EQ peri-parturient problems in the mare

List the possible pre parturient problems in the mare

• Colic

• Over- large mare

  • Ventral oedema

  • Pre-pubic tendon rupture

  • Hydrops —> hydrallantois; hydramnios

• Placentitis

• Varicose veins

• Orthopaedic disease

List some of the possible causes of pre parturient colics

• Intra-uterine foal movement (mild-mod, common)

  • should respond to mild-mod analgesia (buscopan / phenylbutazone)

• GI colic (+ other forms of colic)

• Actually foaling / aborting (do vaginal exam to check if cervix is open)

• Ischaemia/ necrosis/ rupture of caecum & colon

  • Due to weight of foal applying pressure to viscera / stretching blood vessels

  • difficult to diag —> look for signs of peritonitis / endotoxaemia

• Uterine torsion

How does uterine torsion usually present?

• Usually last 1/3 preg

• Usually low grade chronic / intermittent but can be severe

How is uterine torsion diagnosed?

• Rectal —> palpate one tight broad lig

• Vaginal exam not helpful —> unlike cattle, twist cranial to cervix

How is uterine torsion treated?

• Surgery

• Standing flank laparotomy

• GA & midline laparotomy (± caesarean?)

• Rolling under GA NOT recommended

prog = 50% for live foal, 70% for live mare

Why may mares get ventral oedema pre parturient (near term)?

• Compression of lymphatic draiange by foal

  • If mare is well, oedema uniform & non painful —> will recover post foaling (make sure isn't anything more serious)

  • Important to differentiat from other causes of abdo enlargement

How does pre-pubic tendon rupture present?

• Due to weight of foetus —> more common in older mares

• Large plaque of painful oedema, continuous with udder (“dropped” udder).

• Maybe bloody discharge in milk

• Often gives colic signs

• Mare often spends more time recumbent.

How is pre pubic tendon rupture treated?

• Bute

• Will need assistance w/ foaling —> unable to use abdo muscles to contract foal out

• C-section?

• Often progressively becomes more painful → euthanasia

• DON'T BREED FROM HER AGAIN

  • never heal fully & will rupture again (permanently damaged)

What is Hydrops aminion/Hydrops allantois?

• Excessive fluid in allantoic / amniotic space

• May eventually cause colic, dyspnoea, recumbency, circulatory collapse

• Foals usually deformed

How is Hydrops aminion/Hydrops allantois diagnosed?

Rectal exam —> huge fluid filled uterus but foal out of reach

How is Hydrops aminion/Hydrops allantois treated?

• Induce foaling / abortion

• Dilate cervix, drain fluid off slowly

• Manually remove foal

• IV fluids to maintain systemic blood pressure?

How do you assure an owner that a mare is just fat?

Do rectal exam to confirm foal is present & alive; rule out pathological problems

What agents cause placentitis?

Strep. spp., E.coli, Aspergillus.

What are the signs of placentitis?

• Asc. infection from cervix

• Eventually leads to abortion

• Premature udder development and lactation ± vaginal discharge

How is placentitis diagnosed?

• C/S

• U/S —> placental thickening

• Cervical swabs if discharging

How is placentitis treated?

• Potentiated sulphonamides

• Bute

What is the most common cause of vaginal bleeding in a horse?

Varicose veins (more likely in pregnant / older mares)

How do you treat varicose veins?

• Usually no tx required —> more concern to owner than mare

List the intrapartum problems in a mare?

• Dystocia

• Red bag delivery

• Uterine Rupture

• Uterine tear

• Cervical tear

• Perineal tears

Describe orthopaedic dx during pregnancy

Extra weight / bulk of late preg can substantially exacerbate effects of orthopaedic dx —> arthritis, laminitis etc.

Which drug is effective in management of orthopaedic dx during pregnancy?

Phenylbutazone

What are the types of phenylbutazone available?

• Equipalazone solution —> can be used during preg & lactation

• Butagran oral powder —> care if admin to preg mares, foetotoxic @ high dose levels

  • avoid use around time of parturition

potential benefits should be weighed against potential hazard to mare and / or foal

What equip & meds are needed during a dystocia case?

• Sedation (and ketamine?)

• Clenbuterol or buscopan

• Local anaesthesia (epidural)

• Doxapram

• Foaling ropes

• Lubricant

• Hibiscrub

• Needles/syringes

• Waterproofs

How do you handle a dystocia case?

• Check mare not in shock/haemorrhaging

• Clean perineum & vaginal exam w/ plenty of lube to check presentation

• Decide if vaginal delivery poss

• If no clear progress within 15 minutes reassess

  • consider C section or controlled vaginal delivery under GA or terminal C section (GA mare, cut foal out, then euthanise mare)

  • avoid embryotomy (last resort)

What is the prognosis for each of these presentations?

What is a controlled vaginal delivery?

Vaginal delivery under GA

• Pref w/ hindquarters hoisted

• Can proceed to C sec, terminal C sec or euthanasia

What is the prognosis of uterine rupture/ tears in mares?

• Complete rupture —> v. bad, foal may fall into abdomen (extract foal & consider euthanasia)

• Smaller tears —> may not be noticed & only suspected when show signs of peritonitis after foaling (better but still guarded prog)

some may not be full thickness

How is uterine rupture/ tear diagnosed?

• Clinical signs

• Rectal/vaginal exam

• U/S

• Peritoneal tap

How is uterine rupture/ tear treated?

• Medical tx as for peritonitis

• Ex lap & repair for full thikness tears

What is red bag delivery?

• Allantochorion (membrane that attaches foal to mare —> should burst early during stage 2 of parturition) fails to rupture

  • Foal will rapidly asphyxiate

How do you treat a red bag delivery?

• Instruct client to puncture bag & clear foal's nostrils

  • Tough —> may need scissors / knife

How do you treat low grade perineal lacerations?

(Common during foaling)

• Many heal w/o intervention

• Lacerations which substantially disrupt perineal anatomy should be repaired, esp. if natural healing will alter perineal conformation

  • done immediately or delayed for a few days if severe bruising

• AB, NSAIDs, tetanus cover

What is a third degree perineal laceration?

• Where foals foot has penetrated rectum & torn through anus.

• Rectum, vulva & vagina all communicate

How do you treat a third degree perineal laceration?

• Do not repair immediately —> will break down

• AB, NSAIDs, Tetanus cover

• Repair required if mare to conceive again

• Delay surgery for @ least 4-6 weeks until granulated

  • Surgery often difficult (several attempts needed before complete repair occurs)

What is a second degree perineal laceration?

Recto-vaginal fistulas —> treat in same manner as third degree → delayed repair

How do you treat a cervical laceration?

• Usually spontaneous healing

• May need surgical repair

• Delay one month post partum until uterus involuted & inflam subsided

  • note & monitor if cervical incompetence occurs —> mare will be sub-fertile

List the post parturient priblems you can get in the mare?

• Colic

• Prolapse

• Retained placenta

• Metritis

• Hypocal

• Tetanus

What do you need to consider about post-partum colic?

• Some can be rapidly fatal, although most not serious —> careful assessment & montioring

• Make sure foal does not get injured if mare colicking violently

What are the possible causes of colic in a post partum mare?

• Uterine cramps

  • no sign of endotoxaemia

  • mild-mod colic

  • should resolve w/ buscopan / phenylbutazone

• Normal GI colic

• Iscahemia/ necrosis/ rupture of caecum and colon (expulsive forces of foaling)

• Inversion of uterine horn

• Colonic torsion

• Uterine artery rupture

Describe inversion of uterine horn as a cause of post-partum colic

• After forceful foaling / too forceful removal of retained membranes

• Colic which reoccurs despite analgesia

• If cont. to strain → may proceed to uterine prolapse

How is inversion of uterine horn diagnosed?

Vaginal & rectal exam

How is inversion of uterine horn treated?

• Analgesia

• Smooth m. relaxants (buscopan / clenbuterol)

• Manual replacement

• Uterine lavage

What causes a colonic torsion in post partum mare? How is it treated?

• Due to sudden increase of space in abdomen post foaling

• Rapidly fatal unless quick surgical intervention

How may a rupture of uterine artery present?

• Mild to mod colic signs

• Haemorrhage into broad lig / into abdo

  • may be contained within broad lig, but if ruptures / mare haemorrhaging directly into abdo → rapidly fatal

• May not respond well to NSAIDs —> painful

How is uterine artery rupture diagnosed?

• Gentle palpation of broad lig per rectum

• Abdo & rectal U/S

How is uterine artery rupture treated?

• Keep quiet —> sedate?

• Analgesia

• IV fluids —> judiciously (don't want to raise BP)

• Blood transfusions

• Clotting agents —> amino caprionic acid?, 10ml 10% formalin in 1 litre saline?

What is the cause of uterine prolapse?

After excessive traction on foal / retained membranes or after difficult foaling or if mare exhausted

What can uterine prolapse lead to?

• May rupture uterine vessels & cause fatal internal haemorrhage

• Even after replacement, death from metritis / endotoxaemia not uncommon

How is uterine prolapse treated?

• Clean uterus.

• Replace under epidural anaesthesia.

• Oxytocin once replaced

• Treat w/ broad spec AB & NSAIDs for anti-endotoxic effects

At what stage are foetal membranes not passed abnormal?

• On average pass within 2 hours after foaling

• Over 4 hours considered abnormal

• Treat if still retained 4-6hrs post foaling

What happens if membranes are retained?

Decompose rapidly → metritis → induces endotoxaemia → severe laminitis & death

(depends on invidivual how prog is e.g. heavy horses considered v. suscep to effects)

How do you treat RFM?

• Treat promptly as can cause endotoxaemia

• Oxytocin, broad spec AB; flunixin for anti-endotoxic effect, check tetanus cover

• Oxytocin may be enough to stimulate passage

• Gentle manual removal can be used (potentially controversial —> endometrial damage)

  • Gentle traction, if does not work twist

What should you do once you have removed RFM?

• Check for retained fragments (tip of pregnant horn most likely)

  • If can't located retained fragments, lavage until fluid runs clear

  • Admin more oxytocin after lavage , turn mare out

  • AB (3-5d), NSAIDs

  • keep lavaging until uterus involuting & little uterine fluid being generated

What are the features of metritis?

• Maybe due to unnoticed partial retention of placenta or due to contamination of uterus during foaling

• May cause fatal endotoxaemia ± laminitis if untreated

• Tx —> ABs , Nsaids, oxytocin & lavage exactly as described for RFM

How does hypocal present in mares? How do yout treat it?

• M. fasciculations, recumbency, tetany, Diaphragmatic flutter “thumps”

• Give calcium diluted in saline

What do you need for an orphan foal?

• Source of colostrum

• Milk replacer

• Bottle/teat

• Feeding protocol

• Ideally foster mare

  • Hand rearing not recommended

What are the problems with orphan foals?

• Hand-rearing foals is not recommended

• Expensive

• Hugely time consuming

• Growth problems common

• Socialisation and behavioural problems

• Adult hand-reared horses can be exceptionally dangerous.