الفهرس 
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Abstract
The current study was carried out on 75 pure straight Egyptian mares that reared in different private farms. All mares were located in 4 farms in the pyramids area and Cairo-Alexandria desert road. The current study was carried out from January, 2012 to February, 2013.
During the study, 75 mares have been examined for preparation for breeding, and pregnancy has been achieved in 56 mares (74.6%) where as 19 mares (25.4%) have not conceived. There were 2 mares which did not conceive due to problems other than endometritis such as granulosa cell tumor, non-functioning ovaries and 2 mares have early embryonic death and 2 mares aborted after 3 months of pregnancy. There were 26 infertile mares that have undergone to different methods of examination such as general physical examination, vulvar conformation, vaginoscopy, transrectal ultrasonography, long uterine swabbing and endometrial biopsy. After using different methods of treatment for mares that suffered from infertility, there were 13 mares (50%) became pregnant and 13 mares (50%) have not conceived due to many factors which render mares to be pregnant.
By physical examination it was found that, body conformation has an effect on fertility of the mare and sometimes contributes to infertility, such as cases of lordosis, which lead to downward position of the uterus and consequently it becomes pendulous uterus so that the uterus becomes unable to get ride of fluids. As well as, the vulvar conformation has part in the causes of endometritis and infertility as the abnormal vulvar conformation such as tipped vulva, semi-opened vulva and sunken anus, all these factors lead to pneumovagina and occasionally pneumouterus, which contribute to continuous contamination of the uterus, consequently lead to chronic endometritis.
With respect to vaginal speculum examination, it provides valuable information about the causes of fluid formation inside the uterus such as tight closed cervix during estrus phase. It also reveals the cases of urovagina and vaginal varicose veins.
Using of ultrasonography for diagnosis of endometritis in mares was an important step as it revealed many information concerning the affected uterus. Transrectal scanning was the only method of examination was used. In the current study, the most prominent ultrasonographic observation in mares suffering from endometritis was fluid formation. The echogenicity of the formed fluid ranged from clear to turbid in nature, and the turbidity was somehow depend on the type of isolated microorganism, for instance, the turbidity was observed in cases of Staphylococcus and Streptococcus spp. Whilst other cases characterized by non-fluid formation as in cases that was infected with E.coli. the site of fluid accumulation was also diagnostic to some extent, as in cases of fluid accumulation in the body of the uterus only have a cervical defect and deficiency of dilatation while in cases were fluid accumulated in the uterine horns indicate that the cervix was easy to dilate and oxytocin is effective in treatment. Ultrasonography was valuable as well in diagnosis of cases that suffer from urovagina as it was diagnosed by presence of urine in the vaginal cavity dorsal to the urinary bladder. Furthermore, ultrasound was beneficial in detection of pneumometra because it was detected as hyperechogenic interrupted line with shadowing.
In the present study, using of long guarded uterine swab has been applied for further diagnosis and isolation of incriminated microorganisms. The microorganisms that have been isolated were Staphylococcus spp (35.1%), E.coli (18.9%), Proteus vulgaris (13.5%), Streptococcus spp (10.8%), Klebsiella pneumoniae (5.5%), and Pseudomonas aeriogenosa (2.7%) respectively. Although there were many cases bacteriologically negative (13.5%), and when these cases underwent to histopathological examination, it revealed a characteristic pathological changes, consequently, endometrial biopsy was more accurate for diagnosis of endometritis.
Sensitivity tests have been applied for selection of the most effective antibiotic to be used for treatment. Sensitivity was applied for 14 different antibiotics which are Ampicillin-sulbactam, Cefotaxim, Penicillin, Ciprofloxacin, Levofloxacin, Streptomycin, Amoxycillin-Clavulinic acid, Gentamycin, Cefoperazone-sulbactam, Amikacin, Chloramphenicol, Ceftazidime, Imipenem and Flucloxacillin. The more potent antibiotic was obtained from the results was Levofloxacin followed by Ciprofloxacin, Imipenem, Amikacin, Cefoperazone-sulbactam and Gentamycin. It was observed that there were cases which were infertile due to endometritis but showed failure of treatment due to complete resistant to all tested antibiotics.
Endometrial biopsy was one of the most accurate methods for diagnosis of endometritis as well as considered as a prognostic method of diagnosis. By examination of endometrial biopsies, many results have been obtained. The endometrial biopsies examination under the microscope was categorized into 4 groups. Category I showed no or minimal endometrial changes and the conception rate was 100%, while in the category IIA the endometrial changes was mild such as inflammatory cells infiltration, congested blood vessels. In category IIB there were moderate endometrial changes such as congested blood vessels, eosinophilic and mononuclear cells infiltration in the lamina propria, distension of lymphatic lacunae, cystic dilatation of the endometrial glands and periglandular fibrosis. Whereas category III characterized by sever endometrial changes which were focal infiltration of inflammatory cells (lymphocytes and macrophages), glandular cystic dilatation, marked periglandular fibrosis and glandular nesting, vacuolar degeneration of the lining epithelium of the endometrial glands. The conception rate for category IIA, IIB and category III was 75%, 33.3% and 0% respectively.
It is worthy to mention that during our work, we have encountered a pathologic change in the endometrium which was presence of Hemosidren laden macrophages distributed in the endometrium. This mare was suffering from vaginal varicose veins.
The treatment strategies that have been applied in the current study included many different methods such as uterine lavage using normal saline, administration of ecbolics such as oxytocin and prostaglandins, administration of intrauterine antibiotics, corticosteroid therapy and Caslick’s operation. Uterine lavage was performed either before and/or after covering or insemination for getting ride of fluid accumulated in the uterus. Oxytocin has been used in mares producing intrauterine fluid but with good working cervix while prostaglandin was better in cases that have deficiency in cervical dilatation. Antibiotics have been used according to the sensitivity tests and Levofloxacin antibiotic was the best one. In addition, corticosteroid was used as adjunct treatment with other methods of treatment, it was found to decrease edema pattern in cases suffered from high degree of uterine edema. Ultimately, Caslick’s operation has been applied in mares suffering from pneumovagina and pneumometra for correction of abnormal vulvar conformation. Caslick’s operation was carried out under the effect of tranquilizers and local infiltration anesthesia.
The end results and recommendations of the study are summarized as:
• Examination of mares suffering from subfertility is very important for diagnosis of actual cause of infertility. These examination should performed systemically as external physical examination, vaginal speculum examination, ultrasound scanning, endometrial swabbing and bacteriological work up, followed by endometrial biopsy.
• Bacterial isolates were the most important accused causative agents for endometritis.
• Importance of rapid diagnosis of cases of endometritis and application of proper treatment to avoid progressive deterioration of the endometrium.