Clinical Examination of the Broodmare Flashcards
What restraint is recommended for reproductive exams in mares?
usually minimal needed
- place in stall with a kick gate
- tie tail and put to the side to keep hair out of rectum
What are 3 options for chemical restraint for reproductive exams in mares? How long does it take for them to take effect?
- Xylazine - 3-5 mins
- Detomidine - 3-5 mins
- Acepromazine - 20-40 mins
start with a low dose and repeat as needed - need to keep mare from laying down for a proper exam
Where are IV sedatives injected in horses? Why does this need to be done carefully?
jugular vein —> concentrate on upper 1/3 of the vein to avoid the carotid artery and injecting drugs into CNS circulation
Why are breeding soundness exams performed on mares?
- prepurchase
- prebreeding
- cases of infertility
What are the 3 physical barriers to the equine uterus?
- vulva (abnormal alignment = ascending infection)
- vestibulovaginal (transverse) fold
- cervix
What normal external genitalia should be seen in mares?
- vulvar lips/labia —> examine perineal conformation!
- clitoris —> everts when in estrus
What is considered normal perineal conformation in mares? Where should the vulvar opening be located?
vulva sound be vertically oriented with an angle of declination <10 degrees and the labia should meet without disruption of the mucosal seal
2/3 or more of the vulvar opening should be below the pelvic brim —> more space between anus to avoid fecal contamination
What is Caslick’s index? What is normal?
distance between dorsal commissure and pelvic brim x vulval angle
< 100 —> 100-150 = further evaluation, >200 = vulvoplasty required
What is the Windsucker test?
upon separation of the vulvar lips and visualization of the vestibulovaginal fold, no air should enter the vagina
- positive Windsucker means there is a weak transverse fold or cervix allowing air into the uterus
Normal perineal conformation, mare:
able to palpate pelvis with at least 2/3 of vulvar lips below
What is poor perineal conformation associated with in mares?
- pneumovagina
- low pregnancy rates
- ascending placentitis
- abortion
Poor perineal conformation:
- not perpendicular
- close to anus
Poor perineal conformation:
history or prior tear/dystocia
Poor perineal conformation:
- not sealed
- deviated to the left
Positive Windsucker tests:
able to hear air go into vagina!
Negative Windsucker test:
- normal membrane = unable to see cervix
- good barrier against air!
What is important about properly locating the clitoris and sinuses during examination of the equine reproductive tract?
important place to collected samples and transmission of Contagious Equine Metritis (CEM) —> Taylorella equigenitalis
What is a normal accumulation seen in the clitoral fossa/sinus in mares?
smegma —> “bean”
Urovaginal/urine pooling:
- urine able to move cranially, making the mare unable to completely urinate
- can cause infertility during estrus —> embryo does not do well in this environment!
Endometritis:
purulent d/c
Cervical tear:
may require a digital exam
How are transrectal reproductive exams performed?
- reach for and locate cranial uterus
- follow each horn and palpate ovaries and feel for ovulation fossa
- work back and try to palpate cervix —> less cartilage, should be tight and small in diestrus, and larger and more relaxed in estrus
uterus NOT retracted - broad ligament arranged differently
What are the target structures observed on transrectal palpation?
- LANDMARK = cranial margin of the uterus
- ovaries - size, ovulation fossa, follciles, consistency (U/S required for CL)
- uterus - tone, size
- cervix - tone
L and R ovaries and follicles, U/S:
could be cysts, more commonly found paraovarian
more of an issue if it blocks the ovulation fossa, impairing fertility
Cross-section of uterine body, U/S:
r/o edema (estrus) vs. fluid from inflammation or infection
- particles in fluid = debris, cells
Cross section of uterine body:
cysts - more common in older mares, must document size
- more irregularly shaped compared to embryos
R and L ovaries:
large follicles
Uterus, U/S:
hyperechoic spots = air!
- Windsucker +
Uterine body, U/S:
likely an embryo due to regular shape
- r/o cyst by rechecking for growth and movement
When is uterine culturing and cytology useful?
detecting acute, active endometritis and other fungal/yeast infections
- must use sterile technique
- always do BOTH!
Why is a double-guarded uterine swab preferred? How is culture and cytology preferred?
must pass through cervix to reach uterus —> helps swab remain sterile as it’s passed through
- CULTURE = send swab to lab in transport tube
- CYTOLOGY = gently roll on slide and stain with Diff-Quik
What is an alternative to using uterine swabs for cytology?
low-volume uterine flush - 75% sens, 90% spec
- look at fluid clarity —> cloudiness, debris, strands
How is a low-volume lavage performed for uterine culture and cytology? How can the return of the uterine fluid be augmented?
- elevate a 150-250 mL bag of 0.9% sodium chloride or other sterile fluid for gravitational flow
- gently massage the uterus per rectum
- lower the bag once it’s empty to allow a return of the fluid via gravity flow
- centrifuge the recovered fluid, remove the supernatant, and resuspend the pellet
- prepare a cytology slide/sterile sample for culture from the resuspended fluid
single dose of 10-20 IU oxytocin IV
What is an indicator of inflammation of uterine fluid cytology slides?
ratio of 1 neutrophil to 40 epithelial cells
What are these uterine cytology slides indicative of?
- yeast infection
- hyphae - fungal infection
- crystals - likely urine pooling
What is the purpose of uterine biopsies?
detecting chronic inflammatory, degenerative changes, like fibrosis and glandular degeneration
- acute changes will not be represented
How can cervical and uterine biopsy sampled be differentiated?
CERVICAL = no glands
UTERINE = glands
What are the 4 grades of Kenny-Doig uterine classification? What effect on foaling rates is expected?
GRADE I = normal endometrium to focal inflammation or fibrosis - 80-90%
GRADE IIa = mild to moderate inflammation with 1-3 layers of fibroblasts around glands or <2 glandular nests - 50-80%
GRADE IIb = multifocal areas of moderate inflammation or fibrosis +/- 2-4 fibrotic nests - 10-50%
GRADE III = severe inflammation and/or diffuse fibrosis - <10%
What is seen on these uterine biopsies?
L = normal endometrium
R = hemorrhage, inflammation
What is seen on this uterine biopsy?
periglandular fibrosis - spindle cells around glands
What is seen on this uterine biopsy?
fibrotic nest - severe fibrosis fills glands
