Equine Nursing Flashcards
list types of elective orthopaedic surgery
arthroscopy/tenoscopy
angular limb deformities in foals
soft tissue surgery for neurectomy/fasciotomy, desmotomy
list emergency orthopaedic surgery
arthroscopy/tenoscopy
fracture repairs
sequestrum removal
define tenoscopy
looking at tendon sheath
define arthroscopy
looking into joint space
when is arthroscopy and tenoscopy commonly perfromed?
intra-articular fracture repair
OCD
synovial sepsis
sequestrum removal
why does OCD occur in horses?
developmental defects in cartilage and bone
how does arthroscopy manage OCD?
prevents further degeneration of the bone
when do horses typically present for OCD surgery?
3-8years
young
what is synovial sepsis?
bacterial infection leading to septic arthritis
how is synovial sepsis managed?
antibiotics alone not effective
lavage joint and arthroscopy
how do sequestrum form?
trauma results in damage to the periosteum, can result in the bone dying in this region
necrotic bone separates/sequesters and becomes FB
what can be consequences of sequestrum formation?
infection
non-healing wounds
draining tracts
how is sequestrum formation treated?
removal of sequestrum and active involucrum (bed of bone surrounding the region)
describe presentation of angular limb deformity
bendy legs - medial or lateral
foals
what can cause angular limb deformity?
nutrition
incomplete ossification
tendon/ligament laxity
how do you manage and treat angular limb deformities?
operate before 18mo
growth arresting techniques - prevent growth on longer side, transphyseal screw or plating
growth accelerating techniques - accelerates growth on side cut is made and lifted, periosteal transection
what make fracture repair more complicated?
expensive - may not be option for owners if wont return to performance
size of horse puts massive stress on fracture repair
repair needs to be strong for performance
GA recovery can be dangerous - flight animal
contamination from lack of soft tissue on distal limbs
what are the benefits of repairing distal limb fractures awake?
no GA recovery which can be dangerous
list considerations for healthy patients before ortho surgery
vaccine status - flu and tetanus
likely weight bearing on all limbs
may need x-ray and US before surgery
pre-op exam
IV catheter in jug vein
possibly pre clip site to reduce GA time
list nursing considerations for emergency ortho patients
if in doubt treat as fracture
clinical exam and stabilise
IV catheter
sedative if needed - alpha 2
wound care
isolate if not flu vaccine
limb support if needed
imaging
meds - antibiotics, tetanus antitoxin, analgesia
describe wound care in ortho patients
check CV status
consider blood loss
clip
clean with water, chlorhex
describe how to stabilise fractures
splint or bandage to restrict movement
what are the goals of fracture stabilisation?
stabilise fracture
minimise further trauma to bone, soft tissue and vasculature
prevent further contamination
reduce pain and stress
what is a kimsey splint and when is it used?
used on distal limb
usually only on racing yards as have high occurance of fractures
how is robert jones applied in horses?
layers of cotton held by elastic gauze, layers tighter than the one before
should be 3x diameter of limb
sound like watermelon
uses 10-15 rolls of cotton normally
list nurses roles in ortho surgery
scrub nurse - run table
circulating nurse - run the room
list theatre prep for ortho surgery
clippers
antibacterial scrub preps
fluids for horse and arthroscope
meds
u cath
shoe removal
anaesthetic equipment
why should shoes be removed for surgery?
cause trauma to self or room in recovery
very hard to properly clean
describe patient prep for ortho surgery
cover tail and feet - may contaminate surgical site if above
clip hair - 10-15cm away from surgical site
clean and disinfect skin
list skin prep solutions used
chlorhexadine
iodine compounds
povidone iodine
alcohol
what are considerations using chlorhexadine for skin prep?
residual activity - binds to protein in skin
low toxicity
can be toxic to fibroblasts - cover large wound with gel and clean with sterile saline
what are considerations for using iodine compounds for skin prep?
only free iodine is bactericidal
stains
radiopaque
smells
what are considerations for povidone iodine skin prep?
no free iodine unless diluted or combined with detergent
low toxicity
indicated in presence of organic debris
what are considerations for alcohol skin prep?
only effective against bacteria
inactivated by organic debris
no residual activity
commonly used as rinse after skin prep
list considerations for preparing theatre for ortho surgery
horses position
instruments needed
imaging equipment
post-op bandaging materials
how can horses be positioned in surgery?
ropes and supports for legs
padding
why is padding so important in positioning horses for surgery?
prone to myopathies/neuropathies if lying on one muscle group for long time
list imaging considerations for ortho surgery
equipment - radiography, fluroscopy, arthroscopy
sterile bags for x-ray plates
PPE
why is have solid bandages so important in recovery?
lots of forces will be exerted on it
describe how to recover horses from surgery
leave ETT in for early recovery
unassisted and rope recovery common
sling or pool recovery uncommon
how is rope recovery done?
rope on head collar and tail
guide horse up not lift
describe how sling recovery is done
similar to rope but supporting weight
what are benefits and risks of pool recovery?
benefits - no weight bearing on fractured limb
risks - infection, pulmonary oedema
list post-op care for ortho surgery
analgesia
anti-biotics as needed - contamination or infection, implants used
monitoring
hypothermia usually corrects self
feacal output and consistency
appetitie
remove IV as soon as possible
bandage care
list post-op care for synovial sepsis
antimicrobials - systemic, intrasynovial, IV regional perfusion
repeated synoviocentesis to guide antibiotics - look at WBC, TP and SAA
wound management
how is IV regional perfusion of antibiotics performed?
torniquet limb
inject lower than with high dose antibiotics to perfuse area of limb
repeat every other day
list possible complications following ortho surgery
post-op infection
incision breakdown
unacceptable pain
bandage/cast sores
supporting limb laminitis
colic
why are bandage and cast sores common?
protruding bones and low soft tissue coverage
how does supporting limb laminitis occur following ortho surgery?
excess weight bearing compresses vessels causing inflammation
how can you prevent supporting limb laminitis?
frog supports
deep bedding
rubber mats
stable bandage good leg
what can increase risk of bandage complications following ortho surgery?
horse hot
moving around a lot effecting tension of bandage
poor application
how can you reduce risk of bandage complications following ortho surgery?
cross tie
small stable
list cast monitoring considerations
twice daily
temperature of horse
change in comfort
fever
discharge
staining
wear on sole
breakage
heat
flies
smell
list complications associated with fracture fixation
post-op infection of skin, bone or implant
pain
reduced healing
breakage of implant
further fracture of limb
list equipment needed for fracture fiaxation
drill
plates and screws
bone reduction forceps
plate bender
fracture kit
general kit
drapes
mathieu retractor
hohmann retractor
gelpi retractor
weitlaner retractor
list equipment for arthroscopy
tower
camera
synovial resector
trocars
canula
screen
fluid line
scope
light cable
fluid pump
list other equipment needed for ortho surgery
bruns currette
rongeurs straight and curved
how many stages are there in normal foaling?
3
what is stage 1 foaling?
30-60 minutes
cervix relaxation
uterine contraction
water breaks/rupture of chorioallantois
what is stage 2 foaling?
5-30 minutes
delivery of foal
needs assistance if delayed
what is stage 3 foaling?
2-3 hours
placenta and foetal membranes expelled
needs assistance if delayed
list normal foal behaviour
standing in an hour
suckle in 2 hours
pass meconium in 3 hours
urinate in 8-12 hours - colts earlier than fillies
active from birth
sleep with legs extended
periods of sleeping, activity and nursing
list normal foal parameters 2-3 hours post partum
RR - 50-80bpm - due to fetal vessels closing
audible crackles on lungs
mild nasal discharge
list normal foal parameters upto 7 days old
HR 80-100
RR 30-40
temp 37.5-39.5
pink moist MM
good peripheral pulses
warm extremities
MAP over 70mmHg
what are nutritional requirements for foals?
1L colostrum in first 12 hours
20-30% BW in milk per day
100-160kcal/kg/day
what is the result of the high volume of milk foals drink?
high urination
why is colostrum so important to be drank in the first 12-24 hours?
passive transfer
contains antibodies from the mares blood which are absorbed in the GI tract to the foals blood
list possible complications in foaling
trauma
congenital abnormalities
acquired abnormalities
failure of passive transfer
what is a common cause of trauma to the foal in foaling?
dystocia leading to rib fractures
list common congenital abnormalities in foals
cleft pallette - see milk at nostrils
microphthalmia - tiny eyes
limb deformities - flexure, angular limbs
list example of acquired abnormality in foals
patent urachus
what causes failure of passive transfer?
foal not drinking enough or low quality colostrum
list common conditions in foals leading to ICU
sepsis
neonatal isoerythrolysis
neonatal maladjustment syndrome
prematurity/dysmaturity
ruptured bladder
diarrhoea
pneumonia
meconium impaction
what is sepsis in foals?
life threatening, inflammatory response to systemic bacterial infection
list common causes of sepsis in foals
failure of passive transfer
local infection
list clinical signs of sepsis in foals
pyrexia
petechiae
injected MM
dull
flat
unresponsive
recumbency
uveitis
synovial sepsis
hypotension
what are signs of synovial sepsis in foals?
lameness
swollen joints
diarrhoea
pneumonia
umbilical infection
what causes synovial sepsis in foals?
haematogenous spread
what is neonatal isoerythrolysis ?
mare produces antibodies against foals RBCs
foal absorbs these in colostrum so its RBCs are broken down
what causes neonatal isoerythrolysis?
mare has had contact with the foals same RBCs such as previous foal with same sire
list clinical signs of neonatal isoerythrolysis
anaemia
icterus
weakness
how is neonatal isoerythrolysis treated?
stop drinking milk
supportive care until regenerate RBCs
transfusion if needed
what are other names for neonatal maladjustment syndrome?
hypoxaemic ischemic encephalopathy
perinatal asphyxia syndrome
dummy foal
list clinical signs of neonatal maladjustment syndrome
neurological signs
poor suck reflex
failure to nurse
hyperaesthesia
obtundation
coma
abnormal at birth or crash at 24-48 hours
how is neonatal maladjustment syndrome managed?
supportive care
can do madager foal squeeze - pressure on thorax, helps 20%
list signs of prematurity/dysmaturity
silky coat
floppy ears
domed head
immature MSK
incomplete ossification of cuboidal bones
incompatible with life
why is incomplete ossification of the cuboidal bones such a concern in foals?
bone will crush leading to joint abnormalities for life
how do you manage incomplete ossification of cuboidal bones?
keep foal recumbent for as long as possible to allow bones to mature and ossify
what is a premature foal?
less than 320 days gestation
what is a dysmature foal?
normal gestation but appear premature
how do foals with ruptured bladder present?
few days old
colic
abdo distension
hyperkalaemia
low sodium
low chloride
how is ruptured bladder managed in the foal?
surgery
why should you never lift foals by their abdomen?
can rupture the bladder
list signs of meconium impaction
straining to defecate
mild colic
how is meconium impaction managed?
IVFT
management
phosphate enema
what is the role of ICU nurse for foals?
patient care
foal and mares needs
staying organised
keeping unit clean and stocked
communication of patients
wearing PPE
list general nursing care of foals in ICU
maintain sternal recumbency to prevent atelectasis
assist standing every 2 hours if well enough
turn 2 hourly to prevent pressure sores
weigh daily
close examination
what is monitored in NICU exams
complete physical exam
demeanour
nose to tail checks
manage treatments
nutrition
urine and fecal output
at least 4 hourly checks, more if sicker
list CV system checks in NICU foals
MMs - indicate systemic health, multiple locations (buccal mucosa, conjunctiva, ear pinnae), should be pink, moist
CRT - less than 2
HR - 80-100, strong pulses, warm extremities
CO - relies on stable HR
may have murmurs until day 4 as fetal vessels closing
why does CO rely on HR in foals?
cant adjust stroke volume due to immature sympathetic nervous system
what is the result of poor compensation of heart rate in foals?
poor BP and oxygenation
list respiratory system checks in NICU foals
RR - 30-40
regular rhythm
louder bronchial sounds than adults
no wheezes
dullness
crackles
respiratory effort
nasal discharge
check for rib fractures
blood gas for oxygenation
list what may be seen in eye checks for unwell NICU foals
indicate systemic state
dehydration seen with sunken eyes and entropion
sepsis if injected MM, hypopyon (fibrin and pus accumulation), uveitis
trauma seen with injected conjunctiva and swollen eyelids
why are corneal ulcers common in foals?
have reduced corneal sensitivity
what should be assessed in NICU foals MSK?
lameness
septic synovitis/osteomyelitis
check all joints
reduce weight bearing if premature or dysmature
flexural deformities - laxity or contraction
angular limb deformities
list GI system checks in NICU foals
colic if meconium impaction or ileus
tolerance of enteral nutrition
diarrhoea - often secondary to sepsis, or infectious cause
describe how to care for the umbilicus in foals
dip in 0.5% hibitane
twice daily
four times daily if patent urachus or septic
how should you care for mares post-partum?
manage any trauma or illness from birth
check TPR twice daily
manage perineum
check milk
encourage bonding with foal
check placenta passed
how are IV catheters placed in foals?
over the wire
in lateral recumbency in jugular vein
needs 3 people
why are IV catheters for foals made of polyurethane?
less thrombogenic
how do you maintain catheters in foals?
check patency 4 hourly
care when giving drugs in case of sedimentation
lots of care if parenteral nutrition
what should you do if you are concerned a foal has sepsis?
take blood sample for culture following aseptic IV placement to prevent contamination
what is IgG snap test used for?
test levels of antibodies in foals blood
what is the level of antibodies that should be in foals blood?
8g/L
what should you do if foals have lower levels of antibodies than they should?
give colostrum if under 24 hours
give plasma transfusion if older than 24 hours
why cant colostrum be used to increase antibodies in the blood after 24 hours old?
cant absorb antibodies to the GI tract
where do you take arterial blood gas samples from in foals?
lateral metatarsal artery
what are normal blood gas values in foals?
PaO2 - 80-110mmHg
PaCO2 - 40-80mmHg
what is the potential effect of lateral recumbency on PaO2?
reduce upto 30mmHg
what can venous blood gas be used for in foals?
assess electrolytes
why is hypoglycaemia common in foals?
if septic
have poor glycogen and fat reserves
how can you manage foals with hypoglycaemia?
fluids supplemented with dextrose
what does lactate show?
measurement of tissue perfusion
what are normal lactate levels in neonates and 3 days old?
neonates - less than 3-4mmol/L
3 days - less than 2 mmol/L
what does increased lactate in foals indicate?
anaerobic metabolism
insufficient oxygen supply to tissues
hypovolaemia
hypoxaemia
sepsis
how do you fluid resus foals?
warm hartmanns
20ml/kg over 20 mins
reassess and repeat after each litre
maximum 4 litres for 50kg foal
how is ongoing fluid therapy managed in foals?
hartmans and 5% dextrose
3-5ml/kg/hr
6mg/kg/min glucose - 3ml/kg/hr 10% glucose
consider electrolytes
cant tolerate high sodium fluids
risk SC oedema
supplement potassium if not nursing
how is NIBP measured in foals?
tail cuff
try not to stimulate in placement
3 readings and average
when are foals hypotensive?
MAP less than 70mmHg
why does sepsis lead to hypotension?
suppression of myocardial contractility so reduced SV
blood vessels dilate
how do you manage hypotension in sepsis?
inotropes - dobutamine to increase cardiac contractions
vasopressors - vasopressin to constrict blood vessels
what should a foals normal UOP be?
50-70% fluid input
over 2ml/kg/hr
how can you provide intranasal oxygen?
through tubing into nostril up to medial canthus of the eye
taped to tongue depressor
run along face through hole in neck wrap
connect to oxygen
is run through humidifier with sterile water
what are flow rates of providing foals oxygen?
2-15L/min
start at 5L/min and adjust
how do you manage foals with oxygen cannulas?
clean tube daily
replace every other day
list complications associated with intranasal oxygen
nasal irritation
rhinitis
airway drying
other than oxygen how can you support respiration in foals?
nebulisation
ventilation
what is the benefits of nebulisation?
aid secretion removal, with coupage
can give bronchodilators and antibiotics
why is ventilation rarely done in foals?
if its at this point prognosis is very poor
why should seizures be managed?
increases cerebral oxygen demand
can result in neurone damage
how do you manage seizures in foals?
5mg diazepam - lasts 20 minutes, can be repeated
midazolam CRI, phenobarbital, levetiracetam - continued seizures
padding on bones, environment to protect from trauma
what can cause seizures in foals?
neonatal maladjustment syndrome
hypoglycaemia
sepsis
how much nutrition should you provide to foals in hospital?
10% body wieght
500ml every 2 hours approx
start at 50ml and build up as tolerates
how do you feed foals?
feed selves if can
never bottle feed - aspiration risk
NG tube if cant feed
how do you manage NG tube in foals?
check placement on radiographs
secure same as O2 tube
check for reflux before feeding
what is the purpose of TPN in foals?
support energy balance
not enough for growth
what are the types of enemas for meconium impaction?
phosphate - max twice in 24 hours
soapy water - 200ml
acetylcystine retention enema
what enema may be done as a preventative measure in all foals in some yards?
soapy water
how does a acetylcystine retention enema work?
sedated
dissolved meconium
very effective
list common emergency surgeries
colic
dystocia
trauma
synovial sepsis
fracture repair
what is colic
broad term for abdominal discomfort in horses
can involve GI, liver, urinary tract, repro organs
what history should you take from owners of colic horses?
how long has been colicing for
severity of signs
last faeces passed
breed, age, sex
has it happened before
any management changes - turnout, stabling, worming
what history should you take from referring vet for colic cases?
TPR - presentation to now
clinical findings - rectal, NGT
meds given and response
suspected lesion
if surgery is an option
financial concerns
list equipment needed for colic assessment
sedation - xylazine, detomidine, butorphanol
NSAIDs - flunixin, buscopan
clippers
sterile prep solution
catheters
blood tubes
lactate reader
NG tube
rectal gloves
lube
fluids
US machine
how may horses present with colic?
unpredictable
‘well’ or rolling
where should you triage colic patients?
stocks
knockdown box if unsafe
have mobile box with equipment
what is assessed in colic work up?
demeanour
signs of pain
abrasions - indicate severe pain
TPR
GI borborgomi
CV status
MM
abdo distension
rectal exam if safe
NG tube
bloods
AUS
abdominocentesis
what do purple MM indicate?
endotoxaemia due to rupture or close to
what may be needed to perform a rectal exam in colic patients?
sedation or buscopan to relax anal sphincter
why is passing an NG tube so important in colic cases?
horses cant vomit
stomach has high change of rupture
when is NG decompression indicated?
high HR
significant pain
what does reflux indicate in colic cases?
SI obstruction
what bloods should you perform in colic patients?
PCV
TP
lactate
what can be seen in fast abdo US in colic cases?
stomach distension
SI motility
SI distension
displaced colon
thickened intestinal wall
free abdo fluid
what is looked at from abdominocentesis?
total nucleated cell count
TP
lactate
what indicates that colic is surgical?
congested MM
CRT over 3
HR over 60-80
poor pulses
uncontrollable pain
distention or displacement of small or large intestine on rectal exam
over 2L reflux on NG intubation
amotile distended loops of SI on US
high lactate
how do you manage colic patients before moving to surgery?
patent IV
decompressed stomach
can leave NGT in place
clip abdo if safe when awake, 20cm either side of midline over whole ventral abdomen
remove shoes if safe
what should you prepare before knocking down horses for surgery?
theatre bed ready to receive in dorsal recumbency
anaesthetic equipment
hoist
clippers
u cath
surgical scrub
what should be prepped in theatre for colic surgery?
warmed fluid for lavage
carboxymethylcellulose for lubricant - prevent post-op adhesions
2x + surgical kits - replace after entering GI tract
fresh gowns and gloves - after contamination
lots of drapes
hose for colon flush
colon table and dump drum
how is colic surgery perfromed?
ventral midline incision over 20cm
all of GIT assessed
what is assessed in the GI tract of colic patients?
distension
thickening
viability
displacement
how is non-viable intestine managed?
resected and anastomosed
what kit is needed for resection and anastomosis of intestine?
buster drapes
doyen clamps
suture material
fluids for lavage
why are enterotomy and colon dumps needed for large intestine lesions?
dump contents due to weight of pelvic flexure
how is colon dump managed?
tilt colon table down so contents run away from surgical field
how are abdomens closed following colic surgery?
3 layer closure
linea alba
SC tissue
skin
what dressings are used following colic surgery?
melolin, lap bandage as stent, secured with adhesive spray
belly bandage
how is recovery following colic surgery managed?
remove u cath
bandage feet if have shoes on
towel dry
why is it so important to dry horses following colic surgery?
are soaked due to scrub and lavage
list post op care for colic surgery patients
IVFT
lidocaine CRI
analgesia
antibiotics
incision care - monitor for infection and breakdown
why are lidocaine CRIs good following colic surgery?
good for GI pain
prokinetic
reduces NSAID use
why should opioids be avoided if possible for colic surgery pateints?
cause ileus
how should refeeding be managed after colic surgery?
LI displacement - gradually feed when awake and alert
SI resections - no food for 48 hours
start with small amounts of fibre nuts and grass
list possible complications following colic surgery
endotoxaemia
ileus
colitis
jugular thrombophlebitis
peritonitis
incisional infection
define endotoxaemia
bacteria in blood due to contamination in surgery
how is endotoxaemia managed?
IVFT
flunixin/polymyxin B/hyperimmune plasma
laminitis is potential so ice boots, deep bed and frog support
how do you manage ileus following colic surgery?
regular NG tube decompression
promotility drugs - lidocaine, erythromycin, metoclopramide
IVFT
nil by mouth until tolerating
monitor with US
define colitis
inflammation of the colon
how do you manage colitis in colic surgery patients post-op?
will be pyrexic
IVFT
isolate as diarrhoea may shed salmonella
gastroprotectants - sucralfate
how do you manage jugular thrombophlebitis?
remove catheter
local anti-inflammatories
antithrombolytics
how is peritonitis diagnosed?
abdominocentesis
how is peritonitis managed?
broad spectrum antibiotics
how do you manage incisional infection?
manage oedema
may have cellulitis - inflammation of SC tissue
antimicrobials if systemically unwell
swab for culture and sensitivity
encourage drainage
how do you monitor patients following colic surgery?
full exam every 2-4 hours
demeanour
GI borborgymi
fecal output
appetitie
jugular vein
feet - comfort, digital pulses
incision
ensure geldings not urinating on belly bandage
list signs of jugular thrombophlebitis
heat
swelling
pain
patency of catheter
how should IVFT be managed in horses following colic surgery?
crystalloids
50ml/kg/24hr maintenance
assess dehydration and losses
potassium supplements if not eating
how do you manage patients returning to normal following colic surgery?
gradual reduction of analgesia
gradual refeeding of hay when coping with grass
4-6 weeks box rest, walking to grass
small paddock for 1 month
turn out for 1 month
gradual return to normal work
what is meant by red bag delivery?
premature separation of placenta
foal not getting oxygen
chorioallantosis appears at vulva instead of amnion (white)
how is red bag delivery managed?
chorioallantosis ruptured immediately
assisted delivery of foal
what can cause dystocia?
foal malposition
foal abnormalities
1-10% incidence
how is dystocia evaluated?
signalment
time of onset of stage 2 labour
gestation days
assistance attempted
medical treatment
how do you prepare for dystocia cases?
assume is having c section
prepare knockdown box
warm water
lots of lube
foal ropes
hoist for controlled delivery
anaesthetist ready
theatre prepared for dorsal recumbency
foal trolley for resus
how do you manage dystocia in mares on arrival to hospital?
bandage tail
IVC placed
assess delivery options
vaginal exam
how do you manage dystocia if vaginal delivery is possible?
assisted if possible with mare standing
controlled assisted if not productive after 5-15 minutes - mare under GA, hindlimbs hoisted, prep for c section
how is dystocia managed if vaginal delivery not possible?
c section if foal alive
foetotomy if foal dead
how is c section performed?
ventral midline incision
uterine horn located and exteriorised
hysterectomy incision 35-40cm for feet and hocks to fit
umbilical cord clamped and transected
foal lifted with 2 people
foal cared for by separate team
who manages mare during c section?
2 scrubbed
one running room
one anaesthetist
how is foal managed after c section?
2 people to resus as has GA drugs on board
assess for abnormalities
supplement oxygen
IVC placement
umbilicus management
what is a consideration when you have c section cases?
lot of people needed so manage team throughout hospital
how should you help mares recover from GA after c section?
assisted as increased risk of fracture - low calcium due to milk production, exhausted
what are outcomes of dystocia in mares and foals having controlled vaginal delivery or c section?
controlled mare - 87-94%
c sec mare - 87-89%
c sec foal - 10-30%
list post op care following c section
similar to post colic
ensure placenta passed
oxytocin if retained placenta
check placenta intact
uterine lavage - 5-10L isotonic fluid SID/BID
check teats and mammary glands for mastitis
list possible complications of dystocia
reproductive tract trauma - perineal lacerations, uterine rupture
retained placenta
delayed uterine involution (returning to normal state)
metritis (inflammation of the uterus)
peritonitis
uterine prolapse
bladder prolapse
arterial haemorrhage
