Postpartum Conditions of the Mare Flashcards
the mare and cow uterus returns to the pregravid size by ________ days postpartum
25-32
the mare endometrium is repaired histologically by
14-15 days postpartum
when are the next two heats after parturition in the mare
foal heat: 9 days pp
30-day heat: 21 days after foal heat
what is a consideration with breeding on the foal heat and uterine involution in the mare
uterine involution occurs by 14-15 days; the mare heat occurs 9 days postpartum and the embryo will enter the uterus 6d after breeding, therefore the embryo will be entering the uterus as it is finishing repair
what is useful about foal heat breeding
the mare will foal 1 month earlier the next year, which is useful for managing mares foaling late in the breeding season
what are two considerations for breeding on the foal heat
higher rates of EEE and pregnancy rates are lower compared to mares ovulating after 10d postpartum
what criteria would make a mare a good candidate for foal heat breeding
1) normal parturition and postpartum period (no complications)
2) 9x9 rule: by day 9 want to see no intrauterine fluid and uterus 9 cm or less in diameter
3) ovulating after day 10
why do we want the mare to ovulate on day 10 to be a good candidate for foal heat breeding
- ovulate on day 10
- embryo enters uterus 5-6 days after
- histologically repaired by 14-15 days
- means pregnancy IS possible if she ovulates after day 10
when would we do a postpartum exam
1) within 24 h of birth
2) because owner requested it
3) because we suspect a problem
What are some important aspects of the history to obtain when performing a postpartum exam
1) due date
2) past foalings - how many, any history of problems
3) when did she foal
4) problems?
5) did she pass placenta?
6) is foal nursing
7) attitude and appetite?
what are signs that could indicate the foal is nursing? what about not nursing?
foal will lay down and sleep after nursing
milk will be dripping from the udder if foal is not nursin
what are some obvious problems to look for on visual inspection (5)
- retained membranes
- uterine prolapse
- vaginal discharge (normal and abnormal)
- udder
- perineal lacerations
what are typical early postpartum conditions in the mare
- GI colic
- trauma to reproductive tract
- RFM
- metritis
what are three important tests to perform in the mare when doing a postpartum exam
digital pulses, mm, skin tent
what are the 3 steps to the reproductive exam
1) rectal exam
2) vaginoscopy
3) vaginal exam
what is important to assess on the rectal exam (5)
1) uterine involution
2) presence of a RV fistula
3) broad ligament hemorrhage
4) GI tract
5) uterine fluid (big uterus)
what do you ALWAYS need to check for when doing a postpartum vaginal exam
if there is another fetus!
what do we check for when doing the vaginoscopy or vaginal exam
1) perineal tears
2) vaginal tears or bruising
3) cervical tears
4) assess retained placenta
5) discharge (odour, character)
what do we need to suspect in any mare with frank bloody discharge postpartum
a uterine tear
what is the pathogenesis of uterine tear
tear -> hemorrhage of uterine artery -> contamination of abdomen with feces/bacteria/blood -> peritonitis -> endotoxemia -> laminitis
in uterine tears what would you expect to see in an abdominal tap in:
- early stages
- later stages
- early on expect blood
- later on expect neutrophils and bacteria if peritonitis present
what makes the mare sick in the case of a uterine tear and how soon
endotoxemia and peritonitis -> 1-3 days postpartum
what are two diagnostic tools for a uterine tear
1) hysteroscopy (can’t keep air in uterus)
2) dye test (put dye in uterus -> tap abdomen and see if dye present)
what should be on the list of differentials with uterine tear
RFM (also causes endotoxemia)
uterine prolapse usually occurs when
immediately postpartum
what are some contributing factors to uterine prolapse in mares
1) dystocia/forced extraction/fetotomy
2) twins
3) retained placenta
4) uterine intertia
5) abortion
6) rarely associated with GI colic (straining)
what is a similarity and two differences between uterine prolapse in mares vs cows
Similar:
- epidural and sedation
- give antibiotics and anti-inflammatories
Difference:
- no retention sutures (cross-tie instead)
- very bloody in mares
what is the prognosis of uterine prolapse in mares
good if she survives for future breeding
unlike cows, what are the consequences of RFM in mares
toxic metritis -> laminitis -> death
what are risk factors for RFM in mares (4)
- dystocia, twins, abortion
- draft mares
- low Vit E and Se
- genetics -> high in Friesian breeds
T/F RFM can be obvious or not
T
what should you always be suspicious of in a sick postpartum mare
RFM
how might RFM present
1-2 days postpartum with metritis
what are signs to look for on physical exam in the case of suspected RFM (6)
digital pulses; toxic line; dehydration; mm; pyrexia; anorexia
how should you go about assessing RFM on vaginal exam
- first off, must be aseptic!
- assess how tightly adhered the membrane is to the endometrium
- gently twist -> if loosen, ok to keep twisting
- do NOT forceably remove
what are some consequences of forcibly removing a RFM (5)
- hemmorrhage
- inversion of a uterine horn
- uterine prolapse
- leaving a piece behind -> toxemia -> death
- scarring and infertility
how do we treat RFM in mares
1) low dose oxytocin to cause uterine contractions -> expulsion
2) uterine lavage to distend uterus -> contractions -> expulsion
3) systemic therapy if a draft mare or if indicated
what is a technique for treating RFM that can only be done if you know the membranes are completely intact
Burns technique: distend chorioallantois with fluid -> uterine and membrane stretching -> detachment
what is a method for resolving RFM that works well in uncomplicated cases but is risky if it does not work immediately
infusion of the umilical vessels
when would infusing the umbilical vessels to resolve RFM be contraindicated
if the integrity of the abdominal wall is compromised (hydrops, C-section) or if you suspect uterine artery rupture or broad ligament hematoma
what does a broad ligament hematoma present as
variably sized mass dorsal to the uterus
why is it risky to ultrasound a mare with a suspected broad ligament hematoma
you risk disrupting the clotting mechanisms in place and causing more bleeding
how can we diagnose broad ligament hematoma without doing a rectal ultrasound (3)
abdominocentesis -> look for blood
abdominal ultrasound for free fluid
CBC and PVC
what mares are more at risk of broad ligament hematoma
older, pluriparous
how do we treat broad ligament hematoma in mares
1) keep quiet
2) monitor PVC and MM colour
3) can give oxytocin to decrease size of uterus -> less pressure
4) shock therapy
5) supportive care (fluids, blood transfusion)
what is the prognosis for broad ligament hematoma
bad if rupture into abdomen; good for future breeding if they live and hemorrhage is limited to the broad ligament
what are differentials for a sick mare postpartum
1) RFM
2) metritis
3) uterine tear
4) vaginal/cervical tear
5) broad ligament hematoma
6) bladder rupture
7) GI accident/colic
what are differentials for frank bloody discharge postpartum
1) uterine wall hematoma
2) uterine prolapse
3) uterine tear
4) uterine artery rupture/hematoma
