cows should increase about 10 percent each day during that period. Second, be on the watch for sick cows during the first two weeks. Third, take cows’ temperature during the first 10 to 12 days after calving. For cows that appear to be sick, examine and characterize vaginal discharge. What is the consistency? Color? Is there a fetid odor?

What do you recommend for fresh cow housing?
HAMMON: Adequate feedbunk space is critical to ensure adequate dry matter intake. The current recommendation is 30 linear inches of bunk space per cow beginning 25 days prior to calving through 25 days after calving. Constant feed availability and even feed distribution along the bunk are also important. Open housing with a well-managed, deep-bedded pack appears to work best.

MEYERS: We advise limiting pen population using a ceiling of 80 percent populated based on recommendations of 30 inches per cow of feedbunk space and 150 square feet of bedding pack area. It’s key to plan ahead to prevent pen overcrowding during calving slugs.

NEBEL: We work with what the dairy producer has available, unless it is not working. Success will often depend on the time of year and climate, as well as if the herd depends entirely on loose housing and a bedded pack or a pasture or dry lot. Cows must be able to be moved to a box stall, headlock or stanchion if assistance or treatment is needed.

RISCO: I recommend sand bedding in freestalls. There also should be a place for every cow to eat and lie down.

What common mistakes do you see?
HAMMON: The most common problems I see are overcrowding, excessive pen moves and feedbunk management/feed availability. Three moves 25 days prior to calving through 25 days after calving is the goal. Pen moves during the week prior to calving can be particularly problematic. It is recommended that cows be moved into calving pens no more than 48 hours prior to calving.

MEYERS: Overcrowded housing and feedbunk space in the close-up and fresh cow groups, especially during calving slugs, we see as a result of heat-related fertility issues. This has a greater effect on heifers when they are comingled with cows. A lack of heat abatement makes it worse.

NEBEL: The big mistake that is most common is grouping sick cows and fresh cows together. Poorly planned housing and having too short or no fresh cow group is also common.

RISCO: Overcrowding and too many group pen movements. I strongly discourage moving a cow with metritis to the hospital pen. As she’s fighting metritis, her immunity already is challenged, and these other stressors just make matters worse.

How can producers effectively track fresh cow performance?
HAMMON: Where available, the Transition Cow Index (developed by veterinarians at the University of Wisconsin) is a valuable way to evaluate transition cow performance and compare management herd to herd. Transition Cow Index is the deviation of actual milk yield compared to calculated expected milk yield and 305-day projection at the first test date. It can be estimated for each cow of second or greater lactation. Other measurements include percent of cows removed from the herd by 30 or 60 days in milk (DIM) and fresh cow disease incidence rates, if they are well- defined and accurately identified and recorded.

MEYERS: Producers can use first-test milk, first-test butterfat, first-test linear somatic cell score (LS), first-test 305-day Mature Equivalent (M.E.), and week four milk production based on calving date and lactation group cohorts to provide an overview of how fresh cows are doing. If management changes were made to improve fresh cow health, over time, we want to see upward trends in first-test milk, first-test M.E., and week four milk and downward trends in first-test LS and first-test butterfat.

I also like to analyze cull rates for the first 30 and 60 DIM. We aim for less than 4 percent and 6 percent of the herd, respectively. For producers who rely on DHIA-based data, the lag is a challenge, and analysis of disease rates is useful. We aim for incidence rates less than 3 to 5 percent for retained placenta, metritis, milk fever and ketosis, and fewer than 3 percent for displaced abomasum. Finally, producers should make a point of recording daily average close-up and fresh cow dry matter intakes to make sure they are meeting requirements as a proactive approach to transition cow management.

NEBEL: I monitor fresh cow events, metritis, retained placenta, milk fever and displaced abomasums. A goal is to have less than 1 percent of each of these events for the number of calvings per month. If a herd is over 5 percent in any category, producers should look for reasons why. For those who have DairyComp305 management software, they need to look at the monitor weekly.

Milk production is another key way to monitor performance. I like to see over 70 pounds daily by day 15 for cows and production over 100 pounds by 30 days in milk. For heifers I recommend a benchmark of over 50 pounds by 15 days in milk and 75 pounds by day 30. Body condition recommendations are dried off at 3.5 to 3.75 and calving back with a similar score.

RISCO: There are three key monitors that I recommend using:

1) Incidence rate of disease, such as dystocia, ketosis and metritis;

2) Herd monitoring – are more cows developing sub-clinical ketosis from one month to the next?;

3) Peak milk production – if cows are peaking less, what’s causing this?

What treatment do you recommend for metritis?
HAMMON: The goal of antibiotic therapy is to decrease uterine bacteria load to a level that the cow’s immune cells can clear the infection. The typical cow with metritis is moderately to severely immune-suppressed. Therefore, providing adequate nutrition and reducing stressors such as overcrowding and pen moves may help to encourage feed intake and support immune function, allowing the cow to clear the infection more effectively. As always, consult your veterinarian to determine the appropriate treatment of metritis for your herd and to establish proper milk and meat withhold times.

MEYERS: Producers and their veterinarian must first consider the microbiology behind the treatment decision. Gram-negative (coliforms) bacteria are predominant in the early post-partum uterus. In this case, a ceftiofur would be the antibiotic of choice. Over the course of the week, the uterine environment becomes more favorable for gram-positive bacterial growth and ampicillin and penicillin are better antimicrobial choices. I do recommend supportive care for severe metritis cases with aggressive fluid therapy, oral and intravenous, as well as nonsteroidal anti-inflammatory drugs to reduce fever. For cows 10 days post-calving, prostaglandins are used.

NEBEL: We recommend that producers work with their veterinarian to determine a proper treatment protocol. Once the treatment is completed, the challenge of rebreeding begins. To assist a return to normal cyclicity, we recommend a pre-synch protocol of two prostaglandin injections 14 days apart and then on to their chosen breeding protocol.

RISCO: Once metritis is identified, I first recommend treatment with antibiotics. The antibiotic must be proven, labeled for metritis and ideally not require cows to be moved to a different pen for milk withholding reasons. Secondly, sometimes calcium and energy supplements can be helpful to these cows, since they often also have ketosis. The best treatment though is to catch these cows early.  PD

	Doug Hammon Senior Manager Pfizer Animal Health Veterinary Operations

	Cory Meyers Veterinarian Mid-Maryland Dairy Veterinarians

	Ray Nebel Vice President Technical Services Select Sires

	Carlos Risco Professor Food Animal Reproduction and Medicine Services University of Florida