Obstetrics and Gynecology International 7 (a) Ablation of the cervix: repeat surgery with placement of a clove hitch as far as possible from the cervix on the vagina. Then make a cut a few millimetres from the ligature. The stump is then disinfected with an iodine solution and sutured with a perforating simple continuous suture with VICRYL Dec. 3, and returned to the pelvic cavity. The disadvantage of this method is that the ovaries remain in place and the posterior portion of the vaginal mucosa may therefore continue to secrete abnormally for a few months, or even for up to a year later, which can result in the emission of drops of pus at the lower commissure of the vulva. This is why an ovariectomy is preferable and necessary (Figure 4). (b) Return to oestrus: the diﬀerential diagnosis should include cystitis, vaginitis, cervicitis, and inﬂammation or infection of the anal glands, which may be mistaken for signs of oestrus by the owners, which can be detected using a vaginal swab, and/or serum progesterone assay. If the bitch is conﬁrmed as being in oestrus, there are two possible explanations: a residual fragment of the ovary, which was overlooked at the time of the ovariohysterectomy, or the secretion of oestrogens from the corticoadrenal glands due to hypophyseal dysfunction. Repeat surgery is therefore advisable, if the latter fails or if the surgeon is conﬁdent that no ovarian fragments have been overlooked then hormonal treatment can be started [6]. (viii) Bitches who have undergone surgery for pyometria may present with thrombocytopenia: in the days following the procedure, the bitch presents with a marked tendency to haemorrhage. The mucosae are pale, the pulse weak, the bitch is hypothermic (36◦C), and petechiae appear on the gingival and labial mucosae. Subcutaneous oozing is seen at the abdominal incision, and an angry red patch covering the entire caudo-ventral abdominal zone. Occasion- ally, a large quantity of blood clots is discharged from the vulva. Haematology reveals a signiﬁcant reduction in circulating platelets, to the order of 3,500 rather than 300,000–450,000/mm3. The red blood cell count is also markedly reduced to around 120,000 instead of 6,000,000/mm3. The tendency to haemorrhage increases over time and the edges of the wound disunite within 3-4 days, the animal is very pale, comatose, and death follows. 4. Discussion The current success rate is close to 95%, whilst several decades ago failures were to the order of 50%. 5. Conclusion Ovariohysterectomy is the only eﬀective treatment for pyometria and it is a radical treatment for postoestrus metri- tis when it recurs following failure of medical treatment. For the procedure to have the best chances of success, it is important to perform it on a bitch in good general condition. It is also important to remember that after an ovariec- tomy bitches tend to put on weight, 1 kg for every 10 kg after 90 days; the metabolism of the bitch falls from 37 to 33 Kcal/day, it is therefore important to reduce the daily ration by 10%. References [1] P. W. Concannon and V. N. Meyers-Wallen, “Current and pro- posed methods for contraception and termination of pregnancy in dogs and cats,” Journal of the American Veterinary Medical Association, vol. 198, no. 7, pp. 1214–1225, 1991. [2] A. Fontbonne, X. Le´vy, E. Fontaine, and C. Gilson, Guide Pratique de Reproduction Clinique Canine et f´eline, Editions Med’com, Paris, France, 2007. [3] J. P. Mialot, Pathologie de la Reproduction chez les Carnivores domestiques, Editions du Point Ve´te´rinaire, Maisons Alfort, France, 1984. [4] E. van Duijkeren, “Signiﬁcance of the vaginal bacterial ﬂora in the bitch: a review,” Veterinary Record, vol. 131, no. 16, pp. 367– 369, 1992. [5] A. Laznicka, “Microﬂora of genital organs of bitches and its relationship to reproductive disorders. I. Normal microﬂora,” Veterinarstvi, vol. 45, pp. 162–164, 1995. [6] J. Roberts, “Infertility and reproductive diseases in bitches and queens,” in Veterinary Obstetrics and Genital Diseases, pp. 709– 751, SJ Roberts, Woodstock, Vt, USA, 3rd edition, 1990. [7] R. Baron, “Appareil Ge´nitale Femelle,” in Anatomie Compar´ee des Mammif`eres Domestiques. Tome 4, Spalnchnologie II, vol. 4, pp. 268–435, Vogot, Paris, France, 1990. [8] H. E. Evans, “Miller’s antomy of the dog,” in The Urogenital System, chapter 9, pp. 531–558, WB Saunders, Philadelphia, Pa, USA, 3rd edition, 1993. [9] A. Autefage, A. Cazieux, J. Desbordes, et al., “Analge´sie acupuncturale pour l’ovario-hyste´rectomie de la chienne. Bilan D’une anne´e d’expe´rimentation clinique,” Revue de M´edecine V´et´erinaire, vol. 127, no. 6, pp. 901–912, 1997.