Diagnosis of uterine and vaginal disorders by different methodologies is affected by concentration of estradiol in plasma
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The relationship between plasma estradiol concentration at time of examination and prevalence of uterine disorders, agreement among methods, and associations of diagnosis with pregnancy hazard and milk yield was studied in 268 Holstein cows examined at 30 +/- 3 (exam 1) and 44 +/- 3 d in milk (DIM; exam 2). Purulent vaginal discharge was sampled using 2 methods: gloved hand and Metricheck (Simcro, Hamilton, New Zealand; PVD; score >= 3). Percentage of polymorphonuclear leukocytes was determined by endometrial cytology (CYTO; exam 1: >= 18%, exam 2: >= 10%); diameter of uterine horns (UTH; >20 mm), diameter of the inner layer of the cervix (CVX; >20.5 mm), presence of fluid in the uterine lumen (FL), and ovarian structures were evaluated by ultrasonography. A blood sample was collected at each exam for estradiol analysis. Prevalence at exams 1 and 2 was, respectively, 14.2 and 18.5% (PVD), 21.4 and 10.1% (FL), and 40.6 and 50.2% (CYTO). Prevalence of PVD at exam 1 was greater among cows with estradiol >= 2 pg/mL (19.4 vs. 8.2%). Agreement of all methods with CYTO was poor, the greatest being between CYTO and FL (exam 1; kappa = 0.19). Agreement between CYTO and PVD, and between CYTO and FL (exam 1; kappa = 0.15 and 0.35, respectively) was higher among cows with estradiol >= 2 pg/mL. Likelihood of PVD at exam 1 was greater if cows were positive for CVX [odds ratio (OR) = 3.0], FL (OR = 2.6) or had estradiol >= 2 pg/mL (OR = 2.7). Likelihood of CYTO increased with dystocia (OR = 2.3) and FL (OR = 2.5). Estradiol did not influence diagnosis at exam 2. Positive FL or CYTO at exam 1 was associated with reductions in milk yield of 59 to 180 kg by 45 DIM. Pregnancy hazard until 250 DIM was reduced by CYTO at exam 1 (hazard ratio = 0.74) and by PVD (hazard ratio = 0.68) at exam 2. However, FL and CYTO reduced pregnancy hazard only when estradiol was >= 2 pg/mL (exam 1), whereas PVD reduced pregnancy hazard when diagnosed at exam 2 with estradiol <2 pg/mL. Overall, agreement was poor and effects of positive diagnosis differed according to method and DIM at exam. Estradiol concentration influenced prevalence, agreement, likelihood of positive diagnosis, and its effects on days to pregnancy.