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Module 22: Reproduction & Fertility > The Periparturient Mare > Flashcards

The Periparturient Mare Flashcards

1
Q

what are infectious causes of abortion

A

Viral:

  • EHV-1 most common
  • EVA

Bacterial:

  • Placentitis
  • Neonatal sepsis

Fungal

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2
Q

what are non-infectious causes of abortion

A

Foal:

  • Twins
  • Chromosome abnormalities

Placental:

  • Umbilical disorders
  • Umbilical torsion, excess cord length

Mare:

  • Illness
  • Nutrition
  • Toxins
  • Hydrops

Toxic causes:

  • Fescue toxicitity
  • Mare reproductive loss syndrome (Kentucky)
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3
Q

how should you manage an abortion

A

Immediate isolation of mare

  • Containment of fetus and placenta
  • Examine and then submit all

Disinfection

Close premises — no movement

Multiple pregnant mares

  • Segregate into small groups
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4
Q

how should you examine an aborted fetus and placenta

A

Look for ascending placentitis

  • Particularly around cervical star of placenta
  • Chorion should have healthy looking villi — red velvet

Umbilical cord twist

EHV-1

  • Fetus/fluids are often infectious
  • Due to placentitis:
    • Fresh fetus/placenta (still in allantochorion) — rapid expulsion

EVA

  • Due to lethal foal infection (arteritis)
  • Fetus autolyzed

EHV-1 and EVA can produce a sick, high risk foal

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5
Q

how should you investigate an abortion

A

Want answers, especially if other mares

Examine fetus and placenta

Then ideally submit both

If can’t send fetus, submit samples of:

  • Lung, liver, kidney and adrenals, spleen, thymus, skeletal muscle, heart, intact stomach, blood

Mare:

  • Paired serum samples
  • Uterine swabs
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6
Q

how does equine herpes virus 1 cause abortion

A

Infect endothelial cells:

Thrombo-ischemia:

  • Placentitis
  • Pathogenesis dependent on strain
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7
Q

how is EHV-1 abortion prevented

A

Vaccination:

  • 5, 7, 9 months

Biosecurity Small closed herds of broodmares

  • Keep away from young horses
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8
Q

how does equine viral arteritis cause abortion

A

Widespread vasculitis

Variable clinical signs

Abortion from 2 months until then

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9
Q

how is EVA abortion prevented

A

Vaccination:

  • Stallions proven seronegative before first vaccine then annual vaccine
  • Mares not vaccinated, seronegative before breeding

Biosecurity

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10
Q

how does placental dysfunction cause abortion

A

Or produce a high risk foal:

  • Premature
  • Dysmature +/- prolonged gestation

Non-infectious:

  • Premature placental separation
  • Twinning
  • Toxic (fescue)

Infectious:

  • Placentitis
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11
Q

what is the most common cause of abortion/still birth

A

placental dysfunction

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12
Q

how does fescue toxicity cause abortion

A

North America

Ingestion of fescue grass and endophytic fungus

Toxins inhibit prolactin secretion/fetal endocrine function

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13
Q

what are the signs of fescue toxicity

A

Agalactia

Abortion

Prolonged gestation

Thickened placenta

Dead/weak foals

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14
Q

what are the risk factors for placentitis

A

Poor perineal conformation

Breed (TBs)

Poor body condition

Increasing age/parity

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15
Q

what are the signs of placentitis

A

Vulva discharge

Udder development/premature lactation

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16
Q

what is the foal at risk of in a mare with placentitis

A

Foal at risk of septicemia

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17
Q

what history should you gather when seeing a mare with placentitis

A

General health history/age etc

Exact serving date

Scanned in foal, dates, twins? Etc

Previous pregnancies?

Any vulva discharge?

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18
Q

what should your clinical exam include in a mare with suspected placentitis

A

Examine mammary glands

  • Developed, lactation?

Check for vulval discharg

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19
Q

how does placenetitis occur

A

Necrotizing, suppurative inflammation with detachment of placenta in the area surrounding the cervical star

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20
Q

what bacteria are usually involved in placentitis

A

Streptococcus zooepidemicus/equisimilis

E. coli, Pseudomonas spp

Klebsiella pneumonia

Aspergillus spp, Candida spp

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21
Q

what might the appearance of the cervix be in placentitis

A

Cervix can be softened and hyperaemic

Can be purulent material emanating

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22
Q

what are other methods of placentntis infection

A

Occasionally hematogenous

Or introduced at time of breeding

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23
Q

if placentitis is due to hematogenous spread what is the likely causative agent

A

lepto?

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24
Q

if placentitis is due to introduction at time of breeding what is the likely causative agent

A

Nocardioform bacteria

  • Actinomyces (filamentous microorganisms)
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25
Q

where does placentitis occur if it is from bacteria from breeding and what would the signs in the mare be

A

cranioventral aspect of uterus

mare may be normal but premature mammary development

no vulval discharge as cervical star not involved

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26
Q

how should you investigate a case of placentitis

A

Examine vagina/cervix with speculum

Monitor fetal wellbeing

Hormones

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27
Q

how do you examine the vagina/cervix when investigating placentitis

A

be clean as breaching two seals

obtain guarded swab to guide antimicrobial choice

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28
Q

how can you monitor fetal well being in a case of placentitis/high risk pregnancy

A

Rectal including ultrasonography

  • Caudal allantochorion
    • Tissue thickening
  • Placenta and fetal fluids
  • fetal size and development
  • fetal breathing, heart rate/rhythm, activity

Hormones

  • Estrogen - low = fetal stress?
  • Serial progesterone
    • Elevation due to fetal stress
    • Rapid decline due to fetal death/abortion
    • Fail to increase at term — toxicosis?

Fetal ECG

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29
Q

when is monitoring of a high risk pregnancy indicated

A

Previous reproductive problems in mare

Poor perineal/pelvic conformation

Poor mare health

Poor nutritional condition of mare

Previous abnormal foals

Placentitis

Twins

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30
Q

what can a slow fetal HR in a high risk pregnancy indicate

A

hypoxia

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31
Q

what can a fast fetal HR in a high risk pregnancy indicate

A

fetal stress

32
Q

how is placentitis treated

A

NSAIDs

broad spectrum antimicrobials

synthetic progesterone

others

  • tocolytics (clenbuterol)
  • pentoxyfylline
33
Q

what NSAIDs would be used to treat placentitis

A

Flunixin meglumine or phenylbutazone

Prostaglandins elevated in allantoic fluid

34
Q

what broad spectrum abs would be used in placentitis

A

Placentitis but also bacteremia in fetus (and then death)

TMPS, penicillin and gentamicin

  • Guided by culture and sensitivity?
35
Q

what synthetic progesterones would be used to treat placentitis and why is it controversial

A

Altrenogest — 2x normal dose rate (regumate)

Maintain placental blood flow

Controversial and expensive

  • Not a lot of evidence
36
Q

what are tocolytics

A

improve blood flow

Medications used to suppress premature labor

Stop uterine contraction

37
Q

what is pentoxyfylline

A

Inflammation and RBC deformability

38
Q

what is the most common cause of vaginal hemorrhage

A

Varicose veins at vestibular sphincter

Could be premature placental separation, aborting twins, urinary tract?

Check not urine!

39
Q

when does hydrop/allantois typically occur

A

last trimester

rare

40
Q

what are the signs of hydrops/allantois

A

abdominal distention

Difficulty walking

Colic

41
Q

where does exccessive fluid accumulate in hydrops/allantois

A

Extensive accumulation of fluid in either:

Allantoic compartment:

  • Normal <20L
  • Abnormal >100L

Amniotic compartment

42
Q

what usually happens in hydrops/allantois

A

Generally mare’s condition will deteriorate and won’t give a live foal

Induction of parturition often required, sacrifice foal

Some have been medically managed

Drainage of fluid

43
Q

what are the signs of prepubic tendon rupture

A

Udder points the wrong way

Investigate via rectal and US

44
Q

what is the prognosis of prepubic tendon rupture

A

Depends on stage of gestation

Consider termination or perhaps induction of parturition (at appropriate time) allows assisted delivery and immediate supportive care for foal

45
Q

what are the signs of uterine torsion

A

Colic, intermittent, often progressive

46
Q

how is uterine torsion corrected

A

Use fetus as fulcrum (if open cervix)

GA and roll

Laparotomy — flank/midline

47
Q

what should be done in the routine post partum check

A

History:

  • Problems — general health, tetanus states
  • Discharge, mammary development, early lactation?
  • Previous foals and foaling

History of foaling:

  • Relation to due date
  • Time started and time finished — witnessed
  • How is progressed — problems, interventions?
  • Mare since (behaviour including towards foal, colic?) and foal since

Clinical exam:

  • General — including vitals, MM, mammary glands
  • Perineum, vulva
    • Suspicions or history of trauma
  • Examine placenta
  • Examine foal
48
Q

what are the risk factors for RFM

A

Increased risk with dystocia, caesarean, abortion, twins

Uterine inertia

  • Hypocalcemia

Heavy breeds

  • Uterine inertia — reduced oxytocin receptors
49
Q

what might the signs of RFM be

A

igns may be obvious as placenta is visible

But may suspect a piece is retained from looking at placenta

Or presented with a sick mare and a retained piece is a differential

50
Q

what are the consequences of RFM

A

Rapid development of metritis:

  • One small piece is as bad as the whole thing
  • If placenta not examined/missing and a piece is retained then mare may present as off colour/sick

Important Ddx

51
Q

what are sequelae to metritis

A

septicemia/endotoxemia SIRS

laminitis

death

aka toxic metritis

52
Q

how should you assess a mare with RFM

A

History:

  • Pregnancy and foaling as before, tetanus status
  • Time since foaling

Clinical exam:

  • Looking for signs of endotoxemia/SIRS
  • Not if within a few hours of birth, but there is a logarithmic increase in bacterial load
  • HR, RR, temp, MM, CRT
  • Laminitis
    • Digital pulses, hoof testers and comfort (walk and turn)
  • Mammary glands
  • Vulva, perineum
  • Trauma, placenta may be evident
  • Discharge: often brown, copious and can be fetid

Examine foal!

53
Q

what does treatment of RFM depend on

A

Will depend on duration of retention:

  • Routine, preventative removal
  • Prolonged or refractory retention
    • Mare may not be sick but evidence of metritis
      • Placenta is decomposed/brown plus discharge
  • Removal from a sick mare
    • Prolonged retention (including a small piece)
54
Q

how would you approach a routine/preventative removal of a RFM

A

Tie up membranes out of the way

Oxytocin:

  • 10-20 IU intravenous in 30mls saline
  • Or 60-80 IU in 1L saline IV over 1hr

Mare will often ‘colic’

  • Allow time (15min or so)

Then gentle traction/slight twist if needed

  • Generally don’t need to insert hand
55
Q

what is the burns technique

A

Distention of chorioallantois with fluid

  • Dilate endometrial crypts and weight of membranes pulls if free?

Sterile stomach tube and warm fluid

  • 10-12L sterile saline or tap water

Still use oxytocin to aid involution

56
Q

what is infusion of umbilical vessels

A

Either artery or vein is incised and foal stomach tube inserted

Manually held in place then low pressure infusion of water for 5-10 mins

Causes edema of placenta — detachment of microvilli

Still use oxytocin to aid involution

57
Q

how do you treat metritis secondary to RFM

A
  1. continue oxytocin
  2. consider hypocalcemia
  3. uterine lavage
  4. broad spectrum antimicrobials
  5. NSAID
  6. fluid therapy
  7. cryotherapy
58
Q

how do you continue oxytoxin administration in a mare with metritis secondary to RFM

A

IM q2hrs for < 6 doses

Encourages involution of uterus

Uterine response declines

  • May need to increase dose
59
Q

how is a uterine lavage performed in a mare with metritis secondary to RFM

A

Essential if metritis present/suspected

To remove bacteria, debris, endotoxins etc

But also small pieces of placenta

Sterile tube — stomach tube or uterine lavage catheter

  • Can cup end in a sterile gloved hand
  • Can sweep hand around in uterus if distended

Large volume

  • Sterile if possible but initially water will do
  • 10-20L (or until fluid is returned) via gravity
  • Repeat until ‘clean’ return of fluid

2-3x/d

  • Until clean return on first flush
  • Volume infused before returned should decrease rapidly
60
Q

what broad spectrum abs should be used to treat metritis secondary to RFM

A

penicillin and gentamicin

61
Q

why is flunixin useful in treating metritis

A

anti endotoxic effects

62
Q

why is cryotherapy useful in metritis

A

Laminitis prophylaxis

Ice in 5: fluid bags extending above pastern

Support feet?

  • Deep bed
  • Frog/sole supports
63
Q

when is periparturient hemorrhage commonly seen

A

older multiparous mares

64
Q

what is the source of a postpartum hemorrhage

A

uterine artery rupture

  • Broad ligament hematoma/hemorrhage
    • Hemoabdomen
  • Other vessels can rupture and form hematomas/hemorrhage
65
Q

what are the signs of a postpartum hemorrhage

A

colic signs

hypovolemic/shock, fatal

but initially no change in MM and CRT

66
Q

how is post partum hemorrhage diagnosed

A

Keep to minimum as want low stress

Clinical signs

Rectal:

  • Postpone?
  • Palpate hematoma in broad ligament as a firm swelling

US

Abdominocentesis

  • Frank blood
67
Q

how is post partum hemorrhage treated/managed

A

Decrease stress, avoid movement (difficut to refer)

  • Place in dark, quiet box (conservative approach vs invasive)

Sedation:

  • Acepromazine
  • Careful not to exacerbate hypotensive status

NSAIDs:

  • Analgesia and anti-inflammatory

Low dose oxytocin

Hemostatic agents

  • Aminocaproic acid
  • Transexamic acid

Supportive therapy (getting invasive)

  • Volume replacement
    • Careful as hypotensive might be helpful
  • Cystalloids initially then blood replacement?
  • Oxygen, antimicrobials?
68
Q

how are rectal prolapses graded

A
69
Q

what are pp urogenital tract conditions

A
  1. periparturient hemorrhage
  2. uterine rupture (peritonitis)
  3. uterine prolapse
  4. uterine horn intussusception
  5. bladder prolapse/eversion or rupture
  6. perineal lacerations/trauma/rectovaginal fistulas
70
Q

what are postpartum GI conditions

A
  1. rectal prolapse
  2. simple impactions
  3. large colon torsion/volvulus
  4. large colon displacement
  5. foaling trauma to intestinal viscus, including rupture
71
Q

what are the vital timelines of the mare foaling

A

gestation ~335d

second stage parturition <20-30 mins

placenta expelled <3 hours

72
Q

what are the vital timelines of the foal

A

Sternal recumbency within minutes

Suck reflex <30 minutes

Standing <60 minutes

Nursing <2 hours

Passage of meconium <4 hours

Urination <6-10 hours

Nursing frequency 5-7x/hour

Activity and behaviour = lively

73
Q

what are visible maternal factors for a high risk foal

A

General health status

Nutritional status

Vulval dischage/placentitis

  • Examine placenta

Colostral leakage

Maiden mare

Ventral hernia/prepubic tendon rupture

74
Q

what are less visible maternal factors for a high risk foal

A

History of problem foals:

  • Dysmature/premature
  • Neonatal isoerythrolysis
  • Perinatal asphyxia syndrome

Twin pregnancy

History of dystocia

Pelvic lesions

75
Q

what are visible parturition risk factors for a high risk foal

A

Prolonged labour/dystocia

Perineal laceration/fistula

Red bag deliver

Induced parturition

C section

76
Q

what are less visible parturition risk factors for a high risk foal

A

Prematurity

Prolonged gestation

Premature cord separation

Uterine bruising/hemorrhage

Module 22: Reproduction & Fertility (27 decks)

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