68.承上題,本病例最正確的診斷為何?
(A)子宮蓄膿 (pyometra)
(B)産褥性子宮炎(puerperal metritis)
(C)子宮內膜炎(endometritis)
(D)輸卵管卵巢膿瘍(tubo-ovarian abscesses)

產褥期子宮炎(puerperal metritis)

產褥期子宮炎是由於細菌感染子宮引起的急性全身性疾病，通常在分娩後10天內。產褥期子宮炎的特徵是以下臨床症狀：惡臭的紅棕色水樣子宮分泌物，通常為發熱> 39.5C [52]；在嚴重的情況下，還可能出現產奶量減少，渾濁，食慾不振或厭食，心律加快和明顯脫水

產褥期子宮炎通常與胎盤滯留，難產，死產或雙胞胎有關，通常發生在產後第一周末，在產後第二週後很少見[52,54]。

Defining postpartum uterine disease in cattle

Theriogenology 65 (2006) 1516–1530

這題應該是莊老師出的，子宮炎症有很多種定義，但莊老師是以這篇paper定義為主。

這題重點在於分娩十天內與發燒，為什麼惡臭不是區分標準，因為子宮炎也會有，剩下定義大家去看原文，我就不翻譯了~

Puerperal metritis is an acute systemic illness due to infection of the uterus with bacteria, usually within 10 days after parturition. Puerperal metritis is characterized by the following clinical signs: a fetid red-brown watery uterine discharge and, usually, pyrexia [52]; in severe cases, reduced milk yield, dullness, inappetance or anorexia, elevated heart rate, and apparent dehydration may also be present. The term metritis should be used for cows that have delayed involution and a fetid discharge, in the absence of detected fever. Indeed, in some cases of severe bacterial infection pyrexia was not detected, even with daily monitoring of rectal temperature and did not depend on the load or species of bacteria [53]. Puerperal metritis is often associated with retained placenta, dystocia, stillbirth or twins, and usually occurs toward the end of the first week post partum, being rare after the second week post partum [52,54]. We propose that a case of puerperal metritis should be defined as an animal with an abnormally enlarged uterus and a fetid watery red-brown uterine discharge, associated with signs of systemic illness (decreased milk yield, dullness or other signs of toxemia) and fever >39.5 8C, within 21 days post partum. Animals that are not ill, but have an abnormally enlarged uterus and a purulent uterine discharge detectable in the vagina, within 21 days after parturition, may be classified as having clinical metritis.