Post parturient problems in the mare Flashcards
Post partum reproductive problems (9)
- Uterine artery haemorrhage
- Uterine perforation
- Retained placenta
- Uterine prolapse
- Septic metritis and/or delayed involution
- Endometrial haemorrhage
- Vaginal haematoma
- Cervical laceration
- Agalactia/hypogalactia
Post partum GI problems (4)
- Caecal/colonic rupture
- Colon torsion
- Impaction
- Rectal prolapse
Post partum, combine reproductive and GIT problems (2)
- Perineal lacerations
- Rectovaginal fistula
Miscellaneous post partum problems (4)
- Retroperitoneal abscessation
- Pelvic fractures
- Obturator paralysis
- Post parturient recumbency
Uterine artery haemorrhage
Commonly seen in old multiparous mares
Often fatal
Initial signs: acute, moderate to severe colic, sweating, very rapid pulse, progressing to CV shock
Usual site is the (right) middle uterine artery within the broad ligament, not fatal if contained within broad ligament and surrounding tissues
Treatment is controversial, keep mare quiet is agreed on
Uterine perforation
Not common
May follow dystocia or normal parturition
Tears can be in the body or uterine horn
Smaller tears may not become apparent until signs of peritonitis develop over the next hours and even days
Prompt surgical repair and antibiotic treatment is usually the key to a successful outcome
Caecal/colonic rupture
Can occur at, or soon after, parturition or over the subsequent hours or even days
The mare shows signs of colic, cardiovascular shock and acute peritonitis, with injected mucous membranes
Chronic compression of a focal area of the caecum or colon may follow trapping between the fetus and maternal pelvis
Once the diagnosis has been confirmed, euthanasia should be performed on humane grounds
Colon torsion
Typically seen 2-3 days following parturition but may occur up to 2-3 months later
Torsion of the colon follows large intestinal re-positioning within the abdomen, following evacuation of the uterus
The degree of colic is variable depending on the degree of the torsion but, frequently, it is severe and violent, leading to profound cardiovascular shock
Treatment may involve surgery and supportive therapy
Impaction
Some become impacted during 24-48 hours after foaling
Lack of exercise and eating straw predisposes to the condition
Retained placenta
Third stage labour usually complete within 30 mins-2 hours.
Placental retention may occur spontaneously or due to dystocia, abortion, premature delivery, or caesarian section
Retention of non-pregnant placental horn, especially at its tip, is common but not serious, although endometritis, endotoxaemia, and laminitis are major concerns.
Manual removal of the placenta should be attempted with great care and abandoned if not immediately and easily successful to avoid uterine wall damage, haemorrhage, and/or septic metritis.
Hygiene and safety should be maintained, and exercise is encouraged to stimulate involution of the uterus and to expel fluid.
Oxytocin may be given (20 iu i/m) if necessary, and systemic antibiotics and flunixin are indicated if there are concerns of endotoxaemia. Regularly check for signs of laminitis.
Following the release or removal of a retained placenta, a course of intrauterine antibiotic irrigations may be recommended.
Burn’s method may be used if placental removal is still unsuccessful.
Uterine prolapse
Uterine prolapse is uncommon and can occur at normal parturition but is more often associated with dystocia or placental retention.
The mare should be sedated, and an epidural anaesthetic administered to prevent septic metritis.
The uterus should be cleaned with dilute povidone iodine solution and examined carefully for lacerations before it is carefully replaced and re-positioned.
The vulva may be temporarily sutured with heavy-duty suture material.
Exercise will aid uterine involution.
At ‘foal heat’ uterine saline lavages, antibiotics, and oxytocin may be required.
Recovery is usually complete if the uterus is replaced fairly rapidly and without serious damage.
Septic metritis and/or delayed involution
Septic metritis and/or delayed involution may be associated with dystocia, retained placenta, uterine infection, or lack of exercise.
Parenteral antibiotic and NSAIDs should be given if there is systemic involvement.
Uterine lavage/antibiotics combined with intravenous oxytocin are also helpful.
Exercise is important both preventively and as part of the treatment for delayed involution or metritis.
Endometrial haemorrhage
Diffuse endometrial haemorrhage may occur in mares for reasons that are not altogether clear.
A persistent post-partum haemorrhagic vaginal discharge is seen, but in other cases, the diagnosis is only made at routine foal heat examination when poor involution is detected.
Oxytocin may be useful, and severe cases may require treatment by packing the uterus.
Vaginal haematoma
Vaginal haematoma may occur due to trauma during foaling.
It can be treated by drainage and packing with gauze and may require systemic antibiotic therapy if infection occurs.
Cervical laceration
Cervical lacerations are commonly associated with dystocia or attempts at fetotomy during foaling.
Mucosal splits may heal with the aid of applications of local antibiotic ointment, but lacerations involving the muscular layer reduce fertility and interfere with closure of the cervical os.
Surgical repair may be attempted after initial healing with the mare sedated and restrained standing in stocks under epidural anaesthesia.
A three-layer closure is made (internal and external mucosae and muscularis) but fertility remains depressed in most cases.
The closure of ventral cervical lacerations in the Trendelenburg position under general anaesthesia may be recommended for mares that had multiple tears.
Foaling rate is lower in mares that had a tear length >75% compared with smaller tears, but pregnancy rate is similar in both groups.
Dilation may be a problem at parturition with more tearing and a worsening of the problem for the next year.
