Clinic of Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
J Dairy Sci. 2012 Jan;95(1):206-12. doi: 10.3168/jds.2011-4603.
The objective of the study was to evaluate the visual assessment of vaginal discharge by vaginoscopy for the diagnosis of clinical endometritis (CE) in dairy cows. In an in vivo trial, inter- and intraobserver repeatability of vaginoscopic examination (VE) was determined and the effect of transrectal palpation and experience of the investigator evaluated. Holstein-Friesian cows (n=380) were examined by vaginoscopy between 21 and 27 d in milk by 3 investigators twice. Vaginal discharge was categorized on a 4-point classification system (0=clear mucus, 1=mucus containing flecks of pus, 2=discharge containing less than 50% pus, 3=discharge containing more than 50% pus). Cows with a vaginal discharge score (VDS) of 0 were classified as healthy, whereas cows with a VDS of 1 to 3 were classified as having CE. Vaginal discharge score on a scale from 0 to 3 has moderate intra- (Cohen's kappa coefficient, κ=0.55-0.60) and interobserver (κ=0.44) repeatability. The prevalence of CE was comparable between the 3 investigators (first VE: 42.6, 34.8, and 38.7; second VE 46.8, 36.9, and 43.7%). Transrectal palpation (relative risk=0.96-1.03) or experience of the investigator (relative risk=0.9-1.1) did not affect results of VE. In an in vitro trial, sensitivity and specificity of visual assessment were determined utilizing 33 images showing yellow and pink areas in certain percentages as a reference standard. Pus was represented by yellow areas and the mucosa, including clear mucus, by pink areas. These images were visually assessed by 30 investigators via PowerPoint presentation (experiment 1) and by 23 investigators via a simulated vaginal examination (experiment 2) utilizing the same 4-point classification system. Sensitivity was 99.6 and 96.3% and specificity was 96.7 and 90.1% in experiments 1 and 2, respectively. The results provide evidence that a visual assessment conducted by vaginoscopic examination is not perfect but can be considered a reasonable measurement of vaginal discharge and is a practical tool to distinguish healthy from diseased cows.
本研究旨在评估阴道镜检查对奶牛临床子宫内膜炎（CE）的阴道分泌物的目视评估。在一项体内试验中，确定了阴道镜检查（VE）的观察者内和观察者间的重复性，并评估了直肠触诊和研究者经验的影响。对 380 头荷斯坦-弗里森奶牛在泌乳第 21-27 天进行了阴道镜检查，由 3 名观察者进行了两次检查。阴道分泌物根据 4 分分类系统进行分类（0=透明黏液，1=含脓斑的黏液，2=分泌物中脓少于 50%，3=分泌物中脓多于 50%）。阴道分泌物评分（VDS）为 0 的奶牛被归类为健康，而 VDS 为 1 至 3 的奶牛被归类为患有 CE。0 至 3 分的阴道分泌物评分具有中等的观察者内（Cohen 的kappa 系数，κ=0.55-0.60）和观察者间（κ=0.44）重复性。3 名观察者之间的 CE 患病率相当（第一次 VE：42.6%、34.8%和 38.7%；第二次 VE：46.8%、36.9%和 43.7%）。直肠触诊（相对风险=0.96-1.03）或研究者的经验（相对风险=0.9-1.1）并不影响 VE 的结果。在一项体外试验中，利用显示一定百分比黄色和粉红色区域的 33 张图像作为参考标准，确定了目视评估的敏感性和特异性。黄色区域代表脓液，粉红色区域代表包括透明黏液在内的黏膜。这些图像通过 Powerpoint 演示（实验 1）和通过模拟阴道检查（实验 2）由 30 名观察者和 23 名观察者进行目视评估，使用相同的 4 分分类系统。实验 1 和实验 2 的敏感性分别为 99.6%和 96.3%，特异性分别为 96.7%和 90.1%。结果表明，阴道镜检查进行的目视评估并不完美，但可以被认为是阴道分泌物的合理测量方法，是区分健康和患病奶牛的实用工具。
