Toxic Metritis
Basic Information 
Clinical Presentation
Etiology and Pathophysiology
• Ascending bacterial contamination of the uterus occurs during parturition, dystocia, retained fetal membranes, or obstetric manipulations.
• Accumulated intrauterine fluid, autolytic fetal membranes, necrotic or devitalized tissue, and debris provide favorable conditions for bacterial proliferation and release of endotoxins.
• Septicemia and endotoxemia result from disruption of the uterine mucosal barrier and absorption of bacteria or endotoxins into systemic circulation through the highly vascularized postpartum uterus.
• Endotoxemia may also result from transmural movement of endotoxins into the peritoneal cavity.
Diagnosis 
Initial Database
• Complete blood count (CBC): Leukopenia and neutropenia with toxic changes and left shift, hyperfibrinogenemia, hemoconcentration caused by dehydration
• Serum biochemistry profile: Azotemia caused by dehydration or renal damage by endotoxins ± elevated muscle enzymes caused by increased recumbency
• Transrectal palpation: Enlarged, thin-walled, flaccid uterus
• Transrectal ultrasonography: Large amount of free intrauterine fluid of varying degrees of echogenicity, edematous uterine wall
• Vaginal speculum examination: Dark-red or dark-brown fluid pooled in the cranial vagina and originating from the uterus
• Uterine culture: Growth of a mixed bacterial flora, including gram-positive (Streptococcus equi subsp. zooepidemicus, β-hemolytic streptococci, Staphylococcus spp.), gram-negative (Escherichia coli, Klebsiella pneumoniae), or anaerobic bacteria (Bacteroides fragilis, Clostridium spp.); endotoxemia is associated with the presence of gram-negative bacteria
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