Non-surgical management of hematometra in a dog

Introduction

Hematometra, characterized by blood accumulation in the uterine cavity, is a rare reproductive condition in canines, often confused with pyometra due to similar clinical signs (Johnston et al., 2001) [9] . It may result from cervical stenosis, endometrial hyperplasia or hormonal imbalances, primarily affecting intact females during estrus (Root Kustritz, 2010) [18] . This case study details the clinical presentation, diagnostic findings, and non-surgical management of hematometra in a 4-year-old female German shepherd at Clinic, Tirupati, India. The article addresses systemic effects, therapeutic outcomes and documentation challenges, offering a novel perspective for managing this condition in resource-limited settings.

Materials and Methods

A 4-year-old intact female German Shepherd (GSD) dog weighing 28 kg was presented to the Veterinary Clinical Complex, Tirupati, with a two-month history of persistent vaginal bleeding. The owner reported no previous history of mating, parturition or other reproductive interventions. On clinical and physical examination revealed that the vital parameters like temperature, heart rate and respiratory were within normal range and continuous bloody vaginal discharge without signs of systemic illness.

Diagnostic Procedures adopted

A representative ultrasound image showing a distended uterus with hypoechoic fluid (blood), characteristic of hematometra. The image highlights the uterine wall appeared thickened and the echotexture of the fluid was distinct from the echogenic content typically observed in pyometra, allowing a presumptive diagnosis of hematometra. Laboratory assessment of Complete Blood Count (CBC), Liver Profile: Assessed Total Protein (TP), Albumin (ALB), and Globulin (GLOB); Kidney Profile: Evaluated creatinine, urea, urea/creatinine ratio, uric acid, and creatine kinase; and Lipid Profile: Measured total cholesterol, triglycerides, lowdensity lipoprotein (LDL), and high-density lipoprotein (HDL) were also performed.

Therapeutic management

The dog was administered with intravenous fluids @ Ringer's Lactate (250 mL/h) for hydration; Antibiotics: Inj. Ceftriaxone 500 mg, Tab. Cefpet 250 mg; Anti-inflammatories and Supportive Medications: Inj. Pantoprazole 40 µg, Inj. Mebeverine 100 mL, Inj. Domperidone 150 µg, Syr. Hepamust, Tab. Meloxicam 10 mg for a week.

Data Analysis

Laboratory findings were interpreted with reference to standard canine values (Kaneko et al., 2008) [10] . Abnormal values were flagged as High (H) or Low (L). Follow-up data, assessed the treatment efficacy.

Results

Clinical Findings: Patient exhibited persistent vaginal bleeding, recorded multiple times. The laboratory findings are summarized as follows in Tables 123.

Treatment Outcomes

Following treatment, WBC profile was normalized to 8.05 × 10³/µL (Figure 1), and reduced vaginal bleeding, and indicating the successful therapeutic management (No adverse effects were reported).

Case Discussion

This case demonstrates that chronic vaginal bleeding in intact female dogs should prompt consideration of uterine pathologies such as Hematometra. Though Hematometra is relatively rare, it presents a significant challenge due to its subtle clinical signs. Previous studies have emphasized the importance of early intervention in similar cases to prevent severe sequelae, including multisystemic organ failure (Verstegen et al., 2008) [23] . Hematometra's hallmark symptom is persistent vaginal bleeding was evident, aligning with literature descriptions (Romagnoli, 2006) [16] . Initial leucocytosis (WBC 12.3 × 10³/µL) suggests inflammation, possibly secondary to uterine pathology, which resolved with antibiotics. Thrombocytopenia (PLT 190 × 10³/µL) and haemoconcentration (HCT 6 Ettinger 9.9%) indicate blood loss or dehydration, addressed by IV fluids (Ettinger and Feldman, 2010) [5] . Elevated urea (31 mg/dL) and urea/creatinine ratio (27.434) suggest prerenal azotemia, likely from dehydration or systemic stress (Polzin, 2011) [14] . The lipid profile's inconsistencies (low LDL, high LDL*) may reflect inflammation or metabolic disturbances, warranting further investigation (Bauer, 2011) [2] . The non-surgical approach, using antibiotics, antiinflammatories and supportive medications, contrasts with the surgical bias in the literature (Kyles and Hardie, 2005) [11] . This strategy is particularly relevant for resource-limited settings, where imaging was not documented. Documentation errors, such as repetitive entries, highlight the need for improved record-keeping in veterinary practice, a novel discussion point in this context.

Conclusion

This case study demonstrates successful non-surgical management of hematometra in a dog within a resourcelimited setting. Systemic effects (leucocytosis, azotemia, dyslipidemia) and documentation challenges underscore the need for comprehensive diagnostics and improved recordkeeping. The findings contributed to the sparse literature on canine hematometra, offering practical guidance for veterinarians in similar settings.

Author's contribution MP, AT, KS: Conceptualization and design; MP, AT, AN: Data compilation; AT, UP: Performed statistical analysis of data; AT, KS, UP: Performed interpretation of the results.

Acknowledgement

AcknowledgementThe authors are highly grateful to Sri Venkateswara Veterinary University, Tirupati for providing the facilities for this study.

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