Medical Management of Metritis Secondary to Retained Fetal Membranes in a Linne’s Two-Toed Sloth (Choloepus didactylus): a case study

An 11-year-old multiparous female Linne’s two-toed sloth ( Choloepus didactylus ) became lethargic and hyporexic eight days after an uncomplicated delivery of a single healthy offspring. She was treated with intramuscular (IM) injections of ceftiofur crystalline free acid (6.2 mg/kg) and meloxicam (0.1 mg/kg). The next day, the female was immobilized for examination, including transvaginal hysteroscopy, which revealed a marked amount of purulent vaginal and uterine fluid, as well as suspected retained fetal membranes. Treatment included uterine saline lavage and antibiotic infusion (ceftiofur sodium, 1 g), intravenous (IV) enrofloxacin (5 mg/kg for two days), oral broad-spectrum antibiotics (enrofloxacin, 10 mg/kg once daily for ten days and amoxicillin/clavulanic acid, 14 mg/kg twice daily for fourteen days), misoprostol (9.5 µg/kg orally once daily for six days), oxytocin (0.15 IU/kg IM once daily for five days), and supportive care. Culture from the uterine lavage revealed Enterococcus faecalis (3+), Bacteroides sp. (3+), and Peptostreptococcus sp. (2+). Due to difficulty with oral administration, antibiotics were switched to penicillin G procaine (40,000 IU/kg IM) for an additional seventeen days. Four weeks post-initial exam, recheck hysteroscopy revealed moderate white mucoid discharge and adherent placental tissue. Repeat uterine lavage cultured Acinetobacter sp. (1+) and Enterococcus faecalis (1+); supportive care was continued for eight additional days. Eight weeks after initial presentation, the patient was asymptomatic and considered clinically recovered. This report represents the first documentation of medically managed retained fetal membranes and secondary metritis in a Linne’s two-toed sloth.