Management of Equine Dystocia

Question 1

what percentage of foalings are fast and uncomplicated

Answer 1

over 90%

Question 2

rapid resolution of dystocia corresponds to (3)

Answer 2

1) improved fetal outcome
2) improved mare survival
3) improved mare fertility

Question 3

what is a very important question to ask your client while gathering history

Answer 3

what are their financial limitations -> referral or no referral

also want to ask about whether the mare or the foal is more important and how long the dystocia has been occuring

Question 4

what is always on the table, especially if clients cannot afford referral

Answer 4

euthanasia

Question 5

what is a key principle to avoid trauma to the mare

Answer 5

limit in and out movements

Question 6

what can we use for sedation in the mare

Answer 6

detomidine, xylazine or, butorphanol

Question 7

what can we use for epidural in the mare

Answer 7

lidocaine or lidocaine + xylazine

Question 8

what can we use as a tocolytic in the mare

Answer 8

clenbuterol

Question 9

what can we use for general anesthesia to do a field drop on farm

Answer 9

xylazine and ketamine

Question 10

what are indications for assisted vaginal delivery

Answer 10

1) temperament will allow
2) draft horse that you dont want to do GA on
3) minimum manipulations expected to resolve the dystocia

Question 11

what are the indications for controlled vaginal delivery

Answer 11

1) AVD failed
2) temperament will not allow AVD

Question 12

what is the most preferred way to do CVD

Answer 12

dorsal recumbancy with hindlimbs elevated (ex. on a hill, using a tractor)

Question 13

when should you discuss referral with a client

Answer 13

from the beginning

Question 14

when is referral immediately on the table

Answer 14

1) transverse presentation
2) live foal with an expected difficult, prolonged delivery
3) fetotomy indicated and you do not have the proper equipment

Question 15

what does coordinated dystocia management protocol entail

Answer 15

1) assemble team
2) initial evaluation of:
a) presentation, position, posture
b) length of dystocia, trauma, manipulations
3) decision making:
a) financial
b) fetus alive
c) likelihood of outcome

Question 16

more foals are discharged alive if delivered by _____ than by ______ because:

Answer 16

AVD; CVD; CVD usually reflects longer time spent correcting the dystocia

Question 17

what factor associated with the foal can complicate dystocia corrections in the mare

Answer 17

the length of the foal limbs

Question 18

what types of positions can make correcting dystocia particulary hard

Answer 18

• breech
• dog sitting
• head/neck deviations
• contracted tendons
• carpal or shoulder flexion

Question 19

how do you correct dog sitting if:
a) foal is alive
b) foal is dead

Answer 19

a) repel hindlimbs; c-section
b) c-section or fetotomy

Question 20

what is the definition of fetotomy

Answer 20

fetal dismemberment to allow extraction

Question 21

what is the max amount of cuts allowed in a mare for fetotomy and why

Answer 21

2-3 cuts max; mare more sensitive to vaginal manipulation and infertility can result from severe trauma

Question 22

what are some postures when you would consider fetotomy

Answer 22

FETUS IS DEAD and:
- breech
- dog sitting
- bilateral carpal flexion with contracted tendons
- lateral deviation of the head and you cannot reach the nose
- shoulder flexion

Question 23

you are presented a mare with dystocia and all you can see is the amniotic bag with no fetal parts

what are two possible postures

Answer 23

1) breech
2) lateral deviation of head and bilateral shoulder flexion

Question 24

what are ways to resolve breech position

Answer 24

1) CVD -> have hips up, lots of lube
a) convert hip flexion to hock flexion
b) extend limbs (distal comes medially, joints laterally)

can also consider
2) fetotomy
3) c-section

Question 25

how do you correct deviations of the head and neck

Answer 25

1) repel to allow room
2) grasp lower jaw and bring head around into the pelvis
3) use a head snare or a rope

If you can’t reach or dead: fetotomy

Question 26

If a fetus has lateral deviation of the head and neck and you can’t reach the nose how do you correct

Answer 26

fetotomy
1) place wire as far down base of neck as possible and cut off
2) use krey hook on vertebrae to extract
3) use chains on forelimbs to extract

Question 27

how do we fix a bilateral carpal or shoulder flexion
a) if fetus alive
b) if fetus dead

Answer 27

a) 1) repel and reposition
2) intranasal oxygen
3) c-section

b) fetotomy

Question 28

how do we fix a transverse posture

Answer 28

c-section indicated immediately

Question 29

in cases of a live foal where resolution is expected to be long and difficult, or in cases where the mares future fertility is of high concern, what should you opt for

Answer 29

c-section

Question 30

how is a c-section done in the mare

Answer 30

ventral midline incision in dorsal recumbancy (like dogs); under GA

Question 31

what are some possible complications after c-section in mares

Answer 31

1) RFM common
2) stormy anesthetic recoveries, especially if it was a long dystocia
3) fractures on recovery
4) incisional problems
5) long recovery

Question 32

what are some possible complications of dystocia in mares (7)

Answer 32

1) perineal lacerations
2) uterine tears
3) uterine prolapse
4) cervical tears
5) vaginal/cervical adhesions
6) RFM
7) infertility

Question 33

prolonged vaginal manipulation frequently leads to

Answer 33

adhesions

Question 34

what is the biggest aim of dystocia management

Answer 34

reduce the time to resolution