Equine - Dystocia and Postpartum Complication Flashcards
What are the different forms/causes of dystocia?
A slow or difficult labor and delivery, failure to progress in labor, and a pathological labor
What can cause failure to progress in labor?
improper cervical dilation or the offspring does not descend through the pelvis following full dilation
What can cause a pathological labor?
An obstruction or constriction of the birth canal or abnormal size, shape, position or condition of the fetus
What is the etiology of dystocia?
Uterine dysfunction, fetal-maternal mismatch, abnormal fetal presentation, position, and posture, abnormal fetal anatomy, and polytoccus (multiple fetuses) pregnancy
What are the maternal causes of dystocia?
uterine inertia, inability to strain, and obstruction of the birth canal
What are the different forms of uterine inertia?
primary and secondary
What is primary uterine inertia?
uterine contractions fail to ever be initiated
What can cause primary uterine inertia?
myometrial defects, biochemical deficiencies, hysteria/environmental disturbance, deficient/excessive amnionic fluid
What is secondary uterine inertia?
uterine contractions cease after a period of time but before labor is completed
What can cause secondary uterine inertia?
uterine damage and metabolic exhaustion
What can cause a mare to be unable to strain?
age/parity, pain, weakness, and diaphragmatic, tracheal, or laryngeal damage
What can cause obstruction to the birth canal?
boney pelvis, soft tissue obstruction (vulva, vagina, cervix, and uterus)
What are the fetal causes of dystocia?
hormone deficiency, feto-pelviic disproportion, maldisposition, and fetal death
What is the first step of managing a dystocia?
obstetric examination - restrain and clean the patient and do a vaginal examination
What are the three Ps?
presentation, position, and posture
What is presentation?
the relationship between the long axis of the fetus and the long axis of the maternal birth canal
What are the different presentations a foal can have?
longitudinal (anterior or posterior), transverse (ventral or dorsal), and vertical (rare)
What is position?
the location of the surface of the maternal birth canal to which the fetal vertebral column is applied
What are the different positions a foal could have?
dorso-sacral, dorso-pubic, or dorso-iliac (right or left)
What is posture?
The disposition of the head and limbs of the fetus - flexed or extended
If a foal is described to be dog sitting in the womb, how is it positioned?
It has anterior longitudinal presentation, dorso-sacral position, and bilateral hip flexion in anterior presentation
If a foal is described to be breeched (true breech), what is the position that it is in?
it is posterior presentation, the hind limbs are extended forward , the forelimbs are flexed, and the head is extended
What is the normal PPP?
Anterior longitudinal presentation, dorso-sacral position, and complete extension of the head and fore limbs
What is the normal posterior presentation PPP?
Posterior longitudinal presentation, dorso-sacral position, and complete extension of the hindlimbs
What is the PPP for complete down deviation of the head?
Anterior longitudinal presentation, dorso-sacral position, and complete down deviation of the head
What is the PP for ventral position in posterior presentation?
posterior longitudinal presentation, dorso-pubic (ventral) position, flexed hind limbs
What are the different types of treatment for dystocia?
Conservative treatment (uncommon), drug therapy, manipulative treatment, surgical treatment, fetotomy, and euthanasia
What drugs can be used for dystocia management?
Oxytocin, Ca borogluconate, Ca gluconate, Ca lactate, glucose
Why would you use oxytocin to manage dystocia?
to increase myometrial activity
Why would you use calcium and glucose in the management of dystocia?
to correct a chemical imbalance
What are the two types of delivery that can be done with manipulative treatment?
Assisted vaginal delivery - light sedation, standing/lying down
Controlled vaginal delivery - general anesthesia, laying down/hoisted
What are the different types of manipulative treatment?
mutation, repulsion/repelling (retropulsion), and rotation
What is mutation manipulation?
it is correction of fetal malposition
What is retropulsion?
pushing the fetus out of the birth canal into the uterus where there is more room to correct the abnormal position of the fetus and its extremities
What is rotation manipulation?
turning the fetus on its long axis to bring it into a dorso-sacral position
What is the most important tool for dystocia management?
lube
Why would you want to use epidural anesthesia?
reduce abdominal straining, pain management, +/- sedation
What epidural anesthesia drug can be used to reduce abdominal straining?
2% lidocaine
What epidural anesthesia drug can be used for pain management?
morphine
What epidural anesthesia drugs can be used for sedation?
alpha-2 agonists, phenothiazines, benzodiazepines
Why would you want to use a tocolytic?
to inhibit labor, slows down or halt the contractions of the uterus
What tocolytics can be used in equine and which is shorter acting?
Clenbuterol (beta-2 agonist) and Buscopan (spasmolytic, short acting)
When using OB chains,n where should the chain be oriented around?
the fetlock joint - a loop above and a halfhitch below the fetlock joint
When is a C-section indicated?
fetal-dam disproportion, irreducible torsion, incomplete dilation of cervix or birth canal, fetal monster, fractured pelvis, ruptured uterus, damaged or severe vaginal prolapse, evidence of compromised fetal life, failure of uterine inertia to respond to ecbolic treatment, and convenience
What surgical complications are associated with C-sections?
peritonitis, uterine prolapse, wound breakdown, seroma formation, and retention of fetal membranes
What disease processes can result from retention of fetal membranes?
metritis, vaginitis, infertility, ventral edema, mastitis, and sudden death
When is a fetotomy considered unethical?
if the fetus is alive
When is a fetotomy done?
if vaginal delivery is not possible due to a dead fetus too big for delivery or fetal anomalies
What is the prognosis of the mare post fetotomy?
good if it is performed properly
What are the advantages to a fetotomy?
May salvage the dam’s life and subsequent fertility, low chance of trauma if only partial fetotomy is needed, and it could be cheaper with less cuts (?)
What are the disadvantages to a fetotomy?
time consuming, possible reproductive tract trauma, possible danger to the dam and future fertility, and increased incidence of retained fetal membranes and endometritis
When may euthanasia of a fetus be the best option during dystocia?
Dam and offspring are poor candidates for obstetrical intervention and economy doesn’t allow for further obstetric intervention
What are the four general steps of resolution of dystocia?
Inspect reproductive tract, assess need for additional medications, monitor passage of fetal membranes, and offspring nursing/mastitis
Are all obstetric cases emergencies?
yes
When palpating, what should you make sure to do in regards to the foal anatomy (bad question sorry)?
Always trace both legs and the head of the body to verify that they belong to the same fetus
When is it alright to give the dam time during parturition?
IF the labor is progressing
What is the most common postpartum problem in mares?
retained placenta
What are the predisposing factors for retained placenta?
old age, breed (drafts), dystocia, prolonged gestation, and placental disease
What is retained placenta?
the presence of retained fetal membranes more than 3 hours post partum
What is the mechanism for placental detachment?
- Cessation of blood flow through placental vessels
- Decrease in size of chorionic villi
- Increased uterine contractions originating a tip of uterine horns and progressing towards the cervix
- Weight of the placenta causing gentle pressure
What clinical signs can a mare show if she has retained placenta?
May have a fever, lethargy, anorexia, vaginal discharge, etc.
What will be felt on transretal palpation/ultrasound in a mare that has retained placenta?
Decreased uterine tone is an excellent indicator of complications following parturition and fluid in uterus
What will be felt on vaginal palpation in a mare with retained placenta?
the placenta
What are some complications associated with retained placenta?
laminitis (any mare with a retained placenta has laminitis until proven otherwise), uterine prolapse, metritis, septicemia, and death
What are the treatment techniques for retained placenta?
burns technique, oxytocin, broad spectrum antibiotics, and teatnus prophylaxis
What is the Burn’s technique?
Pumping fluid into the allantoic cavity to get it out - must have an intact placenta
Why would you use oxytocin for a retained placenta?
to promote contractions in the mare so that it will come out
Why don’t you want to manually remove a retained placenta?
It can cause several hemorrhage, pulmonary embolism, uterine horn eversion, delay uterine involution, and permanent endometrial damage
What is the newest technique for treating retained fetal membrane?
catheterize the uterine vessel, infuse water with a small hose to get it out
Why is a broad ligament hematoma important?
hemorrhage from the uterine artery is common in older mares and a significant cause of death in aged brood mares
What is the signalment for a broad ligament hematoma?
multiparous mares > 10 years of age are primarily affected
What are the predisposing factors for broad ligament hematoma?
angiosis, dystocia, and induced parturition
What is the pathogenesis of a broad ligament hematoma?
hemorrhage from the uterine artery slowly dissects into the broad ligament between the myomeetrium and uterine serosa
When will a broad ligament hematoma not exsanguinate?
if the resulting clot stops arterial hemorrhage
When will a broad ligament hematoma exsanguinate?
If the broad ligament ruptures or serosa surface of the uterus tears
What are the clinical signs of a broad ligament hematoma?
colic, tachycardic mm palor - not always anemic
How is a broad ligament hematoma diagnosed?
signalment, rectal palpation/US (caution - only go in for a diagnosis)
What is the treatment for a broad ligament hematoma?
Place the mare in a dark, quiet stall with mild sedation if needed. (Her number one choice of treatment)
Give Naloxone or formalin IV, aminocaproic acid, or yunnan baiyao
When may a uterine rupture occur?
It may occur prior to or during the 1st or 2nd stage of parturition due to excessive force or the fetus putting a foot through the uterine wall
What is the treatment for uterine rupture?
close the laceration surgically, lavage the abdomen, and endotoxemia prophylaxis
What does uterine prolapse result from?
uterine horn eversion - rare in mares
How is uterine prolapse treated?
Rapid replacement following cleansing. After replacement, the uterus should be distended with fluid to ensure both horns are completely evaginated
What is the prognosis for uterine prolapse?
grave
Why wouldn’t you want to trailer a mare with uterine prolapse?
because there is big concern for uterine artery rupture
