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Equine Therio > Postpartum complications in the mare > Flashcards

Postpartum complications in the mare Flashcards

1
Q

Postpartum emergencies

A 
• Retained placenta
• Toxic (septic) metritis
• Perineal body lacerations
and rectovaginal tears
• Perineal
bruise/hematoma
• Periparturient
hemorrhage
• Uterine tear
• Urinary tract trauma
• Colic
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2
Q

Cervical laceration causes

A

• oversized fetus
• obstetrical chains/
fetotomy wire
• “normal” parturition

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3
Q

• Clients should call you if placenta is retained for how long?

A

greater than 3 hours

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4
Q

abnormal placenta

A
  • Plaques
  • Mucopurulent discharge/film
  • Avillous areas
  • Too small for size of mare/uterus
  • Incomplete
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5
Q

Plaques or pus - diagnostics

A 
• Impression smears + cytology
• Uterine culture + cytology
• LOOK AT THE FOAL
• Blood cultures
• First rule-out = placentitis (bacterial or
fungal)
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6
Q

incomplete placenta is…

A

a medical emergency

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7
Q

most common diagnosed postpartum emergencies

A 
 Urogenital hemorrhage (16.6%)
– Mares > 13 years of age more represented
– Anemia (32%), hypoproteinemia (36%), hypofibrinogenemia
(26%)
 Large colon volvulus (15.9%)
 Septic metritis (8%)
– Dystocia (70%)
 Uterine tears (5%)
– Leukopenia common (88%)
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8
Q

Instructions to owner in case of emergency - on farm

A 
• Confine mare and foal to a
quiet area
• Keep foal near mare but out
of harm’s way
• Even if owners have
tranquilizers, recommend not
to administer until you
examine the mare
• Hypotensive effects in mares
with broad ligament
hemorrhage
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9
Q

Instructions to owner in case of emergency - transport to hospital

A 
• Bring foal
• Keep foal next to but
separate from mare
• Stall divider
• Straw bales
• Risk for humans who want to
ride with the foal
• Bring placenta if available
• Postpartum complications can
occur even weeks after foaling
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10
Q

risk factors to postpartum conditions

A 
• Age (very young or older
mares > 17 years)
• Breeds (miniature, heavy
horses)
• Previous history of foaling or
postpartum conditions
• History of retained placenta
• Previous injury to the birth
canal (perineal or cervical
laceration)
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11
Q

Retained Placenta (RP)

A 
3 hours postpartum
• This definition may be too
conservative
• The incidence of RP in mares
varies from 2 to 10%.
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12
Q

Risk factors for Retained Placenta

A
  • Dystocia
  • abortion or still born
  • fetal membrane hydrops
  • Placentitis
  • metabolic disorders
  • Breeds
  • The tip of the non-pregnant horn
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13
Q

Oxytocin therapy

A

• Low dose bolus (10-20 IU) every 2 hours
• Continuous rate drip (1 IU/minute) in LRS or saline
• Some mares may experience severe colic with large
doses of oxytocin and cause injury to the foal.

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14
Q

Chorioallantoic distension associated to what?

A

low dose oxytocin

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15
Q

Forced extraction of the placenta

A

Forced extraction of the placenta
• Contraindicated
• Manual removal (Sevinga et al 2002)
• Risks
 Tears
 partial retention
 uterine invagination/eversion or prolapse.
 Necrotic tissue may remain within the endometrial
crypts causing further complications with metritis
and toxemia

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16
Q

Placental retained for more than 6 to 8 hours

A

• Broad spectrum systemic antibiotics: ampicillin,
gentamicin, kanamycin, penicillin, ticarcillin,
ceftiofure, trimethoprim sulfamethazole
• The mare should be monitored for signs of
complications : anorexia, fever, depression, laminitis,
warm feet, and increased digital pulse)
• Transabdominal ultrasound during the flushing
process may reveal remnant
• Supportive therapy in mares showing signs or at risk
for toxemia should include fluid therapy and nonsteroidal
anti-inflammatory drugs (NSAID’s) and
tetanus prophylaxis.

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17
Q

Toxic (Septic) metritis treatment

A 
• Similar for any inciting cause
of endotoxemia
 IV fluid therapy +/- polymixin B
 Flunixin meglumine
 Systemic IV antibiotics
 +/- pentoxifylline PO
• Laminitis preventives
• Large volume uterine lavage
with warm fluid (40-45º C)
with added salt, iodine
 Monitor with ultrasound for uterine
tears/rupture or placental tags
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18
Q

Prognosis septic metritis

A

• Metritis can be fatal, especially in cases of severe
endotoxemia and laminitis
• Typically, if there are no complications, future
fertility is not compromised
• No increased risk of metritis in subsequent
pregnancies
• Wait at least 1 cycle after recovery to breed

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19
Q

Rectal vaginal Tears and Perineal Lacerations

A

• First degree lacerations
 mucous membrane of the vestibule and skin of
vulvar lip.
• Second degree laceration
 deeper tissue of the perineal body
• Both these conditions are not life-threatening
• Surgical management: Caslick’s or vulvoplasty
• Medical management
 Antimicrobials, NSAID’s and tetanus
 Fecal softener (mineral oil, bran mash)
 artificial insemination if it is an option.

20
Q

Perineal bruising and vulvar hematoma

• Etiology

A

 Ruptured obturator or internal pudendal artery during foaling
 Hematomas may occur in conjunction with bladder atony

21
Q

Perineal bruising and vulvar hematoma -

Progression

A

 Large contained hematomas may dissect along the fascial plane
within the pelvic cavity (retroperitoneal hemorrhage)
 Pressure necrosis from the foaling may lead to seroma/abscess
formation within the pelvic canal which may eventually break out
into the vagina, perineum, or into the abdominal cavity

22
Q

diagnosis of Perineal bruising and vulvar hematoma

A

 Vaginal examination
 Transrectal ultrasonography
 Abdominocentesis (if peritonitis due to seroma/abscess rupture)
– Elevated TP and WBC (TP 30-60g/L, WBC up to 100 x 109/L)

23
Q

• Treatment

A

 Antimicrobials
 Anti-inflammatories
 Tetanus toxoid if not boostered in late gestation
 Close monitoring, especially if hemorrhage, abscess, or seroma

24
Q

Postpartum hemorrhage - internal

A
  • Broad ligament
  • Intra-uterine
  • Intra-abdominal
25
Q

Postpartum hemorrhage - external

A

• Vaginal
• Vestibular-vaginal
sphincter

26
Q

Predisposing factors to postpartum hemorrhage

A

• Age
• Dystocia
• The mean age of mares with uterine hemorrhage
seen by the author was 17.5 (range 8 to 21, n=18).
• Histological changes that modify the elasticity of the
arteries “pregnancy sclerosis”
• Copper deficiency
• The right side seems to be more prone to this injury
probably due to displacement of the cecum.

27
Q

Periparturient hemorrhage

• Clinical signs

A

 Colic, sweating, pale or normal mucous membranes,
tachycardia, Flehman response, muscle fasciculations
 Typically evident within 24 hours of foaling (or of artery
rupture)
 Intrauterine/vaginal hemorrhage may result in hemorrhagic
vaginal discharge

28
Q

Periparturient hemorrhage - Dx

A

 Weak thready pulse; signs of hypovolemic shock
 Transrectal palpation of distended broad ligament (if it
is the site of hemorrhage)
 Ultrasonography transrectally or transabdominally
– Demonstrate site of hemorrhage
 Abdominocentesis (hemoabdomen)
CBC
– Anemia (32% of cases) or normal PCV due to splenic
contraction
– Hypoproteinemia (36%)
– Hypofibrinogenemia (26%)
– Leukopenia or leukocytosis

29
Q

Supportive care for periparturent hemorrhage

A

Minimize excitement, Place in dark, quite stall
• Analgesics: Flunixin meglumine + butorphanol
• Prevent chock:
 Corticosteroids (Prednisolone Na succinate IV, 1 to 2 mg/kg)
 Nasal insufflation (5 to10 L/min) + Pentoxyfylline (7.5 mg/kg IV
 Fluid therapy 2 to 3 L hypertonic saline followed by 10 o 20 L of LRS
• Whole blood transfusion (5 to 8 liters over several hours) is
indicated if the PCV < 15%
• Others
 Nalaxone hydrochlorade (block effect of endogenous opioids)
 Aminocaproic acid (antifibrinolytic, loading dose 20 g in 6 L of LRS + 10
g every 6 hours)
 Yunnan Baiyou

30
Q

Uterine tears or rupture

A 
• Increased incidence with dystocia
and obstetrical manipulations
 Can occur in a seemingly normal
foaling
 Pre-partum tears – uterine torsion
or hydrops
 Tears located dorsocranial to the
cervix or at the tip of the gravid
horn
31
Q

Clinical signs of uterine tears or rupture

A 
 Depend on site/size of tear and
progression of peritonitis
 Depression, fever, peritonitis,
tachycardia
 Severe pain/colic after uterine
lavage
32
Q

surgical treatment of uterine tears and rupture

A 
•Surgical:
• Ventral midline celiotomy
• Flank laparoscopy
• Vaginally in dorsal
recumbency
33
Q

medical treatment of uterine tears and rupture

A 
• If small tear, may heal on its
own.
• Medical treatment only may
incur higher costs than surgery
due to ongoing management
• Associated with retained
placenta
•Antibiotics
•Anti-inflammatories
•Anti-endotoxin therapy
•Abdominal lavage
•Laminitis prevention
•High risk of evisceration
into the uterine tear
34
Q 
Partial inversion (intussusception) of the uterine
horn and uterine prolapse risk factors
A

 Aggressive traction on a retained placenta

 Excessive use of oxytocin

35
Q 
Partial inversion (intussusception) of the uterine
horn and uterine prolapse - clinical signs
A

 Colic signs which are not responsive to tranquilizers
 Tachycardia
 Prolapse visible

36
Q 
Partial inversion (intussusception) of the uterine
horn and uterine prolapse  - Dx
A

 Physical examination, transrectal palpation

 Abdominocentesis may show an increased TP but stable WBC

37
Q 
Partial inversion (intussusception) of the uterine
horn and uterine prolapse  - Tx
A

 Partial inversion: manual replacement and distension of the uterus with
large volume of warm water with added salt and iodine
 Complete prolapse: clean prolapsed tissue. Can apply osmotic agents (ie,
sugar). Manual replacement without perforating the tissues
 Caudal epidural or general anesthesia is required for replacement

38
Q

Vaginal or rectal prolapse - secondary to

A
  • Dystocia

* Persistent straining

39
Q

Tx of vaginal or rectal prolapse

A 
Treatment
• Keep tissues clean and moist
• Caudal epidural
• Replacement if no evisceration
• Fecal softeners
• Vaginal – Caslick’s procedure
• Prognosis
• Depends on extent of tissue
damage
40
Q

GI tract complications

A

Large colon volvulus
 Ruptured cecum with associated peritonitis
 Ischemic necrosis of small intestine, small colon, and/or
mesentery due to compression by the foal
 Rectal impaction due to soreness from foaling

41
Q

Eclampsia (Lactation tetany)

A 
• Risk factor: Breed
• Draft horses
• Miniature horses
• Ponies
 Clinical signs
• Restlessness
• Tachypnea
• Dull eyes
• Muscle fasciculations
• Clonic spasm
• Recumbency
42
Q

Dx/Tx of eclampsia

A 
• Diagnosis
• Low serum calcium
levels
• Treatment
• IV fluids with added
calcium borogluconate
43
Q

Non-emergency postpartum conditions

A 
• Agalactia
 mostly due to fescue toxicosis
• Mastitis
 Relatively uncommon, most often seen at weaning
• Lameness, hind limb
• Aggressive behavior towards the foal
44
Q

Agalactia

A 
• Failure of normal mammary
development and lactogenesis
 Endophyte-infected fescue toxicosis
(58% of all tall fescue)
 Malnutrition in late gestation
 Failure of passive transfer risk for foals
45
Q

treatment of agalactia

A

Treatment
• Domperidone (1.1 mg/kg PO, SID)
• FDA approved product 2010
• Start treatment 10-15 days before foaling and continue for 5
days after foaling
• Sulpiride 1 mg/kg IM once or twice daily

Equine Therio (6 decks)

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