Chapter 63 - Uterus and ovaries Flashcards
What is the approximate size of the mare’s ovaries?
70-80 mm long and 40-60 mm wide.
How does the size of the mare’s ovaries vary?
It varies with the season and estrous cycle stage.
What is the ovulation fossa, and where is it located?
A palpable indentation on the ventral free border of the ovary.
What structure attaches to the dorsal border of the ovary?
The mesovarium, part of the broad ligament.
What does the mesovarium contain?
Blood vessels, nerves, and smooth muscle fibers.
Which artery provides blood supply to the ovary?
The ovarian branch of the ovarian artery.
How does the oviduct connect to the ovary?
The funnel-shaped infundibulum loosely attaches around the ovulation fossa.
What are the parts of the oviduct from ovary to uterus?
Infundibulum, ampulla, and isthmus.
Where does the isthmus of the oviduct enter the uterus?
At the tip of the uterine horn at the tubal papilla.
How is the uterine body positioned within the mare’s anatomy?
The majority is in the peritoneal cavity; the caudal part is retroperitoneal.
What ligament suspends the uterus in the caudal abdomen?
The broad ligament, also called the mesometrium.
Which vessels supply blood to the uterus?
The uterine branch of the vaginal artery, the uterine artery, and the uterine branch of the ovarian artery.
Which diagnostic tools are commonly used to evaluate the reproductive tract?
Palpation, ultrasonography, hysteroscopy, and blood work.
How long should food be withheld prior to a laparotomy?
12 to 36 hours.
What perioperative medications are commonly given before reproductive tract surgery?
Antibiotics and anti-inflammatory drugs.
Why might withholding food increase health risks in horses?
It can disrupt the diet and increase the risk of colic or diarrhea.
What type of anesthesia is needed for standing surgery on the cranial reproductive tract?
Sedation, visceral analgesia, and local anesthesia.
What anesthetic protocol is recommended for mares in dystocia requiring a cesarean section?
Total intravenous anesthesia with guaifenesin, ketamine, and detomidine until foal delivery.
What is the preferred anesthetic for maintenance during a C-section?
nhalation anesthesia (e.g., isoflurane in oxygen).
What approach is typically used for a flank laparotomy?
A modified grid approach with a vertical line block.
Where is local anesthesia administered for a flank laparotomy?
A 20-cm vertical line halfway between the last rib and the tuber coxae.
What muscles are separated in a flank laparotomy approach?
Internal abdominal oblique and transversus abdominis muscles.
What is the primary purpose of the ventral laparotomy approach?
To provide access to the ovaries or uterus under general anesthesia.
What anesthesia combination is preferred for inducing anesthesia in dystocia cases?
Xylazine, diazepam (or midazolam), and ketamine.
What alternative local anesthetic technique can be used for the paralumbar fossa?
An inverted L block to desensitize the paralumbar fossa.
Describe the layers from skin to the last interior layer of the abdomen
A vertical incision is made through the skin and subcutaneous
tissue, then extended deeper through the external abdominal
oblique muscle and its aponeurosis. The internal abdominal
oblique and transversus abdominis muscles are bluntly separated
parallel to their muscle fibers. The peritoneum is bluntly penetrated
to gain access to the abdomen. This approach is also
used by some to assist a laparoscopic ovariectomy
How are equine ovarian tumors classified?
By tissue type: surface germinal epithelium, sex cord-stromal tissue, and germ cell origin.
What is the most common type of ovarian tumor in mares?
Granulosa cell tumor (GCT)
What percentage of equine reproductive tract tumors are GCTs?
Approximately 85%.
List three behavioral changes observed in mares with GCTs.
anestrus
nymphomania (continuous estrus)
stallion like behavior
What is the typical age of mares affected by GCTs?
11 years old
Are granulosa cell tumors typically benign or malignant?
Usually benign but may occasionally metastasize.
Which hormone levels are frequently elevated in mares with GCTs?
Testosterone and inhibin.
How do GCTs typically appear on an ultrasound?
They are often multicystic structures.
What is the primary diagnostic marker for GCTs in mares?
Anti-Müllerian hormone (AMH).
What sensitivity did AMH testing show in detecting GCTs in a study?
98% sensitivity.
Which ovarian tumor is often found in juvenile horses and can cause hemoabdomen?
Juvenile granulosa cell tumor (GCT).
What is the significance of performing a colpotomy during diestrus or anestrus?
The blood supply to the ovary is at resting levels, resulting in smaller vessel diameters.
What nonneoplastic conditions may cause ovarian enlargement?
Hematomas, cysts, and abscessation.
What is the preferred treatment for a mare with an ovarian tumor?
Ovariectomy.
In what reproductive stage is colpotomy ideally performed?
During diestrus or anestrus.
Why is the mare kept standing for 2-3 days post-colpotomy?
To prevent eventration (prolapse of abdominal contents).
What is the purpose of using an écraseur in a colpotomy?
To crush the ovarian vasculature, providing hemostasis.
Which postoperative care is recommended to prevent ascending infections after colpotomy?
Placing a Caslick suture.
List two complications that can arise after a colpotomy.
Fatal hemorrhage and eventration.
What additional technique is combined with colpotomy in hand-assisted laparoscopic ovariectomy?
The use of laparoscopic portals in the left paralumbar fossa.
What anesthesia method is used for laparoscopic-assisted colpotomy?
Local anesthetic infiltration under laparoscopic guidance.
Why might it be challenging to remove both ovaries via left-sided laparoscopy in larger horses?
Due to instrument length limitations.
What surgical technique allows transvaginal access for colpotomy closure?
Using a Caslick speculum for access.
Which suture pattern is used for closing the colpotomy incision in laparoscopic-assisted ovariectomy?
A continuous suture pattern.
Which ovary is removed first in the laparoscopic-assisted colpotomy procedure described?
The left ovary.
What complication is associated with failure to properly manage ovarian pedicle bleeding?
Excessive or potentially fatal bleeding.
For ovariectomy by colpotomy you place the mare in the stocks, sedate and..
Place epidural, rectum evcuated, bladder is cathterized, tail is tied upward and perineal region is prepared, vaigna is lavaged with dilute povidone iodine solution
In colpotomy where do you do the incision?
cranial to the cranial fornix is critical and 1 to 2 cm incision through the cranial vaginal wall
4 to 5 cm caudolateral to the cervix.
Position is 2 or 4’ clock or at the 8 or 10 o’clock poisition of the cranial aspect of the vagina
Why inicision site of the colpotomy is so important?
These sites avoid inadvertent penetration of the:
bladder,
rectum,
and uterine branch of the urogenital artery laterally.
once you passe the peritoneum in colpotomy and you inserted you hand and find the ovarium what is the next step?
lidocaine-soaked gauze sponge, tethered with a long strand of umbilical tape, is introduced into the abdomen and held around the ovarian pedicle for 1 minute. The chain loop of the écraseur is placed around an ovary, with care taken to exclude other tissues such as intestine, intestinal mesentery, and the tip of the uterine horn. The écraseur is slowly (over 3–4 minutes) tightened until the ovary falls into the surgeon’s hand. Hemostasis is provided by the écraseur crushing the vasculature and subsequent vasoconstriction. The ovary is removed from the abdomen and the procedure is repeated to remove the contralateral ovary.
are you obliged to close the colpotomy site?
The vaginal incision is allowed to heal as an open wound and the mare is kept standing for 2 to 3 days to prevent the rare case of eventration or closure of the colpotomy using absorbable sutures will aid in the prevention of eventration
Name the complications of colpotomy
fatal hemorrhage from laceration of
- uterine branch of the urogenital artery, excessive (possibly fatal) - bleeding from the ovarian pedicle,
- eventration through the vaginal surgery site,
-septic peritonitis,
-abscessation or
-hematoma formation at the incision sites, and
- adhesions of abdominal viscera to the incision sites
how do you perform the laparoscopic assisted colpotomy technique?
two laparoscopic portals in the left paralumbar fossa and made a colpotomy incision under laparoscopic guidance. A chain écraseur inserted via the colpotomy was used to remove the left ovary. Laparoscopic portals were made in the right paralumbar fossa and the right ovary was removed using the écraseur. Following removal of both ovaries a Caslick speculum was used to provide access to the colpotomy to facilitate closure. The colpotomy was sutured in a continuous pattern using laparoscopic needle holders or a pair of long needle holders.
beside the classic colpotomy what other techniques can you perform?
- laparotomy
- laparoscopic assisted colpotomy
- laparoscopy
- a two-step surgical procedure combining standing flank laparoscopy with recumbent ventral median celiotomy
Flank laparotomy has been recommended for ovaries that are less than
15cm
The most common complication that occurs at the flank surgery site is development of a
postoperative seroma or incisional infection.
A ventral approach to the abdomen can be via 3 sites, mention
midline,
paramedian
diagonal paramedian incision (preferred)
the diagonal paramedian laparotomy approach has as an advantage over the ventral midline and paramedian which is…
is positioned directly over the ovary, less tension is applied to the ovarian pedicle during vessel ligation than with the other ventral approaches.
The diagonal paramedian laparotomy approach is the most useful approach for the
majority of normal or enlarged ovaries
describ the incision the diagonal paramedian until the ovary is identified and pulled
GA - DR -
A 12- to 15-cm long incision is made starting approximately 5 cm cranial to the mammary gland and nearly bisecting the angle formed by the ventral midline and the inguinal depression. The incision is continued through the external rectus sheath, and the rectus abdominis muscle fibers are bluntly separated. Ligation and transection of one to two large neurovascular bundles found coursing perpendicular to the muscle fibers may be required. The internal rectus sheath is opened carefully with scissors. A hand is introduced into the peritoneal cavity, and the ovary is ID and pulled up to the incision. Stay sutures (USP size 2 polyglactin 910) are placed through the ovary in a cruciate pattern. Distended follicles are aspirated to reduce the size of the ovary and to facilitate passage of the enlarged ovary through the incision. Ligatures (USP size 1 or 2 absorbable suture) are placed around the cranial and caudal margins of the ovarian pedicle and used as additional stay sutures. A 90-mm thoracoabdominal stapling device (TA 90) is placed across the ovarian pedicle and discharged. The ovarian pedicle is transected between the stapler and the ovary. A vessel-sealing device can be used to provide hemostasis within the ovarian pedicle and then the pedicle is transected. The ovary is then removed from the surgery site (Fig 63-1)
Figure 63-1. Ovariectomy, using a commercial stapling unit (TA90) for hemostasis prior to ovary resection. No. 2 absorbable suture in an interrupted cruciate pattern. The external rectus fascia is closed with USP No. 2 absorbable suture in a continuous pattern, the subcutaneous tissue with USP No. 1 absorbable suture in a continuous pattern, and the skin with USP No. 0 absorbable suture in a continuous pattern.
The mares are hospitalized overnight and discharged when?
Most mares are hospitalized overnight and discharged the following day.
Posoperative care of laparaotomy for ovarium removal
Postoperatively, mares should be confined to a stall with hand grazing, and hand walking for 1 week, followed by 2 to 3 weeks of small paddock turnout prior to returning to routine care.
The 1ary advantages of the flank laparoscopy compared with the diagonal paramedian laparotomy for ovariectomy are
enhanced visualization of the surgical site with minimal tension on the ovarian pedicle, the ability to quickly and more confidently address potential hemorrhage, and avoidance of general anesthesia.
with surgical site drainage is more common in the diagonal paramedian laparotomy approach or flank laparoscopy?
flank approach
What is the material required for laparoscopy of the flank?
Videoendoscope camera, monitor,
Light source
Cable,
Insufflator and tubing (not always used), a 0-degree or 30-degree 30-cm or 57-cm rigid endoscope,
at least three 10-mm-diameter 15- to 20-cm-long cannulas with trocars,
Laparoscopic forceps, Scissors,
Injection needle, and Ligation instrumentation. Ligation of the ovarian pedicle can be done with ligating loop sutures, a stapling instrument, or a vessel-sealing device.
Placing local anesthetic into the mesovarium, rather than the ovary, has been shown to be more effective in reducing pain responses during surgery - TRUE OR FALSE
TRUE
what is the name of the forceps that provide a safe way to grasp the ovary?
Semm claw laparoscopic forceps
describe the laparoscopic portal
The exact sites of the incisions for the laparoscopic portals vary between surgeons. The hand-assisted laparoscopic ovariectomy technique commences with a modified grid flank approach to the abdomen.4 The cannulas for the endoscope and instruments then are placed to avoid trauma to bowel or the spleen. The ovary is visualized and the mesovarium is desensitized with lidocaine hydrochloride or mepivicaine hydrochloride. Placing local anesthetic into the mesovarium, rather than the ovary, has been shown to be more effective in reducing pain responses during surgery.25 The bipolar vessel-sealing device (LigaSure Atlas) (see Chapter 13) has been used effectively in the authors’ hospital, and others, for hemostasis and transection of the mesovarium (Figure 63-2).26 Semm claw laparoscopic forceps grab the ovary. one of the portals needs to be lengthened to remove an enlarged ovary or ovary is reduced in smaller pieces by direct sharp dissection using a morcellator while held against the body wall incision
Closure: appose muscles followed by subcut and fascia and finally skin
However, USP No. 2 polyglactin 910 sutures placed in a cruciate pattern through the ovary provide a more confident purchase of the ovary than the forceps during laparoscopy - TRUE or FALSE
TRUE
describe the 2 step surgical procedure combining standing laparo and recumbent ventral median celiotomy
Standing flank laparoscopy is used to transect the ovarian pedicle and mesovarium. The mare is then anesthetized and placed in dorsal recumbency. A ventral median celiotomy is used to remove the enlarged ovary from the abdominal cavity. This technique was utilized in 20 mares without any intraoperative or postoperative complications. Within this group of mares 15 of 20 had an ovary that was greater than 20 cm in diameter.
What technique allows the ovary to be reduced in size for removal?
Aspiration or morcellation.
Cannula insertion complications
1) include retroperitoneal insufflation,
2) splenic or bowel puncture,
3) hemorrhage from laceration of the circumflex iliac artery.
What is a reported advantage of transvaginal NOTES ovariectomy?
Provides excellent viewing of the caudal abdomen.
What is a uterine cyst, and where is it typically found?
Fluid-filled structures found in the uterus, often in older mares.
What is the preferred method for removing uterine cysts?
Laser ablation.
How are uterine cysts commonly diagnosed?
Through rectal examination or ultrasonography.
Why can uterine cysts affect fertility?
They can hinder pregnancy diagnosis and affect placentation.
Why is the cervix closed during cyst removal?
To maintain uterine insufflation.
What type of laser is used for uterine cyst ablation?
A diode laser.
What precaution is taken to avoid endometrial damage?
Avoid overinflating the uterus.
What is the benefit of using fluid distension during cyst removal?
It prevents smoke generation during laser ablation.
How is the uterus treated post-ablation?
Lavaged with sterile fluids and infused with antibiotics.
How long is postoperative anti-inflammatory treatment for cyst removal?
3 to 5 days.
What was the observed fertility rate in mares following cyst ablation?
73% for mares bred the year after ablation.
What factor increases the likelihood of foaling after ablation?
Mares younger than 17 years have higher fertility rates.
What recurrence prevention measure is taken for uterine cysts?
Ablating the cyst lining and base.
Each uterine cyst is punctured and drained with the diode laser, set on a power setting of__W
Each uterine cyst is punctured and drained with the diode laser, set on a power setting of 20 W.
describe the surgical ablation of uterine cysts from the moment the mare is placed in the stocks
The tail should be wrapped and tied to the side.
Perineum is cleaned and prepared for surgery. Diestrus or anestrus - will help maintain uterine insufflation.
A 1-m-long videoendoscope that has been cold sterilized and rinsed with sterile water is passed through the cervix into the uterus. This is accomplished by having an assistant don a sterile sleeve and sterile surgery glove to aseptically pass the endoscope through the cervix. The assistant can grasp the cervix and keep it closed around the endoscope during the procedure. The uterus is distended with air or carbon dioxide to allow visualization of the uterine body and both horns. A systematic evaluation of the uterine body and both uterine horns should be performed. Care must be taken not to overinflate the uterus resulting in damage to the endometrium. The diode laser fiber is passed through the biopsy channel of the endoscope into the uterus. Each uterine cyst is punctured and drained with the diode laser, set on a power setting of 20 W. Following release of the fluid, lasing is continued until the remaining cystic tissue has been ablated and the base is charred. Smoke and fluid often need to be evacuated from the uterus during the procedure. Another option is to distend the uterus with sterile fluids so that the procedure is performed under fluid so that no smoke is generated. This can be helpful if there are numerous cysts that need to be ablated. One downside is that more laser energy is used per cyst since the fluid environment absorbs some of the laser energy. Immediately after the procedure, the uterus is lavaged with sterile fluids to remove debris from the procedure then the uterus is infused with antibiotics. The uterus should be lavaged daily for 2 or 3 days postoperatively to remove the retained cyst fluid and debris created by photoablation.
what is the postoperative care of uterine cyst ablation?
The uterus should be lavaged daily for 2 or 3 days postoperatively to remove the retained cyst fluid and debris created by photoablation. Systemic antiinflammatory drugs should be administered for 3 to 5 days postoperatively.
what is the fertility % following uterine cyst ablation?
56-73%
Does the number and location of cysts influence the effect postop?
No, the number and location of the uterine cysts did not have an effect on postoperative fertility
What factor contributes to infertility in mares
Delayed uterine clearance.
How does poor conformation in older mares affect uterine clearance?
It causes the cranial aspect of the uterus to be positioned ventral to the caudal aspect.
What surgical method is used to improve uterine positioning in mares?
Laparoscopic uteropexy.
Describe the procedure for elevating the uterus.
Three laparoscopic portals are created in the left flank; the mesometrium is sutured to elevate the uterus.
What suture type simplifies uteropexy by eliminating the need for knot tying?
An absorbable suture with shallow barbs.
What device can be used to aid the laparoscopic uteropexy procedure?
The Endostitch 10-mm Suturing Device.
describ the surgical procedure fro pendulous uterus correction by fixing it in a more horizontal position
The mesometrium is infiltrated with local anesthetic solution. The left side of
the uterine body and horn are sutured to the mesometrium. The suture line starts at the caudal aspect of the uterus where the mesometrium attaches to the uterus. A suture is passed through the seromuscular layers of the uterus at that level, through the mesometrium approximately 3 cm dorsal to its uterine attachment, and then tied. A continuous suture line is continued in this fashion to near the cranial aspect of the uterine horn. This suture line essentially imbricates the mesometrium. Following placement of this suture, the exact same procedure is performed to elevate the right side of the uterus from the right flank. The original report describes placing the suture line using laparoscopic needle holders.37 The Endostitch 10-mm Suturing Device has also been used successfully for the uteropexy procedure.
What are two uncommon uterine conditions in mares?
Uterine neoplasia and chronic pyometra.
What typically causes chronic pyometra in mares?
Obstruction due to severe cervical trauma and adhesions.
What initial treatments are suggested for chronic pyometra?
Uterine lavage and lysis of cervical adhesions.
If initial treatments for pyometra fail, what procedure is recommended?
Cervical wedge resection.
In cervical wedge resection, how is access to the cervix obtained?
Using a vaginal speculum and stay sutures.
What is the common histological type of uterine tumors in mares?
Leiomyoma.
describe the surgical procedure to open the uterus and drain
full wedge defect (3–4 cm wide with the apex pointing cranially from the external os and extending to the internal os) is removed from the dorsolateral aspect of the cervix using long Mayo scissors to establish a permanent opening into the uterus. The defect is left unsutured. In a report of six mares a cervical wedge resection was performed to resolve chronic pyometra.40 Ovariohysterectomy is indicated if medical treatment and wedge resection fail to resolve the problem. Drainage of the uterine contents prior to surgery
is advisable.
what is the prognosis and fertility in case of uterine tumors?
Because of the rare occurrence of uterine tumors, prognosis and subsequent fertility have not been established.
Ovariohysterectomy is indicated in uterine tumors?
Ovariohysterectomy is infrequently indicated.
Describe the 2 ovariohyesterectomy techniques available
Partial
Complete
what should you consider in the preparation of the mare for ovarioysterectomy?
Prior to surgery the patient should be fasted for 12 to 24 hours to decrease the amount of ingesta in the intestinal tract. In the case of pyometra, the uterus should be evacuated as much as possible prior to surgery.
describe in detail the ovariohysterectomy under GA
Complete ovariohysterectomy is best approached through a caudal ventral midline incision dividing the mammary glands, with the mare under GA - DR
The body wall is incised to the level of the prepubic tendon. Ovariectomy is performed as the first step. The ovarian pedicles are ligated or hemostasis is provided using surgical staples or a vessel-sealing device. Dissection continues caudally through the broad ligament, ligating branches of the ovarian artery and the uterine artery in the process. Once the broad ligament is incised the uterus is exteriorized. Exposure to the caudal aspect of the uterus is improved by using self-retaining retractors as well as manual retractors on the body wall incision. The body of the uterus is transected as far caudad as possible, with care taken to avoid contaminating the peritoneal cavity. Prior to transecting the body of the uterus stay sutures should be placed on each side of the proposed line of transection. Saline-soaked laparotomy sponges should be used to pack off the rest of the contents of the abdomen. Closure of the uterus with USP No. 2 absorbable suture material is started prior to uterine body transection. The uterus is incised cranial to the suture for a distance of 5 cm. The open portion of the uterus is closed in a continuous Lembert pattern. This is repeated in a stepwise fashion until the uterine body is severed. The resulting uterine stump is oversewn using USP No. 2 absorbable suture material in a Lembert or Cushing pattern. The abdomen is lavaged and suctioned. An abdominal drain can be placed for postoperative abdominal lavage at the surgeon’s discretion. The abdomen wall is closed in routine fashion.
Explain the hand assisted laparoscopy for ovariohysterectomy in detail
A hand-assisted laparoscopic approach has been described. In this report the authors ligated and transected the mesovarium and mesometrium under laparoscopic control. The uterus was exteriorized and the uterine body transected through a caudal ventral midline incision. Another report describes the laparoscopic dissection and hemostasis of ovarian and uterine structures followed by inversion of the uterus through the cervix and into the vagina, where the uterus was subsequently successfully resected.
The most common complications following ovariohysterectomy are
1) abdominal pain
2) incisional drainage/infection
3) hemorrhage,
4) septic peritonitis,
5) uterine stump infection,
6) necrosis
7)abscessation
Solitary masses, even if quite large can be successfully removed from the uterine wall with the mare remaining fertile?
yes
What is the goal of partial ovariohysterectomy?
Partial ovariohysterectomy has been used to remove a focal uterine tumor and ovarian masses with adhesions to the uterine horn
Describe the 2 techniques that can be performed in partial resection of uteus
Surgical approaches have included a caudal ventral midline and paramedian laparotomy and a standing flank laparoscopy.
Based on a review of several papers, it appears that most mares can maintain a pregnancy with up to 50% of a uterine horn removed, but fertility decreases proportionally to the amount of horn removed beyond that - TRUE or FALSE
TRUE
When is a complete ovariohysterectomy typically performed?
If medical treatment and wedge resection do not resolve the issue.
What is the preferred approach for complete ovariohysterectomy in mares?
A caudal ventral midline incision.
How is hemostasis achieved during ovariohysterectomy?
By ligating ovarian pedicles or using vessel-sealing devices.
What technique is used to close the uterus in partial ovariohysterectomy?
A continuous Lembert or Cushing suture pattern.
How is uterine torsion commonly diagnosed?
Through rectal examination.
What is a common cause of colic associated with the reproductive system in mares?
Uterine torsion.
What is the typical presentation of a mare with uterine torsion?
Intermittent abdominal pain = colic
What gestational age is associated with higher survival rates for mares and foals in uterine torsion cases?
Less than 320 days.
What non-surgical method can be used to correct uterine torsion?
Rolling the mare in the direction of the torsion.
What surgical technique is preferred for torsions less than 360 degrees?
Standing flank laparotomy - incision on the side towards the uterus is twisted (counterclockwide = left flank)
What condition could necessitate a ventral midline approach for uterine torsion correction?
Suspected uterine rupture or tearing.
is vaginal examination diagnostic of uterine torsion?
NO, because usually the torsion is cranial to the cervix. Only in cows
when does it happen the uterine torsion
usually in the last trimester of gestation (average gestation 345d)
uterine torsion has an age preference?
no, it can affect mares of all ages, but a study showed 90% had less 16 years old u
60% of the mares had torsion in clockwise or counterclockwisE?
60% had the torsion directed clockwise,
80% of the mares had 180 degrees or 360 degrees torsion?
80% had torsions 180 degrees or less
what are the survival rates of the mares ?
depends on the gestation phase
97% if gestation was less than 320 days and 65% if gestation was 320 days or longer.
what is the survival rate of the foals to uterine torsion?
72% in foals less than 320 days of gestation and 32% in foals 320 days or more of gestation.5
what are the factors that influence survival in uterine torsion?
Method of surgical correction, days of gestation, and degree of uterine torsion affected survival of the mare and foal.
Uterine torsion has medical approach (rolling), surgical approach (ventral midline or flank approach). What is the approach more popular?
The standing flank approach has been more popular than the ventral midline approach for surgical repair.
Nonsurgical management usually requires general anesthesia and rolling of the mare 360 degrees in the _________ of the torsion.
Nonsurgical management usually requires general anesthesia and rolling of the mare 360 degrees in the direction of the torsion.
A ventral midline approach should be used if (name the 5 reasons)
A ventral midline approach should be used if uterine rupture, tearing, or devitalization is suspected; if the foal is known to be dead and the mare is preterm; and if attempts at standing correction are unsuccessful
How should the uterus be handled during a prolapse?
Cleaned with saline and protected in a plastic bag.
diagnosis
Uterine prolapse after dystocia or when fetal membranes are retained. Too much oxytocin
The flank incision is made on the side ____________toward/opposite which the uterus is twisted. Therefore if the uterine torsion is in a counterclockwise direction the incision would be performed in the left flank.
The flank incision is made on the side toward which the uterus is twisted. Therefore if the uterine torsion is in a counterclockwise direction the incision would be performed in the** left flank.**
Specifically, the mare is anesthetized and placed in lateral recumbency on the side ____________ (toward/opposite) which the torsion is directed. For example, if the mare has a clockwise uterine torsion (i.e., torsion to the right) then she would be placed in _________ lateral recumbency. A long wooden plank is positioned against the mare’s left flank with a person kneeling on the end of the plank so that body weight is helping to stabilize the gravid uterus while the mare is rolled onto her back into left lateral recumbency.
Specifically, the mare is anesthetized and placed in lateral recumbency on the side toward which the torsion is directed. For example, if the mare has a clockwise uterine torsion (i.e., torsion to the right) then she would be placed in right lateral recumbency. A long wooden plank is positioned against the mare’s left flank with a person kneeling on the end of the plank so that body weight is helping to stabilize the gravid uterus while the mare is rolled onto her back into left lateral recumbency.
What are some complications associated with uterine prolapse?
Bladder prolapse, uterine tear, and intestinal herniation.
What method is preferred for uterine replacement in a prolapsed uterus?
Replacing it while the mare is standing and sedated.
What is the benefit of using tocolytic agents in uterine prolapse cases?
Tocolytic agents are drugs designed to inhibit contractions of myometrial smooth muscle cells
What surgical preparation is suggested for a ventral midline approach?
Fasting for 12-24 hours to decrease ingesta.
What percentage of mares survived uterine torsion correction when gestation was over 320 days?
65%.
What is a potential cause of uterine torsion according to the text?
Fetal activity.
What might indicate the need for ovariohysterectomy in a mare?
Presence of a large uterine tumor or failure of other treatments.
What is a benefit of a laparoscopic approach in uterine surgeries?
It minimizes abdominal contamination.
What are two common suture patterns used in uterine surgery?
Lembert and Cushing patterns.
How is a taut broad ligament used in diagnosing uterine torsion?
It indicates the direction of the torsion.
What percentage of uterine tears occur in the uterine horns?
Approximately 75%.
What is a uterine tear, and when does it most commonly occur?
A tear in the uterus usually occurs during dystocia or normal foaling. Tears near the tips of the uterine horns are likely the result of acute rapid thrusts of the fetal hind feet during foaling
Why epidural should be avoided while replacing the uterus standing?
Epidural anesthesia can be helpful in reducing straining. However, the author does not routinely use epidural anesthesia because it may not eliminate all straining, and its use is contraindicated if general anesthesia is performed.
Very rarely, a fetus gains access to the abdomen through a uterine tear, necessitating abdominal surgery to deliver the foal and repair the uterus. - TRUE or FALSE
TRUE
Most uterine tears are diagnosed 1 to ___ days postpartum
Most uterine tears are diagnosed 1 to 3 days postpartum
what are the common clinical signs of uterine rupture?
The most common presenting signs are depression, fever, mild abdominal discomfort, and tachycardia
What are common findings in peritoneal fluid for uterine tears?
High WBC count and total protein.
what is the median age of mares with uterine tears in one study?
10.5 years.
Where are uterine tears more likely to occur: the right or left horn?
Right horn (75%).
What was the median WBC count in peritoneal fluid for these cases?
Approximately 70,000/μL.
What was the overall survival rate across two retrospective studies for uterine tear?
about 76%
What difference did one study find in survival rates between horn and body tears?
Uterine horn tears had a higher survival rate (84%) than body tears (58%).
What percentage of mares with uterine horn tears survived in one study?
84%.
How were most uterine horn tears accessed surgically?
Via a caudal ventral midline celiotomy.
Which suture pattern was used to close uterine horn defects?
Simple-continuous and a continuous inverting pattern.
How long post-surgery was uterine lavage started?
1 day postoperatively.
How many days was the abdomen lavaged postoperatively?
For 2 to 3 days.
Where are caudal uterine body perforations repaired?
In the standing mare per vagina.
What suture type is commonly used for caudal uterine repairs?
No. 2 absorbable sutures.
What is periparturient hemorrhage?
Bleeding from reproductive tract arteries around foaling.
Which artery is most commonly affected in periparturient hemorrhage?
Uterine artery.
What age group is most at risk for periparturient hemorrhage?
Aged, multiparous mares.
What rectal examination finding is typical in periparturient hemorrhage?
A fluctuant mass in the broad ligament.
How soon after foaling do most periparturient hemorrhages lead to death?
Within 24 hours.
What is the survival rate for periparturient hemorrhage cases discharged from the hospital?
84%.
What key goals guide treatment of periparturient hemorrhage?
Stabilize cardiovascular volume, control pain, and prevent infection.
What is an elective C-section, and when might it be chosen?
Planned surgery, for cases with birth canal compromise or previous dystocia.
Why should an elective C-section be timed close to natural foaling?
To maximize foal viability and minimize adverse effects on the mare.
What mammary secretion change indicates impending foaling?
Sodium decreases; potassium and calcium increase.
What fetal survival rate is expected after an elective C-section?
Over 80%.
What additional circumstance may necessitate an emergency C-section?
Near-term colic surgery or correction for uterine torsion.
What is the survival rate for term foals delivered during colic surgery?
Only about 38%.
Why is incisional complication uncommon after C-section?
ecause significant issues are rare during subsequent parturition.
How long should the time be from deciding to perform a C-section to foal delivery?
Less than 20 minutes.
What is the length of the ventral midline incision typically made?
35-40 cm.
What position is the mare placed in for the C-section?
Dorsal recumbency with the ventral midline slightly tilted toward the surgeon.
Where does the ventral midline incision start?
0 cm caudal to the umbilicus.
What is the primary purpose of stay sutures during a C-section?
To minimize contamination and facilitate uterine closure.
Where are stay sutures commonly placed on the uterus?
Near the tip of the uterine horn and near the body of the uterus.
What technique can be used by an assistant instead of stay sutures?
Grasping the uterine horn with wet laparotomy sponges in each hand.
What additional drape is placed on the surgical field for a C-section?
An impermeable drape over existing drapes.
Where is the uterine incision made during the C-section?
Between the fetal hocks and feet.
What might happen to the uterine wall during foal extraction?
It can tear slightly at the end of the uterotomy.
How is the fetus lifted out of the uterus?
The surgeon grasps the hind limbs and hands them to an assistant.
What is done to the amniotic membrane during the C-section?
It is elevated and incised for fetal removal.
What is done to the umbilical cord once the fetus is removed?
It is clamped and transected.
How much of the chorioallantois is separated initially after delivery?
3 to 4 cm along the uterine wall incision so not include in suture - start suturing because bleeds profusely
what approach is used if the hind limbs are not in the uterine horn?
An incision is made at the base of the horn and uterine body within the abdomen.
Why is the chorioallantois usually not removed immediately?
It is typically still well attached.
What type of suture line is used on the uterine wall’s incised edge?
A continuous suture line.
What benefit does the hemostatic suture line provide?
Ensures close examination of uterine edges and reduces postoperative bleeding.
How many layers are used in the uterine closure?
Two layers, important that external is inverting serosal-serosal to avoid adhesions
What is administered to the mare post-uterine closure?
20 IU of oxytocin intravenously.
Why is oxytocin administered?
To stimulate uterine contractions and aid in placenta expulsion.
In what cases might a terminal C-section be performed?
For mares with terminal illness or severe conditions (e.g., neurologic abnormalities).
Which surgical approach is typically used in terminal C-sections?
Low flank approach after anesthesia induction.
Is sterility prioritized in terminal C-sections?
No, speed of delivery is prioritized instead.
What is the initial oxytocin dosage in postoperative care?
40 IU in 1 L of lactated Ringer solution given IV over 30-60 minutes.
What is done if the placenta is not passed in the recovery stall?
Administer oxytocin again 2 to 3 hours after delivery 40 IU in 1 L of RL over 30 to 60 minutes
How long is uterine lavage performed post-surgery?
Typically once daily for 3 to 4 days.
What medication is commonly given for 3-5 days post-surgery?
Systemic antibiotics and flunixin meglumine.
What are postoperative dietary recommendations for the mare?
Laxatives may be administered, and water should be freely offered.
What is included in discharge instructions for exercise?
Stall rest with hand walking 2-3 times daily for 30 days.
What percentage of dystocia cases are resolved by controlled vaginal delivery (CVD) at a referral hospital?
71%.
What percentage of dystocia cases require a C-section?
25%.
What survival rates are reported for mares undergoing CVD for dystocia?
94% survival rate
What is the mare survival rate for C-sections to resolve dystocia?
Between 82% and 91%.
What was the survival rate to discharge for foals delivered during colic surgery?
38%.
How does the year of breeding post-C-section affect pregnancy rates?
Year 1 post-C-section: 51% pregnancy rate; Year 2: 69% pregnancy rate.
Usually, the placenta passes within ____ hours after delivery.
Usually, the placenta passes within 8 hours after delivery.
