Journal of Animal Science, 2020, Vol. 98, No. Suppl.

1, S117–S125

doi:10.1093/jas/skaa135
Received: 19 August 2019 and Accepted: 29 April 2020
ICPD Proceedings

ICPD PROCEEDINGS
Update on postpartum dysgalactia syndrome in sows
Nicole Kemper1
Institute of Animal Hygiene, Animal Welfare and Farm Animal Behavior, University of Veterinary Medicine Hannover,
Foundation, D-30173 Hannover, Germany

Corresponding author: nicole.kemper@tiho-hannover.de

1

ORCiD numbers: 0000-0003-0092-4302 (N. Kemper).

  

Introduction standards may show PDS. It even occurs on excellently managed

farms with optimized disinfection practices. Most research on
Postparturient disorders in sows represent an economically
this topic was conducted between the 1970s and 1990s (Gerjets
important disease complex in modern piglet production
and Kemper, 2009). Despite continued research activities, no real
worldwide. Possible findings affecting the mammary glands
breakthrough has been made, and no single pathway has been
and/or the reproductive tract and the sow’s general condition are
identified. This either confirms the multifactorial etiology or
summarized as a syndrome consisting of a set of symptoms such
indicates that if there is one single pathway, it may be masked
as mastitis and/or metritis. The term postpartum dysgalactia
by other overlaying factors. Both can be expected in a syndrome
syndrome (PDS) is most commonly used (Klopfenstein et  al.,
defined as a set of symptoms. However, PDS is still regularly
2006), but other names such as mastitis–metritis–agalactia
diagnosed on farms. In practice, most clinical cases can be
(MMA) (Martin et  al., 1967), agalactia toxemica (Ringarp,
treated effectively with anti-inflammatory drugs, hormones, or
1960), agalactia complex (Penny, 1970), agalactia postpartum
antibiotics. Nevertheless, because of the evolving need for the
(Hermannson et al., 1978), lactation failure (Elmore and Martin,
prudent use of antimicrobials in the last decade, a more detailed
1980), periparturient hypogalactia syndrome (Smith et al., 1992)
look into pathoetiology and possible prevention of PDS has
or puerperal septicemia and toxemia (Bostedt et al., 1998) have
become necessary. As clinical signs are as varying as possible
been suggested, too. The predominant symptom is reduced milk
etiologies, this review aims to summarize recent insights into
production with or without apparent mastitis during the first
PDS gained in the last decade, with a main emphasis on mastitis
days after farrowing (Ross et  al., 1981; Wegmann et  al., 1986;
and its prevention by considering the respective contributory
Heinritzi and Hagn, 1999). Increased piglet losses due to high
factors.
mortality rates caused by a lack of sufficient milk production lead
to a significantly reduced number of weaned piglets. Possible
causes of PDS vary, and the etiology of the syndrome is clearly
Etiology
multifactorial (Gerjets and Kemper, 2009). In most cases, PDS is
limited to a few animals and may only be sporadic. Nonetheless, One widely accepted theoretical model of etiopathogenesis
almost epidemic cases in affected herds were described with of PDS is that bacteria of the sows’ environment infect the
documented incidence in sow herds of up to 60% (Hirsch et al., mammary gland via the galactogenous or the endogenous
2004). The average incidence thereof was described as being route. Via the galactogenous route, bacteria can enter the teat
approximately 13% (Hermannson et  al., 1978; Jorsal, 1983; duct and the two glands systems behind it, whose orifices are,
Bäckström et  al., 1984; Madec and Leon, 1992; Papadopoulos in contrast to those of cows, not closed by muscular sphincters
et  al., 2008a). However, these epidemiological studies on (Klopfenstein et  al., 2006). Several experiments confirm this
incidence at herd level are not directly comparable because of hypothesis of a galactogenous route of infection and show a
different trait definitions of PDS with no commonly defined reduction in mastitis incidence after protecting the mammary
phenotype. Sows in herds of different hygienic practices and glands against fecal contamination (Middleton Williams et  al.,

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S117
 S118 | Journal of Animal Science, 2020, Vol. 98, No. Suppl. 1
Abbreviations
ExPEC
extraintestinal pathogenic Escherichia
coli
LPS lipopolysaccharides
MMA mastitis–metritis–agalactia
PDS postpartum dysgalactia syndrome
SPP species
1977; Bertschinger et al., 1990). In an experimental setting, the
time of galactogenous infection was determined to happen
in more than 50% of the cases before birth, but only before
the 108th day of gestation, and then again in the first 2 d
after farrowing before the teat order of the piglets was finally
established (Bertschinger et al., 1990). In infection experiments
inoculating sows intramammarily with Escherichia coli to provoke
mastitis, the infection dose was very low with less than 100
bacteria (Österlundh et  al., 2002). Concerning the endogenous
route of infection, it was hypothesized that bacteria colonize
the mammary gland after passing the barriers in the gut or the
uterus. However, the uterine origin of bacteria isolated from
the mammary gland does not seem likely. Indeed, in a previous
study comparing the bacterial flora in different gut sections, the
uterus, and the mammary gland, Gram-negative bacteria were
only isolated from the latter and the ileum (Morkoc et al., 1983).
These findings are supported by earlier studies (Armstrong
et  al., 1968; Bertschinger et  al., 1977a). A  variety of bacterial
species have been isolated from the milk of PDS-affected sows
and their contribution to pathoetiology has been the subject of
controversial discussion (Awad Masalmeh et  al., 1990; Kobera,
2000; Kemper et  al., 2013). Bacteria of the bacterial genera
Escherichia, Citrobacter, Enterobacter, and Klebsiella, belonging to
the class of coliforms were the most frequent species isolated
from mastitis-affected sows (Ross et al., 1981; Awad Masalmeh
et al., 1990; Hirsch et al., 2003; Angjelovski et al., 2016). Infection
experiments demonstrated the role of these bacteria in the
etiology of sows’ mastitis (Bertschinger et al., 1977b; Ross et al.,
1981; Wegmann and Bertschinger, 1984; Pedersen Mörner et al.,
1998; Österlundh et  al., 2002). However, other species, such as
Streptococcus species (spp.), Staphylococcus spp., Pseudomonas
spp., Clostridium spp., Proteus spp., or Corynebacterium spp.,
were isolated from milk samples of diseased sows, too (Baer
and Bilkei, 2005; Angjelovski et al., 2016). As discussed in detail
later in the section on bacteria as an influencing factor, the
exact determination of the role of bacteria in pathogenesis is
challenging. First, bacteria were also isolated in colostrum and
milk of sows showing no signs of clinical PDS (Preissler and
Kemper, 2011; Kemper et  al., 2013; Angjelovski et  al., 2016),
and second, not all sows inoculated with defined amounts
of infectious strains developed clinical PDS in infection
experiments (Österlundh et  al., 1998). This indicates that even
though bacteria cause inflammation, the development of PDS
is related to other factors, too. In a recent commentary, it was
suggested to define PDS as “subclinical coliform mastitis”
similar to coliform mastitis in cows and to take advantage of
this similarity in further research approaches (Pospischil and
Bertschinger, 2018).
Another hypothesis for etiology of PDS is the involvement
of lipopolysaccharides (LPS) endotoxins triggering various
endogenous mediators causing a strong pathological reaction in
sows (Elmore et al., 1978). As a major part of the outer membrane
in Gram-negative bacteria, especially those located in the gut,
LPS are set free when these bacteria decay. They show a strong
systemic effect on the general condition, but with regard to PDS,
their impact on the hormonal regulation of colostrum and milk
secretion is of special importance; already in 1985, Smith and
Wagner (1984) showed that LPS suppresses prolactin release by
the anterior pituitary. In this way, cortisol concentration increases
and the circulating thyroid hormone decreases, resulting in
decreased milk production and secretion (Smith and Wagner,
1984; Reiner et  al., 2009). After experimentally administering
LPS intravenously, subcutaneously, intramammarily or via
the uterus, clinical, and also blood chemical changes similar
to on-farm PDS cases were observed (Nachreiner and Ginther,
1974; Elmore et al., 1978).
Summarizing the known risk factors and putting them in
a new context, namely homeorhesis, Martineau et  al. (2013)
proposed that the clinical approach to PDS also has to consider
physiology, endocrinology, innate immunology, and ethology in
the critical time around parturition with the critical shift from
anabolic to catabolic state. First studies comparing hormonal
and metabolic alterations in PDS-affected and healthy sows
every 14 h in the period from 60 h before to 36 h after parturition
showed significant differences in several of the examined
hormones and metabolic indicators before birth indicating an
imbalance in later diseased animals (Kaiser et al., 2018a, 2018b),
supporting the theory of Martineau et al. (2013). This seems to be
true especially in modern hyperprolific sows, with large litters
and longer birth durations (Peltoniemi et al., 2016), and possible
relations to the development of PDS should be investigated in
further research.
Diseased Sow-Affected Piglets
Even though PDS is primarily a disease occurring in sows,
mainly the piglets suffer as a consequence because of the
restricted access to milk. PDS therefore affects both sows’ and
piglets’ health and welfare.
In the first weeks of life, the access to colostrum and milk is
vital, and the piglets are totally reliant on the sow. Milk yield and
composition are critical factors in determining the growth rate
in suckling piglets (Gruen et al., 1993). PDS-affected sows fail to
meet the needs of their piglets due to dysgalactia in combination
with an increased soreness of the mammary gland. Affected
sows tend to lie on their mammary glands, therefore refusing
piglets access to their painful teats. The lack of milk provision
leads to an increased mortality rate and growth retardation in
piglets (Ringarp, 1960; Penny, 1970). The combination of weak,
undersupplied piglets and the sow’s raised tendency to lie down
in lateral recumbency leads to increased incidence of crushing
(Hellbrügge et  al., 2008). In litters of PDS-affected sows, piglet
mortalities within the first-week postpartum were reported to
increase by 5.0% (Hühn and Rehbock, 1999) to 38.6% (Bäckström
et al., 1984).
As PDS is characterized by the occurrence of reduced milk
production during the first days after farrowing, it is obvious
that the colostrum period within the first 24  h after birth
(Farmer et  al., 2019) is affected. The special importance of
sufficient colostrum intake in neonatal piglets has been well
established. For the survival of piglets, the first days after birth
are the most critical period, and inadequate intake of colostrum
is the underlying cause for the majority of piglet deaths during
this period (Quesnel et  al., 2012). It is essential to fill the low
glycogen stores in new-born piglets because they are not able
to perform sufficient glyconeogenesis, and hypoglycemia may
be induced by the rapid decrease in glycogen (Farmer et  al.,
2019). Besides its energy content, colostrum is essential for the

healthy development of piglets because of the maternal transfer
of immunoglobulins and lymphocytes (Chase and Lunney,
2019). Primarily, inadequate colostrum intake can result in
inanition, poor growth, and even deaths due to starvation and
hypothermia. Secondly, it can also lead to secondary infections
such as diarrhea if the piglets are not protected by maternal
antibodies (Rooke and Bland, 2002).
Even in circumstances with no evidence of PDS in a sow
herd, the provision of milk, and especially of colostrum, can be
critical in hyperprolific sows. It was shown that with increasing
litter sizes over the last decades, milk production has risen,
too. However, this is not proportional to the number of piglets
(Prunier et al., 2010). Even more important, increasing litter sizes
lead to a decrease in the colostrum amount per piglet in modern
hyperprolific sows (Devillers et  al., 2007). As the cited studies
were conducted around 10  years ago, it can be assumed that
the proportions might be worse today, but this requires further
verification. However, it is clear that this situation exacerbates
with the occurrence of PDS.
In this context, the vicious circle of lacking milk withdrawal
(Figure  1) worsens the situation. Only milk withdrawn by the
piglets is reproduced, and only vital and healthy pigs are capable
of adequately suckling on a healthy sow allowing them to do
so. If the sow’s willingness and her ability to provide sufficient
milk are impaired, the piglets become weaker and suckle even
less, which can result not only in hypoagalactia but also in
agalactia. To break this vicious circle, not only lactation has to
be stimulated again, but also adequate provision for the pigs is
essential to ensure their vitality.
Diagnosis
The main clinical signs of PDS in sows are mastitis, dysgalactia,
and fever above 39.5  °C in sows within 12 to 48  h postpartum
(Furniss, 1987; Gerjets and Kemper, 2009). However, due to a highly
variable clinical picture, diagnosis can be difficult. The most
common practice for early diagnosis on commercial farms is to
measure the rectal temperature after farrowing. Nevertheless,
this should be performed ideally in combination with an
examination of mammary gland changes, and consideration
of signs of decreased milk production or reduced appetite. The
range of critical temperature thresholds varies between 39.3 °C
and 40.5 °C (Waldmann and Wendt, 2001), and treatment, mainly
with antibiotics, is administered as soon as these thresholds
are exceeded. However, physiological hyperthermia is often
observed in postparturient sows, especially gilts, leading to
misinterpretations (Klopfenstein et al., 2006; Gerjets et al., 2008;
Stiehler et al., 2015). Stiehler et al. (2015) stress that temperature
measurement should be standardized and measured at the
same time of the day.
Investigation of mammary glands, and especially of
behavioral changes in sows and piglets, allows a more precise
Figure 1.  The vicious circle of lacking milk withdrawal.
Kemper | S119
diagnosis. Mammary glands can appear normal or pathologically
altered, varying from swollen, firm, and warm to the touch to
changes in color. Changes can be limited to only a few teats with
variable localization or generalized. Concerning the location
of affected mammary glands, the abdominal glands are more
prone to pathological changes compared with the pectoral ones
(Baer and Bilkei, 2005). Another criterion related to a high risk
of developing PDS can be any sign of constipation, such as solid
and dry feces, or no defecation at all (Pendl et al., 2017).
As already mentioned, the sows’ behavior can be altered
with regard to their general condition and their will to allow
the piglets access to the udder by lying permanently. The
teats can become traumatized and show superficial or deeper
lesions caused by the piglets in their desire for milk after
strenuous nursing efforts. On the one hand, behavioral changes
in sows have to be considered in diagnosis; on the other
hand, conspicuous behavior of piglets can give hints of sows
developing PDS. For instance, vigorous nursing efforts might be
noticed. The reduced or absent milk ejection leads to decreased
nursing intervals and an increase in the piglets’ activity, often
with agonistic behavior, also followed by skin lesions (Prunier
et al., 2010). Subsequently, with diminishing energy reserves, the
piglets’ attempt to nurse weakens, and they often retreat to the
warmest parts of the farrowing pen and show signs of isolation
behavior (Klopfenstein et al., 2006). Moreover, they try to intake
other liquids, which, in combination with the lack of colostrum,
might cause diarrhea (Sărăndan et al., 2009).
As the measurement of body temperature is nonspecific,
with an increase only indicating alterations in the physiological
state of warm-blooded animals, and the other aforementioned
behavioral factors indicating PDS are not necessarily assessed
on the farm, it can be supposed that a significant percentage of
PDS is wrongly diagnosed. Therefore, special emphasis should
be laid on correctly diagnosing PDS.
One further clinical diagnostic approach was the use of
ultrasonography as a precautionary measure for differentiating
sows having suffered recurrent PDS and showing hyperechogenic
images from healthy animals (Baer and Bilkei, 2005). However,
it has not been implemented in sow management due to
additional costs and impractical handling.
Instead, a number of laboratory indicators have been proposed
to diagnose PDS more precisely (Mirko and Bilkei, 2004; Zhu et al.,
2004, 2007a, 2007b). However, these have not been put into practice
on farms due to different reasons. All approaches to diagnose PDS
based on changes in the blood, whether inflammatory markers
or hormones, are not feasible on farms because the taking of
blood samples is much more laborious than measuring sows’
body temperature. These practical limitations also hold true for
attempts to diagnose PDS according to changed parameters in
the urine of diseased sows (Petersen, 1983; Papadopoulos et  al.,
2008b) or in their milk. Parallel to the use of mastitis indicators in
cow milk, cell count (Persson et al., 1996) and milk pH (Waldmann
and Wendt, 2001) were suggested as indicators. Nonetheless, due
to difficulties in gaining adequate amounts of milk from sows in
practice, their use is very limited, too. Besides the problems in
acquiring suitable sample material, another shortcoming of the
suggested parameters is the nonspecific information they provide.
For instance, similar to fever, levels of plasma concentration of
acute phase proteins increase in stressful situations such as PDS,
and therefore were reported to change in diseased sows (Mirko
and Bilkei, 2004). However, these levels are nonspecific and can
also, as fever, vary substantially around birth (Magnusson and
Fossum, 1992). More recently, saliva has been proposed as a
promising matrix to identify PDS-affected sows at an early stage,
 S120 | Journal of Animal Science, 2020, Vol. 98, No. Suppl. 1
with increased concentrations of salivary chromogranin A  and
cortisol in affected animals (Kaiser et  al., 2018b). In addition,
serum 8-epi-PGF2 was shown to be increased in PDS-affected
sows before parturition, indicating oxidative stress (Kaiser et al.,
2018b).
All these restrictions of alternative diagnostic parameters
illustrate the importance of carefully monitoring the sows and
their piglets after farrowing, recording any changes in their
behavior in order to correctly diagnose actual cases of PDS.
Influencing Factors
The factors shown to have an influence on the clinical
development of PDS are numerous and are summarized in
Figure 2. In research, PDS has been only a minor issue over the
last years in published research articles. This can be related
to the fact that with its multifactorial etiology, most probably
not only a single pathway is responsible for the outcome of the
disease, or, if a single, hitherto unidentified pathway is relevant,
it might be masked by other influencing factors. Thus, so far,
the single factors can be categorized into those decreasing the
immune defense, increasing the infection pressure, or extending
the duration of birth. In the following, the factors “bacteria,”
“husbandry and management,” and “sows’ predisposition” are
elucidated in more detail.
Bacteria
Bacteria isolated from sow’s milk are only of informative value in
combination with the clinical picture. The occurrence of bacteria
in sow’s milk alone does not lead to clinical signs, and in milk
samples of healthy sows, various bacteria can be found regularly
(Kemper et al., 2013; Angjelovski et al., 2016). One reason can be
the relatively open teat ductus with possibly ascending bacteria
from the sow’s environment. The other reason might be related
to the sampling procedure, because milking a sow after the
first hours postpartum is all but easy, and often only realizable
after oxytocin injection. The whole procedure may lead to
contamination and false-positive results.
Escherichia coli is the pathogen most frequently isolated in
association with PDS (Armstrong et  al., 1968; Ross et  al., 1981;
Awad Masalmeh et  al., 1990). Further studies on the virulence
Figure 2.  Scheme of potential influencing factors contributing to PDS, which can be summarized as factors decreasing the immune defense, increasing the infection
pressure and extending the birth duration.
profiles of E. coli did not reveal differences in the prevalence or in
specific virulence gene profiles of isolates from either diseased
or healthy sows (Gerjets et  al., 2011b). In this study, a variety
of virulence genes were detected in E.  coli isolates both from
PDS-positive and -negative sows, with most virulence genes
belonging to the large group of genes related to extraintestinal
pathogenic Escherichia coli (ExPEC). However, a categorization
into the pathotype ExPEC only by virulence gene typing was not
possible (Gerjets et  al., 2011b). There is no single E.  coli-strain
causing PDS; rather, any given E. coli strain, even if considered
to be nonpathogenic, can cause PDS in sows if further adversely
environmental, genetic, or other influencing factors promoting
infection are present.
Besides E.  coli, other bacteria such as strains of
Staphylococcaceae, Streptococcaceae and other bacteria families
have been isolated from milk of affected sows with an unclear
contribution to actual pathogenesis (Awad Masalmeh et  al.,
1990; Hirsch et  al., 2004; Kemper et  al., 2013). Most of the
isolated species are ubiquitous in the sows’ environment and
can originate from both fecal, urine and other contamination. As
in the case of E. coli, other unfavorable influencing factors play
a significant role in the development of clinical disease. These
factors can be attributed to the host or the environment.
However, it has to be mentioned that also other pathogens can
cause clinical pictures similar to PDS. For instance, Mycoplasma
suis has recently been described to cause dysgalactia in a Belgian
sow herd (Laitat et al., 2019). Ju et al. (2019) detected Pseudomonas
spp. to be the most frequently isolated bacteria from mammary
lesions in South Korean slaughterhouse sows and suggested that
there may be a higher prevalence of cases of these agents causing
mastitis than previously estimated. The occurrence of mycotoxins,
originating from moldy feed or other material, is also discussed as
impacting lactation negatively (Heinritzi et al., 2006).
Husbandry and Management
Environmental factors such as husbandry and hygiene
management as well as feeding can affect the clinical course
of PDS. Overviews of risk factors increasing PDS prevalence, as
studied so far, are discussed in detail elsewhere (Papadopoulos
et al., 2008a; Gerjets and Kemper, 2009). Regarding the likelihood
of a sow becoming affected by PDS, existing data on the impact

of parity number are inconsistent (Bertschinger et  al., 1977b;
Baer and Bilkei, 2005). Gerjets et al. (2011a) detected an increased
risk for developing PDS in sows of the first parity, with litters of
more than 13 piglets born alive and more than one piglet born
dead, and after birth intervention. These results were confirmed
by Bardehle et al. (2012), revealing significant relations between
PDS, birth induction, and obstetrics. Sows affected by PDS often
show delayed or extended parturition over 4 h (Tummaruk and
Sang-Gassanee, 2013), and therewith birth assistance is more
likely (Berg et al., 2001). Another strongly correlated influencing
factor is nutrition, for instance, lack of crude fiber in the ration
(Plonait and Bickhart, 1997), and diet-related conditions such as
obstipation (Bostedt et al., 1998), which is also often caused by
physical inactivity of periparturient sows, whether voluntarily
or due to confinement in the farrowing crate. In this context,
sufficient water intake also plays an important role (Krüger
et  al., 2002; Jenny et  al., 2015). Nutrition can influence the
hypothalamo-hypophysical gonadal axis, and therefore also
lactogenesis itself, as reviewed by Cosgrove and Foxcroft (1996).
Other documented factors increasing the risk of developing PDS
are gestation duration exceeding 116  days (Awad Masalmeh
et  al., 1990), prolonged births (Petersen, 1983; Bostedt et  al.,
1998), occurrence of urinary tract infections (Bilkei et al., 1994),
high ambient temperatures (Quiniou and Noblet, 1999), and
late introduction into the farrowing pen after the 110th day of
gestation (Valenčak et al., 2006). Peltoniemi et al. (2016) reviewed
the data on space provision for sows and offering of nest-
building material before parturition, showing the potential to
reduce farrowing duration, stillbirth rate, and potential stress
also during the early nursing period. As stress is a risk factor for
PDS, both space allowance and provision of nesting material can
have beneficial effects.
Sows’ predisposition
As one key factor for the clinical outcome of disease, the host
defense status is of major importance (Burvenich et  al., 2003).
The individual skills of sows to cope with possible pathogenic
bacteria is an important factor in the etiology of PDS, being
influenced by many factors, such as parity number, birth
duration, and genetic variation.
A potential genetic predisposition to PDS has been discussed
for some time (Ringarp, 1960; Preissler et  al., 2012b). Based on
various definitions of phenotypes, heritability ranging from
2% to 20% has been estimated (Lingaas and Ronningen, 1991;
Berg et  al., 2001; Krieter and Presuhn, 2009; Preissler et  al.,
2012a). In the most recent study, an estimated heritability of
approximately 9% in modern sow lines was assessed, and with
that, a genetic background cannot be excluded (Preissler et al.,
2012a). On the one hand, even with this relatively low heritability
percentage, breeding success is possible as shown for mastitis
in dairy cows (Heringstad et  al., 2003). On the other hand, a
heritability in this range clearly shows the importance of other
influencing factors and the need for an optimized environment.
With modern technologies enabling whole-genome studies,
a first study to detect genetic variation in PDS was conducted
in five commercial pig breeding lines (Preissler et al., 2013). The
genetic susceptibility to PDS was confirmed in this previous
study. However, no single causative gene or genomic regions
for PDS were identified, but several contributing genes in
different regions: Three significant SNPs were located on Sus
Scrofa Chromosome (SSC) 13, SSC 15, and SSC 17 (Preissler et al.,
2013). These first findings are promising for potential genetic
improvement, even of low heritable traits. Nonetheless, further
Kemper | S121
studies are necessary to validate these results in other lines and
larger data sets.
Treatment and Prevention
The main treatment of PDS includes the administration of
nonsteroidal anti-inflammatory drugs (NSAIDs) or other
analgetic drugs to help the sows and enable continued suckling
in piglets (Pendl et  al., 2017, Farmer et  al., 2019). To maintain
milk production, oxytocin can be additionally administered
(Hirsch et al., 2003; Gerjets and Kemper, 2009; Pendl et al., 2017).
Maintenance of milk production, or milk provision by other
sources, is essential for the piglets’ health. If they are already
weakened, additional heating should also be provided.
Considering prudent use of antibiotics, as demanded in the
EU Guidelines on the Prudent Use of Antimicrobials in Veterinary
Medicine (2015), temperature alone should not be used as a
single criterion to treat PDS with antibiotics in sows postpartum.
The temperature threshold is defined rather subjectively,
and its use might be regarded critically, since increases and
decreases in temperature can appear physiologically, especially
in the peripartal period. It is essential to perform a diagnosis
of PDS not only due to temperature increase, but also based
on a combination of the appropriate criteria mentioned above.
Wrongly diagnosed PDS cases should be avoided to reduce the
use of antimicrobials and the occurrence of bacterial strains
resistant to one or more antibiotics (Silley and Stephan, 2017).
Moreover, antibiotics should only be administered if the
treatment with NSAIDs and Oxytocin was not successful.
In Swedish (Clemensson Lindell et al., 2019) and Swiss sow
herds (Hartmann, 2016), PDS was shown to be the most frequent
reason for antibiotic treatment. One finding of the latter and
another Swiss study was the high percentage (23% to 33%) of
“Highest Priority Critically Important Antimicrobials” for human
medicine (Jenny et al., 2015; Hartmann, 2016), as defined by the
World Health Organization (2019), such as fluorochinolones
or third and fourth generation cephalosporines used for PDS
treatment. Moreover, Jenny et  al. (2015) showed that in 54% of
antibiotic treatments, treatment duration was too short, and
in 19% thereof the dosage was too low, which both can have
triggering effects on antibiotic resistance.
The reduction in antibiotic administration in lactating sows
is not only strived for because of antibiotic resistance prevention,
but also because of other disadvantages related to excessive use.
Hartmann (2016) showed that antibiotic treatments in sows in
the peripartal period are followed by increased antimicrobial
treatment of diarrhea, polyarthritis, and runting in suckling
piglets and weaners. Since antibiotics can be partially excreted
via milk and affect the development of a physiological intestinal
flora in piglets, antibiotics should only be administered after a
confirmed diagnosis (Oliel, 1995).
As the economic impact of PDS is significant, prevention is
most important. Indeed, a model eliminating the risk of PDS
showed that the value of sow space by €279 compared with
the baseline scenario (Niemi et  al., 2017). Economic losses are
mainly related to increased piglet losses, lower weight gain in
piglets, and a reduced sow lifetime performance by one parity
(Hühn and Rehbock, 1999; Hoy, 2003). Prevention is, therefore,
the best way to cope with PDS in a population, but difficult to
accomplish due to etiology. Even though various studies have
been conducted to elucidate causative factors and the potential
genetic background including individual resistance (Preissler
et al., 2013), the reason for only some sows developing clinical
signs of infection after contact with ubiquitous bacteria remains
 S122 | Journal of Animal Science, 2020, Vol. 98, No. Suppl. 1
unknown. However, providing a suitable environment and
adapted feeding strategies for preparturient sows accounts for
a large proportion of successful long-term prevention. It was
shown that the use of prepartal transition feed is an effective
tool for reducing PDS prevalence (Pendl et al., 2017). An overview
on recent literature on feeding the sow for ease of farrowing,
and with that, for PDS prevention, can be found elsewhere
(Peltoniemi et al., 2016). It has to be stressed that the provision
of roughage is recommended both as nest-building material and
as source of fiber to prevent constipation.
Special care should be taken for sows at risk such as
primiparous sows and sows with a prolonged duration of
farrowing over 4 h, because those have a high risk of developing
postparturient disorders (Tummaruk and Pearodwong, 2015).
As stated by Peltoniemi et  al. (2016), it can be assumed that
prolonged parturition affects uterine health. Especially in
contemporary, highly prolific sows, the duration of farrowing is
increased due to the high number of piglets, and with that, often
also the need for birth induction and obstetrics, being further
risks factors for PDS. The effect of larger litter size on PDS has
not been investigated in detail yet.
All measures to reduce the risk factors mentioned in
the sections above are beneficial. The correlations between
physiology and behavior around farrowing and the influence
of prolonged farrowing, retained placenta, development of PDS
and impaired involution of the uterus on colostrum yield, and
subsequent fertility are presented in a review by Peltoniemi et al.
(2016). In this review, several recommendations for successful
farrowing and the following lactation are given, for instance,
the provision of suitable nest-building material, freedom
of movement, and a diet to reduce the risk of constipation
and obesity. Moreover, the importance of a short parturition
duration is emphasized (Peltoniemi et al., 2016). To enable easy
births and to provide obstetrics if needed, regular controls,
at least hourly, in the time around expected parturitions are
beneficial, also during nightshifts. In outdoor sows, which were
allowed to move freely, a lower incidence of PDS was detected
(Mortensen et  al., 1994). Sufficient water intake is essential to
avoid obstipation, and may be supported by an open water
source. A general high level of farm hygiene management and
specific measures to reduce the infection risk, that is, washing
the sows before entering the farrowing compartment, decrease
PDS risk, too (Hulten et  al., 2004). During parturition, a high
level of hygiene should be realized. Soiling has to be avoided in
the critical period around birth and lactation, and in farrowing
pens or crates, the sow should not lie in her own excreta, which
requires regular removal of feces.
Summary and Conclusions
As a multifactorial syndrome, PDS is not only variable in its
clinical picture but also in its underlying causes. Accordingly,
a comprehensive knowledge of all potential influences and
their optimization is a prerequisite for raising healthy sows
and piglets. With mainly ubiquitous bacteria as pathogens,
emphasis has to be laid on noninfectious risk factors. PDS is not
so much a challenge in treatment, but more so in prevention
and early diagnosis. As is the case for almost all on-farm
situations, and especially for multifactorial diseases, the
human factor is of utmost importance: careful and close animal
monitoring is the key to early identification of sows and litters
at risk of developing PDS. The often practiced administration
of drugs just based on a detected increase in body temperature
postpartum is not justified professionally. The prudent use of
antibiotics demands a proper trait definition, and therefore
other traits should be included in diagnosis. An increased
body temperature above 39.5 °C within 12 to 48 h postpartum
indicates PDS. However, additional clinical alterations on sows’
teats (reddening, swelling, hardening, etc.) and/or noticeable
behavioral changes in sows and piglets have to be present to
confirm the diagnosis. Sow’s and piglet’s behavior should be the
focus of each routine observation of farmers or farm personnel
when checking the farrowing compartments, and even slight
changes should be followed up. This is of special importance
particularly the higher the demands on management are if
litter size is large. Increasing litter size has been one goal in
pig breeding over the last decades, but modern sow lines with
large litters represent a challenge in pig farming, especially
during farrowing and lactation. Uneven litters and prolonged
duration of birth are associated with increasing litter sizes
(Farmer et  al., 2019), and the latter is a known risk factor for
PDS. Other risk factors, which might be related to the etiology
of PDS such as physiological challenges facing highly prolific
sows during this period still remain unknown. Even with these
unknown correlations, documentation of birth duration and
possible problems such as need for obstetrics or subsequent
PDS represents a useful tool for prevention when sows are
selected based on these traits. Moreover, there is still potential
for adaptations and improvements in existing farrowing
systems to increase the general immune defense of sows,
reduce infection pressure, and decrease birth duration, this way
preventing PDS.
Conflict of interest statement
The author declares no real or perceived conflicts of interest.
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