Risken att drabbas av postpartumendometrit efter vaginal förlossning är cirka en till fyra procent. Efter kejsarsnitt är risken 10 till 20 procent. De flesta fall av postpartumendometrit orsakas av streptokocker, tarmbakterier, agens från sexuellt överförbara infektioner och bakterier från vaginalfloran. Riskfaktorer för att utveckla postpartumendometrit är bland annat kejsarsnitt, multipla vaginala undersökningar, lång vattenavgång och låg socioekonomisk status. Många fall av postpartumendometrit är lättbehandlade men en del infektioner utvecklas snabbt till ett mer allvarligt tillstånd - puerperalsepsis. Mödradödligheten är globalt sett hög, framför allt i vissa delar av världen, där infektion efter förlossning är en bidragande orsak. Syftet med denna litteraturöversikt var att undersöka hur barnmorskan kan förebygga postpartumendometrit och därmed också minska risken för mödrar att utveckla puerperalsepsis under postpartumperioden. För att besvara syftet användes metoden rapid review och totalt 15 studier inkluderades i arbetet, varav en av studierna var av kvalitativ ansats och 14 med kvantitativ ansats. Under dataanalysen framkom tre huvudkategorier; Kliniska interventioner, Verktyg för barnmorskans proaktiva arbete samt Kunskap, motivation och följsamhet. En del kliniska interventioner, användandet av varningssystem för riskfaktorer och tidiga tecken på infektion samt kunskap, motivation och följsamhet hos vårdpersonal är viktiga faktorer i det preventiva arbetet mot postpartumendometrit. Slutsatsen belyser vikten av det preventiva arbetet mot postpartumendometrit och ett steg att minska mödradödlighet orsakat av puerperalsepsis. / The risk of postpartum endometritis after vaginal delivery is about one to four percent. After a caesarean section, the risk is 10 to 20 percent. Most cases of postpartum endometritis are caused by streptococci, intestinal bacteria, STI agents and bacteria from the vaginal flora. Risk factors for developing postpartum endometritis include caesarean section, multiple vaginal examinations, prolonged fluid leakage and low socioeconomic status. Many cases of postpartum endometritis are mild and easily treated, but some infections quickly progress to a more serious condition - puerperal sepsis. Maternal mortality is high, particularly in some parts of the world, with postpartum infection as a contributing factor. The aim of this literature review was to investigate how midwives can prevent postpartum endometritis and thereby also reduce the risk of mothers developing puerperal sepsis in the postpartum period. To answer the aim, the rapid review method was used and a total of fifteen studies were included in the work, one of these conducted a qualitative approach and fourteen a quantitative approach. Three main categories emerged during the data analysis: Clinical interventions, Tools for midwives' proactive work and Knowledge, motivation and compliance. Some clinical interventions, the use of alert systems for risk factors and early signs of infection, and knowledge, motivation and compliance of health care workers are important in the preventive work against postpartum endometritis. The conclusion highlights the importance of the prevention of postpartum endometritis as a step in reducing maternal mortality caused by puerperal sepsis.

Ziel der vorliegenden Arbeit war es, 1. die Einflüsse von Alter bzw. Parität auf Prävalenz und Entwicklung endometrialer Alterationen beim Rind zu untersuchen, 2. einen repräsentativen Überblick über die mittels Endometriumbiopsie erfassbaren Erkrankungen bei klinisch gesunden Kühen zu schaffen 3. die Entwicklung der histopathologischen Befunde nach einer weiteren Trächtigkeit zu dokumentieren. Grundlage dieser Arbeit sind sechs Endometriumbioptate von klinisch (inklusive rektaler Untersuchung) gesunden Färsen (Gruppe A), 165 Bioptate von klinisch gesunden Kühen (Gruppe B) sowie Bioptat-Paare (Gruppe C) von 46 Tieren, die im Abstand einer Trächtigkeit entnommen wurden. Die Proben der Gruppe A dienten als Kontrollgruppe, wobei die Gefäße als Grundlage für die Normalstruktur vor der ersten Trächtigkeit herangezogen wurden. Innerhalb der Endometriumbioptate der Färsen (Gruppe A) waren keine pathologischen Veränderungen (Endometritis, Endometrose, Angiosklerose) und keine Lymphfollikel nachweisbar. Bezüglich der Endometritis-Prävalenz, die bei 23,6 % lag, ließ sich in Gruppe B keine Abhängigkeit von der Parität oder dem Entnahmezeitpunkt nachweisen. Eine Endometrose trat überwiegend bei Erstkalbinnen (24,4 %) und Tieren mit fünf Abkalbungen (41,6 %) auf. Eine Korrelation mit dem Alter lag nicht vor. Auffällig war die signifikant höhere Endometrose-Prävalenz innerhalb der ersten acht Wochen p.p. (20,1 %), im Vergleich zu später entnommenen Proben (3,2 %). Für das Auftreten von Lymphfollikel, die im Mittel bei 53,3 % der Kühe auftraten, konnten keine Korrelationen mit der Parität oder dem Zeitpunkt der Bioptatentnahme ermittelt werden. Auch scheint weder das Vorliegen einer Endometritis die Entwicklung von Lymphfollikeln zu begünstigen, noch schützen Lymphfollikel im Endometrium vor einer Entzündung des Uterus. Mit steigender Parität war eine Zunahme der Angiosklerose-Prävalenz zu verzeichnen, allerdings konnte keine statistisch signifikante Korrelation zum Grad der Gefäßveränderungen (anhand der H.E.-Färbung) nachgewiesen werden. Innerhalb der Karunkel lagen signifikant höhergradige Veränderungen vor als in interkarunkulären Gefäßen. Da das Alter der Tiere eng mit der Anzahl der Abkalbungen korreliert, war eine gesonderte Betrachtung der altersassoziierten Einflüsse anhand des untersuchten Materials nicht möglich. Mittels der durchgeführten Untersuchungen ließ sich kein negativer Einfluss der vorwiegend geringgradigen histopathologischen Veränderungen im Endometrium (Endometritis, Endometrose, Angiosklerose, Lymphfollikel) auf die Fertilität (Erstbesamungserfolg, Rastzeit, Güstzeit, Gesamtträchtigkeitsrate) nachweisen. Innerhalb der Gruppe C konnte nach einer weiteren Trächtigkeit ein signifikanter Anstieg der Endometrose-Prävalenz von 7,0 % auf 25,6 % nachgewiesen werden, während der Anteil der Tiere mit einer Endometritis bzw. Angioskerose nahezu unverändert blieb. Bei einigen Tieren wurde allerdings in der ersten Probe, jedoch nicht im Folgebioptat, eine Endometrose diagnostiziert. Bei einer Kuh lag dabei sogar zuerst eine mittelgradige periglanduläre Fibrose vor, die im zweiten Bioptat nicht mehr nachweisbar war. Im Hinblick auf die Entwicklung vaskulärer Alterationen konnte nach einer weiteren Trächtigkeit eine signifikante Zunahme der Faserzubildungen (Pikrosiriusrot-Färbung) in der Tunica media interkarunkulärer arterieller Gefäße und karunkulärer Arterien sowie in der Tunica adventitia von interkarunkulären Arteriolen nachgewiesen werden. Weiterhin wurden im Zweitbioptat anhand der Pikrosiriusrot-Färbung signifikant höhergradigere Veränderungen (Gesamtschädigung) der karunkulären Arterien und Arteriolen diagnostiziert. Für alle übrigen Gefäßtypen lag zwar eine Zunahme der Gesamtschädigung im zweiten Bioptat vor, diese war jedoch nicht statistisch signifikant. Zu beiden Untersuchungszeitpunkten konnten innerhalb des untersuchten Materials vor allem Elastosen und Elastofibrosen nachgewiesen werden. Dabei lagen bezüglich der Art der zugebildeten Fasern keine signifikanten Unterschiede zwischen beiden Proben vor. Insgesamt konnten anhand des untersuchten Materials von klinisch gesunden Kühen zahlreiche pathologische Befunde im Endometrium diagnostiziert werden. Allerdings ist die Interpretation der Befunde bislang schwierig, da keine Einflüsse auf die Fertilität nachweisbar waren. Jedoch lagen besonders im Hinblick auf die Endometritis und Endometrose meist nur geringgradige Veränderungen vor, so dass sich diese vermutlich nicht negativ auf die Fruchtbarkeit auswirken. Weiterhin ist anhand der vorliegenden Ergebnisse fraglich, ob eine Endometrose beim Rind als irreversible Erkrankung angesehen werden muss. Hierzu sind weitere Studien erforderlich.

The mare experiences a transient innate immune response to breeding, the resolution of which is crucial for optimal fertility. The majority of mares are able to modulate this inflammation in a timely fashion, but a subpopulation exists which fail to do so and are considered susceptible to persistent breeding-induced endometritis (PBIE). Seminal plasma has been shown to modulate aspects of this inflammation. Recently, two seminal plasma proteins have garnered interest for their immune modulating properties: cysteine-rich secretory protein-3 (CRISP-3) and lactoferrin. These proteins have been found to alter the binding between sperm and neutrophils based on sperm viability in vitro, but minimal work has evaluated their effect on endometrial mRNA expression of cytokines and inflammation in response to breeding. Experiments were performed to analyze the expression of equine CRISP-3. Found to be primarily synthesized in the ampulla of the vas deferens and to a lesser extent in the vesicular gland, CRISP-3 expression was only seen in the postpubertal stallion. Due to the effect of sperm viability on protein function in vitro, varying sperm populations were analyzed for their effect on gene expression in the uterus. It was determined that viable sperm suppressed the gene expression of the inflammatory modulating cytokine interleukin-6 (IL-6) in comparison to dead sperm. Next, the effect of CRISP-3 and lactoferrin on endometrial gene expression in the normal and susceptible mare was investigated. Neither protein had a significant effect on the mRNA expression of inflammatory cytokines in the normal mares at six hours post-breeding. In contrast, lactoferrin was found to significantly suppress the expression of the pro-inflammatory cytokine tumor necrosis factor (TNF)-α in susceptible mares. Due to this, lactoferrin was further analyzed as an immunomodulant for the treatment of PBIE. Susceptible mares were infused with varying doses of lactoferrin at six hours post-breeding. Although not in a dose-dependent fashion, lactoferrin was found to decrease both fluid retention and neutrophil migration, in addition to suppressing the expression of the pro-inflammatory cytokine interferon gamma (IFNγ) and increasing the gene expression of the anti-inflammatory cytokine interleukin-1 receptor antagonist (IL-1RN). In conclusion, CRISP-3 expression occurs in secretory aspects of the male reproductive tract, and appears to be up regulated after sexual maturation. Viability of spermatozoa affects the immune response to breeding and should be taken into consideration for experimental design and interpretation of data. The seminal plasma proteins CRISP-3 and lactoferrin have minimal effect on endometrial gene expression in normal mares, but lactoferrin suppresses the expression of TNF in susceptible mares. Finally, lactoferrin was found to function as a potent anti-inflammatory for the persistent inflammation seen in susceptible mares when administered post-breeding. This protein should be further investigated as a potential therapeutic for the treatment of persistent breeding-induced endometritis.

Com o objetivo de avaliar a função metabólica de vacas da raça Holandesa com diferentes graus de catarro genital, foram examinadas 230 vacas e foram colhidas 133 amostras de sangue de fêmeas no puerpério tardio, entre 15 e 42 dias. As amostras foram separadas em quatro grupos de animais, os que apresentaram catarro genital grau I, aqueles com catarro genital grau II, animais com catarro genital grau III e animais saudáveis que formaram o grupo controle, sendo dos grupos G1, G2, G3 e G4 respectivamente. Avaliou-se a função renal a partir da determinação dos teores séricos de uréia e creatinina, a função hepática através da determinação dos teores séricos de proteína total, de albumina, da atividade enzimática da aspartato aminotransferase (AST) e da gamaglutamiltransferase (GGT), o lipidograma foi avaliado por meio da determinação dos teores séricos de colesterol, de triglicérides e dos teores plasmáticos de ácidos graxos não esterificados (NEFA) e do betahidroxibutirato. Além disso foram avaliados os teores plasmáticos de glicose e séricos dos íons cálcio, fósforo e magnésio do soro. A determinação dos teores das variáveis estudadas foram quantificadas em analisador bioquímico automático da marca MAS®, modelo Liasys®. Os teores séricos de uréia foram estatisticamente diferentes entre os grupos 1 e 2. Os teores séricos de creatinina foram estatisticamente maiores nos animais doentes. Não houve diferença estatistica entre os teores de proteína sérica total nos diferentes grupos. Houve diferença estatistica entre os teores séricos de albumina entre os grupos 1 e 3. Houve diferença estatistica entre os teores séricos de AST entre os grupos 1 e 4. Não houve diferença estatistica entre os teores séricos de GGT. Houve diferença estatistica entre os teores séricos de colesterol entre os grupos. Não houve diferença estatistica entre os teores séricos de triglicérides entre os grupos. Não houve diferença estatistica entre os grupos em relação aos teores plasmáticos de NEFA, de β-Hidroxibutirato e de glicose. Houve diferença estatística entre os teores séricos de cálcio entre os grupos 1 e 4. Houve diferença estatística entre os teores séricos de fósforo entre os grupos 1 e 2 e entre os grupos 1 e 4. Houve diferença estatística entre os teores séricos de magnésio entre o grupo 1 e 4. / In order to evaluate the metabolic function of Holstein Friesian cows with different degrees of vaginal catarrh, 230 cows were examined and 133 blood samples were collected from late postpartum females between 15 and 42 days. The blood samples were separated into four experimental groups, animals with vaginal catarrh grade I, animals with vaginal catarrh grade II, animals with vaginal catarrh grade III and healthy animals comprising the control group, being G1, G2, G3 and G4, respectively. We evaluated renal function by determining the levels of serum urea and creatinine, liver function by determining the levels of serum total protein, albumin, the enzymatic activity of aspartate aminotransferase (AST) and gammaglutamyltransferase (GGT), the lipid profile was evaluated by determining the levels of serum cholesterol, triglyceride levels and plasma non-esterified fatty acids (NEFA) and β-hidroxibutyrate. In addition we evaluated the levels of glucose in plasma, calcium, magnesium and phosphorus in serum. The determination of the levels of variables were quantified with the use of automatic biochemical analyzer, AMS® brand, model Liasys®. The serum urea levels were statistically different between groups 1 and 2. The serum creatinine levels were statistically higher in diseased animals. There was no statistical difference between the levels of total serum protein in the different groups. There was statistical difference between serum albumin levels between groups 1 and 3. There was statistical difference between serum AST levels between groups 1 and 4. There was no statistical difference between the serum levels of GGT. There was statistical difference between serum cholesterol levels between the groups. There was no statistical difference between the serum triglyceride levels between the groups. There was no statistical difference between groups in relation to plasma levels of NEFA, β-hydroxybutyrate and glucose. There was statistical difference between the serum calcium levels between groups 1 and 4. There was statistical difference between serum phosphorus levels between groups 1 and 2 and between groups 1 and 4. There was statistical difference between serum magnesium levels between groups 1 and 4.

Do ponto de vista da produtividade, a fertilidade é um dos parâmetros de maior importância em um rebanho bovino comercial e esta é influenciada por vários fatores, entre eles estão as condições do trato reprodutivo das fêmeas e a qualidade do sêmen utilizado. O influxo de células inflamatórias no local da deposição do sêmen logo após a inseminação artificial (IA) pode ser intensificada na presença de maior número de espermatozoides lesados durante a IA, caracterizando uma endometrite. Este estudo foi conduzido em três experimentos. Com o objetivo de comparar os métodos de colheita de material endometrial por escova ginecológica (EU) e lavado uterino (LU), bem como a interferência destes procedimentos na hemodinâmica uterina, foi proposto o Experimento 01, onde pode-se constatar que ambas as técnicas permitem o recolhimento de amostras em quantidade e qualidade suficiente para contagem, e que a porcentagem de células polimorfonucleares obtidas pela técnica LU foi superior a EU. Maior fluxo sanguíneo das artérias uterinas foi encontrado no momento de 4 horas após a realização de LU, sugerindo que este influencia na resposta vascular inflamatória. Para avaliar o efeito da LU após a IA em Tempo Fixo (IATF) na fertilidade dos animais, executou-se o Experimento 02 e constatou-se que não há diferença no índice de prenhez entre os animais submetidos ou não à LU, demonstrando que a técnica não interfere na taxa de fertilidade. Com o intuito de investigar a interferência da qualidade do sêmen na fertilidade, resposta inflamatória e hemodinâmica uterina, foi proposto o Experimento 03, onde foi possível observar influência da qualidade do sêmen sobre a taxa de prenhez, verificou-se maior porcentagem de vacas prenhes quando inseminadas com sêmen com maiores percentuais de espermatozoides apresentando integridade das membranas plasmática e acrossomal e função mitocondrial (PIAIC). Notou-se ainda a ocorrência de endometrite em 65,3 % dos animais, os quais apresentaram taxa de prenhez inferior aos que não apresentaram inflamação. Pode-se concluir que a qualidade do sêmen e a endometrite interferem na taxa de fertilidade bovina. / When productivity is taking into account, fertility is one of the most important parameters in a commercial herd. It is influenced by several factors, especially by the conditions of the female reproductive tract and the quality of the semen used. The influx of inflammatory cells at the site of semen deposition after artificial insemination (AI) can be intensified by the deposition of a greater number of dead spermatozoa during AI, which characterized endometritis. This study was conducted in three different experiments. In order to compare the methods of collection of endometrial sampling by swab using a gynecological brush (GB) or uterine flushing (UF), as well as the interference of these procedures in uterine hemodynamics, we designed experiment 01. Our results reveal that both techniques allow collecting samples with good quality and sufficient quantity to be counted; moreover, the average percentage of polymorphonuclear cells obtained by UF was greater compared to those obtained by GB. It may be noted that the increased blood flow was observed in samples collected four hours after the UF procedure, suggesting that it may have an influence on the vascular inflammatory response. To evaluate the effect of uterine flushing after AIFT on animal fertility we designed the experiment 02. Our results revealed that there is no statistical difference in pregnancy rates between flushed and non flushed animals, showing that the UF does not interfere with fertility rate. Experiment 03 was designed in order to assess the inflammatory response induced by different qualities of semen and their interference on uterine hemodynamic and fertility. There was an influence of semen quality on pregnancy rates: higher percentage of pregnancy was found in the group of cows inseminated with semen with plasma and acrossome membrane integrity and mitochondrial function (PIAIC). Endometritis was noticed in 65.3% of the cows and these animals presented lower pregnancy rate compared to those that did not show an inflammatory response. We concluded that semen quality and endometritis interferes with fertility rate in bovine species.

<p>This study was undertaken to investigate the involutional changes of the uterus and uterine cavity by ultrasound (US), gray-scale and Doppler, after normal delivery, and to compare with the corresponding findings from women with puerperal complications, particularly retained placental tissue (RPT). The overall design was exploratory and prospective, with the use of descriptive statistics for analysis. </p><p>Forty-two women with uncomplicated vaginal term delivery were examined on post-partum days 1, 3, 7, 14, 28 and 56. The AP diameters of the uterus and uterine cavity and morphological findings were recorded. The maximum AP diameters of the uterus and uterine cavity diminished from 92.0 mm on day 1 to 38.9 mm at day 56 and from 15.8 mm at day 1 to 4.0 mm at day 56, respectively. The uterus was most often empty in the early and late puerperium while a mixed echo pattern over the whole cavity was found during mid puerperium (I).</p><p>Seventy-nine women with secondary post partum hemorrhage (SPH) were examined on the day they presented with clinical symptoms. US revealed an echogenic mass in the uterine cavity in 17 of 18 patients treated surgically and histology confirmed placental tissue in 14 of these. Sixty-one patients with either an empty cavity or mixed echo pattern had an uneventful puerperal course after conservative treatment (II).</p><p>AP diameters and morphological findings for 55 women with endometritis, 28 after caesarean section and 20 after manual evacuation of the placenta overlapped extensively with normal references (III).</p><p>The physiological vascular involution studied in 45 women after normal delivery showed that PI and RI indices did not change significantly until day 28 postpartum. The presence of at least one uterine artery notch was found in 13.3% of the women at day 1 and in 90.6% at day 56 postpartum (IV).</p><p>PI and RI values were measured and compared with reference values in 20 women with clinical suspicion of RPT who were to undergo surgical evacuation. Mean resistance indices were below the 10th percentile for eight of these 20 women, but overlapping was considerable. Doppler US has limited value as a diagnostic tool for RPT. The absence of a hyper-vascular area in the myometrium does not exclude RPT but an echogenic mass in the cavity is a sign of RPT (V).</p>

This study was undertaken to investigate the involutional changes of the uterus and uterine cavity by ultrasound (US), gray-scale and Doppler, after normal delivery, and to compare with the corresponding findings from women with puerperal complications, particularly retained placental tissue (RPT). The overall design was exploratory and prospective, with the use of descriptive statistics for analysis. Forty-two women with uncomplicated vaginal term delivery were examined on post-partum days 1, 3, 7, 14, 28 and 56. The AP diameters of the uterus and uterine cavity and morphological findings were recorded. The maximum AP diameters of the uterus and uterine cavity diminished from 92.0 mm on day 1 to 38.9 mm at day 56 and from 15.8 mm at day 1 to 4.0 mm at day 56, respectively. The uterus was most often empty in the early and late puerperium while a mixed echo pattern over the whole cavity was found during mid puerperium (I). Seventy-nine women with secondary post partum hemorrhage (SPH) were examined on the day they presented with clinical symptoms. US revealed an echogenic mass in the uterine cavity in 17 of 18 patients treated surgically and histology confirmed placental tissue in 14 of these. Sixty-one patients with either an empty cavity or mixed echo pattern had an uneventful puerperal course after conservative treatment (II). AP diameters and morphological findings for 55 women with endometritis, 28 after caesarean section and 20 after manual evacuation of the placenta overlapped extensively with normal references (III). The physiological vascular involution studied in 45 women after normal delivery showed that PI and RI indices did not change significantly until day 28 postpartum. The presence of at least one uterine artery notch was found in 13.3% of the women at day 1 and in 90.6% at day 56 postpartum (IV). PI and RI values were measured and compared with reference values in 20 women with clinical suspicion of RPT who were to undergo surgical evacuation. Mean resistance indices were below the 10th percentile for eight of these 20 women, but overlapping was considerable. Doppler US has limited value as a diagnostic tool for RPT. The absence of a hyper-vascular area in the myometrium does not exclude RPT but an echogenic mass in the cavity is a sign of RPT (V).

La vaca lletera d’alta producció actual pateix un estrés metabòlic ques’uneix a altres tipus d’estrés com el del part i de la gestació. Malgratles millores en nutrició i genètica, la eficàcia reproductiva d’aquestsanimals ha anat disminuint any rere any. Per aquest motiu, l’objectiud’aquesta tesi es establir un protocol diagnòstic i terapèutic durant els dies 15-21 postpart que identifiqui els animals amb endometritis i millori la recuperació postpart de vaques lleteres d’alta producció. Alhora, es planteja un protocol desincronització basat en progesterona intravaginal aplicat juntament ambgonadotropina coriònica equina. Aquest protocol pretén millorar laeficàcia reproductiva de la vaca lletera d’alta producció, amb elevat nombre d’anestre postpart. / La vaca lechera de alta producción actual sufre un estrésmetabólico quese une a otrostipos de estrés, como pueden ser el parto o la gestación. Apesar de las mejoras en nutrición y genética de los últimosaños, laeficacia reproductiva de estos animales ha disminuidoconsiderablemente. Por este motivo el objetivo de esta tesis es establecer un protocolodiagnóstico y terapéuticodurante los días 15-21 postparto que identifique los animales con endometritis y mejore la recuperaciónpostparto de las vacaslecheras de alta producción. A suvez se plantea un protocolo de sincronizaciónbasado en progesteronaintravaginalimplementado con gonadotropina coriónica equina (eCG). Esteprotocolopretendemejorareficaciareproductiva de la vaca lechera dealta producción, especialmente de las vacasanéstricas. / Nowadays, high producing dairy cow suffers a metabolic stress that may be associated to other stress such as parturition or gestation.Despite the nutritional and genetic improvements in last decades,reproductive performance has dramatically decreased. For that reason, the aims of this thesis are to implement a diagnostic and therapeutic protocol during Days 15-21 postpartum that detect cows suffering from endometritis and to improve postpartum involution and subsequent reproductive performance in high producing dairy cows. Moreover, a progesterone based synchronization protocol plus equine chorionic gonadotrophin (eCG) is tested. The objective of this protocol is to improve the reproductive performance of high producing dairy cows, especially anestric cows.

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Orientador: Marco Antonio Alvarenga / Banca: Marco Antonio Alvarenga / Banca: José Antonio Dell'Aqua Jr. / Banca: Rodrigo Costa Mattos / Resumo: A endometrite persistente pós-cobertura (EPPC) é a principal causa de redução da fertilidade nas éguas, causando impactos importantes dentro do mercado do cavalo. Os tratamentos comumente utilizados para EPPC visam apenas minimizar os fatores predisponentes a sua instalação, não atuando diretamente no processo inflamatório. Com o intuito de reduzir a resposta inflamatória, estudos recentes têm demonstrado um aumento da fertilidade de animais acometidos por EPPC, quando se utiliza agentes imunomoduladores. O PRP é modulador da resposta inflamatória que está sendo largamente utilizado na medicina veterinária. Este concentrado de plaquetas contém diversos fatores de crescimento que atuam diretamente nos mediadores inflamatórios, reduzindo o processo e promovendo reparação tecidual. O PRP é benéfico no tratamento de inflamações tendíneas e osteoarticulares, modulando a inflamação e acelerando a regeneração do tecido lesionado. Mais recentemente alguns pesquisadores demonstraram o efeito benéfico do PRP em tratamentos intrauterinos de éguas. Desta forma o presente estudo tem por objetivo revisar os aspectos relacionados a EPPC assim como ao PRP e seu mecanismo de ação. / Abstract: The persistent breeding-induced endometritis (PBIE) is the main cause of decrease fertility in the horses, thereby causing significant impact in the horse's market. The treatments commonly used for PBIE view only minimize the predisposing factors and do not act directly in the inflammatory process. Aiming to reduce the inflammatory response, recent studies have shown an increase in fertility of animals with PBIE when used immunomodulatory agents. A modulator of the inflammatory response that has been largely used in veterinary medicine is the platelet-rich plasma (PRP). This platelet concentrate contains many growth factors which act directly on inflammatory mediators, reducing process and promoting tissue repair. Several studies have shown that PRP is beneficial in the treatment of osteoarticular and tendon inflammations, modulating inflammation and accelerates the regeneration of injured tissue. More recently some researchers have demonstrated the beneficial effect of PRP in intrauterine treatment of mares. Thus, the present study aimed to do a literature review on the aspects related to PBIE, as well as the PRP and its mechanism of action. / Mestre