Lesson 9 - Equine Gestational & Post-partum Problems

What are the gestational problems seen in equine?

1. vulvar hemorrhage pre-partum

2. uterine torsion

3. prolonged gestation

4. hydrops condition

5. rupture of pre-pubic tendon

6. abdominal hernia

7. ventral edema

What is the cause of vulvar bleeding pre-partum?

varicose veins near the vestibulo-vaginal folds leak blood during pregnancy

What type of patient will you see vulvar bleeding pre-partum in?

older mare a few days to weeks before foaling

What is the treatment for vulvar bleeding prepartum?

1. do nothing

2. can cauterize

3. silver nitrate

How does silver nitrate help with vulvar bleeding prepartum?

it acts as a chemical cauterizing agent

How do we not want to treat vulvar bleeding prepartum?

do not ligate

When does uterine torsion occur in mares?

last 3 months of gestation

What are the signs of uterine torsion?

mild, chronic colic but no gastrointestinal abnormalities

What is the risk of uterine torsion?

fetal hypoxia and uterine necrosis

What do you need to do first if you suspect uterine torsion?

perform transrectal palpation and verify the orientation of the broad ligament

How do we treat uterine torsion in mares?

1. surgical reposition

2. rolling procedure

How is surgical reposition of uterine torsion in mares performed?

flank incision on the side of the rotation and you lift the uterus up and flip back in to normal position

What is needed in order to perform the rolling procedure for uterine torsion?

sedation

How do you perform the rolling procedure?

place mare on the side towards which the uterus has rotated then place plank to keep uterus fixed and rotate the mare

What causes fescue toxicity?

1. tall fescue frass infected with an endophyte fungus

2. Acremonium coenophialum which secretes ergot alkaloids

What is the effect of fescue toxicity?

1. dopamine agonist

2. prolactin antagonist

3. suppresses prolactin

4. causes agalactia

What are the reproductive problems caused by fescue toxicity?

1. abortion

2. prolonged gestation

3. oversized fetus and dystocia

4. thickened placenta, placental insufficiency

5. fetal asphyxiation

6. red bag delivery

How do we prevent fescue toxicity in mares?

1. maintain pregnant mares on non-fescue pastures

2. dilute the toxin by overseeding pastures with palatable legumes

3. kill infected pastures and reseed with endophyte resistant strains of fescue

4. remove mares from fescue pastures during last 90 days of gestation

How do we treat fescue toxicity in mares?

1. domperidone at least 10-15 days before due date

2. sulpiride

3. continue after foaling if mares are not producing adequate milk

What breed more commonly has hydrops conditions?

draft horses

What should you warn the owner of when you suspect hydrops condition?

foal is generally not viable

What does hydrops condition predispose the mare to?

rupture of the prepubic tendon or abdominal musculature

How do you treat mares for hydrops conditions?

very slowly remove excess fluid with transcervical catheter and assist with delivery of the fetus

Why do we need to remove fluid slowly with hydrops in mares?

risk of hypovolemic shock

Why do we need to assist mares with delivering fetus after hydrops condition fluid removal?

overstretched uterus may have poor contractility

What are the signs of rupture of prepubic tendon in mares?

1. no or insufficient milk

2. blood in milk

3. visual enlarged and dropped abdomen

4. may see lip curl as it is very painful

What is the sequelae to ruptured prepubic tendon?

1. permanent lesion that cannot be repaired surgically

2. mare should not be bred again

What should you inform the owner of if a mare has abdominal hernia and he's asking about the mares future reproductive ability?

not life threatening and can become pregnant again

What is a gestational problem that may look like prepubic tendon rupture but is not painful?

ventral edema

How do we treat ventral edema?

1. resolves spontaneously after foaling within 1-2 days

2. mild exercising may stimulate circulation and lymph drainage

What is a difference between placentitis in bovine vs equine?

more risk of losing foal in equine due to diffuse placenta and not having much placental reserve

What is a difference between uterine torsion in bovine vs equine?

bovine don't typically show until parturition while equine show earlier

What causes placentitis?

1. always of infectious origin

2. ascending infection

3. hematogenous infection

4. activation of a nidus of bacteria present in the uterus (rare)

What is the most common bacterial agents that cause ascending placentitis?

1. Streptococcus equi subsp. zooepidemicus

2. Escherichia coli

What bacteria are typically involved with hematogenous placentitis?

1. salmonella abortus equi

2. leptospira

What bacteria is typically involved with activation of a nidus in the uterus causing placentitis?

Nocardioform placentitis

What fungi can cause placentitis?

Aspergillus fumigatus

How does the placenta appear if there was placentitis?

thickened and discolored especially around the region of the cervical scar

What is a common issue with parturition when there is placentitis?

red bag delivery due to foal not being able to burst through membranes as easily

What are predisposing factors for placentitis?

1. poor perineal conformation

2. compromised barriers

What are the barriers between the outside and the fetus?

1. vulva

2. vestibulovaginal junction

3. cervix

What is the pathogenesis of placentitis?

bacteria invade the chorioallantois causing an increase in pro-inflammatory cytokines in the placenta which causes PGE & PGF2alpha release

What results from PGE and PGF2alpha being released in the placenta?

inflammatory cascade, increase in uterine contractility, premature delivery

What is a way that we can diagnose placentitis early?

premature development of mammary gland, milk production, and milk let-down but no other signs of illness

Why is "bagging up" not a completely reliable signs of placentitis?

only means fetus is in distress

How can we diagnose placentitis?

ultrasound combined thickness of uterus and placenta (CTUP)

What is the goal of placentitis treatment?

contain the infection and inflammation as much as possible to buy time to allow fetus to reach maturity

What is the treatment for placentitis?

1. antiobiotics like TMS or penicillin and gentamicin

2. nsaids like banamine

3. progestagens like altrenogest

What is the purpose of progestagens with placentitis?

helps keep uterus quiescent

What should you be ready for when delivering a foal from a mare with placentitis?

foal may be compromised and likely may have septicemia

What can we give to help a premature foal to stimulate lung maturation?

corticosteroids but risk of laminitis

What is the prognosis for the foal with placentitis?

very guarded

How do we prevent placentitis?

1. correction of perineal defects

2. do not open the seals in a pregnant mare

What will the placenta look like if placentitis was caused by Nocardioform?

avillous lesions in the lowest part of the placenta

How can we diagnose a fungal placentitis?

impression smear and cytology

A 10-year-old Thoroughbred mare is observed to have udder development and intermittent mammary secretion at 11 months of gestation. What is the correct interpretation of the findings?

findings are normal, the mare doesn't need any treatment

A 10-year-old Thoroughbred mare is presented with udder development and intermittent mammary secretion at 9 months of gestation. What is the correct interpretation of the findings?

findings are a result of fetal distress

What is a normal time for the placenta to be expelled?

3 hours

What occurs on the first day postpartum for mares?

1. decrease in uterine size

2. uterus feels firm on palpation

3. expulsion of watery, red-colored fluid

What occurs on day 3-5 postpartum for mares?

lochia fairly thick, dark red to brown secretion

What occurs on day 7-9 postpartum for mares?

1. lochia discharge should have ended

2. pregnant horn is slightly larger than non-pregnant

What occurs 15 days postpartum for mares?

histological involution is complete

What is foal heat?

6-8 days postpartum with first ovulation around day 10

Can we breed a mare on her foal heat?

yes if everything was normal, but if there were complications then involution may be delayed

What is an early warning sign that may indicate a compromised foal?

placental changes

What is a concern if any pieces of placenta remain in the uterus?

predisposes mare to metritis, laminitis, etc.

What is a placental sign of stress in utero?

meconium staining

What should we do with the placenta postpartum?

1. weight the placenta

2. lay it in an F-shape to examine

3. check umbilicus

4. measure length of umbilical cord

What is a normal weight of the placenta?

+/- 6 kg or 11% of foals weight

What does placenta >8kg indicate?

edema and inflammation

What does placenta

inadequate placentation

Where is it normal to see some edema on the placenta?

at tip of pregnant horn

Where are tears in the placenta most common?

tip of pregnant horn due to hooves

What is a normal length of the umbilicus?

36-83 cm in thoroughbreds

How many twists are normal for the umbilicus?

5-6 twists

Examination of the placenta in a mare that foaled about 2 hours ago indicates a missing area on the chorionic surface of the placenta corresponding to the gravid uterine horn. You are not sure if it is real or an artifact from handling the placenta. Should the mare be treated for retained fetal membranes?

yes

How long must it be before interfering with retained fetal membranes?

> 3 hours post foaling

When are there higher incidences with retained fetal membranes?

1. draft mares

2. dystocia

3. induced parturition cases

4. old mares

What are complications of RFM?

1. delayed uterine involution

2. metritis

3. septicemia and endotoxemia

4. laminitis

How do we treat RFM?

1. tie up RFM and tail to prevent mare from stepping on it

2. oxytocin every 30 minutes to 4 hours

3. large volume uterine lavage

4. antibiotics

5. NSAIDs

6. foot care like ice pads to prevent laminitis

7. I/V fluids

What are the techniques for removing placenta with filling it with fluids?

1. burns technique where you fill the chorioallantois

2. modified burns technique where you fill the placental vasculature

What must be checked before performing the burns technique?

check for placental tears

A mare has foaled 2 hours ago but has not passed the fetal membranes yet. What is the correct recommendation?

monitor the mare but do not treat yet

A mare foaled 3 hours ago but has not passed the fetal membranes yet. What is the correct recommendation?

it is an emergency; begin treatments for retained fetal membranes

What is a first degree perineal laceration?

primarily mucosa and skin of the vulva

What is a second degree perineal laceration?

extends through the musculature of the vulvar sphincter and compromises closure

What is a third degree perineal laceration?

complete disruption of the roof of the vesibulum/vagina, floor of the rectum and anus

What is a recto-vaginal fistula?

all layers between vagina and rectum are disrupted but anus remains intact

How do we treat a third degree perineal laceration?

1. treat conservatively in the acute stage

2. allow to heal by second intention

3. then correct surgically

How do we treat rectovaginal tear?

second intention and then maybe attempt surgical repair

How do we treat cervical lacerations?

1. conservative treatment with antibiotic/nsaid ointment

2. surgical repair if more than 50% of the cervical length is involved

How do we diagnose cervical lacerations?

final diagnosis by digital palpation when mare is in diestrus

You get a call that there is a mare with uterine prolapse. What is your initial thought?

emergency because it is life threatening

Why is uterine prolapse an emergency?

1. rupture of ovarian arteries and rapid death may occur

2. signs of shock due to ischemia and necrosis with endotoxemia may occur

How do we treat uterine prolapse?

1. sedate with alpha 2 agonists

2. epidural

3. elevate prolapsed uterus, check and clean

4. low dose oxytocin

5. systemic antibiotics

6. nsaids

What do we need to evaluate if we find a uterine laceration?

whether it connects with abdomen - peritonitis

How do we treat uterine laceration?

1. conservative treatment with antibiotics and nsaids

2. surgery

3. abdominocentesis if connect with abdomen

What causes postpartum hemorrhage?

rupture of the uterine arteries

What mares is postpartum hemorrhage more common in?

older mares

What does postpartum hemorrhage look like?

bleeding between the two layers of the broad ligament forming a hematoma; sometimes blooding into the abdomen