Postpartum Conditions of the Mare

Question 1

what are some PP conditions? (9)

Answer 1

-Uterine prolapse
-Retained placenta/ Metritis
-Uterine tear
-Hernias/ Ruptured PPT
-Rectovaginal fistula
-Perineal Lacerations
-Cervical tear
-Vaginal tear
-Hemorrhage of uterine artery

Question 2

when is mare endometrium is histologically normal

Answer 2

Mare endometrium is histologically normal by 14‐15 days postpartum

Question 3

what is foal heat

Answer 3

-“Foal Heat” –first postpartum estrus ‐ at 9 days PP – can conceive and carry!
-Next heat occurs 21 days later – “30 day heat”

Question 4

when does mare uterus return to pre-pregnancy size

Answer 4

Mare and cow uterus returns to pregravid size by 25 to 32 days postpartum

Question 5

what is the voluntary waiting period for cows and why is it important

Answer 5

-Voluntary waiting period 50‐60 days
-allows repair to occur to increase chance of successful next pregnancy

Question 6

Selection of mares that are good candidates + which one is most important (4)

Answer 6

-Normal parturition and postpartum period
-No intrauterine fluid by day 9
-Good uterine involution – 9 cm diameter or less by day 9
-Ovulating after day 10

Question 7

when will mares have higher early embryonic death rates

Answer 7

Mares bred at foal heat have higher early embryonic death rates

Question 8

when are pregnancy rates higher in mares

Answer 8

-Pregnancy rates are higher for mares ovulating after day 10 postpartum
-Embryo enters uterus at day 6 post ovulation

Question 9

when is a PP exam done

Answer 9

-Frequently requested by owner (Mare and Foal)
-Anytime a problem is suspected
-Usually within 24 hours of birth

Question 10

what are some questions to ask in PP exam history? (7)

Answer 10

-Due date
-Past foalings – how many, any history of problems
-When did she foal?
-Problems?
-Pass Placenta?
-Attitude, appetite?
-Is Foal Nursing?

Question 11

what is part of the visual inspection of the PP exam

Answer 11

Obvious
-Retained Placenta
-Uterine Prolapse
-Vaginal Discharge – lochia vs. abnormal?
-Perineal Lacerations
-Udder

-Attitude, Appetite, painful?

Question 12

what three things are included in the reproductive exam

Answer 12

-Rectal exam
-Vaginoscopy
-Vaginal Exam

Question 13

what are some common PP conditions after foaling that you should look for in PP physical exam

Answer 13

GI colic, trauma to repro tract, RFM with metritis in mares

Question 14

why do you need to check digital pulses in mares PP

Answer 14

Digital pulses in mares, mucous membranes

Question 15

what are some abnormalities you may come across in PP rectal exam (4)

Answer 15

-RV fistulas
-Broad Ligaments
-Uterine fluid
-GI tract

Question 16

what do you need to do in the recal exam (3)

Answer 16

-Examine perineal area first (Tears, discharge, frank blood?)
-Rectal exam
-Assess uterine involution

Question 17

whats to look for in Postpartum Exam ‐ Vaginoscopy and Vaginal Exam (6)

Answer 17

-Always check for another fetus!!!
-Vaginal tears or bruising
-Cervical tears
-Perineal lacerations
-Assessment of retained placenta
-Discharge – Odour? Character?

Question 18

what must you suspect in any mare with frank bloody discharge post partum

Answer 18

uterine tear

Question 19

prognosis of uterine tears in mares

Answer 19

-If recognized early surgical repair carries a good prognosis for survival and future breeding
-If found later, and peritonitis present, prognosis is guarded to poor

Question 20

where is a common location for uterine tear

Answer 20

-Ventral uterine body
-Often tip of pregnant horn – cannot reach on vaginal exam

Question 21

is uterine prolapse common in mares and cows? when does it occur?

Answer 21

-Common in cows
-Rare in mares
-Usually immediately postpartum

Question 22

Contributing factors of uterine prolapse in mares (6)

Answer 22

-Dystocia, forced extraction, fetotomy
-Manual removal of placenta
-Uterine intertia
-Twins
-Following abortion
-Rarely‐ assoc. with straining due to GI colic

Question 23

Uterine Prolapse Treatment in mares

Answer 23

-Sedation and Epidural
-Clean well and replace
-NO vulvar retention sutures (Severe swelling and necrosis of vulva, Cross‐tie in stall for 1‐2 days instead)
-Systemic antibiotics
-Anti‐inflammatories
-Prognosis good (if she survives) for future breeding

Question 24

risk factors for Retained Fetal Membranes in Mares (4)

Answer 24

-Dystocia, twins, abortion
-Draft mares (also at high risk for laminitis with RFM)
-? Low Vit E and Selenium
-Genetics? – high prevalence in Friesian breed

Question 25

what can retained placenta in mares lead to

Answer 25

-potential for serious complications is high
-Rapid onset of toxic metritis, laminitis and death

Question 26

when do you consider at placenta retained in mares

Answer 26

-Retained if not passed within 3 hours
-Diagnosis – obvious (hanging from
vulva) – or NOT

Question 27

what happens if you forcibly remove a RP from a mare (5)

Answer 27

-Severe hemorrhage – even death
-Inversion of a uterine horn
-Uterine prolapse
-Leave a piece behind – toxemia and death
-Scarring and infertility with microscopic remnants

Question 28

what do you need to evaluate when you suscept RFM in mares?

Answer 28

-Physical examination – ? Presence of complications
-Increased digital pulses?, mucous membranes, dehydration, toxemia, pyrexia, anorexia
-Perform vaginal exam using aseptic technique
-Evaluate how tightly adhered (Can just be hung‐up in cervix, Gently twist membranes ‐ ? If Loosen – ok to keep twisting)

Question 29

treatment for RFM in mares (4)

Answer 29

Low dose oxytocin – 10 ‐ 20 I.U. repeated
-Uterine contractions ‐‐‐ expulsion
-Mild signs of colic common
-Note – high doses over 60 I.U. associated with tetanic spasm of uterus

Uterine lavage
-Distension of uterus ‐‐‐‐ uterine contractions ‐‐‐‐expulsion of membranes
-Removal of potentially toxic debris/bacteria

Systemic therapy if indicated or if a draft mare
-Antibiotics, Anti‐inflammatories
-Fluid therapy

Monitor for complications

Question 30

burns technique; what is it and when does it work

Answer 30

-Distend the intact chorioallantois with fluid – 20‐30 mins
-Stretches membranes and uterus
-Separation – detachment
-Can only be done when membranes are completely intact (no holes)

Question 31

Infusion of Umbilical Vessels with Water for RFM in Mares; when can you use it

Answer 31

-Seems to work well in uncomplicated cases
-Risky if it does not work immediately
-Particularly if the integrity of the abdominal wall is compromised (eg. with hydrops cases, or post C‐section)
-Or if you suspect uterine artery rupture/broad ligament hematoma

Question 32

what do you look for when you palpate the broad ligament

Answer 32

Palpate broad ligament for hematoma

Question 33

Broad Ligament Hematoma in Mares; when is it common, treatment, prognosis

Answer 33

-More common in older, pluriparous mares

Treatment
-Keep quiet – consider low dose acepromazine if mare is anxious
-Supportive care – fluid therapy, blood transfusion
-+/‐ oxytocin;
-N‐butyl alcohol; aminocaproic acid; IV Formalin?, naloxone and other shock therapies
-Monitor PCV and MM colour

-If hemorrhage into abdomen ‐ prognosis is grave
-Usually live if hemorrhage limited to broad ligament
-Prognosis for future breeding; low risk for future bleed

Question 34

differentials for Sick Postpartum Mare (6)

Answer 34

-Uterine tear
-RFM
-Anterior vaginal/ Cervical tear into abdomen
-GI Accident/Colic
-Broad ligament hematoma
-Ruptured bladder

Question 35

Differentials for Bloody Discharge PP
‐differentiate from lochia or pus (4)

Answer 35

-Uterine tear
-Uterine artery rupture/hematoma(+/‐)
-Uterine wall hematoma
-Uterine prolapse