Management of Equine Dystocia Flashcards
what percentage of foalings are fast and uncomplicated
over 90%
rapid resolution of dystocia corresponds to (3)
1) improved fetal outcome
2) improved mare survival
3) improved mare fertility
what is a very important question to ask your client while gathering history
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
what is always on the table, especially if clients cannot afford referral
euthanasia
what is a key principle to avoid trauma to the mare
limit in and out movements
what can we use for sedation in the mare
detomidine, xylazine or, butorphanol
what can we use for epidural in the mare
lidocaine or lidocaine + xylazine
what can we use as a tocolytic in the mare
clenbuterol
what can we use for general anesthesia to do a field drop on farm
xylazine and ketamine
what are indications for assisted vaginal delivery
1) temperament will allow
2) draft horse that you dont want to do GA on
3) minimum manipulations expected to resolve the dystocia
what are the indications for controlled vaginal delivery
1) AVD failed
2) temperament will not allow AVD
what is the most preferred way to do CVD
dorsal recumbancy with hindlimbs elevated (ex. on a hill, using a tractor)
when should you discuss referral with a client
from the beginning
when is referral immediately on the table
1) transverse presentation
2) live foal with an expected difficult, prolonged delivery
3) fetotomy indicated and you do not have the proper equipment
what does coordinated dystocia management protocol entail
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
more foals are discharged alive if delivered by _____ than by ______ because:
AVD; CVD; CVD usually reflects longer time spent correcting the dystocia
what factor associated with the foal can complicate dystocia corrections in the mare
the length of the foal limbs
what types of positions can make correcting dystocia particulary hard
- breech
- dog sitting
- head/neck deviations
- contracted tendons
- carpal or shoulder flexion
how do you correct dog sitting if:
a) foal is alive
b) foal is dead
a) repel hindlimbs; c-section
b) c-section or fetotomy
what is the definition of fetotomy
fetal dismemberment to allow extraction
what is the max amount of cuts allowed in a mare for fetotomy and why
2-3 cuts max; mare more sensitive to vaginal manipulation and infertility can result from severe trauma
what are some postures when you would consider fetotomy
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
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
1) breech
2) lateral deviation of head and bilateral shoulder flexion
what are ways to resolve breech position
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
how do you correct deviations of the head and neck
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
If a fetus has lateral deviation of the head and neck and you can’t reach the nose how do you correct
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
how do we fix a bilateral carpal or shoulder flexion
a) if fetus alive
b) if fetus dead
a) 1) repel and reposition
2) intranasal oxygen
3) c-section
b) fetotomy
how do we fix a transverse posture
c-section indicated immediately
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
c-section
how is a c-section done in the mare
ventral midline incision in dorsal recumbancy (like dogs); under GA
what are some possible complications after c-section in mares
1) RFM common
2) stormy anesthetic recoveries, especially if it was a long dystocia
3) fractures on recovery
4) incisional problems
5) long recovery
what are some possible complications of dystocia in mares (7)
1) perineal lacerations
2) uterine tears
3) uterine prolapse
4) cervical tears
5) vaginal/cervical adhesions
6) RFM
7) infertility
prolonged vaginal manipulation frequently leads to
adhesions
what is the biggest aim of dystocia management
reduce the time to resolution
