Postpartum Disorders Flashcards
What is one of the most common problems associated with dystocia?
Retained placenta
A placenta is considered retained if it has not been passed in what amount of time?
3 hours
Which species has a higher incidence of retained placenta, equine or bovine?
Bovine
Which species have more severe consequences associated with a retained placenta, equine or bovine?
Equine
What are 4 consequences that can be seen with a retained placenta in mares?
- Toxic metritis
- Septicemia
- Laminitis
- Delayed uterine involution
The likelihood of a retained placenta can increase with what 3 conditions?
- Dystocia
- Abortion
- Placentitis
What drug can be given with a retained placenta?
Oxytocin
Should a retained placenta be manually separated?
No
What are 6 aspects of handling a retained placenta?
- Manual assistance
- Antibiotics
- NSAIDs
- Tetanus prophylaxis
- Watch for metritis and laminitis
- Uterine lavage/infusion
How should manual assistance in removal of a retained placenta be performed?
Reach as far forward as possible and grab chorioallantois then add twisting, gentle traction to deliver
What can happen if part of the chorioallantois is retained within the uterus?
Torn retained placenta
What are 2 ways to confirm a torn retained placenta?
- US
- Manual examination
If a torn retained placenta is detected, what should be done with the mare?
Place mare on preventative therapies
What are 2 things that can be used to aid in removal of a torn retained placenta?
- Lavage
- Oxytocin
Does the mare eat the placenta?
No
Fetal monsters usually require what in a mare?
Fetotomy or cesarean section
What are 4 types of fetal monsters that can be seen with foals?
- Torticollis
- Contracted tendons
- Schistosomus reflexus
- Hydrocephalus
With partial duplication/double monsters, is it better to perform a c-section or a fetotomy?
C-section
The brain forms outside of the fetal skull in what condition?
Exencenphalus
What are 5 examples of trauma that can be seen postpartum in the mare?
- Recto-vestibular fistula
- Perineal lacerations
- Cervical trauma
- Vaginal trauma
- Vulvar trauma
When should cervical trauma be repaired?
With what?
- Repair during estrus
- Use long-handled instruments
What are 2 things to watch out for with vaginal trauma in the mare?
- fat/intestinal prolapse
- Vaginal adhesions
How can vulvar trauma be repaired?
Caslick
What degree of perineal laceration involves the skin and mucous membranes of the dorsal commissure of the vulva/vestibule?
First degree
What degree of perineal laceration involves deeper structures but does not involve the rectal sphincter?
Second degree
What degree of perineal laceration involves complete disruption of the recto-vestibular shelf?
Third degree
What is used to correct a first degree perineal laceration?
Caslick
What is used to correct a second degree perineal laceration?
Caslick plus reconstruction of perineal body
What is another term for a recto-vaginal fistula?
“Gill flirter”
What are 2 aspects of treatment for a third degree perineal laceration?
- Initial treatment with antibiotics, NSAIDs and debridement
- Surgical repair once healed in 6-8 weeks
Surgical repair of a third degree perineal laceration should be held off for how many weeks?
6-8 weeks
What type of suture pattern should be used on the vaginal mucosa with perineal laceration repair?
Inverted suture pattern
When assessing for a prolapse in a young animal, it is important to check for what?
Persistent hymen
What are 3 things that a vaginal prolapse can be secondary to?
- Irritation
- Coughing
- Tear
Since the urethra in a mare is short and wide, what is possible?
Bladder prolapse
Uterine prolapse can occur secondary to what?
Uterine inertia
Once the uterus has passively started to evert and has entered the vaginal canal, what can cause further eversion?
Ferguson’s reflex
Why might a retained placenta exacerbate a prolapsed uterus?
Placenta pulls on the uterine horn, starting eversion.
What should be done with the tail during a uterine prolapse?
Why?
- Wrap the tail and move it out of the way.
- So it doesn’t damage the endometrium of the uterus.
What are 4 things that should be done right away with a uterine prolapse?
- Restrain mare
- Support uterus with a clean plastic board
- Perform epidural
- Place tail wrap, clean perineum/uterus
How should the uterus be manipulated back into the body?
Using flat hands and working the edges in slowly.
What is something that can be done to the uterus to try and decrease edema?
Wrap towels around the uterus.
Once the uterus is placed back in the body, what needs to be done?
Uterine horns need to be extended
What are 4 types of treatments that can be administered after a uterine prolapse has been corrected?
- Oxytocin
- Systemic antibiotics
- NSAIDs (Banamine)
- Tetanus prophylaxis
What is done surgically after a prolapsed uterus is placed back in the body?
Use a Buhner needle to place a purse string around the vulvar opening.
How long is a purse string left in a mare after a uterine prolapse?
3-5 days
After a uterine prolapse, it is a good sign if a mare can do what right away?
Urinate
What is the cause of cervical hyperplasia?
Unknown
Does a mare have to be pregnant for cervical hyperplasia to occur?
No
What is the normal range for total protein in the foaling mare?
Total nucleated cell count?
- TP less than 2.5 g/dL
- Total nucleated cell count less than 500 cells/uL
What is the primary cell type seen in the peritoneal fluid of non-dystocia mares?
of post-dystocia mares?
- Non-dystocia: mononuclear
- Post-dystocia: neutrophils
Up the what percentage neutrophils is normal in the peritoneal fluid of postpartum mares?
When an acute inflammatory process exists?
- 70%
- 85-100%
What are 3 peritoneal fluid values that are suggestive of the mare becoming ill?
- TP greater than 3 g/dL
- Total NCC greater than 15,000 cells/uL
- Neutrophil count greater than 80%
Hemorrhage postpartum is more common in what age mares?
Older mares greater than 12 years
Which artery is more predisposed to rupture from parturition?
Why?
- Right middle uterine artery
- Cecum pushes uterus to left, possibly increasing tension on right artery
Postpartum hemorrhage can be secondary to what 4 events?
- Uterine torsion
- Uterine rupture
- Uterine trauma
- Normal foaling
Age related vessel changes can cause what?
Aneurismal dilation leading to rupture and hemorrhage.
What deficiency may predispose the mare to hemorrhage postpartum?
Why?
- Low copper
- Copper is responsible for increased elasticity of vessels
What are 3 aspects of treatment for uterine artery rupture?
- Keep mare quiet
- Monitor PCV
- US for fluid in abdomen
A mare with a uterine artery rupture may need what?
Transfusion
With a uterine artery rupture, be careful not to do what?
Why?
- Do not over-hydrate
- Increases blood pressure
Mares with a ruptured uterine artery often present with what?
Colic
Should a mare that has ruptured a uterine artery be re-bred?
No
What is the most common drug used for uterine artery rupture in mares?
Aminocaproic acid
A mare that is presenting post-foaling with an inability to defecate but appears to be bright and alert may be experiencing what?
Rectal mucosal sloughing
Damage to what artery during foaling can lead to loss of blood supply to the rectum and rectal mucosal slugging?
Mesocolic artery
What type of a prognosis does a mare with rectal mucosal sloughing have?
Poor outcome
A post-partum mare should always be checked for what?
Mastitis
A mare with mastitis may present with what?
Lameness
How should a sample be collected to test for mastitis in a mare?
- Wipe teat end with alcohol
- Strip small amount
- Wipe teat end again
- Collect sample into sterile container for C/S
What are 4 forms of treatment for mastitis in mares?
- Strip frequently, giving oxytocin just prior
- Systemic antibiotics and udder infusion
- NSAIDs (Banamine)
- Warm compress
Rejection of the foal is seen more commonly with what type of mare?
Maiden mare
What is a drug that can be given to a mare that treats agalactia and causes some sedation?
Reserpine
What is a technique that can be tried with mares that initially reject their foals?
Adoption technique
