Effectiveness of intrauterine treatment with cephapirin in dairy cows with purulent vaginal discharge  N. Tison, E. Bouchard, L. DesCôteaux, R.C. Lefebvre  Theriogenology  Volume 89, Pages 305-317 (February 2017) DOI: 10.1016/j.theriogenology.2016.09.007 Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 1 Synchronization protocol. Timeline for treatment of PVD cows, monitoring of cure, and evaluation of uterine health. At EXAM1, cows were randomly assigned to receive either cephapirin or no treatment. PVD+ cows were defined based on the highest sum of sensitivity and specificity on pregnancy status at 120 DIM. DIM, days in milk; EXAM1, first genital examination; EXAM2, second genital examination; PGF, prostaglandin; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 2 Different vaginal discharges: 3 = mucopurulent; 2 = cloudy mucus; 1 = clear mucus; U = Urine. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 3 Survival curves for time to pregnancy up to 300 days after parturition in 477 cows based on uterine status at 34 DIM (EXAM1): CONT PVD− cows (n = 374) () and CONT PVD+ cows (n = 103) (). The median time to pregnancy (95% CI) was 118 (107–128) and 158 (130–204) for CONT PVD− and CONT PVD+ cows, respectively. CONT, control cows that received no treatment; DIM, days in milk; EXAM1, first genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 4 Survival curves for time to pregnancy up to 300 days after parturition in 468 cows based on uterine status at 48 DIM (EXAM2): CONT PVD− cows (n = 394) () and CONT PVD+ cows (n = 74) (). Median time to pregnancy (95% CI) was 118 (107–129) and 181 (145–218) for CONT PVD− and CONT PVD+ cows, respectively. CONT, control cows that received no treatment; DIM, days in milk; EXAM2, second genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 5 The cumulative proportion of cows not pregnant after diagnosis of PVD at EXAM1 and EXAM2 and treatment with intrauterine cephapirin. CONT PVD+/PVD+ group () (n = 38) is different from CEPH PVD+/PVD+ group () (n = 36). CONT PVD−/PVD− () is only on the graph as a visual reference. The treatment administered at 34 DIM to PVD+ cows improved the median time to pregnancy of the cows that were PVD+ again at 48 DIM (CEPH PVD+/PVD+: 132 days; 95% CI = 110–175 and CONT PVD+/PVD+: 216 days; 95% CI = 160–241). CEPH, cows that received intrauterine cephapirin treatment; CONT, control cows that received no treatment; CI, confidence interval; DIM, days in milk; EXAM1, first genital examination; EXAM2, second genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 6 The cumulative proportion of cows not pregnant after diagnosis of PVD at EXAM1 and treatment with intrauterine cephapirin. The PVD+ CONT group (n = 103) () was significantly different from the other groups (PVD+ CEPH (n = 121):, P = 0.02; PVD− CONT (n = 374): , P < 0.01; PVD− CEPH (n = 394): , P < 0.01). The treatment improved the median time to pregnancy of PVD+ cows at 34 DIM (PVD+ CONT: 158 days; 95% CI = 130–203 and PVD+ CEPH: 120 days; 95% CI = 94–132). CEPH, cows that received intrauterine cephapirin treatment; CONT, control cows that received no treatment; DIM, days in milk; EXAM1, first genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 7 The cumulative proportion of cows not pregnant after diagnosis of PVD at EXAM2 and treatment with intrauterine cephapirin. The PVD+ CONT group (n = 74) () is significantly different from the other groups (PVD+ CEPH (n = 88): , P = 0.02; PVD− CONT (n = 394): , P < 0.05; PVD− CEPH (n = 422): , P = 0.01) The treatment improved median time to pregnancy for PVD+ cows at 48 DIM (PVD+ CONT: 181 days; 95% CI = 145–219) and PVD+ CEPH: 116 days (95% CI = 98–132). CEPH, cows that received intrauterine cephapirin treatment; CONT, control cows that received no treatment; DIM, days in milk; EXAM2, second genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 8 Survival curves for time to pregnancy up to 300 days after parturition in 468 cows based on uterine status at 34 DIM and 48 DIM (EXAM1/EXAM2): CONT PVD−/PVD− cows (n = 331) (), CONT PVD−/PVD+ cows (n = 36) (), CONT PVD+/PVD− (n = 63) (), and CONT PVD+/PVD+ (n = 38) (). Median time to pregnancy (95% CI) for these four groups was: 116 (97–127), 137 (108–197), 130 (105–184), and 217 (159–243), respectively. There was a significant difference between PVD+/PVD+ and the other groups (see in the Results). CEPH, cows that received intrauterine cephapirin treatment; CONT, control cows that received no treatment; DIM, days in milk; EXAM1, first genital examination; EXAM2, second genital examination; PVD, purulent vaginal discharge. Theriogenology 2017 89, 305-317DOI: (10.1016/j.theriogenology.2016.09.007) Copyright © 2016 Elsevier Inc. Terms and Conditions