1.4.2 Postpartum Conditions of the Mare Flashcards
1
Q
what is Uterine Involution? when does it occur and how long does it take?
A
- Mare and cow uterus returns to pregravid size by 25 to 32 days postpartum
2
Q
how long does it take for most dairy cows to start cycling post partum?
A
- Most (dairy) cows will start cycling by 25 days pp
3
Q
how long after parturition does it take for the cow endometrium to be repaired? what is the voluntary waiting period?
A
- Cow endometrium is repaired histologically by about 45 days postpartum
- Voluntary waiting period 50‐60 days
4
Q
how long does it take for the mare endometrium to be repaired post partum?
A
- Mare endometrium is histologically normal by 14‐15 days postpartum
5
Q
what is the “foal heat”? when does the next heat occur?
A
- “Foal Heat” –first postpartum estrus ‐ at 9 days PP – can conceive and carry!
- Next heat occurs 21 days later – “30 day heat”
6
Q
when is foal heat breeding useful?
A
- If the mare conceives on “foal heat” she will foal about one month earlier next year compared to this year
- Very useful for mares foaling late in breeding season
7
Q
issues associated with foal heat breeding?
A
- Pregnancy rates are higher for mares ovulating after day 10 postpartum
> Embryo enters uterus at day 6 post‐ovulation - Mares bred at foal heat have higher early embryonic death rates
8
Q
how do we select mares that are good candidates for foal heat breeding?
A
- Normal parturition and postpartum period
- No intrauterine fluid by day 9
- Good uterine involution – 9 cm diameter or less by day 9
- Ovulating after day 10
9
Q
is a mare ovulates 10 days after foaling, is pregnancy possible? why? what timeline is important to keep in mind here?
A
- If she ovulates on day 10
- and embryo enters uterus 5‐6 days after
ovulation - the uterus is repaired by 14‐15 days postpartum
- Then pregnancy IS possible! (if she ovulates day 10 or later)
10
Q
important history to take for a postpartum exam?
A
- Due date
- Past foalings – how many, any history of problems
- When did she foal?
- Problems?
- Pass Placenta?
- Attitude, appetite?
- Is Foal Nursing?
11
Q
Postpartum Exam – Visual Inspection
A
Obvious:
* Retained Placenta
* Uterine Prolapse
* Vaginal Discharge – lochia vs. abnormal?
* Perineal Lacerations
* Udder
- Attitude, Appetite, Painful?
12
Q
what should we look at in a postpartum reproductive exam?
A
- Rectal exam
- Vaginoscopy
- Vaginal Exam
13
Q
what should we examine and what. abnormalities should we look for in a postpartum rectal exam?
A
- Examine perineal area first
- Assess uterine involution
Abnormalities: - RV fistulas
- Broad Ligaments
- Uterine fluid
- GI tract
14
Q
what should we look for in a postpartum vaginal exam and vaginoscopy?
A
- Always check for another fetus!!!
- Vaginal tears or bruising
- Cervical tears
- Perineal lacerations
- Assessment of retained placenta
- Discharge – Odour? Character?
15
Q
when can we see uterine tears in mares?
A
- Dystocia, or normal‐appearing delivery
16
Q
signs of a uterine tear in a mare
A
- May be “off”, mild colic signs
- Suspect in any mare with frank bloody discharge post partum
- Mare becomes sick 1‐3 days postpartum due to endotoxemia and peritonitis (other main differential is RFM)
- Free abdominal fluid on transabdominal ultrasound
- Abdominocentesis –positive for blood in early stages
- Positive for neutrophils and bacteria if peritonitis present
17
Q
treatment and prognosis for uterine tear in mare
A
- If recognized early surgical repair carries a good prognosis for survival and future breeding
- If found later, and peritonitis present, prognosis is guarded to poor
18
Q
what is a common spot for a uterine tear in a mare?
A
- Ventral uterine body is a common location
- Often tip of pregnant horn – cannot reach on vaginal exam
- May find mare painful on rectal palpation of the affected portion of uterus
19
Q
is uterine prolapse common in cows and mares? when do we usually see it?
A
- Common in cows
- Rare in mares
- Usually immediately postpartum
20
Q
factors that contribute to a uterine prolapse in mares
A
- Dystocia, forced extraction, fetotomy
- Manual removal of placenta
- Uterine intertia
- Twins
- Following abortion
- Rarely‐ assoc. with straining due to GI colic
21
Q
Uterine Prolapse Treatment. what is the prognosis?
A
- A blood‐bath in mares
- Sedation and Epidural
- Clean well and replace
- NO vulvar retention sutures
> Severe swelling and necrosis of vulva
> Cross‐tie in stall for 1‐2 days instead - Systemic antibiotics
- Anti‐inflammatories
- Prognosis good (if she survives) for future breeding
22
Q
is there a big risk of retained fetal membranes in cows and mares?
A
- Unlike cows, potential for serious complications is high in mares
23
Q
presentation of retained fetal membranes
A
Rapid onset of toxic metritis, laminitis and death
24
Q
risk factors for retained fetal membranes in mares
A
- Dystocia, twins, abortion
- Draft mares (also at high risk for laminitis with RFM)
- ? Low Vit E and Selenium
- Genetics? – high prevalence in Friesian breed
25
at what point do we consider fetal membranes to be retained?
* Retained if not passed within 3 hours
26
is diagnosis of rfm obvious in mares? when will we see signs and what signs should we look for?
what should we be mindful of?
diagnosis - obvious if hanging from vulva, but may not be
May present 1‐2 days postpartum with metritis (fever, anorexia, foul vaginal discharge, signs of laminitis)
‐ always be suspicious of remnants left behind in a sick postpartum mare
27
what should we look for/ will we find on a physical exam in mares?
* Increased digital pulses?, mucous membranes,
dehydration, toxemia, pyrexia, anorexia
* Perform vaginal exam using aseptic technique
* Evaluate how tightly adhered
28
should we forcibly remove retained fetal membranes in the mare? why or why not?
DO NOT forcibly remove – can cause:
* Severe hemorrhage – even death
* Inversion of a uterine horn
* Uterine prolapse
* Leave a piece behind – toxemia and death
* Scarring and infertility with microscopic remnants
=>if very loose/not adhered, we can twist to remove
29
how do we treat rfm in mares?
* Low dose oxytocin – 10 ‐ 20 I.U. repeated
>uterine contraction, expulsion
* Uterine lavage
* Systemic therapy if indicated or if a draft mare
>antibiotics, antiinflammatories, fluid therapy
* Monitor for complications
30
what is burns technique? when can we use it?
for retained fetal membranes:
* Distend the intact chorioallantois with fluid – 20‐30 mins
* Stretches membranes and uterus
* Separation – detachment
* Can only be done when membranes are completely intact (no holes)
31
Is Infusion of Umbilical Vessels with Water for RFM in Mares effective? when can we use it?
* Seems to work well in uncomplicated cases
* Risky if it does not work immediately
* Particularly if the integrity of the abdominal wall is compromised (eg. with hydrops cases, or post C‐section)
* Or if you suspect uterine artery rupture/broad ligament hematoma
32
when we remove RFM in mares, what should we ensure about the removed membranes?
-always inspect the membranes for completeness
33
how can we diagnose a hematoma postpartum in a mare? what should we be careful about?
Physical exam:
* Depressed, uncomfortable, mild colic signs
* Pale mucous membranes
* Rapid, weak pulse
Vaginal exam:
* Bloody vaginal discharge (may or may not be present)
* Rectal exam: Feel a mass
* Palpate broad ligament for hematoma
* BUT – there are disadvantages to rectal exam in a mare with a hematoma. Can also do:
* Abdominocentesis for blood
* Abdominal ultrasound for free fluid
* CBC and PCV
* Suspicion based on clinical signs
34
what type of mares more commonly get a broad ligament hematoma?
* More common in older, pluriparous mares
35
treatment for broad ligament hematoma in mares? Prognosis?
* Keep quiet – consider low dose acepromazine if mare is anxious
* Supportive care – fluid therapy, blood transfusion
* +/‐ oxytocin;
* N‐butyl alcohol; aminocaproic acid; IV Formalin?, naloxone and other shock therapies
* Monitor PCV and MM colour
* If hemorrhage into abdomen ‐ prognosis is grave
* Usually live if hemorrhage limited to broad ligament
-low risk for repeat blled if breeding again
36
Differentials for Sick Postpartum Mare
-uterine tear
-RFM
-anterior vaginal/cervical tear into abdomen
-GI accident/colic
-broad ligament hematoma
-ruptured bladder
37
Differentials for bloody discharge in the post partum mare
* Uterine tear
* Uterine wall hematoma
* Uterine prolapse
* Uterine artery +/- hematoma
