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Clinical Reproduction > Equine Obstetrics & Pediatrics > Flashcards

Equine Obstetrics & Pediatrics Flashcards

1
Q

You are called in to see a pregnant mare who is 3 months ante-partum. What are the most common problems seen at this time?

A

1) Ventral body wall hernia or prepubic tendon rupture
2) Uterine torsion

Others:

  • Hydrops of the fetal membranes
  • Colonic torsion
  • Vaginal haemorrhage
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2
Q

You are called in to see a pregnant mare who is currently foaling. What are the most common problems seen at this time?

A

1) Dystocia
2) Red bag delivery
3) Rectal prolapse

Others:

  • Uterine, cervical, vaginal or perineal lacerations + bleeding
  • Bladder inversion
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3
Q

You are called in to see a pregnant mare who is in post partum. What are the most common problems seen at this time?

A

1) Placental retention
2) Uterine artery rupture
3) Small colon necrosis
4) Colonic torsion

Others:

  • Abnormal behaviour
  • Nerve paralysis and pelvis/hind leg fracture
  • Painful placental expulsion
  • Uterine prolapse and inversion
  • Post-partum constipation
  • Ruptured bladder
  • Post-partum incontinence
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4
Q

What are the late term pregnancy changes seen in a mare pre-partum?

A

1) Behavioural changes
2) Physical changes:
- increase in abdominal volume
- relaxation of the pelvic ligaments
- ventral edema (especially in mares kept in a box)
- vulvular relaxation
- mammary development = “she is bagging up”. This can occur as early as 6 weeks before foaling but usually 2 weeks before
“She is waxing up” = most significant sign for the breeder. The clear fluid will turn white and then to a very sticky yellow colostrum (wax-like substance)
– Foaling is expected within 6-48 hours when she is waxing up

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5
Q

A mare presents with a giant ventral swelling and abnormal abdominal shape, she is in pain and is reluctant to walk. You diagnose Prepubic tendon rupture/ abdominal wall hernia, what is the treatment?

A

1) Strict box rest
2) Abdominal support (hernia belt or sling)
3) NSAIDs (Flunixin)

If 330+ days of pregnancy or unstable: induce parturition or perform a terminal C-section

If <330 days of pregnancy or stable mare: supportive care, laxative and light diet, assisted foaling

Prognosis: Guarded to poor

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6
Q

You are called to see a pregnant mare who is within 2 months of foaling, she has signs of colic, what are your DDx?

A

1) Uterine torsion: confirm on rectal palpation where the broad ligaments will be asymmetrical
2) Non-specific GIT colic

Note: if it is a uterine torsion, figure out how severe and if the fetus is even alive

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7
Q

You diagnose a mare to have a uterine torsion, what can be done for treatment?

A

Before foaling:

  • Rolling BUT this is controversial
  • Surgery: standing flank laparotomy if just uterus is torsed. Midline laparotomy if the GIT is involved in the torsion

At foaling:

  • Manually rotate the uterus through the vaginum
  • Standing C-section or Midline C-section
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8
Q

You have just treated a mare with a uterine torsion, what is the post-op care needed for her?

A
  • Broad spectrum antibiotics
  • NSAIDs
  • IV fluids
  • Pre-term torsions will require careful monitoring of the fetus to ensure survivability
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9
Q

The Owner of a pregnant mare who has had a uterine torsion wants to know what her prognosis is, and if she will have any complications, what should she be advised?

A

Complications:

  • Premature placental separation leading to fetal death
  • Rupture or uterin necrosis
  • Peritonitis and adhesions
  • Septic shock
  • Reoccurance of the torsion

Prognosis:

  • Mare survival: excellent for pre-term torsion
  • Mare survival: fair to good for torsion at term

Note: pregnancy rate following a torsion is Good

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10
Q

An owner with a mare that is foaling has called because her mare’s water broke but the amniotic membrane has not appeared yet after 5 minutes, what do you tell the Owner?

A

This is a TRUE emergency!
The mare is likely experiencing dystocia, probably due to foal malpositioning

The fetus is at risk of hypoxia, and due to the long limbs of the foal it will be difficult to manipulate and ruptures or tears are more likely –> haemorrhage and hypovolemic shock

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11
Q

You diagnose a mare to have dystocia over the phone based on what the Owner is telling you, what should you advise the Owner to do?

A

1) Walk the mare and wrap her tail
2) Have 2-3 clean buckets of warm water ready
3) Perform a TPR and mucosa check: how bad is she?
4) Clean the perineum/ vulva and your arms
5) Lubricate your arms copiously
6) Do a vaginal exam: how is the genital tract doing? is the fetus alive? what is the cause of the dystocia?

7) What is the financial situation? Can she be brought to the hospital?
8) Who is the priority? Mare, fetus, both?

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12
Q

What are the 3 main options when dealing with a dystocia?

A
  • Manipulation of the foal
  • Fetotomy if the foal is dead or malformed
  • C-section
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13
Q

What is the post-dystocia care for a mare?

A
  • Oxytocin 20 IU/ 450 kg IV/IM q2-4hours
  • Broad spectrum antibiotics
  • NSAIDs
  • Uterus flush BID until its clean
  • Prevention of laminitis
  • Breeding soundness exam 2 weeks post-dystocia
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14
Q

What is the prognosis of the mare and the foal with a dystocia?

A

Mare: good to excellent if chosen technique is mastered
note: her reproductive performance will also be reasonable

Foal: <30%
note: the biggest consideration is the time from chorioallantoic rupture to delivery. Survival is improved with very early referral

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15
Q

You are called to see a mare in parturition, and you notice a large red bag of fluid protruding from the vulva, what do you suspect?

A

Red Bag Delivery: red-purple tissue bulging from the vulva, this is the allantochorion that has detached, this means the foal does not receive ANY oxygen –> Severe hypoxia

DDx: bladder prolapse (small pink mass)

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16
Q

What are the potential causes of Red Bag in pregnant mares?

A
  • Placentitis
  • Stillbirth
  • Systemic maternal disease
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17
Q

What is the treatment and prognosis of Red Bag in mares?

A

1) Differentiate between prolapsed bladder FIRST and true allantoic membrane
2) If allantoic membrane, open it up with fingers or sharp object
3) Pull the foal as the mare contracts
4) Be prepared to resuscitate the foal

Prognosis: Mare is good to excellent
Foal is guarded depending on duration and severity of hypoxia

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18
Q

A mare has a slight rectal prolapse during the early stages of foaling, you are on your way to help, but what can the Owner do while you are on your way?

A
  • If just happened: stimulate the mare to get up and walk to avoid excessive straining
  • Can also gently reduce the prolapse and insert a small towel to prevent reoccurrence
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19
Q

You have arrived on the farm where a mare has a rectal prolapse, what is the prognosis and treatment associated with a rectal prolapse in mares?

A
  • Type 1-2 prolapse (rectal mucosa at the anus margin): prognosis is good and requires conservative management as long as the tissue is still viable
  • Type 3-4 (rectum or small colon invaginates and appears at the anus margin: prognosis is guarded to poor and will require surgical treatment = emergent!
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20
Q

What is the normal sequence of post-foaling events to look out for?

A

1) It will take the foal 20 - 40 minutes to recover
2) Mare should smell and lick her foal
3) Mare will pass the placenta in 30mins to 3 hours- she may show mild signs of colic while doing this

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21
Q

A mare has foaled a couple of days ago and she is showing signs of colic, sweating, increased HR and pale mm, what do you suspect and how can you diagnose it?

A

Suspect Hematoma of the broad ligament

Diagnose via rectal palpation by feeling a painful mass within the broad ligament

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22
Q

You diagnose a Heamatoma of the broad ligament in a mare, what is the Tx and prognosis?

A

1) Keep the mare quiet/ sedate
2) Intravenous fluids (fluids or blood or plasma depending on severity)
3) If the mare is very weak, move the foal away

Prognosis related to severity, uncontrolled bleeding into the abdomen = poor to guarded

note: do an abdominal tap, and see if bleeding into the abdomen

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23
Q

You successfully treat a hematoma of the broad ligament in a mare, what should the Owner know about potential future risks?

A
  • If she has bled once, she is likely to bleed again in future pregnancies
  • Perhaps retire the mare
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24
Q

A post-partum mare (several days after foaling) presents being dull, inappetant, signs of colic, increased HR and increased temp
What do you suspect, what are the DDx and how can you diagnose?

A

Suspect uterine tear in the cranial part of the uterus or pregnant horn

DDx: acute endometritis, or intestinal necrosis

Diagnosis: Laparoscopy/ Hysteroscopy

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25
Q

What is the average gestation of a horse?

A

340 days

- Can be earlier and can be as long as 380 days

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26
Q

At what day of gestation is a foal considered pre-mature?

A

Born <320 days of gestation

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27
Q

What are the issues surrounding a pre-mature foal?

A
  • lung function and capacity is reduced (lack of surfactant)
  • lack of ossification of bones, which can lead to joint problems
  • all organs are not yet fully mature
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28
Q 
What are the normal times it takes for a neonatal foal to:
Breathe
Lie sternal
Stand
Nurse
A
  • Breathe: within 30 seconds
  • Lie sternal: within 5 minutes
  • Stand: within 2 hours
  • Nurse: within 3 hours
29
Q

A foal is born and doesnt breathe within 30 seconds or has an irregular breathing pattern or has a HR below 40bpm, what must be considered?

A

Resuscitation:

1) Rub vigorously to stimulate
2) Circulation check
3) Airway breathing

30
Q

You vigorously rub a foal to stimulate it after being born and not breathing for 30+ seconds, what do you do to check circulation and airway?

A

Circulation:

1) Check for heart beat
2) Check for rib fractures
3) Place foal laterally with its back against a wall, kneel b/w legs
4) Start chest compressions at the level above the elbow, ideally 100-120 bpm
5) Check HR, pulse and pupil size every 2 minutes
- Dilated pupils = poor circulation to the brain = poor prognosis

Airway:

1) Clear mucus, membranes and meconium
2) Suction nostrils with a bulb syringe or tubing
3) Place an ET tube (7-9mm diameter, 55mm length)
4) 1L Ambu-bag: squeezing to half way, ideally 20-40 breaths/min

31
Q

A foal has been born and wasnt breathing, after vigorously rubbing, checking airways and circulation, what drugs can be administered?

A
  • Epinephrine 0.001-0.002 mg/kg every 3 minutes IV
  • Vasopressin
  • Glycopyrrolate
32
Q

How long must resuscitation continue in a foal that is not breathing?

A
  • Until HR > 60-70 bpm and is breathing normally

Unfortunately the success rate for equine CPR is <10%
There is also likely to be subsequent effects from hypoxia and ischemia even if you do get the foal to breathe

33
Q

How can you predict whether a foal has had sufficient colostrum intake/ quality?

A

Measure serum IgG levels at 24 hours in the foal

34
Q

How can you predict if the mare’s colostrum is of high enough quality?

A

Measure colostrum specific gravity (should be > 1.060)

35
Q

At 12 hours of age, what should the foal be doing?

A

1) Following the mare and nursing well: nurse for 1-2 mins, ~4 times an hour
2) Urinate normally
3) Pass meconium: thick, black, tar-like dung
4) Sleep - nurse - play - urinate - sleep cycle several times an hour

note: foals should sleep lying down, its very abnormal for a foal to sleep standing up

36
Q

What are the normal HR, Temp, RR and MM parameters for a foal?

A
  • HR: 80 - 120bpm
  • Temp: 37.2 - 38.9
  • RR: 20 - 40 bpm
  • MM: pink and moist
37
Q

A 1 day old foal has a HR b/w 72 - 96bpm, with a systolic murmur, what is this suspicious of?

A

Patent Ductus Arteriosus

This should close by Day 4!

38
Q

A foal is seen with milk on its head, and hasn’t been seen nursing yet, what should be investigated?

A

Neurological issues: unable to detect or latch onto the udder

39
Q

A foal has milk coming from its nostrils, what should be investigated?

A
  • Cleft palate

- Causes of dysphagia: abnormal swallow

40
Q

A foal is straining to pass urine and feces, what should be investigated?

A
  • Meconium impaction

- Ruptured bladder

41
Q

What are the 9 common perinatal conditions encountered in foals?

A
  • Hypoxic Ischemic Disease
  • Septicemia
  • Neonatal Iso-erythrolysis
  • Meconium Impaction
  • Ruptured Bladder
  • Botulism
  • Tetanus
  • Tyzzer’s disease
  • Gastro-duodenal ulcers
42
Q

What can cause Hypoxic Ischemic Disease in a foal?

A

Any event that will impair utero-placental blood flow leading to hypoxia and ischemia

  • Pre-partum: placentitis, premature placental separation, twins, maternal disease
  • Intra-partum: Dystocia, premature placental separation
43
Q

A foal is believed to have Hypoxic Ischemic Disease, why is this a concern?

A

Development of SIRS (Systemic Inflammatory Response Syndrome)

Which can progress to multiple organ dysfunction secondary to abnormal perfusion, hypoxia, ischemia and infection

Multiple organ dysfunction = clinical signs are widely varied

44
Q

A mare is having dystocia, the foal is born with some assistance but you are concerned about Hypoxic Ischemic Disease, what should the Owner look out for in the next few hours to days?

A

Overall deterioration

  • Loss of affinity for the mare
  • Loss of suckle reflex
  • Wandering aimlessly
  • Abnormal vocalization: barking
  • Weak, recumbent, SIRS
  • Seizures
45
Q

You believe a foal has Hypoxic Ischemic Disease, what is the management protocol for these cases?

A

IV access:

  • Measure blood glucose + IgG
  • CBC + biochem + Acute Phase Proteins
  • Blood culture

Treatment:

  • Fluid therapy: crystalloid or colloid fluids
  • Nutrition: enteral or parenteral
  • Treat seizures: anticonvulsants, diuretics, anti-inflammatory drugs, Vit E/Selenium
  • Broad spectrum Antibiotics

Note: It is important to milk the mare every 2 hours, if you don’t she will dry up and then when the foal is better you will want to put the foal onto her

46
Q

You believe a foal is septicemic, what bacteria are usually at fault, and how did they gain access to the foal?

A
  • Usually gram neg, but can be a mixed infection: E.coli, Actinobacillus, Staphs and Streps
  • Bacteria usually enter through the placenta, GIT, lungs, umbilicus, or a penetrating wound
47
Q

What are the effects of septicemia on the foal?

A
  • Endotoxemia + SIRS + DIC –> damage of the endothelium, multiple organ dysfunction and organ failure
SIRS = systemic inflammatory response syndrome
DIC = Disseminated Intravascular Coagulation
48
Q 
A foal presents with:
Brick red to purple mm
Petechial haemorrhage
Tachycardia + Tachypnea
\+/- Fever
Depression
Not nursing
Weak/ recumbent

What is this indicative of?

A
  • Septicemia: Endotoxemia + SIRS

- Hypoxic Ischemic Disease: SIRS

49
Q

What is the management protocol for a foal with septicemia?

A 
Same as Hypoxic Ischemic Disease: 
IV access: 
- Measure blood glucose + IgG
- CBC + biochem + Acute Phase Proteins
- Blood culture

Treatment:

  • Fluid therapy: crystalloid or colloid fluids
  • Nutrition: enteral or parenteral
  • Treat seizures: anticonvulsants, diuretics, anti-inflammatory drugs, Vit E/Selenium
  • Broad spectrum IV Antibiotics
\+/- Thoracic rads
\+/- Fecal culture
\+/- A-FAST, T-FAST
\+/- CSF tap
\+/- Arthrocentesis
50
Q

You diagnose a foal with Hypoxic Ischemic Disease (HID) + Septicemia
What is the management for a ‘Down Foal’?

A
  • Check everything and often
  • Keep warm and dry
  • Maintain and feed in sternal
  • Flip the foal q2hours if laterally recumbent
  • Monitor urine and fecal output
  • Dip umbilicus in chlorhex until it dries up and falls off
  • Stain corneas, manage entropian + ulcers
  • Careful watch over the IV access, oxygen access and NG tube
  • Monitor and care for the MARE! Often if the foal is sick, the mare was/ is sick and there was something wrong with the pregnancy.
    Look out for RFM, peritonitis, endometritis etc.
51
Q

What is the nutritional and fluid requirements of a ‘Down Foal’?

A

Nutrition:

  • Mare’s milk: 200 - 500 mL every hour by NG tube
  • Alternatively can use milk replacer, or goat’s milk

Fluid Therapy:
- 4ml/kg/hr (e.g. a 50kg foal would get 200mls/hr)

52
Q

What is Neonatal Isoerythrolysis in the Foal?

A

Neonatal isoerythrolysis is an IMHA that develops in neonatal animals following ingestion of colostrum containing antibodies against antigens on their erythrocytes

Foals inherit RBC antigens from the stallion, and the mare lacks these antigens

She develops alloantibodies to the RBC antigen of the foal through exposure by prior pregnancy, blood transfusion, or transplacental contamination with fetal blood earlier in the current pregnancy. At birth, the foal ingests colostrum containing the alloantibodies. The alloantibodies then bind to the RBCs of the foal, resulting in agglutination, lysis, or both

53
Q

What are the most common RBC antigens involved in Neonatal Isoerythrolysis?

A

The most common antigens involved in neonatal isoerythrolysis (NI) are Qa and Aa; mares without Qa and Aa factors are at an increased risk of producing NI-causing antibodies.

54
Q

You diagnose a foal with Neonatal Isoerythrolysis, what is the management protocol for these cases?

A
  • Prevent further colostrum intake
  • Provide alternate nutrition
  • Fluid therapy
  • Antibiotics: risk of septicemia due to lack of protection from colostrum
  • Oxygen support
  • Transfusion if the PCV drops rapidly below 16-18%: best donor for transfusion is from mare, but the RBC’s need to be washed because the mare’s plasma will contain the antibodies that will attack the foals RBC’s
    If washing of the RBC’s cant be done, then a gelding with no history of transfusion is the next best option
55
Q

How can Neonatal Isoerythrolysis be prevented in foals?

A

Prior to breeding:

  • Test mare for Aa, Qa antigens
  • Blood type stallion

During Pregnany:
- Test for NI antibodies in late gestation in the mares serum

After foaling:

  • Jaundice foal agglutination test: mix colostrum with foal blood.
    note: only tests for aggluination, not lysins
56
Q

How can a Meconium Impaction be diagnosed?

A
  • Signs of colic: straining, abdominal distension, rolling, kicking
  • History: has it passed milk feces
  • Rectal exam: black tarry feces
  • US/ radiographs
57
Q

What is the treatment for a Meconium Impact in a foal?

A
  • Soapy water enema +/- acetylcysteine
  • Fluid therapy: oral or IV
  • NSAID’s
58
Q

How can a Ruptured Bladder or Urinary Tract Disruption be diagnosed in a foal?

A
  • clinical signs: lethargy, depression, colic, abdominal distension
  • No normal urine stream despite frequent straining
  • Abdominal US: fluid filled abdomen
  • Peritoneal tap: peritoneal: serum Creatinine ratio can be done (Creatinine ratio > 2:1 is indicative of a uroperitoneum)
59
Q

What is the treatment for a Urinary Tract Disruption/ Ruptured Bladder?

A

1) Stabalize prior to Sx:
- IV fluids without K+ (e.g. NaCl)
- Correct acidosis
- Urinary catheter placement + drain abdomen slowly as fluids are given. Removal of fluid too quickly will disturb electrolyte and hydration

2) Sx for repair

60
Q

What are the 4 main causes of Acute Enterocolitis in foals?

A
  • Bacterial
  • Viral (rota and coronavirus)
  • Parasitic
  • Nutritional (rapid change in diet)
61
Q

How can Acute Enterocolitis be diagnosed?

A
  • clinical signs: diarrhea, colic, bloat, reflux
  • History + physical exam
  • CBC + biochem
  • Fecal and blood culture
62
Q

How can Acute Enterocolitis be treated in foals?

A
  • Maintenance and replacement fluid therapy, electrolyte and acid-base balance
  • Nutrition
  • Ab’s and NSAID’s
63
Q 
A foal presents with:
Slight nostril flaring
Increased RR and effort
Cough
Unable to keep up with the mare

What is this indicative of, and what diagnostics can be used to support your diagnosis?

A
  • Bacterial Pneumonia

Diagnostics:

  • CBC + biochem
  • Blood gas analysis
  • Blood culture
  • TTW + culture and sensitivity
  • Radiographs
64
Q

You diagnose a foal with bacterial pneumonia, what is the treatment for this?

A
  • Antibiotics
  • NSAIDs
  • Oxygen
  • Maintain the foal in sternal to allow for optimal respiration
65
Q

You suspect a foal to have Gastro-duodenal ulcers, what are the causes of Gastro-duodenal ulcers in foals?

A
  • Decreased milk intake
  • Certain medication
  • Disease
  • Stress
66
Q 
A foal presents with:
Bruxism
Salivation
Decreased appetite
Rolling on his back
Failure to thrive (gaining less than 1.5kg/day)

What are you suspicious of and what diagnostics can be done to support your hypothesis?

A
  • Gastro-duodenal ulceration

Diagnosis:

  • Endoscopy
  • Response to therapy: omeprazole + Sulcralfate
67
Q

You have treated a foal for Gastro-duodenal ulceration, what are the complications that can arise from Gastro-duodenal ulceration?

A
  • Perforation if severe enough
  • Stricture formation
  • Reflux
  • Aspiration pneumonia
68
Q

What is the etiological agent of Tyzzer’s Disease?

A

Clostridium piliformis

69
Q 
A foal presents with:
Depression
Fever
Pronounced icterus
White/ grey feces

What are you suspicious of, and what is the prognosis for this foal?

A

Suspect Tyzzer’s Disease (caused by Clostridium piliformis)

Prognosis: 100% fatality

Clinical Reproduction (9 decks)

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